Inspection on 11/10/05 for Old Manse The

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Manse The 13/02/07

Old Manse The 10/05/06

Old Manse The 16/01/06

Old Manse The 18/03/05

Old Manse The 25/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Old Manse The The Old Manse 243 Main Road Biggin Hill Kent TN16 3JY Lead Inspector Lorraine Pumford Unannounced Inspection 11th October 2005 14.30p Old Manse The DS0000006970.V256523.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 Old Manse The DS0000006970.V256523.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. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Old Manse The Address The Old Manse 243 Main Road Biggin Hill Kent TN16 3JY 01959 571695 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) CARE (Cottage and Rural Enterprises Ltd) Mrs. Pethrona Fray Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 Adults of either sex with a learning disability within the category mental handicap 18th March 2005 Date of last inspection Brief Description of the Service: The Old Manse is a detached two-storey house situated in the High Street at Biggin Hill. It has been converted to meet its present purpose as a care home. Shops and public transport links are within easy walking distance. The home is registered to provide care for eight service users with learning disabilities. The communal areas are on the ground floor and consist of a lounge, kitchen/diner, utility room and three bedrooms. Each one has a wash hand basin, and is wheelchair accessible. On the ground floor is a bathroom and shower room. On the first floor, via a flight of stairs, are five bedrooms with en suite facilities. All bedrooms have TV sockets and an alarm call system. There is a large back garden, which is accessible via a ramp. There is a garage at the side of the house and off-street parking at the front. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector who was in the home from 2:30 p.m. until 5:30 p.m. during that time some service users and members of staff were spoken with, some records examined and parts of the premises inspected. All Registered Care Homes receive a minimum of two inspections within a 12 months period, as this inspection may not have covered all the “National Minimum Standard” on this occasion, should further information be required it is recommended that a copy of the last inspection report also be obtained. What the service does well: What has improved since the last inspection? Since the last inspection the home has received a gas safety inspection and the certificate issued in relation to this was seen during the course of this inspection. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 6 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. Old Manse The DS0000006970.V256523.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 Old Manse The DS0000006970.V256523.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): None of these standards were inspected on this occasion. EVIDENCE: Old Manse The DS0000006970.V256523.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): 6,7,9,10 There are detailed records regarding service users assessed needs, with clear aims and objectives and guidance for service users and staff regarding action to be taken to meet these. Service users can be assured that all information regarding then will be treated as confidential. EVIDENCE: Records seen indicated that each service user has a detailed written care plan this included a personal risk assessment in relation to time spent outside of the home, personal care and domestic tasks undertaken. On the day of inspection a comparatively new member of staff who had recently completed an induction period was left to work alone in the home whilst another member of staff provided an escort for a service user required to attend a hospital appointment. Discussion took place around the need to complete a risk assessment in relation to this practice to ensure that a member of staff was not left alone with a service user whose behaviour may be potentially aggressive or unpredictable, further that any service user left alone with one member of staff must know the action to take in the event of an emergency leaving the member of staff being unable to raise the alarm. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 10 Records seen in relation to one service user indicated there are issues around their aggression towards staff and other service users. Discussion took place around the need to minimise possible injury to all parties, in this instance specifically the number of knives easily accessible in the kitchen. There was evidence that care plans are reviewed on an annual basis. This practice was confirmed by a relative who the inspector spoke with during the course of the inspection. There was evidence that service users had been involved in the process of care plan reviews and where possible service users had signed their own care plans at the time of the review. Copies of letters indicated that care managers had also been asked to attend and contribute to this process. It was not possible to complete the audit of service users care plans as their daily records as completed by staff during the service users recent holiday, had not yet been returned to the home. It is clear that staff promote service users independence, in one instance a service user returned unaccompanied by staff from a shopping trip. Another service user offered to make the inspector a cup of tea and provided refreshments for the inspector and member of staff on duty. Service users were able to demonstrate they are involved in decision-making processes, which affect their lives. Service users participate in menu planning and are able to choose the colour scheme for their bedrooms to be decorated, as well as the furniture and soft furnishings. Service users care plans was seen to be stored in a locked cupboard when not in use. Old Manse The DS0000006970.V256523.