CARE HOME ADULTS 18-65
Cowley House Ray Park Road Maidenhead Berkshire SL6 8PZ Lead Inspector
Marie Carvell Unannounced Inspection 24th July 2006 DS0000011288.V294859.R01.S.doc Version 5.1 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 DS0000011288.V294859.R01.S.doc Version 5.1 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. DS0000011288.V294859.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cowley House Address Ray Park Road Maidenhead Berkshire SL6 8PZ 01628 638851 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Limited Ms Jacqueline Tracy Duggan Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places DS0000011288.V294859.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Cowley House is registered to provide accommodation and care for up to twelve service users, whose care needs, arise from learning disability. The range of care needs within the home is diverse and complex. Several service users have needs, which can challenge the service. The home is registered to accommodate service users over the age of eighteen years; many of the current service users are over the age of sixty five. The current scale of charges as at July 2006 is between £ 650.00 and £1200.00 per week. There are additional charges for toiletries, chiropody, magazines, some activities and holidays. DS0000011288.V294859.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report has been prepared using information provided on the preinspection questionnaire completed by the manager of the home: our inspection records held at the local office of CSCI: six service user surveys and an unannounced site visit on the 24th July from 11.25am until 6.25 pm. During the site visit time was spent with the manager, staff on duty, all of the service users, a relative and a visiting social worker. One service user had requested to speak to the inspector to discuss specific issues. A tour of the communal areas of the home and several bedrooms at the invitation of service users, were seen. A sample of records required to be kept in the home were examined including the case tracking of four service user files. At the last inspection in October 2005,four requirements were made. These were that a procedure was developed for admitting service users to the home as an emergency, that sufficient staff are on duty to meet the need of service users, that the duty roster accurately records staff on duty and that an annual development plan is produced and sent to the CSCI. All requirements have been complied with. What the service does well:
Service users have a named key worker and regular service user meetings take place, where service users are encouraged to express their views and opinions about the services and care that they receive. Service users have a weekly activities sheet and activities undertaken are recorded in daily diaries and on activities sheets. The home has a mini bus and service users enjoy frequent day trips. Visitors are made welcome and offered refreshments. This was confirmed by a relative, who expressed his appreciation of the care and attention provided to his sister and the cheerfulness and patience of the staff team. It is evident from letters received by the home, that the manager and her team have a good relationship with relatives and visitors to the home. DS0000011288.V294859.R01.S.doc Version 5.1 Page 6 Service users are involved with menu planning, food shopping and food preparation. Menus demonstrated that a varied and well balanced diet is provided to service users. Service users said that they enjoyed all the meals provided. Personal care needs are provided in the way that service users prefer and require. Healthcare needs are provided by a local GP practice. Medication storage, administration and recordings are satisfactory. Complaints were seen to be appropriately recorded, with action taken and outcomes. Service users said that if they were unhappy then they would speak to the manager. The home was seen to be clean, fresh smelling and hygienic. There is a daily cleaning schedule, which is monitored by senior staff. The home is run in the best interests of the service users, service users expressed their satisfaction of the care that they receive and feel that their views are taken into consideration. What has improved since the last inspection?
A procedure has been developed for the admission of service users admitted to the home as an emergency. Sufficient staff are on duty to meet to meet the needs of service users, staff on duty is accurately reflected on duty rosters. An annual development plan for the home has been developed. DS0000011288.V294859.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
DS0000011288.V294859.R01.S.doc Version 5.1 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000011288.V294859.R01.S.doc Version 5.1 Page 9 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 DS0000011288.V294859.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a comprehensive admissions procedure. Service users are assessed prior to admission and are given the opportunity to visit the home before moving in. Standard 4 was subject to requirement at the last inspection. EVIDENCE: There has been no new service users admitted to the home since the last inspection. At the last inspection a repeat requirement was made that a procedure was put in place for service users admitted to the home as an emergency admission. This has now been complied with. DS0000011288.V294859.R01.S.doc Version 5.1 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 the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have a comprehensive care plan and appropriate risk assessments in place. EVIDENCE: Service user plans are completed with service users, service user’s key worker and service user representatives, as appropriate. Completed plans are agreed and signed by the service user, representative and key worker. Regular review meeting take place to ensure that any changing needs are being addressed. During the site visit a review meeting was being held. Risk assessments are in place to support service user plans with detailed guidelines, as necessary. Service users have a named key worker and regular service user meetings take place, where service users are encouraged to express their views and opinions about the services and care that they receive. Meetings are minuted and were available in the home. Service users spoken to were able to name their key worker. DS0000011288.V294859.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users enjoy a wide range of activities and leisure opportunities. Staff support service users to maintain appropriate friendships and relationships. Service users are aware of their rights and are assisted, as appropriate, to make choices regarding aspects of their daily lives. A varied and well balanced diet is provided based on the food preferences of the service users. EVIDENCE: Service users have a weekly activities sheet and activities undertaken are recorded in daily diaries and on activities 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 and leisure facilities. The home has a mini bus and service users enjoy frequent day trips. On the day of the visit, two service users were shopping in Maidenhead accompanied by staff. Several service users were playing darts and one service user was cooking. Some activities were planned for the afternoon, so service users could enjoy the sunny morning in the rear garden of the home.
