CARE HOME ADULTS 18-65
Keepers Cottage Falcon Lane Ledbury Herefordshire HR8 2JN Lead Inspector
Jean Littler Unannounced Inspection 16th January 2006 02:45 Keepers Cottage DS0000024718.V278488.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 Keepers Cottage DS0000024718.V278488.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. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Keepers Cottage Address Falcon Lane Ledbury Herefordshire HR8 2JN 01531 670772 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) tony.lafford@saltershill.org.uk Salters Hill Charity Limited Mr Anthony Gerald Lafford Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents may also have a mental disorder or a physical disability Date of last inspection 12th July 2005 Brief Description of the Service: Keeper’s Cottage is a rurally based Care Home situated on the outskirts of Ledbury. It is one of a small group of services set up and managed by the Salters Hill Charity. The Home is on two stories and provides accomodation in single bedrooms for eight younger adults, of either sex, with mild to moderate learning disabilities. The home will accept people who are over 18 years on admission and who have an interest working with animals or on the land. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 2.45pm and 5pm. The manager was on duty and assisted with the inspection process. The premises were toured and one support worker was spoken with. Three residents were at Home for some of the inspection and one spoke briefly with the inspector while he showed her his bedroom. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection were also considered as part of the assessment process. What the service does well: 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. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 6 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 Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 7 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): EVIDENCE: These standards were not assessed, however the manager confirmed that the Organisation’s Terms and Conditions document had been revised to include clearer information about extra charges that are made to residents over and above the basic weekly fees. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 8 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, 10. Residents’ personal information is being held securely. Positive work is continuing to fully involve residents in the care planning and reviewing processes. EVIDENCE: Care plans are being held in the office and only shared with those authorised to see them. The Organisation has a policy on confidentiality that all staff are made aware of. A support worker showed the inspector how she and a colleague had assisted the resident they keywork to be involved in planning their care. The resident meets regularly with the workers to prepare monthly review summaries and make any suggestions for changes to current support and activity arrangements. The resident had also been involved in developing a report for a recent review meeting. The resident cannot read very well so could not understand the written report. Consideration should be given to using pictorial images in the reports. The manager reported that photographs are now being used at meetings so residents can show their families their achievements. This has proved a very positive step. Recently video footage of one resident horse riding was shown to his family at his review meeting. This received such a positive reaction that one member of staff has now been asked to teach other staff to use the video equipment.
Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: These standards were not fully assessed, however it was noted that the Home had a calm and relaxed atmosphere. The residents were all busy attending activities of their choice. The residents seen looked well and interacted confidently with the manager and staff. One spoken with in private reported that he was very happy with the support he receives. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 10 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): 20. Medication is being safely managed and it is positive that some residents are now being supported to self-medicate. Some of the storage and record keeping practices could be further strengthened. EVIDENCE: The medication management arrangements were inspected. It is very positive that following the completion of risk assessments three residents are now involved in managing their own medication and have had storage cabinets fitted in their bedrooms. The central medication storage cabinet is appropriately located and the key is stored securely. The cabinet is small and currently oral medicines are being held next to topical creams. A second storage cabinet is available and the manager confirmed he would arrange for this to be used for topical treatments to help prevent any contamination. Packets and bottles should be dated when opened to allow for the monitoring of expiry dates and to assist with the auditing process. The records showed that doses had been administered as prescribed and the quantities of medication coming into and leaving the building were being monitored. The records would be further improved if two staff prepare and
Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 11 checked the administrations charts each month and sign each sheet to confirm the accuracy of the information. All staff undertake in-house medication training with one of the directors, who is a nurse, before being permitted to administer medication. Training arrangements are due to be made more robust by staff also attending an in depth course that has been accredited by CSCI and the Royal Pharmaceutical Society. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: These standards were assessed at the last inspection. No complaints or adult protection issues have been reported to the Home or the Commission since the last inspection. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: These standards were not fully assessed, however the Home was clean, warm and homely. The one resident’s bedroom seen was attractive and comfortably furnished. One resident mentioned at the last inspection that she wanted her bedroom decorated. She has now chosen her preferred colour and the room has been decorated to her requirements. She was not at Home during the inspection but staff reported that she is very pleased with the results. It is very positive that the possibility of extending the smallest bedroom and adding an additional bathroom on the first floor are currently under consideration. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 14 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): 34. Suitable staff recruitment arrangements are in place. EVIDENCE: Suitable staffing levels are being maintained. Two new staff have taken up support worker posts since the last inspection. One staff recruitment file was inspected. This showed that three references had been taken up following an interview by a panel that included three residents. Consideration should be given to dating the references when they are received to provide evidence that they were received prior to the worker starting. The CRB information is held by the administrator and so could not be accessed. The details of the CRB check should be added to the recruitment file i.e. the disclosure number, date of receipt and outcome. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 15 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): 41. Polices and procedures are in place to provide a management framework for the service and to guide staff. These are being kept under review. EVIDENCE: The management arrangements are being changed as the deputy has recently left and the post is not being filled. A part time support worker post has been created to cover the care hours that the deputy used to work. The manager is confident that he can carry out all management tasks with the support of the part-time administrator. Consideration should be given to who will take management decisions when the manager is on annual or sick leave, or leaves his post, if there is no senior structure in place. The Organisation has a comprehensive set of policies and procedures. These were not looked at in detail, however it was clear that they were being kept under review. The medication policy was being revised and a new policy about lone-working was due to be developed following a member of staff’s recent accident whilst working alone over the Christmas holidays. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 16 Health and safety arrangements were not fully assessed, however it is positive that the work to improve the fire safety arrangements, that were suggested by the Fire Safety Officer, are being implemented including the installation of an additional fire exit. Infection control arrangements have been further improved by the introduction of paper towels at communal sinks. First aid cover has been assessed and the providers are confident that a suitable level of cover is being provided. Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 17 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 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 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 x X X X X 3 X x Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 18 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 Refer to Standard YA20 Good Practice Recommendations Keep oral and topical medication separately. Keep evidence that two staff have checked the accuracy of the administration charts at the beginning of each month. Date medication packets and bottles when they are opened. Consideration should be given to dating the references when they are received to provide evidence that they were received prior to the worker starting. The CRB information should be added to the recruitment file i.e. the disclosure number, date of receipt and outcome. The providers should give consideration to who will take responsibility for day-to-day management decisions when the manager is on annual or sick leave, or leaves his post, if there is no senior structure in place. Further develop quality monitoring systems so the service is regularly reviewed against all the National Minimum Standards. The method of reporting to stakeholders and to the Commission shows an ongoing cycle of
DS0000024718.V278488.R01.S.doc Version 5.1 Page 19 2 YA34 3 YA37 4 YA39 Keepers Cottage improvements. (Brought forward, not assessed). Keepers Cottage DS0000024718.V278488.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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