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): 12,13,14,17 Social activities and meals are both well managed, creative and provide daily variation and interest for service users. EVIDENCE: On the day of inspection a number of service users in the home had only just returned from a holiday in Turkey. Service users were keen to share their experiences with the inspector and described the Villa they stayed in and the facilities provided as well as the activities they had participated in. There were a number of photographs showing service users dancing and clearly having fun. Records seen indicated that service users also attend Adult Education Classes most recently for computer skills. One service users care plan made reference to the fact he should have regular opportunities to go swimming, this was initially identified when the care plan was compiled in 2003, whilst staff stated this activity was still taking place, there was no records the inspector was able to audit to support this. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 12 Records in relation to service users meals were examined. Generally service users have their main meal of the day at the day centre they attend. Records indicated a cooked light meal is provided each evening which is a varied and well balanced. The day centre provides details of the meals provided to service users. Records seen indicate that service users likes and dislikes were taken into account. The inspector was informed that service users choose an alternative meal if they do not like the planned meal, this was confirmed by a service users spoken with. In these instances a record should be kept of the alternative food provided to demonstrate that all service users are receiving a varied nutritional diet. Records seen indicated that service users participate in community activities, including when they wish local church services. Old Manse The DS0000006970.V256523.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): 18,20 The current procedures for recording medication are inadequate and do not safeguard service users. EVIDENCE: Medication is kept in a secure locked cupboard. Records seen indicated there is currently no record of staff signatures; it was therefore not possible for the inspector auditing the records to ascertain the members of staff responsible for administering the medication. The record was also being incorrectly used to record when a service user had received physiotherapy and assistance with teeth cleaning. Discussion took place around the need for this information to be included in the service users daily care plan and not on the MAR sheet. The MAR sheet indicated a service user had been prescribed paracetamol, although staff signatures indicated the medication had been administered there was no record to indicate if one or two tablets had been given. Discussion took place around the need for this to be made clear and that the MAR sheet being used can accommodate this information in detail on the back of the document. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 14 Medication had been prescribed for one service user to alleviate the symptoms of extreme anxiety. The MAR sheet indicated the medication had been administered on one occasion during the service users holiday period. On this occasion it was not possible for staff to provide evidence that it had been necessary to administer the medication, as the record had not yet been returned to the home following the service users holiday. Staff spoken with stated that they were not permitted to administer medication until they had attended formal training and had been assessed as being appropriately competent to undertake the task. A baby listening device was seen in the office. Staff stated this was used to monitor one service user who is known to have seizures. This method is an invasion of privacy. Research should take place to find a more effective system i.e. the use of pressure detection equipment may alert staff to a service user requiring assistance without listening into general activity within the bedroom. Good interaction was seen between staff and service users throughout the inspection. Old Manse The DS0000006970.V256523.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): 23 Procedures are in place to protect service users from abuse. EVIDENCE: From discussion with staff it is apparent that they understand the term whistleblowing and have received appropriate training in relation to adult protection issues. A new members of staff stated she had received training in relation to this as part of her NVQ training and had received further training in relation to this as part of her induction programme when she commenced employment with the provider. Old Manse The DS0000006970.V256523.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): 24,26,27,29,30 Service users live in a safe, clean and homely environment. EVIDENCE: The home is well maintained, clean, warm, bright, homely and attractive. Service users who were home at the time of the inspection, were keen to show the inspector their bedrooms. Service users benefit from having ensuite facilities. At present service users wash hand basins are positioned in their bedroom rather than the ensuite, wherever possible consideration should be given to installing a small wash hand basins in the ensuite to promote good hygienic practice and reduce the risk of infection. Rooms were individually personalised, service users stated they had participated in choosing the colour scheme and soft furnishings of their bedroom. Although generally the upstairs bedrooms were much smaller than Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 17 the ground floor rooms service users had made good use of the space available and were still able to fit in their chosen electrical appliances. Each bedroom door has a lock and service users hold the keys to their own bedrooms. A lockable facility has been provided in each bedroom solely for the service users own use. There is a spacious ground floor bathroom. The bath has been provided with an appropriate hoist; at the time of the inspection it was not possible to ascertain when the hoist has received its last safety check. Staff sleeping in are provided with a separate WC and shower facilities. Although generally the home was well maintained, the kitchen flooring would benefit from replacement and the fascia on the cupboard door next to the dishwasher is disintegrating which makes it difficult to effectively clean. Staff stated that the manager was aware of the situation and plans were in hand to address this matter. There is a well equipped laundry, the equipment is domestic in size and therefore suitable for service users to use independently, equipment is designed to commercial use specifications and includes an appropriate foul wash facility. Access to the home, ground floor accommodation and garden are suitable for wheelchair dependent service users. