Inspection on 16/01/06 for Old Manse The

This inspection was carried out on 16th January 2006.

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 6 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 11/10/05

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 Ann Wiseman Unannounced Inspection 16th January 2006 12.30p Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 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) www.care-ltd.co.uk 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.V275257.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 Adults of either sex with a learning disability within the category mental handicap 11th October 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.V275257.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection, one resident and a staff member was at home when the Inspector arrived. The house is homely, comfortable, well decorated and clean. The Assistant Manager was out dropping off some of the Residents at the day centre and she facilitated the Inspector on her return. The Inspector was able to talk to all the Residents and two staff members. Everyone, including staff and Residents were open, friendly and welcoming. The Inspector has areas of concern based on the staffing of the house and feels that this should be reassessed taking into account the needs of the Residents. The quality of care is not an issue. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards in this group were assessed on this occasion. The house has all necessary information for prospective Service Users to be able to make an informed choice before moving in and would be able to test drive before making a final decision. EVIDENCE: The home has the required information in their statement of purpose and Service Users guide, all existing Service Users have been resident at the house a long time but had assessments carried out before going to the house and were given an opportunity to visit the house before they made a final decision. The home has a vacancy and it is expected that it will follow due procedure while working towards filling it. The Inspector examined three care plans and all were found to have Care Plans that highlighted the Service Users needs and aspirations and also a contract. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards were assessed during this Inspection. Regular review meetings are held, Service Users are encouraged and enabled to make decisions about their lives and to take risks as part of an independent lifestyle. There is still an issue and outstanding Requirement regarding risk assessments being done on working alone in the home. EVIDENCE: All Service Users have an annual Life Plan Meeting where hopes and aspirations are set out and outcomes are tracked and reviewed. It is evident that the Service Users are included in the reviews. Service Users are assisted to make decisions about their lives and take risks, two of the ladies travel independently to attend church and go to the local shops and manage their own money. During the Inspection Service Users were consulted on plans for the evening and the meal and one made a hot drink for the Inspector. It is normal practice for only two staff members on duty at any one time. On the Inspectors arrival the Assistant Manager was out of the building transporting Service Users to their day centre leaving one staff member alone Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 9 in the building. On this occasion there was only one Service User at home who does not display challenging behaviour but as it is usual for the house to provide transport to and from day care services and other appointments it is usual for a staff member to be alone with several Service Users. It was a requirement from the last Inspection that risk assessments are carried out to safeguard Service Users and staff when staff are working in the home alone with Service Users. This has not been done, the Service User, whose challenging and violent behaviour had caused concern during the last Inspection, has moved on. However the Service Users could still be at risk if a lone worker became ill or incapacitated. This Requirement will be restated. Please see Requirement 1 Similarly, the Inspector raised concerns about staff members driving a car while alone with several Service Users (one resident is epileptic); Risk assessments must be done taking into account actions needed in the event of an accident or breakdown, violence towards staff from members of the public or a Resident and what to do in the event of a Service User becoming ill or needing attention for other reasons. Consideration should be given to increasing staff numbers on duty; with the current staff ratio it is inevitable that there will be people working alone in both situations several times throughout a day. Please see Requirement 2. There are further concerns about staffing levels covered in a future section Any personal information is stored in a locked cabinet in the office. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 10 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): Standards 11 to 17 were assessed during this Inspection. The Old Manse gives opportunities for Service Users to develop, to take part in appropriate activities and to be responsible in their daily lives. EVIDENCE: All Service Users go to a day centre. One of the Service Users has a job in a local super market, three attend a local church and bible classes, all have opportunities to go peer appropriate clubs and get out to pubs, the pictures and have meals out. Service users are encouraged and enabled to keep in contact with family and friends, many receive regular visits from their families and have overnight stays at their family homes. All contact between staff and the Service Users observed by the Inspector was done in a respectful way, before the tour of the building the Service Users were asked if it was alright for the Inspector to see their rooms, none objected. The food served appeared nutritious and well cooked and was in sufficient quantity for all, the fridge and freezer was well stocked. Detailed menus are kept. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 11 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): All standard in this area were inspected. Care plans set out the Service Users preferences and needs and staff members were knowledgeable about each individual. Health needs are met and there is a policy in place that deals with aging, illness and death. Some issues remain with the safe handling and administration of medication. EVIDENCE: Care Plans and client folders that were examined were and contained necessary information for staff to ascertain Service Users preferences and needs regarding personal care. One of the Service Users can take a long time to carry out his personal care and does not like to be rushed so extra hours have been allocated to allow him to have 1-1 support in the mornings. The files show evidence that the Service Users received regular reviews and that the Care Plans were updated. Also there were reports from doctor’s visits and other professional input such as OT and Psychology. One of the Service Users files contained a completed document “When I Die” that set out the Service User’s preferences for funeral arrangements. A baby monitor is no longer used in the house to monitor Service Users. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 12 None of the Service Users self medicate and on examination some of the blister packs contained medication from previous weeks that should have been dispensed. The Assistant Manager explained that some of the parents are in the habit of keeping a store of medication separate to the house supply for when a Service User stays at home. This is not good practice as holding medication surplus to requirement can lead to errors. It is requirement that a policy be drawn up and implemented that means that medication from the home is used when the Service User is staying elsewhere. Detailed records must be kept to monitor what medication is leaving and entering to the building; thus creating a paper trail to allow required checks on medication. Also all surplus medication should be appropriately disposed of. Please see Requirement 3 There is now a current record of staff signatures; therefore making it possible for the inspector auditing the records to ascertain the members of staff responsible for administering the medication. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 13 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): Standards 22 and 23 were judged on this occasion. Safeguards are in place to protect Service Users from abuse. EVIDENCE: From discussion with staff it is apparent that they understand the term whistle blowing and have received appropriate training in relation to adult protection issues. A member 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. There has been one recorded complaint since the previous Inspection. There were few details recorded about the complaint and there was no record of the investigation or outcome. It is important that these details are included with the original complaint so that its progress can be followed and audited. Please see Requirement 4 Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 14 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): All standards were assessed. The Service Users benefit from a homely, safe and clean environment. EVIDENCE: The home is well maintained, clean, warm, bright, homely and attractive. Service users benefit from having en-suite facilities with showers and toilet but the shower rooms are too small to accommodate wash hand basins as well, they have been placed in the bedroom close to the bathroom. Consideration should be given to fitting the basin in the shower room in it becomes possible in the future. The rooms were individually personalised, service users had participated in choosing the colour scheme and soft furnishings of their bedroom. 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 and a specialised toilet has been fitted to assist Service Users with their personal hygiene. The sleep-in staff is provided with separate WC and shower facilities. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 15 The floor in the kitchen that has been highlighted in the previous Inspection is still in need of replacement. The Assistant Manager informed the Inspector that an ongoing replacement program is in place and it is intended to replace a few floors in the house starting with the kitchen, this was also stated in the last inspection report. Please see Recommendation 1 Generally the home was well maintained. 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.V275257.R01.S.doc Version 5.1 Page 16 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): All standards were judged on this occasion. The staff appear competent and knowledgably of the needs of the Service Users. EVIDENCE: Staff interviewed were clear on their roles and responsibilities and appeared competent. There is evidence of appropriate training being offered and a staff member reported that she received supervision at regular intervals. She also 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. The Inspector was unable to confirm these details as staff records are stored in a locked cupboard and the Manager holds the key and was not available. Staff records should be available for inspection at all times. Please see Requirement 5 The staff member who was on shift that morning (Monday) was a permanent member of staff until she recently decided to leave and join