DS0000011288.V294859.R01.S.doc Version 5.1 Page 13 Several service users attend a local church on a Sunday morning accompanied by a church volunteer. Six service users have recently been on holiday and showed the inspector photographs of the trip. Further holidays are being planned. Visitors are made welcome and offered refreshments. This was confirmed by a relative, who expressed his appreciation of the care and attention provided to his sister and the cheerfulness and patience of the staff team. It is evident from letters received by the home, that the manager and her team have a good relationship with relatives and visitors. Service user’s rights and responsibilities are respected and this is evidenced in service user records and in discussion with service users. The right to be alone is respected by staff, who do not enter service user’s bedrooms without permission. Bedroom doors are lockable. Service users are involved with menu planning, food shopping and food preparation. Food stocks were plentiful with fresh fruit, salad and vegetables. Menus demonstrated that a varied and well balanced diet is provided. Meal times are treated as social events in the home, with service users and staff discussing the day’s events. Service users said that they enjoyed all the meals provided. DS0000011288.V294859.R01.S.doc Version 5.1 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 the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users personal care needs are provided in the way they prefer and require. Healthcare needs are provided by a local GP practice. Medication storage, administration and recordings are satisfactory. EVIDENCE: Detailed service user plans are in place and are developed with the needs and choices of service users taken into consideration. Healthcare records are well maintained and evidence that healthcare professionals are involved, as appropriate. Records were seen to be up to date and well maintained. In discussion with a visiting social worker, it was confirmed that staff are attentive to the needs of service users and that the care provided is of a good standard. Regular reviews of healthcare issues take place and is was evident that the manager and her team have a good working relationship with healthcare and social care colleagues. Medication is administered by staff who have received appropriate training. Medication storage, administration and medication administration sheets are maintained to a satisfactory standard.
DS0000011288.V294859.R01.S.doc Version 5.1 Page 15 DS0000011288.V294859.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a comprehensive complaints procedure and procedures are in place to protect service users from abuse. EVIDENCE: The home has a comprehensive complaints procedure and a copy of the procedure in pictorial format is provided to service users. Service users and a visiting relative were clear about the process for reporting any concerns or complaints. The CSCI have not received any complaints about this service since the last inspection. The home has received five complaints; these were appropriately recorded, with action taken and outcomes. Service users said that if they were unhappy then they would speak to the manager. There is a policy on the protection of service users from abuse and all staff have received training in the protection of vulnerable adults from abuse. A copy of the multi-agency procedures was available in the home. DS0000011288.V294859.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 24, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is comfortable, safe and well maintained. Access to the rear garden is limited for service users who are wheelchair users. EVIDENCE: The home is generally in good decorative order; furniture is of a good standard. The carpet in the lounge area needs relaying, as it is a potential trip hazard. One service user is wheelchair dependent, several service users have mobility difficulties and at least one service user requires the use of a wheelchair for outdoor use. Although the front of the premises has ramped access the rear garden does not. Staff were observed struggling to lift service users and wheelchairs up and down several steps, whist causing distress to the service users who were being tipped backwards and forwards in the wheelchairs. The home was seen to be clean, fresh smelling and hygienic. There is a daily cleaning schedule, which is monitored by senior staff.
