Inspection on 13/12/05 for Cromarty House

This inspection was carried out on 13th December 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cromarty House 18/07/07

Cromarty House 06/07/06

Cromarty House 26/05/05

Cromarty House 02/02/05

Cromarty House 29/07/04

Cromarty House 03/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cromarty House 11 Priory Road Bodmin Cornwall PL31 2AF Lead Inspector Philippa Cutting Unannounced Inspection 13th December 2005 08:15 Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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 Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cromarty House Address 11 Priory Road Bodmin Cornwall PL31 2AF 01208 78607 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) Mr Roger Tarrant Mrs Debra Tarrant Miss Katherine Maggs Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 6 adults with a learning disability (LD) aged 18 to 65 years. 26th May 2005 Date of last inspection Brief Description of the Service: Cromarty House is a detached property set in its own grounds with private parking at the rear of the house. The home is within easy walking distance of Bodmin town and shopping area. Cromarty House provides care and accommodation for up to six younger people with a learning disability, some of who may present with challenging behaviour. The home provides six en-suite single bedrooms and well-furnished communal areas. The accommodation is on two floors, three ground floor bedrooms and three first floor bedrooms. There is a bathroom on the first floor and an additional toilet on the ground floor. Externally there is a garden area for the use and enjoyment of the service users. The accommodation would not be suited to anyone who was reliant on wheelchair for mobility although a person with limited walking ability could probably manage in a ground floor room. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started at 8.15am. The service users were just beginning to get up. During the day the five people living in the home went out for a walk to a favourite place and later did some cooking. They had opportunities to spend time in the lounge or their rooms. They talked with the inspector who was shown their lifestyle books that they have compile. The premises & a selection of records were inspected and discussions with staff were held. A particular problem that had been brought to the attention of the Commission for Social Care Inspection was discussed with the registered manager. The inspector met two service users who were known previously in other accommodation. Both appeared to be well and improved in health. What the service does well: What has improved since the last inspection? What they could do better: The home needs to keep a stable staff team, as there have been a lot of changes. This makes it difficult to arrange and build on training, training that is essential if the home cares for people with challenging behaviour. The issue of abuse, in all its forms, and the use of language in recording needs thought. Other documentation in symbol or other format would help service users, especially the complaints procedure. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 6 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. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 7 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 Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 8 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): 1,4,5 Service users and their families can be provided with information about the home when making enquiries or seeking a placement. Alternative formats containing this information would be helpful for service users. EVIDENCE: The home’s statement of purpose & service users guide set out the services offered by Cromarty House. The information is supplied to service users and their families. A prospective service user is offered opportunities to visit the home for varying periods of time when making the decision about moving in. Service user contracts were seen to included statements from the home about the services that would be provided specifically for each person. It may include access to alternative therapies if felt to be beneficial. This is prepared as part of the funding package for the purchaser. Preparing the information in alternative formats (PECS or CD rom etc) might enable service users to gain a better understanding of the home when they are considering a move that will affect their future. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 9 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): 6,7,8,9,10 The recording has been revised and reviewed. It is now prepared in formats that included symbols etc. that the service users can understand and thereby participate in the process. The registered manager acknowledged that, with hindsight, the previous records had not always been full enough. EVIDENCE: The care plans for the service users have been revised and are now detailed. Service users also complete a ‘My Life’ folder in which they can express their views and opinions so that this complements their care plans. The registered person & registered manager said that they were planning to incorporate person centred planning into these documents in the future. Symbols and alternative communication systems have been added to assist service users in their understanding of these files. The registered manager has just completed this review. If the files are maintained in this form, they will be good. The daily recording on each service user is full and outlines what has taken place. Some comments include ‘brilliant day’ or ‘fabulous trip’. It is important not to use hyperbole when recording, as what might be ‘brilliant’ in one person’s estimation may not be the same to another, whether carer or service Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 10 user. Equally comments like ‘trying’, ‘needs to be told’ can be very subjective. It may indicate that the problem lies with the carer, not the service user and time should be taken to see if adverse reactions in particular occur more with some members of staff than another. One:one meetings, which are minuted, are arranged on a regular basis with service users where there are issues that need individual time and input. The service user and staff who attend these meetings (usually senior personnel) sign these minutes. House meetings are held as well where there are opportunities to raise any difficulties encountered. Service users’ understanding of confidentiality needs to be stressed constantly as the daily recording suggested that the home had experienced problems when a person had eavesdropped or passed on overheard comments. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 11 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): 11,12,13,14,16,17 A variety of opportunities are provided for service users to enable them to participate in activities of their choice and be part of the local community. EVIDENCE: The daily records detail the activities that people are offered. These can include attendance at Day Centres, exercise sessions, trips out, visits to favourite local places and time away with families etc. Service users help with the shopping for the home. Each service users completes a personal diary in which his/her activities and interests are included. When at home people like to watch television, listen to music of their choice or generally relax. Some choose to cook. Service users had helped make and put up decorations in the house for Christmas. Moving to Cromarty House can be the first experience for some service users of leaving home and starting to live a more independent life. Examples of records, where people have had to be reminded to be considerate towards Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 12 others, especially if they want the same consideration for themselves, were seen. The menu that was displayed appeared to provide a varied and satisfactory diet. The home had, with the dietician and medical supervision, helped a service user successfully lose weight. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 13 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): 18,19,21 As a younger group of people, the service users are well. The home needs to ensure that staff remain constant in their approach to people’s emotional needs and do not get drawn into manipulative situations. EVIDENCE: Although one person is under investigation for a medical problem, the current group of service users were all in reasonable health at the time of this inspection with none needing regular attention from the community nursing services etc. Members of the learning disability team are consulted when needed. The inspector noted entries in a service user’s record where an element of exasperation (by some of the staff) showed. This suggests that further input could be needed in some service users’ emotional needs or staff need more support in difficult situations. The inspector was told that medication is administered by staff for the service users although not all service users require any medication. Four members of staff have undertaken a course in the safe handling of medication. The medication process was not looked at in any further detail on this occasion. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 14 The home has policies regarding the illness or death of a service user but they have not been required to date. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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 the following standard(s): 22,23 The number of staff changes that have occurred in the home made it difficult for the inspector to ascertain that all staff have a good and full understanding of the difficult issue of abuse. The group of service users at Cromarty House have some complex needs that can lead to disagreements. Service users may need help to access and understand the complaints procedure. EVIDENCE: A complaints procedure is displayed in the home. This too may need to be provided in an alternative format in case service users wish to action it. This inspection addressed a complaint that has been received by the Commission for Social Care Inspection and will be responded to separately. The registered manager commented that one of the reasons for reviewing documentation was to provide better evidence if and when complaints are made. Two members of staff have attended the PoVA seminars currently being run by Social Services; four have yet to attend a session although a video is used for training purposes to alert staff to abuse issues. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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 the following standard(s): 24,25,26,27,28,29,30 Service users have comfortable accommodation that is well maintained and meets their needs. EVIDENCE: Cromarty House is decorated and maintained to a good standard with service users being encouraged to personalise their own rooms, which are all en suite. The registered provider stated that thermostatic valves are fitted to all hot water outlets. The radiators are not guarded but the registered person said that they are kept at a low temperature that satisfied the requirements of the Environmental Health Officer (Health & Safety). Cromarty House needs to be able to demonstrate what care would need to be taken if the weather was very cold and the heating needed to be adjusted. The communal space was warm and comfortable. Service users do not eat all together. They sit at different tables, some in other rooms. This has been arranged to allow people who may have problems with eating the space to manage without inconveniencing others. There are two night staff who sleep. One person has access to a bedroom; the other uses the lounge. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 17 Externally the rear garden provides some parking and a level patio area. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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 There were adequate numbers of staff at the time of this inspection but the home appears to have had difficulty in retaining carers. EVIDENCE: There have again been staff changes since the last inspection in May 2005. The registered manager said that the home has changed its recruitment policy, thereby hoping to attract people who wish to make caring a career rather than job. Staffing details were not looked at in detail but the registered manager said the home was now fully staffed. One new member of staff has started work before references and Criminal Records Bureau checks have been verified. This should not occur even when employed as a supernumerary member. The registered provider said that the home has had difficulty if accessing LDAF courses so that to date none of the staff have been able to enrol for this learning disability targeted course. It would appear to be essential that a stable team of staff remain in place, as any training that takes place is lost when people leave. A good mix of staff on the rota would ensure that less experienced staff work with seniors rather than senior staff being on shift together. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 19 Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 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): 37,41 A limited number of records were inspected and were found to be satisfactory. EVIDENCE: The registered manager is undertaking her registered manager’s award. Fire training and testing of equipment was current. The accident book conforms to the Data Protection Act 1998 and had been completed when necessary. The home completes ‘incident reports’. These need to be analysed to see if there are any patterns of behaviour occurring. Two members of staff hold first aid certificates and four have basic food hygiene qualifications. A health & safety folder was noted but not inspected. Regulation 26 reports from the registered provider reporting on monthly visits were not looked at. Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 21 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 3 X X 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cromarty House Score 3 2 X 3 Standard No 37 38 39 40 41 42 43 Score 3 X X X 3 X X DS0000044661.V271322.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA34 Regulation 7,9,19 Schedule 2 Requirement Written references and Criminal Records Bureau checks must be obtained prior to any employee starting work in the home. Timescale for action 01/01/06 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 YA1 Good Practice Recommendations The statement of purpose service users guide and other documentation should be produced in alternative formats so that they are more accessible and understandable for service users. Guidelines for the response by staff if a difficult or potentially manipulative situation develops should be clearly in place and adhered to. Staff should be enrolled on appropriate training courses for the care of people with learning difficulties. 2 3 YA19 YA32 Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cromarty House DS0000044661.V271322.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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