CARE HOME ADULTS 18-65
COWLEY HOUSE Ray Park Road Maidenhead Berkshire SL6 8PZ Lead Inspector
Marie Carvell Unannounced 18 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Cowley House Address Ray Park Road Maidenhead Berkshire SL6 8PZ 01628 638851 01628 623609 N/A Care Management Group Ltd 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) Ms Jacqueline Tracy Duggan Care Home 12 Category(ies) of Learning Disability (LD) - 12 registration, with number of places COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: ,None Date of last inspection 23/08/05 Brief Description of the Service: Cowley House is registered to provide accommodation and care for up to twelve service users, both male and female aged between the ages of eighteen and sixty five years of age, whose main need for care arises from learning disability. A number of the service users have lived together for many years. The home is owned and managed by Care Management Group who have care homes situated all over England. Cowley House is a large detached house close to the centre of Maidenhead and the river Thames. Shops, parks and leisure facilities are within walking distance. Cowley House has bedrooms on the ground and first floors of the home, the first floor bedrooms are accessed by a staircase. The home does not have a passenger lift. Bedrooms consist of two bedrooms for shared occupancy and eight singe occupancy bedrooms. There is ground floor shower room and toilet with a walk in shower and appropriate aids to assist with independence. On the first floor there is a bathroom with assisted bath and toilet and a shower room and toilet. This shower room is suitable for more able bodied service users. Communal areas consist of two lounges and a separate dining room.
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this inspection on a weekday afternoon and evening over a period of seven hours. A tour of the building took place during which all bedrooms and communal areas were seen. A sample of staff, service users and health and safety records were seen. Time was spent with all service users during the inspection including joining service users for the evening meal. Time was also spent with all the staff on duty, individually or as a group and the manager of the home. Discussion took place with the manager, throughout the inspection. At the last inspection twenty three requirements were made, some of these were outstanding from July 2003. Twenty requirements had been met and three requirements remain outstanding. What the service does well:
Service users able to express an opinion said that they were happy with the care provided and said that the staff were friendly. Care is provided flexibly around the needs of the service users. Service users are able to rise and retire to bed at a time of their choosing. Service users are treated with respect and dignity and service users able to express an opinion said that if they were unhappy they felt able to speak to a member of staff or the manager. Service user meetings take place every six weeks and these are recorded. Visitors to the home are made welcome and many complimentary letters have been received from relatives to the home, who expressed their satisfaction of the care provided and the good communication between the relatives and home staff. Each service user has a detailed activity plan and the manager together with the service users and staff are working towards developing the range of activities further. Staff in the home are well motivated and work hard to ensure that the needs of the service users are met. During this inspection staff were observed to be cheerful and carrying their work in a professional manner. There is a good rapport between service users and staff.
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection?
The Manager was registered with the Commission for Social Care (CSCI) in December 2004. The home had been without a registered manager for a number of years. The homes refurbishment plan has been completed, this includes a ramped area leading up to the front door, a new ground floor shower room and first floor bathroom with appropriate aids to assist with independence. Non slip flooring has been fitted in the two shower rooms and bathroom. Several communal areas of the home have been decorated with new carpets and furniture. The laundry facilities have been relocated in the laundry room, a non slip floor has been fitted and the area decorated. Some service users bedrooms have new furniture and carpets. Some staff vacancies have been filled and the home now employs a part time cleaner for two full days per week. Newly employed staff are competing induction training and training in core subjects. Several staff are working towards National Vocational Qualifications (NVQ). The home was clean and free from unpleasant odours and was seen to be homely and welcoming. Staff morale has improved and members of staff were pleased with the home refurbishment. The Statement of Purpose and Service User Guides have been reviewed and updated. The documents are written in plain English and are easy to read. The Service User Guide is available in Pictorial signs for those service users unable to read. Since the last inspection the manager and company have worked hard to meet the majority of requirements made. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 7 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. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 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 COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 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) 2,4 and 5 There is a detailed admissions procedure for planned admissions to the home. However, an admissions procedure needs to be developed for emergency admissions. This should include reviewing of the placement, care management involvement and appropriate care planning and risk assessments. A detailed written contract should be provided to all service users whether admitted to the home as an emergency or whether the placement is planned. EVIDENCE: Since the last inspection two service users have been admitted to the home. One service user file was examined. Individual records are kept for each service user. One service user was admitted to the home as an emergency placement and therefore was unable to visit the home prior to moving in. The second service user was admitted to the home following a full assessment of need being undertaken and was able to visit the home and stay for a trial period prior to an offer of a permanent placement being made. Both service users have a copy of the homes statement of terms and conditions written in pictorial format. The service user admitted as an emergency in September 2004, has not yet been given a copy of the written
