CARE HOME ADULTS 18-65
Harrington Cottage Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT Lead Inspector
Lois Tozer Announced Inspection 6th February 2006 09:30 Harrington Cottage DS0000023434.V273889.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 Harrington Cottage DS0000023434.V273889.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. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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.V273889.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: Harrington Cottage is registered to provide accommodation, personal care and support to six people who have a learning disability. 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. It is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Miss Claire Harman. Overlooking Romney Marsh, the house is homely and comfortable. 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 garden is well maintained and a new patio and seating area has been developed to the rear of the house. The kitchen (which also houses the washing machine) is fully accessible. All bedrooms are registered for single occupancy. The office area is of sufficient size to contain all documentation, medication and offer a 2nd staff sleep in bed. Two WC’s, within the shower and bathrooms are situated on the 1st floor, with a separate WC on the ground floor. Access into the wider community relies on the homes transport (the bus service is reported as infrequent) so there are two dedicated vehicles provided for communal use. A computer and art classroom is situated in the grounds. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 6th February 2006 between 9.30 am and 2.50 pm. There are currently six people living at the home, four residents gave verbal / signed feedback to help with the inspection process. All either said or indicated that they were very happy living at Harrington Cottage. Paperwork seen included individual support plans, risk assessments; medication and administration documents; induction documentation, training details, duty rota, and menu. All service users were engaged in activities for the vast majority of the visit, either within or outside of the home. There was a happy, easygoing atmosphere, and staff ensured service user involvement remained the focus of all domestic chores. There is a high level of activities available to residents and the range of choice for activities outside of the home is extensive and well supported both financially and by staff availability. Six service user comment cards were returned, and verbal comment expressing what life was like in the home is as follows; - ‘I like the staff, if I had a problem, I would tell Claire (the manager), I know she would help me’. ‘I enjoy going home and coming back, I have lived here for years, and really like my room’. ‘Going to wrestling soon, excited’. ‘It’s a very nice house, my room is nice. When you go to college, its not to far to walk. I like going out and tidying up my room myself’. ‘Its very interesting, go out a lot, go to the cinema. I don’t like other residents shouting. I would like more new staff to come, as X has left now’. ‘I like music in my room & having a bath’. ‘I like it all, it’s nice at Harrington’. ‘It can be a laugh when we try, but its not so good when people are moody in the mornings! I try and do my best with my jobs’. A relative of a service user was available, and said that he thought Harrington Cottage to be a good home, and had no complaints, but would not hesitate to speak to the manager if there were problems. Five relatives comment cards were returned, all said they were satisfied with the overall care provided. Comments included ‘X is extremely happy. The only unsettled time was when a lot of staff changes took place’. ‘Harrington Cottage continues to be excellent’. What the service does well:
The home is vibrant, happy and full of life. Service users live in a very homely environment and enjoy their lives at Harrington Cottage, and really enjoy getting out and about to do other activities. The range of activities is extensive, and service users are regularly consulted to make sure what they are doing still suits them.
Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 6 Weekly service user meetings take place, and this is where menus, group activities and holidays are discussed. Any problems to do with the running of the home are also discussed, and residents have an opportunity to say if anyone is annoying them. Service users have lots of input about decisions as individuals that which affect the group. People are well supported to be engaged and involved with the day to day running of the home. What has improved since the last inspection? What they could do better:
Individual plans are quite informative, and are easy to use, but have not been developed with the person at the centre and fully involved. Some support plans aim is not to empower the service user, or seek a way of increasing independence. All plans are presented in text form only. Person centred plans were discussed, and information passed to the manager. Risk assessments for the use of ‘chip n pin’ cash cards have been completed, and show a risk, but action to reduce the risk has been minimal. Greater accountability of all withdrawals and monitoring systems need to be put in place. Long term, a safer method of withdrawing money needs to be developed. Risk assessments need reviewing in light of some actions stifling service user independence, in relation to hot water temperatures in the shower. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 7 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. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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 the following standard(s): 1 The statement of purpose and service user guide is up to date, informative, and in an accessible format. EVIDENCE: Both documents have recently been revised, and are available from the home upon request. The service user guide is an excellent document that has been created in pictorial form and gets the point across really well. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 10 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 Individual plans are under review, and would benefit form a person centred focus leading this process. Service users are supported to make decisions about the future, and to be actively involved in running the home. Risk is generally well managed, but some need further review. All documentation is stored confidentially. EVIDENCE: Although the individual plans show the reader how to support the individual, they do not recognise or demonstrate the aspirations and personal goals of the individual. Some areas that could be developmental opportunities are handed over to staff to carry out. Communication assessments need reviewing to establish the best way of encouraging a person to do a task. Staff said that a service user works well with them, and said what they thought the reason was, but this great work and strategy was not reflected in the plan. Service users have lots of opportunities to make meaningful decisions and be actively involved in daily participation in the home. Staff were observed working really well, for a prolonged period of time, with a service user, who was clearly enjoying the activity. Risk assessing is generally sound, but some areas such as finance, (see standard 23) and environmental risks to hot shower water need reviewing.
Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 11 Shower temperatures are the main risk factor, but the assessment is stifling the service user desire and ability to be independent, so this should be reviewed. All documentation is kept reasonably up to date and stored in a safe manner. Harrington Cottage DS0000023434.V273889.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): 11, 12, 13, 14, 15, 16, 17 Personal development is well supported through activities and events that are enjoyable. The residents choose activities within and outside of the home. All are supported to get out into the community and go to places that hold interest. Friendships and family relationships are well supported. Individual rights and responsibilities are well supported. Residents choose a wide variety of fresh food, and staff support with food preparation. EVIDENCE: Personal development is supported through the use of speech and language, psychologist, and group therapy sessions. Residents enjoy a lot of activities, in the local colleges, work placements, special interest sessions and in the computer centre within the grounds. Community based outings and events are chosen by the residents, and this is discussed at residents meetings. Documentation and photos show an active life is had by all. Residents are listened to, residents meeting minutes show that ideas are supported and carried out. Daily routines are specified in each persons individual plan, but are led by the service users on the day. All residents and staff are clear on what planned activities are taking place, as a large planner is on the residents notice board, and people who use symbols have theirs displayed pictorially in
Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 13 their room. Menus are planned with all resident involvement, and lots of the meals are prepared with fresh ingredients. Some residents have a regular cooking night, to prepare the food for the rest of the group, and this is recommended, where possible, to be extended to the rest of the service users. Harrington Cottage DS0000023434.V273889.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, 20 Personal support is sensitive, but documentary support plans need to emphasise on developing greater independence. Healthcare is well supported. Medication is well managed. EVIDENCE: Service users said that staff are kind, and helpful, when assisting with personal support. However, support plans have not been reviewed to develop individuals to take a bigger, lead role, in their personal care. Examples of this were great reliance on staff for hair washing, where the task could be reassessed to enable the service user more independence. Healthcare concerns are followed up swiftly, and outcomes documented. All primary health visits take place as per recommended frequencies. Medication management was robust and well managed. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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 Service users are listened to, and have opportunities to complain. Protection of the person is very good, but shortfalls in relation to safe handling of money need addressing. EVIDENCE: Service users said that they could tell staff their problems and were listened to. Complaints procedures were on display, in symbol form and text. The system for making a complaint has been streamlined and is easy to follow. Weekly residents meetings highlight any intra-resident / staff issues, which are then resolved. All staff have received adult protection training, and are aware of the reporting of concerns procedure. Residents feel safe. The way money is handled on service user behalf needs improving, as the ‘chip n pin’ system is still in place for all, despite the risk assessments highlighting this to be quite a risk. Internal monitoring systems were absent, which were discussed at length, and are required to be put in place. Further work to reduce this risk is needed. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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 The home is comfortable, homely, and safe. Bedrooms are highly personalised and are enjoyed by the individuals. Shared space meets all the resident’s needs, is well maintained, and enjoyed by all. Adaptations that have been assessed as necessary for physical movement have been implemented, but further assessment may be of benefit to retain the level of service user involvement in kitchen activities. Improvements to the bathroom have been identified as required. EVIDENCE: Although external decoration remains outstanding, a budget has been identified to do this work, which will commence in the near future. The home is very comfortable and really represents the shared, domestic dwelling that it is. Service users have benefited from a new kitchen refit, and will soon (planned March 06) benefit from a bathroom refurbishment. Adaptations, as needed, are supplied. Discussion regarding mobility and soft furnishings took place, the manager having service user changing needs under review. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 17 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): None of these standards were inspected. EVIDENCE: Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 Quality assurance processes are in place to ensure service users voices are heard in running and development of the home. Health and safety is generally well managed, but some risk assessments need reviewing. EVIDENCE: The home has regular meetings, weekly, with service users. All have an agenda, some in text, others in symbol form, which they work from. All changes, proposals and ideas are discussed, and evidence is available to show that outings, activities, decoration and the like have all been generated from this forum. Families and care managers are asked for their input each year. A conversation regarding the importance of self monitoring and the future of inspection took place, as, using person centred planning approaches, the home could easily exceed this standard. All safety tests and certificates and staff statutory training is up to date. A point needing attention is the temperature of the hot water from the power shower, which can deliver extremely hot. Although service user risk assessments are in place to say that the individuals should not bathe without Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 19 support, this is restrictive to independence development and safety cannot be guaranteed, should a service user choose to shower anyway. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 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 3 2 X 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X X X 3 X X 2 X Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 21 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 Standard YA6YA18 Regulation 12 14 15 18 Requirement Previous requirement timescale unmet 01/12/05 – timescale extended; Service user plan be developed in consultation with the individual & presented in an understandable format. Must identify the strengths & needs and show what support will be put in place to promote greater independence and maintain skills. Previous requirement timescale unmet 01/09/05 - Having risk assessed the service user ‘chip n pin’ access; take action to make the situation safe. Previous requirement timescale unmet 01/09/05 - Risk assess and enable personal support to increase independence & dignity. Take action to limit the temperature of shower water, as risk assessment decrees necessary. Timescale for action 01/06/06 2 YA9 YA23 13 16 01/04/06 3 YA9YA18 YA43 12 13 01/04/06 Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 22 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 YA8 Good Practice Recommendations Assess and rota in opportunities for all service users to be involved in special cooking nights. Harrington Cottage DS0000023434.V273889.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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