Inspection on 25/10/05 for Myrtle Cottage

This inspection was carried out on 25th October 2005.

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

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

Other inspections for this house

Myrtle Cottage 19/02/07

Myrtle Cottage 20/04/05

Myrtle Cottage 01/12/04

Myrtle Cottage 24/06/04

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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 Myrtle Cottage 123 New Brighton Road Emsworth Hampshire PO10 7QS Lead Inspector Drew Gurney Unannounced Inspection 25th October 2005 09:30 Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Myrtle Cottage Address 123 New Brighton Road Emsworth Hampshire PO10 7QS 01243 370500 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) Dolphin Homes Limited Miss Stephanie Leigh Turner Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th April 2005 Brief Description of the Service: Myrtle Cottage is a large, detached older style property set within the residential area of Emsworth, Hampshire. The property blends suitably in style with the surrounding properties and has been tastefully converted to provide a suitable home for six younger adults with learning disabilities. There is a large lawn area to the front of the property, surrounded by fencing to ensure privacy and a smaller rear garden. Adequate car parking is provided to the front of the property. Bedrooms have been installed with en-suite facilities and these are tastefully decorated and furnished with service users being encouraged to personalise their room to reflect their interests. There is a spacious, family feeling throughout the home. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The second unannounced inspection during the current financial year was undertaken on 25th October 2005. The majority of service users were not at home, having left the establishment to either attend educational or social events, arranged as part of their care provision. The inspector was able to speak with one service user for a considerable period of time and obtain favourable views about living at Myrtle Cottage and was also able to observe the interaction between staff and two service users as all prepared for an outing to the local swimming pool. The atmosphere was relaxed and happy and service users were encouraged by staff to state their wishes and preferences and to enjoy the preparation process. Records were viewed for both service users and staff who have either been admitted or employed since the previous inspection. The inspection was conducted with the recently registered manager and recently promoted deputy manager and lasted for a period of four hours. One requirement was placed during the inspection process. What the service does well: The service continues to provide well for service users who require one to one care support and especially for high dependency requirements. Preassessment information is very detailed and informative to ensure that the correct level of support is provided for service users and staff alike. New admissions are vetted thoroughly by the management team, who attend appropriate care meetings and reviews prior to decisions being reached, to ensure that any new resident being admitted to Myrtle Cottage, will both fit in with the existing residents and with the abilities of care staff to provide care and support. The team is very focused in activity-based care and each service user has a detailed programme directed towards individual needs. Risk assessments are very specific and fully describe and support all activities, both on a care and social basis. The recruitment process is robust and induction and ongoing training needs of care staff, receive a high priority. The role of deputy manager has been introduced. The condition of the home was favourable and bedroom accommodation personalised, reflecting the various interests of each service user. Advocacy is sought for specific needs and has proved beneficial not only for service users, but for the staff team. Policies and procedures are regularly reviewed. Hazard analysis procedures have been introduced and these support regular checks being made on various health and safety measures. Fire procedures are regularly followed. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 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. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 All prospective service users and representatives have sufficient information to make an informed choice to live at Myrtle Cottage. Service users’ needs are appropriately assessed prior to admission and all have contracts or terms and conditions. EVIDENCE: Two service users have been admitted to Myrtle Cottage since the last inspection took place. Information referring to both service users was viewed. This information indicated that an updated Statement of Purpose and Service User Guide had been provided to both the service user and to the family. The inspector viewed the needs assessments undertaken for recently admitted service users. The assessment was undertaken following an application received from care management and meetings were held with all individuals involved in the enquiry to ensure that the home was appropriate for the prospective service users’ needs. A summary of the care management assessment was received and was available on files. This was supported by the home’s assessment paperwork and covered sufficient information to provide the management team to reach decisions about the suitability of the home for the persons involved. This included the suitability of the accommodation; the ongoing day care and educational facilities available locally, that the specific specialist input and condition-related needs could be supported and that in general, the needs of the applicant could be met in a safe and suitable manner. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 9 An appropriate contractual agreement was provided to both service users outlining the agreed terms and conditions applicable for any stay at Myrtle Cottage. