CARE HOME ADULTS 18-65
Harrington Cottage Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT Lead Inspector
Lois Tozer Key Unannounced Inspection 14th May 2007 09:50 Harrington Cottage DS0000023434.V329338.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 Harrington Cottage DS0000023434.V329338.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. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harrington Cottage Address 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) Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT 01233 720814 Canterbury Oast Trust Miss Claire Anne Harman Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd October 2006 Brief Description of the Service: Harrington Cottage is registered to provide accommodation, personal care and support to six people who have a learning disability. Over 50 of staff hold NVQ2 (or above) certificates. A large cottage, set in its own extensive grounds, the home is set well back from the road and is approximately 20 minutes walk from the village shop and 15 minutes from the local pub. Access into the community relies on the homes transport (the bus service is reported as infrequent) so there are two dedicated vehicles provided for communal use. There is a computer and art classroom is situated in the grounds. Communal facilities consist of a good size dining room (that is used as a staff sleep over area at night) and a large lounge, with TV, music and computer. The kitchen (which also houses the washing machine) is freely available for people to use. WC, shower and bathrooms are situated on the 1st floor, with a separate WC on the ground floor. Harrington Cottage is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Miss Claire Harman, who has an NVQ4 qualification. Miss Harman has been the registered manager of the home since 14th July 2005, and was previously the deputy / acting manager. Fees currently start from £941.73 per week with additional costs met by the service user for hairdressing, toiletries, magazines, personal admission fees and beauty / chiropody. Inspection reports can be obtained from the home. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key site visit took place on 14 May 2007 between 09.50am and 2.30pm. The manager, Clare Harman, service users and staff assisted with the process. Six people live at the home, three gave face-to-face feedback and all sent in responses to our survey. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The manager and a service user gave a tour of the main parts of the home. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well:
People are getting out and about a lot. The staff numbers are right for what service users do each day. People are planning their holidays. People know that if they speak up, or tell staff they have a problem, something will get done about it. Relationships are supported discreetly and sensitively. Everyone has a chance to cook and do chores around the home. Everyone gets on well with each other and there is a good, happy atmosphere. People who want to go to Church are supported, and extra staff have been provided. Feedback from one relative said that confidence and speech had improved, and another said that Harrington Cottage provided a loving home. A care manager said they had not been to the home for over 1 year, but said that there was stimulating and meaningful day activities, and the home was very good at listening to client wishes. All feedback from people living at the home was generally positive. Some boxes ticked could have been misunderstandings, as face-to-face feedback
Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 6 said all was well. The home should use their own communication aids to help people understand forms better. Some feedback from people at the home said ‘I like all my friends here. I’m always happy here’. ‘Everything is all right. This is a very nice house. I am happy living here’. ‘I’m alright’. What has improved since the last inspection? 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.
Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 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 Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know that their needs will be met, and their aspirations are being developed. EVIDENCE: Needs assessments are in place for all people living at the home. Developmental work is taking place to identify and build in aspirations. The individuals choose day-to-day lifestyles. They say, or indicate that they are very happy with their choice of home. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 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. 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. Improved approaches to planning and risk taking are putting service users in a better position to say what type of life they wish to lead. EVIDENCE: Personal support plans are developing well. People have been consulted about the care provided to them, and have signed their names to the plans. More work is needed to make sure that the support given and the goals chosen are what the individual has indicated they want. Finding the right method of offering decision-making opportunities is important; service users views should be sought first, with staff helping to make the choice a reality. In some cases this is quite evident, with clear statements telling people what particular communications really mean. The home is heading in a more person centred direction, with increased use of pictures and symbols to improve communication on complicated issues. Lots of work around decisions and choices is taking place. There are excellent pictorial diaries being developed
Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 10 with the service users. People are very much involved with the day-to-day running of the home, and this was clear during the visit. All people were encouraged to do tasks, and staff were prompting involvement. Risks around personal development have been considered; the home has a positive attitude to people trying new things. Some risk assessments have not been sufficiently reviewed. The development of competence, familiarity and skill within an activity has not been recognised within the assessment. Potentially this may prevent the individual from taking the next natural step forward. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the lifestyle they want and enjoy. They are supported to improve their skills. EVIDENCE: Service users say that they are having the lifestyle that they enjoy. Their relatives and a care manager agree that the home provides a very high quality of life. Relatives have seen improvements in self-confidence and social skills. Individuals choose activities and efforts are made to change the structure of the day to fit better with service user choice. Although situated in a rural location, everyone gets out into the wider community a lot. All do their own personal shopping and take turns to do the household shop. People are supported to have a wide range of relationships, and the home does not have any problems with relationship development. Rights and responsibility taking is improving. People are starting to take more control over their lives, such as medication administration and gaining qualifications. Skills teaching is being
Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 12 adopted, with one person already enrolled onto the National Proficiency Tests Council course. The manager aims to have all service users who are interested in this involved. The healthy meals made with good quality ingredients are chosen and (with staff support) prepared by the people who live at the home. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported to take greater control of their personal healthcare and medication. EVIDENCE: The type and style of personal support given to each person is written in the individual plan. People said staff were kind and helpful, and gave the help they needed. Everyone is supported to have the right sort of healthcare for them. Developing health action plans with service users was discussed, which would help people take more control over their own health issues. Work with the community nurse showed that excellent teaching aids around specific health issues were being used. This work is totally person centred and individual to their needs. Medication management is still held centrally by staff, but one person has started the process of supported self-administration, which is a good step forward. The manager said they will assess other people and work towards people having support to control their medication within a supportive risk assessment. All records were clear and up to date. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 14 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. Service users are listened to and are protected from harm. EVIDENCE: People living in the home said they feel safe. They know who to turn to if they have a problem. The complaints procedure is in pictures and is displayed on the residents notice board. Staff have had adult protection training. They understand how and when to report abuse, and are working in a positive way with all service users. There are no restrictions within the home or grounds. Each person has their own bank account and is the only person who can withdraw money from the account. There are clear records of withdrawals and expenditure made with service users. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 15 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, 25, 27, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, safe and hygienic. It is a place people enjoy living in. EVIDENCE: The home remains really cosy and homely. People love the cottage type environment and have enough communal space for recreational activities. People decorate and furnish their rooms in their own style. The bathroom has been refurbished and looks lovely. The downstairs loo has a latch that cannot be over-ridden in an emergency. The garden is being developed by service users and staff, with plans for the summer in place. The external decoration is planned for September 2007. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can feel confident that the staff team will understand and support their needs, and that staff have had all the necessary safety checks. EVIDENCE: Staff are encouraged to use Makaton signs with service users, but have had only very basic training. The manager said team meetings have a Makaton using segment, and some staff were using signs consistently. Service users would benefit from staff signing to each other and non-signers, so signing people could be included in conversations. The forthcoming training schedule offers more service user focused training, but places are limited, the manager reporting that her staff will need to wait for future opportunities. Although individual planning has improved, training around person centred planning would help staff support people to have a bigger say in their lives. Staff numbers are provided to meet service users planned activities. Service users say they are happy with the level of staffing, they can get out and do Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 17 what they plan. Recruitment processes are now solid and gather all the data necessary to make sure service users are protected. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 18 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, 39, 42 Quality in this outcome area is .good. This judgement has been made using available evidence including a visit to this service. The home is run in service users best interests, but improvements in quality assurance will ensure all service users are given equal opportunities to develop. EVIDENCE: The manager has reviewed the level of consultation offered to service users, and is putting in measures to improve it. She has kept up to date with her NVQ Assessor training, and has looked and implemented ways to improving opportunities for service users. There is lots of good work taking place that show the service to be run in service users best interest (such as service user and staff meetings), but the current development plan is not reviewed very often. The people who are responsible for action are not named, and the date
Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 19 for action is seldom stated. It is difficult to see how service users and other stakeholder views have been incorporated into the development and review of the plan. Some items are ripe for service users to take more control (with staff support). The manager said this was an area for improvement. Some good practice documentation and potential ways of improvement were discussed, and how beneficial person centred planning training would be. All health and safety issues, certificates and fire risk assessments are up to date, or are currently being reviewed, providing people with a safe environment. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 20 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 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 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 4 3 X 3 X 2 X X 3 X Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard YA35 YA39 Good Practice Recommendations To benefit service users choice and say in their lives, staff should be familiar with the concept of person centred planning and support. The annual development plan should reflect service users own views, aims and objectives. It should have clear action points that are reviewed on a regular basis. Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
© 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 Harrington Cottage DS0000023434.V329338.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