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 18 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): 31,32,33,34,35 Service users are cared for by suitably qualified and competent staff. Staff recruitment procedures are robust and safeguard people living in the home. EVIDENCE: At the time of the inspection the rota did not accurately reflect staff working in the home. One person shown listed as working a day shift was in fact on a course, a second member of staff had to leave the home to accompany a service user to attend a hospital appointment, another staff member listed on the rota had in fact just ceased working in the home. This left one member of staff with the remaining service users. General discussion took place regarding staffing levels. Staff on duty thought the home currently had one vacancy. A number of duties were being covered by members of bank staff, who stated they had worked regular shifts within the home for some time and were now familiar with the needs of the service users. Funding has been provided to employ an additional member of staff to work on a one-to-one basis with one service user. Staff stated this was provided on a regular basis, the mother of the service user concerned stated that it was not always possible to provide the level of care her son had been assessed as needing. The number of additional hours to be provided should be clearly Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 19 documented along with whether the home has been able to provide the hours required. At the time of the evening meal additional staff had arrived and general discussion took place regarding staffing levels in the home. Staff expressed the opinion that the current staffing levels lead them to feel they are working under pressure. Quality assurance mechanisms must include a regular reviews of service users needs with staffing levels amended to reflect the change in service users health, welfare and general activities. A member of staff recently appointed was spoken with, in addition to having previous experience of working with people who have a learning disability and an NVQ two qualification, she stated she had been provided with a comprehensive induction programme, at the time of her employment the organisation had completed compulsory POVA and CRB checks. The organisation had provided her with a contract and a job description stating her terms and conditions of employment and both parties rights and responsibilities. The member of staff stated that to date she has completed training in relation to moving and handling, food hygiene, health and safety and first aid. Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 20 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): None of these standards were inspected on this occasion. EVIDENCE: Old Manse The DS0000006970.V256523.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 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Old Manse The Score 2 X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000006970.V256523.R01.S.doc Version 5.0 Page 22 NO Are there any outstanding requirements from the last inspection? Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 23 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 YA9 Regulation 13(4)(C) Timescale for action Ensure risk assessment is carried 30/11/05 out to safeguard service users (and staff) when staff are working in the home alone with service users. Ensure that the record of food 30/11/05 provided for service users is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition. The registered person must 30/11/05 make suitable arrangements to ensure that the care home is conducted in a manner, which respect the privacy and dignity of service users. Ensure there is a sound policy 11/10/05 and practice in place regarding the administration of medication to service users. Ensure that all equipment (in 30/10/05 this instance bath hoist) is regularly maintained. A copy of the duty roster of 11/10/05 persons working at the care home, and a record of whether the roster was actually worked. The registered person must 30/10/05 establish and maintain a system for reviewing and improving the quality of care provided at the care home (in this instance to monitor that sufficient staff are employed to meet the needs of service users). DS0000006970.V256523.R01.S.doc Version 5.0 Page 24 Requirement 2 YA17 sch 4(13) 3 YA18 12(4)(a) 4 YA20 13(2) 5 6 YA29 YA33 23(2)(c) Sch 4(7) 7 YA33 24 Old Manse The 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 YA6 Good Practice Recommendations Records made in relation to service users whilst away from the home, should be returned promptly at the same time as the service users, as important information may need to be accessed promptly in an emergency. Ensure records are kept to evidence that service users are participating in activities. Where possible wash hand basins are fitted in service users ensuite bathrooms, to promote good hygiene practice and reduce the risk of possible infection. 2 3 YA14 YA27 Old Manse The DS0000006970.V256523.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Old Manse The DS0000006970.V256523.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!