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 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, 8 and 10 All service users have well designed, detailed care plans and these include full and explanatory risk assessments. The confidentiality of service user information is observed by various methods including training and recording practices. EVIDENCE: Care plans viewed by the inspector included a wide range of detail to ensure the well being of this vulnerable service user group. Information includes names and addresses of individuals involved, date of admission to the home, the name and address of any authority or organisation arranging admission, a photograph of the resident, contractual agreements, and detailed risk assessments and care plans. Care plans have been reviewed to focus on person centred care plans and goals towards which both service user and staff are aiming to achieve. Files had full information for staff to provide supportive care. Care plans had been signed by either service user or a supporting relative. Daily records are maintained by staff and these include information on socialisation and behaviour, care notes, progress, eating and drinking, personal relationships and care required or observed during night periods. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 11 The inspector was informed that the services of an advocate had been sought to support a service user and that the staff team had found the service invaluable not only in providing independent support for the service user, but also in enhancing the staff team’s knowledge and that this had proved beneficial all round. The confidentiality policy, updated on 15 August 2005 was viewed, and recording practices at Myrtle Cottage include information being held in locked cabinets or being entered on password protected computer. Confidentiality is part of the induction procedure and includes seven questions to be answered. All staff are required to sign a confidentiality statement. A signed statement was observed on a staff file. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 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): 13 and 17 Service users participate in local events and continue to be well accepted by the local community. Healthy and varied diet is offered to service users. EVIDENCE: A very positive relationship continues with the local community and service users are supported to attend local events. Since the last inspection, staff have attended local events with service users, including the Food Festival held during a specific weekend annually in Emsworth. All service users were encouraged to participate in the Trafalgar event this year and all participated in visits to the seafront to observe the fleet activities and royal visit. There is a weekly discussion to resolve the menu for the week ahead. Individual, dated menus were on those files viewed. As service users were not present for lunch, direct observation of meal preparation was not possible. Staff were observed preparing a nourishing picnic lunch and service users clearly indicating sandwich filling preference to suit their personal taste. This preparation was conducted in a hygienic manner, using appropriate protective measures. All sharp knives are maintained under specific, risk-assessed conditions. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 13 Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 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): 20 Medication procedures are appropriate and well recorded. EVIDENCE: Shift leaders administer medication administration. Medication training is obtained from Basingstoke College; the course has just been completed and certificated for shift leaders. Training for remaining staff is under negotiation with the college. Medication is stored in a lockable cupboard in the kitchen. The inspector viewed medication administration procedures and storage. A sample check was undertaken on controlled drugs and found to be accurate. No self-administration of medication takes place at Myrtle Cottage. Induction staff training includes an overview of risk awareness of medication. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Complaint and adult protection procedures are documented and are dealt with in an appropriate manner. The manager maintains satisfactory financial procedures. EVIDENCE: There is a complaint procedure at Myrtle Cottage and service users, their supporting relatives and anyone who requests information is provided with details on how their concerns would be addressed. Staff provide explanations to service users to the best of their ability in the format of makaton and relatives are provided with the prepared information for the purpose. No complaints had been received since the previous inspection was held on 20th April 2005. All staff are provided with training on adult protection issues. The Hampshire adult protection procedure and the Department of Health document ‘No Secrets’ are the basis for training and these include any issues of concern being brought to the attention of the appropriate professionals, including the Commission for Social Care Inspection (CSCI). A package based on induction training has been purchased by the registered person includes adult protection issues. This training package also includes regular updates on legislation. The inspector viewed the training package. The ready cash finances for three service users were checked and all balance totals were accurate. Records of financial negotiations were clearly available. Various members of the management team or Social Services are named appointees for specific service users and parents hold a Power of Attorney in some instances. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 16 Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 17 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): 28 and 29 Shared spaces and communal areas are satisfactory both in condition and for the use of service users. Appropriate servicing of equipment is conducted as required by legislation. EVIDENCE: The communal area at Myrtle Cottage consists of a dual sitting room and dining area, with additional eating space in the kitchen if service users choose to eat there. The communal area is appropriate in size to meet the needs of six service users. Since the last inspection was undertaken, the carpeting in the dining area has been replaced with laminate flooring and this has not detracted from the family atmosphere in the sitting/dining area. The flooring is found by staff to be easier to maintain, more hygienic for all and looked attractive and represented modern flooring fashion trends. The dining furniture is of good quality and continues to be well maintained in appearance. Curtaining and general décor throughout communal areas is pleasant, attractive and very appropriate for a small family style group. The sitting room furniture is sturdy, of good quality and well maintained. The Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 18 seating is comfortable and maintained in a clean condition and is sufficient in quantity. The only specialist equipment in regular use within the building is an assisted bath hoist in the downstairs bathroom. Regular servicing documentation was viewed and found to be in accordance with legislation. The home owns a wheelchair for general use, if required. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 19 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 and 35 Appropriate staff were on duty throughout the inspection process and indicated on work rotas for day and night cover. The home has robust recruitment practices and training procedures, including a high level of NVQ training structured to appropriately meet the needs of service users. EVIDENCE: It was evident from those staff files viewed by the inspector, that induction training is pursued for new staff, leading towards NVQ qualifications. The team consists of eleven members of staff including the manager, deputy manager, two shift leaders, day and night-support workers. The post of deputy manager has recently been introduced and has encouraged the promotion of a former support worker. Two recent support worker vacancies have recently been filled and the appointed staff will shortly join the team. Currently, a bank member of staff from the group of homes is providing sufficient support to ensure that enough staff are on duty. There were five members of staff on duty during the shift whilst the inspection took place, and this provided a good balance of care and support for service users to pursue various activities and also for staff to undertake designated procedures. The inspector spoke with two members of staff, who confirmed having received induction training. The registered manager has achieved NVQ level 3. The deputy manager and one support worker have completed NVQ level 3. Two further support workers have NVQ level 2 and one member of staff has almost completed NVQ level 2. A structured training programme is followed for induction and progressive training. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 20 Certificates and full recruitment information were available on those files viewed. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 21 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, 39, 40, 41, 42, 43 Service users do benefit from a well run home however, a quality assurance programme, in an appropriate format, must be developed to ensure that the views of service users and supporting relatives are sought. There are sound health and safety measures promoted and management practices do protect the service users. EVIDENCE: The registered manager has former experience in a management post and is currently studying for the Registered Manager’s Award. The manager has been provided with a job description and contract of employment and receives regular support from the Director of Care for the group. The manager is continuing with a personal training programme, holds budgeting responsibility, and ensures that records are well maintained by staff and that contracts are issued to service users. Information viewed during the inspection, had been well recorded and included servicing documentation and staff and service user records. Fire records were checked and are recorded regularly. A hazard analysis has been introduced in Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 22 the home since the last inspection and this information enables staff to record information on incoming food, both chilled and frozen, cleanliness records, refrigerator, freezer and prepared food temperatures. Regular monthly meetings are held for service user participation, but are not currently formally recorded. Documentation is not available, indicating that the views of service users or relatives are regularly sought and written in a format suitable for the service user group. A requirement was placed that these issues are addressed by the home. Service users are encouraged to attend staff meetings if this is their choice. The home has appropriate policies and procedures that comply with current legislation. Those viewed by the inspector had been reviewed, signed and dated. Regular monthly visits to the home are documented by the Director of Care and a copy submitted to the to the Commission for Social Care Inspection, indicating contact with service users, staff and the general state and condition of the home. Regular notification of any incidents is also sent to CSCI. Accident information was viewed on individual files. Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 x 3 Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x 3 3 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Myrtle Cottage Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 3 3 3 3 DS0000058347.V258894.R01.S.doc Version 5.0 Page 24 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 YA3939 Regulation 24 Requirement Recording practices must include a quality assurance system for service users and relatives, in a format appropriate to service users, and based on seeking their views; service user meetings must be recorded. Timescale for action 25/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Myrtle Cottage DS0000058347.V258894.R01.S.doc Version 5.0 Page 26 - 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. 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