the bank staff as the shift pattern did not suit her childcare needs. On inspection of the Rota it Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 17 became apparent that she had previously worked a late shift and sleep-in duty on Sunday and was booked to continue working until 10pm and was going to sleep in for the second night. It is hard to believe that any staff member would be able to offer an effective service to the Service Users after such a long spell on duty. The Service Users are also at risk from staff failing in their duty or making a mistake due to tiredness. Therefore putting themselves and the Service User in danger. The number of vacancies and the need to cover annual leave is creating the culture of working long hours, it is recommended that recruitment takes place as soon as vacancies occur and that consideration is given to developing policies on what is considered good practice for staff working regimes. Please see recommendations 2 and 3 Currently there is normally two staff on duty each shift, consideration must be given to whether it is desirable to restrict Service Users opportunities to access the community due to insufficient staff numbers or whether the ratio of two staff to eight Service Users allows staff to devote quality time to each individual on a regular basis. The Health and Safety of both Service Users and staff must also be added to the equation. Quality assurance mechanisms must include regular reviews of service users needs with staffing levels amended to reflect the change in service users health, welfare and general activities. This is a restated requirement. Please see Requirement 2 It is noted from the previous Inspection Report and from talking to staff that Funding has been provided to employ an additional member of staff to work on a one-to-one basis with one service user. It was understood that this arrangement was to supply staff additional to the staffing allocation, but it is apparent, from the rota and from information given, someone, already on duty, will be allocated to spend time with this particular Service User. Therefore deflecting input from others. The Inspector requires clarification as to the nature of the allocated hours, how the hours were intended to be used, where they are funded from, what were the expected outcomes of the additional input and who it was that was expected to work with the Service User. Please see Requirement 6 The previous Inspection Report suggested that the number of additional hours to be provided should be clearly documented along with whether the home has been able to provide the hours required. This is now a recommendation. Please see recommendation 4 Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 18 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): Standards 39 and 43 were not assessed during this inspection. The Manager was not present but staff referred to the Manager as being supportive and easy to talk to. The Service Users are safeguarded by the homes record keeping and polices and procedures. EVIDENCE: Apart from the constraints caused by staffing numbers and the number of vacant hours held at the house the home appears to be well run, from talking to the Service Users and staff the Service Users seem to benefit from the good ethos, leadership and management of the home. The policies, procedures and record keeping inspected were within regulation. A random selection of Health and Safety records were inspected and checks and maintenance programs were found to be in place, including a hoist maintenance check outstanding from the previous inspection. Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 X 3 3 3 X Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 20 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 YA9 Regulation 13(4)(C) Requirement Timescale for action Ensure risk assessment is carried out to safeguard service users (and staff) when staff are 09/04/06 working in the home alone with service users. The registered person must 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). It is requirement that a policy be drawn up and implemented that means that medication from the home is used when the Service User is staying elsewhere. Also detailed records must be kept to monitor what medication is leaving and entering to the building; thus creating a paper trail to allow required checks on medication. Also all surplus medication should be appropriately disposed of. 2 YA33 24 09/06/06 3 YA20 13(2) 09/06/06 Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 21 4 5 YA22 22 YA34 19 Records of complaints should be detailed and include a record of the investigation and outcome. Information as set out in schedule 2 must be available for inspection whenever required. The Inspector requires clarification as to the nature of the allocated hours, how the hours were intended to be used, where they are funded from, what were the expected outcomes of the additional input and who it was that was expected to work with the Service User. 09/04/06 09/06/06 6 YA33 18 09/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA30 YA33 Good Practice Recommendations The kitchen floor is damaged and needs replacing. Consideration should be given to limiting hours that can be worked by any individually, particularly in relation to people having the opportunity to rest properly between shifts. Recruitment to vacant posts should be carried out immediately. The number of additional hours to be provided, as 1-1 support should be clearly documented along with whether the home has been able to provide the hours required. 3 4 YA33 YA33 Old Manse The DS0000006970.V275257.R01.S.doc Version 5.1 Page 22 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.V275257.R01.S.doc Version 5.1 Page 23 - 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!