Inspection on 27/01/09 for Myrtle Cottage

This inspection was carried out on 27th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Myrtle Cottage 28/02/07

Myrtle Cottage 19/01/06

Myrtle Cottage 12/09/05

Myrtle Cottage 23/02/05

Myrtle Cottage 14/09/04

Myrtle Cottage 04/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Myrtle Cottage 16 Fore Street St Blazey Par Cornwall PL24 2NJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Myrtle Cottage 16 Fore Street St Blazey Par Cornwall PL24 2NJ 01726813806 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Doreen Frances Pooley Name of registered manager (if applicable) Mrs Doreen Frances Pooley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: Service users to include up to 5 adults with a learning disability (LD) Service users to include up to 5 adults with a sensory impairment (SI) Total number of service users not to exceed a maximum of 5 Date of last inspection Brief description of the care home Myrtle Cottage is located in the centre of St. Blazey, on the outskirts of St. Austell. It is set back from the road within easy walking distance of the village centre. Myrtle Cottage is a care home for up to five younger adults who have a physical disability, sensory loss, or a learning disability. Service users are encouraged to pursue leisure activities and hobbies of their own choice and are encouraged and enabled to play an active part in the day-to-day running of the home. Myrtle Cottage is a non-smoking establishment. The accommodation on the first floor includes a double bedroom, and Care Homes for Adults (18-65 years) Page 4 of 30 care home 5 Over 65 0 0 5 5 Brief description of the care home two single bedrooms, a bathroom and staff accommodation. On the ground floor there is a single bedroom, a dining/sitting room, kitchen and an office. Outside at the back of the house is a laundry and an office. There is a large private garden. A copy of information about the home, the Service User Guide and Statement of Purpose are available from the office. The fees are pounds 377 per week, this does not include toiletries, transport or clothing. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included a site visit to Myrtle Cottage that took place on 27/1/09 between 8.40am and 12.20 pm. Mrs Pooley, the Registered Provider was present throughout the visit. As part of this visit we spoke with three of the people who live at the home, and were also shown around the house by them. We looked at the care provided to two of the people. This included looking at the care records, at the medication, at how risks are managed and how information is recorded. In addition we looked at the records relating to the management of staff and to ensuring that the home is well run and kept safe. In addition we sent surveys to all of the four people who live in the house, they told us that these were completed and returned, however they were not received by the Care Homes for Adults (18-65 years) Page 6 of 30 Inspector. We also contacted two social services care managers, one who provided some feedback the other who did not respond. We also spoke to staff from the day centre which some of the people from Myrtle Cottage attend. We also received information in the form of an Annual Quality Assurance Assessment competed by Mrs Pooley. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone thinking about moving to Myrtle Cottage can be confident that their needs will be known about prior to a move to the home. Evidence: No new people have moved to Myrtle Cottage since the last key inspection. Most of the people who live at the home have lived their for many years. Mrs Pooley, the Registered Provider, told us about how important it was to get to know and understand someone who might live at the home. We looked at the information about how needs assessments are carried out for people who are already living at the home. There is a format for assessments and information is well, and succinctly recorded. We saw that a Service User Guide had been produced. This is a document that tells someone who is thinking about moving to a home or living at a home what is provided and what they might expect. The information was clear, well presented and used photographs to better communicate what Myrtle Cottage was like. Mrs Pooley explained that where people had difficulties reading because of poor eyesight then Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: information was read out. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Myrtle Cottage are able to make decisions and choices about their own lives and are given the support they need to both meet their needs. Evidence: As part of this visit, we looked at the information that is held on two of the four people who live at Myrtle Cottage. We found that each person had information about their needs and how these are to be met, this was in the form of a Care Plan (or Service User Plan). The information had been regularly reviewed. We discussed with Mrs Pooley keeping a record of discussions with the individual so that their is a record of consultation. We spoke with three of the people who live at Myrtle Cottage about rules and decisions they can make. We were told that it was up to them to decide when they got up, went to bed and things like that. We also told that Mrs Pooley sometimes suggested things such as going to bed, but that it was up to the individual to make their own final Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: decision. The one rule was that they should let the staff know when they were going out and when they returned, in case there was a fire. We were advised that one person needed some assistance with going out, and we saw that this was recorded in the documents. We discussed with Mrs Pooley new legislation which affects peoples rights to make decisions, the Mental Capacity Act, and recommended that she becomes conversant with this legislation and the implication that it might have for people living at Myrtle Cottage. We saw that risk assessments had been completed in relation to individuals and any perceived risks. We discussed with Mrs Pooley the need to ensure that these assessments are regularly reviewed, and kept up to date. We were told by the people who live at Myrtle Cottage that they look after their own money. Mrs Pooley confirmed the arrangements. Any personal income is paid to individuals bank accounts. Money due to the home as part of the fee is then paid to Mrs Pooley. Mrs Pooley confirmed that individuals, where entitled, were in receipt of their own disability living allowance (mobility component). Mrs Pooley explained to us how she saw her role in supporting people to make decisions. She explained that she was very conscious of not putting her own views forward as these might unduly influence a choice. She place a strong emphasis on people making their own decisions. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Myrtle Cottage are able to active lifestyle, reflecting their abilities. A good standard of healthy meals are provided, which are to the taste of the people at the home. Evidence: We started this inspection visit at 8.40 am, one person had already gone out for the day, and two others were just about to leave. We talked with people about how they spent their time, and they were very satisfied with what they did. Two of the individuals told us about the clubs and activities that they attended during the evening. We were also told about the many holidays that people had gone on over the years. When we were shown around the house, it was possible to see that people had particular hobbies, evidenced by the music, computer or DVDs that were there. When we asked if people had enough to do then we were told yes, there was. We looked at Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: the records that are kept in the home, and saw that information is recorded each day for each individual. We asked people about the meals at Myrtle Cottage. We were told that the food was good. During the weeks the evening meal is a light meal, as people tend to eat at their day centre or out. The people who live at Myrtle Cottage were particularly enthusiastic about the meals at weekends. We were told that on Saturday they have a cooked breakfast, and a lunch time one person goes out and buys pasties, which appeared to be a great favorite. We noted in looking around the home that there was fresh fruit and vegetables. Mrs Pooley explained that she did try and encourage healthy eating and for individuals to manage their weight. The people who live at Myrtle Cottage told us that they had a key to the front door, though there were no bedroom door locks. As has already been noted people are free to come and go as they please, as long as they inform the staff. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Myrtle Cottage have the help they need to make choices about staying well and healthy. People are given the opportunity to self medicate however the records and storage provided for individuals is lacking, and needs to be improved so that there can be no confusion or mix ups. Evidence: As has already been noted the people who live at Myrtle Cottage were able to tell us that they are able to make choices about their daily lives.Mrs Pooley explained that she was mindful of ensuring that people made their own decisions and did not make decisions to please her. The people who live at Myrtle Cottage told us that they were able to see the doctor when they needed to, and attended a Well Person Clinic every 6 months, to check on their health. Mrs Pooley confirmed that this was the case. We looked at the records relating to health needs, and inparticular in relation to epilepsy. We found that whilst Mrs Pooley was very aware of what peoples needs were in relation to epilepsy, this was not fully recorded. We saw that a record of seizures are kept at times when there Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: are concerns, and would recommend that such specific records are kept at all times. All of the people we met at Myrtle Cottage were well dressed, reflecting that they received any help they might need with personal care. We were told that the people at Myrtle Cottage are, for the most part, independent in this area. We looked at the way medication is managed at Myrtle Cottage. Some of the people are able to look after their own medication. We found that there were risk assessments relating to people being able to self medicate however the actual practice needs to be improved. We found that one person keeps all of their own medication in their own room, however there is no place where this may be kept locked. A lockable store must be provided for an individual for their own medication. Another of the individuals is given their medication on a daily basis. This medication is dispensed each week into 7 small boxes. A box is then given to the individual each day. This sort of dispensing is known as secondary dispensing and is not recommended. We asked to see if there were any records of medication given to the individual to self administer. There were no records of this. A record must be kept of all medication kept in the home, of medication administered or of medication given to an individual to self administer. Mrs Pooley agreed that she would look at the options available to improve the medication system whilst ensuring that the individuals maintain their independence. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well protected from abuse and know how to raise any concerns if they have them. Evidence: As part of the information that Mrs Pooley (Registered Provider) sent the Commission, she has said that In terms of complaints or adult protection issues all residents have established channels through which they can complain without involving staff. We were shown copies of the information about how to complain. We discussed with Mrs Pooley the need to up date the address for the Commission which has recently changed. We asked Mrs Pooley about actions she would take if she had concerns about the safeguarding or protection of any individual. She was able to explain what she would do. Mrs Pooley told us that she had not received any training provided by Cornwall Social Services, who would have a responsibility for taking a lead in coordinating such matters. We would recommend that both she and her staff undertake such training, so that they are aware how the safeguarding system works in Cornwall and the local contacts. We talked to three of the people at Myrtle Cottage about how they felt about raising any concerns or issues they might have, and was told that they could speak to Mrs Pooley. We asked Mrs Pooley about how she finds out about what the people who live Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: at Myrtle Cottage think and want. She said that she sits down after Sunday lunch and talks informally, she has found this is the best way of getting the four people to come together and to talk. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Myrtle Cottage are provided with a good standard of clean and comfortable accommodation. Evidence: We were shown around the house by three of the people who live there. There are curently three bedrooms in use: one double room and two single rooms. The accommodation was clean and in good order and reflected individual tastes. Mrs Pooley explained that she was in the process of re-furbishing one of the bedrooms. We asked the people who live in the house what they thought about there accommodation, all three were happy though one commented that his/her bedroom was cold. We checked this and found that in spite of being a very cold day, that the room was warm. Three of the people who live at Myrtle Cottage had a degree of visual impairment. These individuals have lived at the home for many years and are clearly very familiar with the layout of the place and were able to move freely around. We looked in both of the bathrooms and checked to see if there was hot water, which there was. One of the people who lives at the home said that there was always plenty. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There is a laundry to the rear of the building, which is accessed from the outside. There is a large and well kept garden to the rear of the house. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home receive support from competent and trained staff. Evidence: Mrs Pooley told us that no new staff had been recruited since the last inspection. We asked Mrs Pooley about the checks that she would make if she were to need to recruit and she was familiar with what she would need to do. We looked at the training file for one of the current members of staff, the person had received substantial training in previous years, although less in more recent years. There was a record of staff appraisals on file. We asked to see the rota, Mrs Pooley was unable to provide a current rota. She said that there was always one person on duty in the home at any time. A rota should be kept, as this helps avoid any confusion about who is working, but is a record of who was accountable for the service at any one time. We asked the people who live at Myrtle Cottage about how they are treated by staff, one person said that it was the best place he had been, that they were looked after well, and that at another place he had been they were just names and numbers, this was not the case at Myrtle Cottage. Care Homes for Adults (18-65 years) Page 23 of 30 Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Myrtle Cottage benefit from a well run home. Evidence: Mrs Pooley runs Myrtle Cottage and provides a substantial amount of the care to the people who live in the house. This is a small home, and from discussions with Mrs Pooley it is clear that she is aware of what is happening in the home. Mrs Pooley confirmed that she had completed the National Vocation Qualification in Care and in Management. Information provided by Mrs Pooley showed that the she had a range of policies and procedures relating to the running of the home, however there was no missing person procedure. We discussed with Mrs Pooley the need to have such a procedure as it is required by the regulations. We asked about risk assessments and were shown a number of documents which had been recently reviewed. These are important in helping to try and identify how risks Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: can be managed and unnecessary harm avoided. Checks had been made to portable electrical appliances in December 08, and Mrs Pooley told us that the full electrical wiring checks were due next year, and therefore was not required as stated in the previous report. Mrs Pooley confirmed that the gas fires and boilers were checked on an annual basis by an appropriately trained person. We also saw that checks had been made of the fire system. We asked about a quality assurance system, and was told that there was no formal system. Mrs Pooley said she meets regularly each week with the people at Myrtle Cottage on an informal basis, and listens to what they have to say. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Individuals who self medicate must be provided with secure storage to keep any medication. This is to keep medication safe and to avoid harm to others. 01/04/2009 2 20 13 A record must be kept of 01/04/2009 medication given to a person to self administer. This is so that there can be no confusion over what has been given, and it provides an audit trail and hence accountability for medication. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 All staff should receive training in relation to the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 28 of 30 2 3 4 5 19 23 31 40 Comprehensive information relating to how to manage health care needs in relation to seizures. All staff should receive training in the local arrangements for protecting people from abuse. A rota should be kept of when and in what role any staff are working, so that there is accountability for the work. The home should have a missing person procedure. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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