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 10 contract between the purchasing authority and care provider as this has not yet been agreed. It was acknowledged that an emergency admission to the home is not an ideal situation and generally the home does not admit service users in an emergency situation. The service user admitted as an emergency said that he was happy living at Cowley House and that he had made many friends. Information provided to the home for both service users was detailed and available from a wide source of professionals involved. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 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 and 9 Service users have comprehensive care plans and are involved as much as possible with decision making. Appropriate risk assessments are in place. Three monthly meetings take place to review care plans and risk assessments. There is a need for documents to be completed and returned from head office in a shorter timescale than is current practice. EVIDENCE: Service user plans are completed with the service users, service user representatives and key worker. Completed plans are signed and dated by the service user/ representative and home staff. Service user plans are reviewed on a regular basis. Risk assessments are in place to support service user plans. Service users have a named key worker and there are six weekly service user meetings held, where service users are encouraged to express their views about the care and service they receive. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 12 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) 12,13,14,15,16 and 17 Service users enjoy a range of activities and leisure opportunities. Staff support service users to maintain appropriate relationships. Service users are aware of their rights and are assisted as appropriate to make informed choices regarding aspects of daily lives. A varied and well balanced diet is provided based on food preferences of service users. EVIDENCE: All service users have a weekly activity sheet. Activities undertaken are recorded in service users daily diaries and activity sheets. Two service users attend a local day centre for several days per week. The home is close to the town of Maidenhead and within walking distance of shops, parks and leisure facilities. The home has a mini bus and several service users said that they enjoyed trips out. The range of activities includes arts and crafts, sewing, flower arranging, bingo, board games, meals out, indoor exercises walks and cooking. One service user has recently purchased a new piano and takes delight in playing for others. Several service users attend a church service on a Sunday and are accompanied by a volunteer.
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 13 Visitors are welcomed to the home and service users from Cowley Cottage are invited to some activities, as are relatives. One service user said that since moving to the home he has made lots of friends. The manager is hoping to develop the range of activities available to service users. Service users are able to choose when to be alone or in company. One service user has chosen to be able to lock his bedroom door with a key. Service users are involved with menu planning and food shopping. One service user said he enjoyed assisting with some food preparation. Dietician advice has been obtained to develop varied and well balanced diets for all service users. The manager and a senior support worker attended a seminar on diet and nutrition. Menus were seen to be varied and balanced. One service users told the inspector ‘ you can’t fault the food here’ and that he’ liked good old fashioned plain meals. Food stocks were plentiful with fresh vegetables, salad and fruit. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 14 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 and 20 Service users physical and personal care needs are well met. Not following the correct procedure for the administration of PRN medication , could potentially put service users at risk of over medication. EVIDENCE: Service users physical and personal support needs are detailed in service user plans. Personal care given during the day is recorded on contact sheets. Regular appointments take place with medical and healthcare professionals, this is well recorded and includes advice and guidelines given. Medication is administered by senior staff only, who have received appropriate training in medication administration. Medication administration records were up to date with no gaps in recordings. Two service users are prescribed medication to be given PRN (when required). The home is not complying with the companies ‘Care of medication procedure’. None of the service users retain, administer or control their own medication. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 15 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 and 23 The home has a comprehensive complaints procedure and protects service users from abuse. EVIDENCE: The home has a comprehensive complaints procedure and a copy of the procedure in pictorial format is given to all service users and displayed in the home. Service users able to express an opinion said that they would speak to a member of staff or the manager if they were unhappy. No complaints by service users have been recorded in the last year. There is a comprehensive policy on the protection of service users from abuse and the home has a copy of the Multi-Agency Policy and Procedures for the protection of Vulnerable Adults from Abuse. All staff have received training in the protection of vulnerable adults. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30 The home is comfortable, safe and meets the needs of the current service users. EVIDENCE: The home has benefited from refurbishment, redecoration and the purchasing of new furniture. The home is generally in good decorative order. Furniture is of a good standard, although the sofa in the small lounge is badly soiled and needs cleaning of replacing. The entrance to the home now has a ramped access and is now suitable for wheelchair users and less mobile service users. The ground floor shower room has been refurbished and now includes a ‘walk in ‘ shower and non slip floor covering. Appropriate aids have been fitted to the toilet to assist with independence. The first floor bathroom has been refurbished and now has a assisted bath and appropriate aids have been fitted to the toilet to assist with independence. Non