DS0000011288.V294859.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staff are clear about their roles and responsibilities and staffing levels are maintained at an acceptable level to meet the needs of the service users. Standard 33 was subject to requirement at the last inspection and has been complied with. The home’s recruitment procedures need to be more robust, as current practices do not protect service users, some core training and NVQ training is outstanding and staff supervision needs to be provided. EVIDENCE: The home currently has vacancies for a full time support worker and bank support workers. Staffing levels are currently reduced to three support workers and the manager on duty during the day; these levels are reduced to three staff on duty at the weekends. At night there is one awake member of staff on duty with a second support worker providing “sleep in” support. A bank cleaner is employed for one day per week and staff on duty undertake cleaning, catering and laundry duties. In discussion with staff on duty, all said that they felt that staffing levels were adequate to meet the needs of the nine service users. Duty rosters were seen and accurately reflected staff on duty. A sample of four staff personnel files were examined. All applicants completed an application form and an interview was conducted by the manager and the
DS0000011288.V294859.R01.S.doc Version 5.1 Page 19 deputy manager. Application forms seen gave minimal information about previous employment history; no evidence was recorded that gaps in employment history had been explored. Reference requesting needs to be more robust, as the application form requests three referees and only two are ever requested. Some references were obtained from relatives, friends or previous employers not referred to in the employment history; some references were not from the referee named on the application form. It was not evident that criminal reference checks are completed, including the checking of the protection of vulnerable adults list prior to staff commencing employment. One member of staff was employed without a POVA check being completed using a previous CRB check. All offers of employment is subject to the completion of a satisfactory probationary period. Three files contained blank probationary forms. Evidence of a comprehensive induction programme is in place. Several service users have behaviours that can challenge the service; training is required in these areas. There are currently fourteen support workers in post; only one has completed NVQ level II training. However, the majority of staff have worked in the home for a number of years and know the needs of the service users well. The manager is addressing NVQ training with a local college. Staff were observed to be carrying out their duties in a professional and cheerful manner, it was evident from discussion with service users and staff on duty that there is a good rapport between, service users, staff and the manager. Staff spoken to said that they felt supported by the manager and colleagues and that all staff worked well as a team. Staff meetings are held on a regular basis and are minuted, these were available for examination. All staff are given a supervision contract agreeing to one hours supervision every six weeks, this is not being adhered to and was confirmed in discussion with staff. The majority of staff do not receive formal supervision. DS0000011288.V294859.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is run in the best interests of the service users, service users expressed their satisfaction of the care that they receive and feel that their views are taken into consideration. The health, safety and welfare of service users are safeguarded. Standard 39 was subject to requirement at the last inspection and has been complied with. EVIDENCE: The manager is currently undertaking NVQ level IV and the Registered Managers Award. The manager has worked hard to improved care practices in the home and the quality of life for all service users; she is respected by staff, service users, relatives and colleagues. Staff described the manager as fair, hardworking and approachable. A visiting social worker and relative were also complementary about the professionalism of the manager. DS0000011288.V294859.R01.S.doc Version 5.1 Page 21 There is an annual development plan available in place for 2006/2007. The last report on the conduct of the home written on behalf of the provider, following a visit to the home, was dated March 2006. It was observed that an entry made in the office diary referred to the provider representative having made an appointment to visit on the home, to undertake this report. These visits must be undertaken unannounced. The manager confirmed that none of the staff have received training in moving and handling or infection control, not all staff have received training in basis food hygiene. Staff spoken to confirmed their understanding of COSHH and were observed to be using aprons and gloves appropriately. Policies and procedures are updated as necessary and are available for staff. A sample of record relating to health, safety and fire were up to date and well maintained. DS0000011288.V294859.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 3 3 x 4 3 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 x 26 x 27 x 28 x 29 2 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 1 35 2 36 2 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 x 2 x 2 x x 2 x DS0000011288.V294859.R01.S.doc Version 5.1 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA29 Regulation 13 Requirement That the manager advises CSCI of action to be taken to provide safe access to the rear garden for service users with reduced mobility. That the CSCI are sent details of what action is to be taken to achieve 50 of support staff with NVQ level II. That the CSCI are sent details of action taken to ensure that recruitment practices in the home are robust. That all staff are provided with training appropriate to meeting the assessed needs of service users. That all staff are supervised and this meets the home’s supervision policy. That a report is written on the conduct of the home, following an unannounced visit by a provider representative That all staff are provided with training in moving and handling, infection control and food hygiene. Timescale for action 01/09/06 2. YA32 18 01/09/06 3. YA34 19 01/09/06 4. YA35 18 30/09/06 5 6 YA36 YA39 18 26 30/09/06 31/08/06 7 YA42 18 30/09/06 DS0000011288.V294859.R01.S.doc Version 5.1 Page 24 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 DS0000011288.V294859.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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