Inspection on 08/06/06 for Holly Cottage

This inspection was carried out on 8th June 2006.

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

Holly Cottage 12/11/07

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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Holly Cottage Highlands Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Mrs Sally Gill Unannounced Inspection 8th June 2006 9:00 Holly Cottage DS0000066932.V297291.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 Holly Cottage DS0000066932.V297291.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. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Cottage Address Highlands Farm Woodchurch Ashford Kent TN26 3RJ 01233 861493 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) Canterbury Oast Trust Mrs Ann Kathleen Combes Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Holly Cottage is registered to provide accommodation for up to 5 adults with a learning disability and admits people with low to medium dependencies. The Canterbury Oast Trust (COT) owns the business and the newly Registered Manager, Ann Combes has day-to-day control. Holly Cottage was previous registered under the umbrella of Highlands Farm this is the first inspection as a stand-alone registration. Holly Cottage is a purpose built bungalow with all accommodation on one level. There are 5 single rooms, a shower/toilet, bath/toilet, toilet, laundry, kitchen and lounge/diner. Service users have access to garden areas. Holly Cottage is situated on Highlands Farm, which is a well-known tourist attraction in a rural area on the outskirts of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs. The Cottage has transport, which can be used for the service users and a local bus service passes the farm entrance. Currently charges are £798.69 per week. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Holly Cottage was previously registered under the umbrella of Highlands Farm this is the first inspection as a stand-alone registration. This unannounced inspection took place on 7th June 2006 between 9.10am and 5pm, the newly registered manager, Ann Combes and two staff assisted with the process. Five people were living at the home and have been for several years. The inspector spoke to four service users during the inspection and support and interactions were observed. The inspector accessed all communal areas of the home and the garden. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to service users, families and care managers. Surveys were received from service users and families all of which was positive feedback. Various records were viewed during the inspection. What the service does well: The home is clean, safe and homely and run in the best interests of the service users who are able to make decisions regarding their own lives as well as the day to day running of the home. Independence and participation is promoted wherever possible. The atmosphere at the home is relaxed with plenty of interaction and laughter. The staff and manager are committed to meeting service users needs and developing their skills and abilities where possible. Service users gave totally their surveys. Comments lots of friends in craft and restaurant”, “the staff are make my own decisions”. positive feedback both during the visit and through included “I am really happy at Holly Cottage, I have at horticulture”, “I like it here and working in the very kind”, “I am happy living at Holly, I like to Positive feedback was received from relatives including “x is very happy at Holly Cottage s/he has a full and satisfying life and his/her relatives are always welcomed whole heartedly by the staff. I have absolutely no complaints about her/his care which is of a very high standard” and “x is very happy at Holly Cottage s/he has her/his independence and lots of friends also a job”. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 6 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. Holly Cottage DS0000066932.V297291.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 Holly Cottage DS0000066932.V297291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to test drive the home and have information to make an informed choice. The home ensure that they can meet service users assessed needs and aspirations following assessment. Contracts are in place with individual service users. EVIDENCE: A copy of the newly reviewed Statement of Purpose and Service User Guide has recently been submitted to the commission. All service users have received a copy and one is displayed within the home. A new COT assessment form has recently been developed and will be a good tool. Care plans or assessments from professionals were seen on individual service users files. There have been no new admissions to home since 1999. COT has a proven history of a good admissions procedure with service users able to test drive the home prior to admission. Contracts were in place on files with notes that they had been read and explained to the service user. Holly Cottage DS0000066932.V297291.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 at least once during a 12 month period. 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. To ensure service users safety and all care needs can be met consistently care plans and risk assessments should be reviewed and kept up to date. Service users are involved in decisions about their lives and assistance is given appropriately. EVIDENCE: Two care plans and risk assessments were case tracked. Both were drawn up in June 05 and have not yet been reviewed. The newly registered manager was aware of this shortfall and has plans to review them shortly. Some updates had been hand written in and these would benefit from being dated. Care plans did not contain any goal planning to develop skills and promote further independence. Information discussed and agreed at reviews had not been brought forward into the care plan. However care plans were detailed, covered all areas and were user friendly. There is no immediate risk to service users as there is good verbal communication within the small staff team. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 10 Monthly meetings are held with service users. It was evident through minutes, observations and discussions with service users and staff that service users are involved in the decision making of the home and are able to and encouraged to make decisions about their own lives. Risk assessments again were not reviewed in timescale and some risk assessments were still on file, which were no longer relevant. Holly Cottage DS0000066932.V297291.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 at least once during a 12 month period. 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. Service users have opportunities for a range of appropriate activities and enjoy access to the local community. Service users are supported to have a variety of personal relationships. Service users rights and responsibilities are respected although goal planning could further enhance skills. Service users are involved in menu planning; enjoy a varied and healthy diet and relaxed and sociable mealtimes. EVIDENCE: Observations, discussions and records confirmed opportunities to a range of activities and also a holiday all of which are obviously thoroughly enjoyed by service users. Service users have access to the local community including the Rare Breeds events, library, shops, swimming pool etc. Service users talked happily of relationships including visits, holidays and phone calls with families and also other friends on the farm. Positive feedback was received from all relatives that responded. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 12 Observations and discussions with service users evidenced their involvement in housekeeping tasks from cleaning to laundry. As previously mentioned care plans lack goal planning, which could further enhance independence and develop service users skills and abilities. There was good interaction observed between staff and service users with plenty of laughter particularly at mealtime. Evening menus are planned weekly with service users. Lunch and breakfast is free choice and independent where possible. Service users are involved in cooking and preparation of meals. They are also aware of and follow healthy eating diet. Holly Cottage DS0000066932.V297291.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 at least once during a 12 month period. 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. Service users receive any personal support in the way they prefer and their health care needs are met. Independence is promoted wherever possible. Medication systems promote independence where possible although the minor changes will ensure service users are completely safe and protected. EVIDENCE: Care plans evidenced service users preferred routines around personal care where assistance is required. Observations and discussions evidenced independence is promoted where possible. Service users confirmed that bedtimes are flexible. Service users are aware of their key worker. Health care needs are met including regular checks. A range of professionals are currently involved in the care of some service users. A new cabinet had been fitted for medication storage. Internal/external medicines need to be stored separately. The Medication Administration Record (MAR) charts show good use of signatures and codes. Instructions for medication must reflect correctly the prescription label and any additional information needs to be recorded on the PRN written instructions, which are Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 14 currently lacking. Risk assessments are in place for self-administration or part self-administration. Discussion took place about developing self-administration further with use of the MAR chart. Medication is logged out for home visits but not returns, which should be. Staff are trained in medication and a competency check is completed. Service users are encouraged and do manage their own medical conditions where possible. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted on but some paperwork practices regarding complaints should be improved. Service users are protected from abuse. EVIDENCE: The complaints procedure is displayed. The last complaint was received in September 2005 from a member of staff. However the details of this complaint were not available for the inspection. Any information is stored securely including blank complaint forms, which means any complainant has to record their complaint on a blank sheet of paper. A log is also not maintained and should be. Service users feel comfortable expressing their views, which are listened to and acted upon. Staff are trained in adult protection. A policy is in place to deal with abuse. All staff have an enhanced CRB. Service users finances are held securely and balances and records are in order. Guidelines are in place to deal with aggressive behaviour. Staff are trained in NAPPI. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely environment, which is safe, clean and hygienic. EVIDENCE: The home was clean, tidy, safe and homely. Bedrooms were not entered although records showed that some new curtains had been purchased for bedrooms and also the lounge. Staff confirmed that a dedicated team deals with maintenance problems usually in an efficient manner. On the day of the visit service users were enjoying the garden and had free access to all parts of the home. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 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): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A committed staff team supports service users who are qualified. Although improvements are needed to induction training and training is not linked to LDAF. A robust recruitment process protects service users. EVIDENCE: NVQ numbers are up from previous inspections and currently meet the 50 target. Two staff files were checked and contained all relevant information to evidence a robust recruitment procedure is adopted. A training matrix is maintained alongside a training file containing individual records and certificates. No induction training book/competency check could be found and the certificate did not evidence all units from Skills for Care are covered during induction. Induction training is still not linked to LDAF. The home is currently still working on old induction standards. Staff are trained in core and specialist subjects. Holly Cottage DS0000066932.V297291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home where their health, safety and welfare is promoted and protected. Service users views underpin the development of the home. The registered manager should obtain the relevant qualification. EVIDENCE: The commission has recently registered the manager although at present she does not have the relevant qualification (NVQ level 4 in both care and management) and will need to obtain this. Staff and service users confirmed that she is supportive. The atmosphere in home was relaxed with plenty of laughter. The registered manager and staff demonstrated a commitment to developing the home in the interests of service users first and foremost. Holly Cottage DS0000066932.V297291.R01.S.doc Version 5.2 Page 19 Quality assurance questionnaires were seen on file from service users, relatives and care managers. These are usually completed at or following the review and all showed positive outcomes. Regulation 26 visits are regularly conducted and the commission receive a copy of the report. Service users meetings are also held where they are asked for their views. Families are heavily involved in the Trust as well as the home. Health and safety checks are carried out regularly. Good maintenance of the home is maintained. The accident book was viewed and all reports are recorded appropriately. Staff are trained in core subjects. Holly Cottage DS0000066932.V297291.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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 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 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 3 X Holly Cottage DS0000066932.V297291.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. 1 Standard YA20 Regulation 13(2) Requirement Operate a safe system for medication (MAR chart to reflect accurately the prescription label, written PRN instruction for staff, separate internal/external storage, log medication returned from visits) Timescale for action 08/06/06 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 2 2 3 4 5 Refer to Standard YA6 YA9 YA16 YA22 YA35 YA37 Good Practice Recommendations Care plans to be up to date and reviewed regularly at least 6 monthly Risk assessments to be up to date and reviewed regularly at least 6 monthly Goal planning to enhance skills and independence should be developed A complaints log should be maintained and information regarding individual complaints should be complete Induction training should evidence that it is to Skills for Care specification and training should be linked to LDAF The registered manager to be qualified at level 4 NVQ in both care and management DS0000066932.V297291.R01.S.doc Version 5.2 Page 22 Holly Cottage 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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