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 17 slip floor covering has been fitted. The second shower room is available for more able service users. Staff have been provided with mobile alarms to call for assistance from other staff in the event of an emergency whilst dealing with service users. Several bedrooms have benefited from new furniture and service users are encouraged to personalise their bedrooms. The laundry facilities have been relocated to a more appropriate area and non slip flooring fitted. Remedial work to the outside of the building has been completed and work to improve the driveway is in progress. Occupational Therapy assessments have been carried out for service users and the premises. There are two double and eight single bedrooms. Two service users made a informed choice to share a bedroom. The remaining double bedroom is single occupancy. The home is now comfortable, homely and clean. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 18 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) 33,34 and35 The home continues to have several staff vacancies. There is a core of experienced staff in the home who know the needs of the service users well. The home has several bank workers and therefore do not use agency staff, to provide consistent staff in the home. Recruitment processes are robust. The home needs to develop a staff training and development programme. EVIDENCE: Staffing levels have been increased to meet the assessed needs of service users. The staff team now consists of a deputy manager, senior support workers and support workers. There is always a senior member of staff on duty. Each shift consists of four staff in addition to the manager, who is supernumery. At night there is one awake member of staff on duty with a second member of staff providing ‘sleep in’ support. Staff records for the two most recently recruited staff were seen. These included an completed application form, references received, documentation detailing responses made by the applicant during interview and completed CRB checks. The home has the support of a training department. A comprehensive induction programme is in place. All staff receive training in basic food
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 19 hygiene, first aid, protection of vulnerable adults and moving and handling. N.V.Q. training is available to all staff. The manager now has a designated staff training budget and the deputy manager has responsibility for the staff training and development programme. It was a requirement at the last inspection that a staff training and development programme is produced. The manager said that this had not yet been completed. Staff would benefit from training in continence promotion to assist service users more effectively. The home has staff vacancies for a night support worker to work four nights per week and two full time support workers. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 20 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 and 42 This is a well managed home. Policies and procedures are in place. Health, safety and service user welfare is safeguarded. EVIDENCE: The manager was registered with the CSCI in December 2004, following a long period of time when the home was without a registered manager. The manager has a clear sense of direction and leadership. She has a good knowledge if the needs of the service users and issues previously identified in the home and is an effective manager. The manager has improved care practices in the home, developed staff training and introduced supervision. There is a good rapport in the home between the manager, service users and the staff team. She is a good communicator, professional in her approach and leads by example. Health and safety maintenance checks are completed on a regular basis and records are maintained.
COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 21 Reports are written on a monthly basis, by a provider representative. Policies and procedures have been updated and reviewed as necessary. It was a requirement at the last inspection that an annual development plan for the home is produced and a copy sent to the CSCI. This remains unmet. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 22 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 x 3 x 1 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
COWLEY HOUSE Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 1 x x x x H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 23 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. Standard 4 5 Regulation 14 5 Requirement That a procedure is developed for service users admitted to the home in an emergency. That all service users are provided with a copy of the agreement specifying the agreement made between the provider of the service and the purchaser.( previous timescale of 07/09/04 not met) That the administration of PRN medication must comply with company policy. That a staff training and development programme is produced. (previous timescale of 07/09/04 not met) That an annnual development plan is produced and a copy sent to the CSCI.(previous timescale of 07/09/04 not met) Timescale for action 18.06.05 18.06.05 3. 4. 20 35 13 18 25.04.05 18.06.05 5. 39 24 18.06.05 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
H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 24 COWLEY HOUSE 1. None made at this inspection. COWLEY HOUSE H52-H01 11288 CowleyHse V214360 180405 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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