CARE HOME ADULTS 18-65
Newlands Cottages 8 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS Lead Inspector
Claire Taylor Unannounced Inspection 27th October 2005 12.00p Newlands Cottages DS0000025817.V262622.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 Newlands Cottages DS0000025817.V262622.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. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Newlands Cottages Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 8 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS 01883 349 507 01883 349 507 THF Care Estates Limited Dana Thompson Care Home 1 Category(ies) of Learning disability (1) registration, with number of places Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11 April 2005 Brief Description of the Service: 8 Newlands Cottage is owned by THF Care Estates Limited and is registered to provide residential care for one adult with a moderate learning disability. The registered manager manages the service in conjunction with no.10 Newlands cottages with both homes adjoining each other and sharing the same staff group. The cottage is an older style detached property situated in a quiet rural area between Coulsdon and Caterham (Surrey). The home is very close to a local bus route and a parade of local shops is within easy walking distance. 8 Newlands Cottage is a single ground floor bungalow with its own communal lounge, a small spare room, kitchen and bathroom/WC. Laundry facilities are located in the garage and shared with 10 Newlands cottages, as is parking at the front of no.10. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year 2005/06 and was unannounced. The service is managed in conjunction with no.10 Newlands cottages for which a separate report is available. It must be noted that there are similarities in this inspection report as there are in the report for the adjoining care home, no.10. The documentation is almost the same, as both homes are run together on the same site and share the same manager and staff group. Additionally, the two cottages have the same registration category and are owned by the same organisation. The service user who lives in the home spoke with the inspector and is thanked for his time. Records were examined and a brief tour of the premises took place. All key standards were assessed at the home’s previous inspection in April 2005 and the reader is therefore referred to that report should they require any further information. What the service does well:
Records showed that this home continues to provide good support for one person to live as independently as possible. The home is furnished and personalised with the service user’s chosen possessions and belongings. The service user benefits from a supported living type environment and is encouraged to take responsibility for running the home and learn, or further develop independent living skills such as cooking, budgetary and household management. There are many activities offered in a variety of ways. Support is often given on a one to one basis, offering the service user quality time with members of staff. The care planning process is managed to a good standard; care plans are reviewed and revised regularly and the service user is fully involved. This demonstrates that the home continues to meet their individual needs. The service user gave favourable comments about the home, the staff team and activities. The staff team remains largely unchanged resulting in stability and familiarity for the service user. Staff have a variety of skills and knowledge relevant to the setting, are provided with appropriate training opportunities and benefit from a supportive home manager who has worked there for many years. Newlands Cottages DS0000025817.V262622.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. Newlands Cottages DS0000025817.V262622.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 Newlands Cottages DS0000025817.V262622.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): 3, 4 and 5 The home has its own assessment plan to ensure that any new service user’s needs are fully assessed prior to their admission and that staff are aware of how to support them. Full contracts need to be provided to ensure that the service user is fully informed about the services and support they can expect to receive. EVIDENCE: A detailed needs assessment for the service user was in place. Person centred to their individual needs, the assessment provides staff with comprehensive information about the individual and how they should be supported. Records also showed that the care manager from the placing authority assesses the service user’s needs at appropriate intervals. Copies of contracts between the service user and their placing authority are still being held at the owning organisation’s central offices. These must be made available to service users in the home as they outline full terms of occupancy including other arrangements for holiday costs. This requirement is therefore repeated. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 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 and 9 The care planning process is well managed and ensures a very personalised and consistently high level of service provision for the service user living in the home. Staff support the service user to make decisions about their life that maximises their involvement and opportunities to contribute to the operation of the home. The service user is provided with the necessary support to take risks so that independence is maximised as far as possible. EVIDENCE: A written plan of care is in place that describes what the service user can do independently and when support is needed from staff. The plan is reviewed six monthly with the service user, family and other relevant professionals. Daily records are also kept which highlight progress; achievements and any activities participated in. Plans are flexible so that daily programmes can alter if the service user chooses to do something different. There are formalised opportunities for the service user to participate in group discussions/ meetings about the operation of the home. These are held in conjunction with the service users living at the neighbouring home, 10 Newlands cottages. Minutes of service users meetings were sampled and discussions are geared towards their views. Service users are asked about the things that they like, what they want and how they want things to happen.
Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 10 Care plans illustrate detailed risk assessments for the service user. These cover a variety of different areas, for example, money management, cooking, taking medication and going out in the community. Risk plans are reviewed by staff regularly and show that action is taken to minimise risk, whilst encouraging independence for the person. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 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): 11, 13, 14 and 17 The service user has the opportunity for self-development and supported to continue education and appropriate activities, so that they can maximise fulfilment and achievement in their life. The service user is provided with a range of opportunities for recreational and social activities. Improvements could still be made towards funding social activities however. Meal provision reflects variety and choices, whilst seeking to maintain a healthy lifestyle for the service user. EVIDENCE: Social needs are clearly described within the individual care plan that takes account of personal preferences. A good range of activities is provided with staff focused on promoting independence and valuing the service user’s individuality. The service user spoke about his interest for rock and roll music and memorabilia from the 1950’s era. He is supported to follow his interests and goes to a pub for a themed music night each week. In addition, the service user was due to go away on a themed weekend trip to Butlins with staff. The service user has the freedom to come and go as he chooses and has been provided with keys to his bedroom and the front door. The home keeps a social activity diary of all activities undertaken which includes going out on a monthly
Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 12 social event that is chosen by the individual. Recent events included a visit to “Cadbury’s World”. The service user attends Tandridge Hill Farm five days a week, which offers a wide variety of opportunities for people to develop their educational, vocational, and practical life skills through animal care, gardening, horticulture, and art and crafts. The registered provider for the home also owns the farm and working at the farm forms part of the service user’s contract / fees. Disappointingly, the registered providers, THF Estates have not addressed the previous recommendation concerning the funding of activities for service users. This has also been highlighted in the report for 10 Newlands cottages. When an outing is arranged, the service user is expected to pay for staff costs as well as their own. E.g. admission fees, meals out, travel cards any other costs. With the exception of travelling to the farm, the service user also contributes towards petrol expenses for the home’s own vehicle when going out socially. Given that the majority of other organisations contribute funds towards service users social activities, the registered provider should provide a budget for staff expenses and /or social outings. The menus are planned around the service user’s choices and preferences are recorded weekly on a menu chart. Mealtimes are arranged flexibly to suit individual work and activity schedules. Food provided is nutritious and offers a well balanced diet. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 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 and 21 The service user’s welfare is closely monitored and suitable arrangements are in place to ensure that their physical health and emotional needs are met. EVIDENCE: The service user is very independent and requires little or no assistance with personal care. Any support required is clearly documented within the individual care plan. Daily routines and house rules promote independence and individual choice for the service user. Times for getting up/going to bed are flexible, as are mealtimes. Staff were observed to consult with the service user in a courteous manner and respect their preferences. The service user lives on his own and staff provide him with good opportunities to take on responsibilities for maintaining an independent lifestyle as far as possible. Records confirmed that the service user is supported to further their skills in areas such as cookery, shopping and household management. There are risk assessments in place to reflect this. Information relating to personal and healthcare needs including both routine and one off health interventions are well recorded. The care plan and specific strategies identify individual and specialist needs, and also reflect any changing needs. Records seen indicated that healthcare needs are being closely monitored and that the service user is supported to manage their own healthcare wherever possible. Referrals to other appropriate professionals are also made where necessary. The service user is registered with a local GP practice and has access to other NHS facilities as necessary.
Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 14 E.g. dentist, optician, Consultant and community psychiatric nurse. The home has developed a form to record the service user’s wishes concerning ageing, illness and death so that their beliefs would be observed and choices respected. Appropriate records are kept in the care plan. Medication records for the service user are held at the adjoining home, were checked at the previous inspection and standards assessed as met. Newlands Cottages DS0000025817.V262622.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 Arrangements for dealing with complaints are well managed to ensure that the service user feels listened to and their views are acted upon. Standard 23 was assessed as met at the April 2005 inspection. EVIDENCE: A clear complaints procedure is in place and the service user provided with a summary of the complaints procedure which they had signed receipt for. Informal concerns raised by the service user are addressed through discussion with staff on a day- to- day basis and at regular house meetings held with the service users living at 10 Newlands cottages. No complaints had been made about the home since the last inspection (April 2005). Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 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, 28 and 30 Overall, the home is decorated and furnished to a good standard and provides the service user with safe, comfortable surroundings in which to live. The home is kept clean, hygienic and in a generally good state of repair although the lounge carpet is in need of replacement and the garden area tidied. EVIDENCE: The service user lives on their own with minimal support from staff. The communal areas in the cottage are reasonably well furnished and personalised with the service user’s chosen possessions and belongings. The carpet in the lounge is in need of replacement due to discolouration and numerous cigarette burns in several places. The former recommendation is therefore now made a requirement. The service user’s bedroom was not viewed on this occasion. Laundry facilities are in a separate garage area and are shared by the neighbouring cottage; no.10 Newlands. As previously required, suitable lighting has been fitted and a hot water supply now available in the laundry room. The provider is required to make improvements to the garden adjoining both cottages, as it appeared poorly maintained with overgrown shrubs and grass. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 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, 33 and 35 There is a stable staff team, who have a range of experiences and relevant training that enables them to meet the needs of the service user living at the home. Standard 34 was assessed as met at the April 2005 inspection. EVIDENCE: The home is managed in conjunction with the neighbouring no 10 Newlands cottages and shares the same manager and staff group. Since the last inspection, the staff team remains largely unchanged and a consistent core team of bank staff is used to cover any leave or staff sickness. Rota allocation allows for one to two members of staff per shift with one sleep in staff at night. The service user benefits from a supported living type environment and one to one support and supervision from staff when needed. The senior bank staff on duty during this inspection demonstrated a clear understanding of the service user’s needs and how to support them. In addition, she spoke respectfully with the individual and supported his chosen routine for the day. The staff member described what training she had received which included an orientation to the home, abuse awareness, first aid and food hygiene. In addition, training on mental health awareness had recently been held in the home which she also attended. Regular staff meetings are held on a monthly basis and in depth consultations about the home’s care practices and service users needs are routinely discussed. Staff records were not checked on
Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 18 this occasion but were examined during the previous inspection. (April 2005). Certificates and records of training were in place for staff as well as a schedule of planned training for staff individuals. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Further improvements are still needed with the quality assurance system to ensure that quality of care is regularly appraised and the home is meeting its objectives. The health, safety and welfare of the service user is overall promoted and protected. Standard 37 was assessed as met at the April 2005 inspection EVIDENCE: At the previous inspection, the home was required to implement a quality assurance system and an annual development plan. The home has offered a questionnaire to the service user, their relatives and other interested parties but findings from these have yet to be evaluated. Information gathered from these questionnaires needs to be published in an annual development plan for the home. The results of any surveys carried out should be made available to the service user, staff and any interested stakeholders. This would then demonstrate what action the home has taken to act upon any findings and thus, improve its quality of care. As this has not commenced, the requirement remains in force.
Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 20 Overall, health and safety practices are well observed. The servicing and maintenance records for the home were sampled at random and generally up to date. As previously required, the manager had reviewed risk assessments for safe working practices and the premises. A regular check and walk round the premises is carried out monthly to ensure that it remains safe for service users, the staff and any visitors. Fire drills are organised at regular intervals and fire alarms and equipment had been checked in September 05. Accurate records are kept for accident and incident reporting. The home keeps the Commission appropriately informed of any incidents that affect the service user’s well being. Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 21 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 X X 3 3 2 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X 3 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Newlands Cottages Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X DS0000025817.V262622.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES- 2 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 YA5 Regulation 5(1) 17(2) Requirement Contracts between the service user and their placing authority must be made available to them in the home. (Timescale of 31/05/05 not met) The lounge carpet needs to be replaced due to its poor condition. The garden between the home and adjoining no.10 Newlands cottages is in need of attention due to its overgrown/ untidy condition. The registered provider must ensure an annual quality assurance development plan is implemented for the home. A copy of which must be sent to the local office of the CSCI.(Outstanding from inspection October 2004) Timescale for action 31/12/05 2. YA24 23(2)(b) 12 23(2)(b & o) 31/01/06 3. YA24 31/03/06 4. YA39 24(2) 31/12/05 Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 23 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 YA14 Good Practice Recommendations The registered providers, THF Estates should consider alternative ways of funding service users activities i.e. pay towards staff expenses and/ or provide a budget for social activities.(Recommendation outstanding from April 2005 inspection) Newlands Cottages DS0000025817.V262622.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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