Inspection on 15/04/05 for Rose Cottage

This inspection was carried out on 15th April 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rose Cottage 05/09/07

Rose Cottage 02/06/06

Rose Cottage 24/11/05

Rose Cottage 18/11/04

Rose Cottage 19/07/04

Rose Cottage 12/06/03

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Fairways

Treloar College

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

CARE HOME ADULTS 18-65 Rose Cottage Grange Road Bursledon Southampton SO31 8GD Lead Inspector Wendy Thomas Unnannounced 15.04.05 12.00 noon 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 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 Stationary 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. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rose Cottage Address Grange Road Bursledon Southampton SO31 8GD 02380 407048 02380 407048 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wessex Regional Care Limited CRH 4 Category(ies) of Learning Disability - LD - 4 registration, with number of places Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD referred to above to be admitted between the ages of 20 and 45 years. Date of last inspection 18.11.04 Brief Description of the Service: Rose Cottage provides a residential service to four people who have a learning learning disability and have behaviour which is challenging to service providers. The home is in a rural location. There is no homes vehicle, although service users use taxis and buses to get out and about. The home is a bungalow with four single bedrooms, a sleeping-in-room for staff, a lounge, kichen and dining area, utility room and office. There is a bathroom and a shower-room each with a wc. There is a good sized enclosed garden. Wessex Regional Care have three homes in the area, another one in Hampshire and one in Southampton. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was in the home for five and a half hours. She met with all the service users and had discussions with two of them, one in private and one in the presence of members of staff. Other service users either chose not to, or were unable to communicate with the inspector. The home has been without a manager since the summer of 2004. An acting manager is currently working in the home who has been drafted in from another part of the organisation. The inspector spent time in discussion with her and another member of staff, looking at the records of one service user in particular, and observed staff administering a service user’s medication. There have been a number of incidents in the home over the past few months that have involved a service user being physically restrained. The inspector, therefore, looked primarily at the care received by this service user. The previous two inspection reports did not contain requirements or recommendations with the care in the home being found to be satisfactory. Action is needed by the home in relation to the challenging behaviour currently being presented and the organisation’s response to meeting these needs. What the service does well: What has improved since the last inspection? The previous two inspection reports found the home to be satisfactory in the areas inspected. This inspection looked mainly at the problems the home was currently encountering. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) These outcomes were not inspected on this occasion, as there have been no new admissions since the last inspection. EVIDENCE: Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) 6 and 9 Although a new care plan format provides a wide range of information to meet service users’ needs, one service user did not have sufficient guidelines in place to promote a consistent and safe way of responding to behavioural issues. The absence of some risk assessments and lack of updating of others potentially places service users at risk. EVIDENCE: The home was in the process of adopting a format for service user plans developed at one of the other homes in the group. These were well structured and contained relevant information. It was reported that these will be reevaluated every month and reviewed every three months. The acting manager explained that three of the service users had taken an active role in completing their own service user plans. For several months the home has been presented with behaviour from a service user which the staff are finding particularly difficult to manage. After a delay they are now receiving support from the specialist health care team and further support plans and guidance will be developed. At the time of the inspection however, the care plans and guidelines developed by the home were Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 10 insufficient. The service user was frequently being restrained and the guidelines did not indicate interventions that should be used to de-escalate the situation or redirect the service user to a different activity before resorting to restraint. Discussion with one of the directors indicated that this was happening some of the time, but that staff were not routinely using these techniques. Post-incident recording did not demonstrate that any distraction or de-escalation techniques were being used. The inspector discussed some of the techniques being used with this service user with the acting manager. It was agreed that some of the strategies were inappropriate and may exacerbate the situation. There was a sense of optimism now that the specialist health care team were involved and it was hoped that they would help the home to develop more effective ways of working with the service user. There had been a meeting the previous week between the directors, acting manager and deputy manager to look at how the service user’s behaviour was being managed. One of the directors was in the process of drawing up new management of aggression guidelines. Some important issues were omitted from the service user plans e.g. the fact that one service user’s toiletries were kept locked away and the reasons for this. These should be included. Service user risk assessments were in need of reviewing and updating. In looking at the file of one service user and talking to staff, issues of risk were identified for which there were no risk assessments. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) 11. 12 and14 One service user’s opportunities for personal development and leisure activities outside the home are limited by the lack of a vehicle, the staffing levels and responding to current service user needs. EVIDENCE: One member of staff said that what they liked about working in the home was to see the service users develop. They described the personal developments achieved by the service user who most recently joined the household. The service users take part in the activities involved in running the household, such as helping to unpack the shopping, putting out the laundry, ironing, watering the plants, occasionally doing cooking activities etc. Because of the need for one service user to have two staff present, staff can only support one activity out of the home at a time. The “community activities record” for this service user was examined. In the previous month they had had four trampoline sessions, three local walks, a hospital appointment, a trip to the hairdressers and been out for a meal to celebrate their birthday. The home not having a vehicle restricts the range of activities and locations this Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 12 service user can visit. The inspector has been informed that the lack of a vehicle and the current staffing levels do not restrict other service users’ activities and opportunities. These include one service user going to a local college one and a half days a week and another service user having three halfday sessions. The whole group have a half-hour trampolining session together once a week. At the time of the inspection one service user was out at college, two were occupying themselves in the house with some support from a member of staff and the other was watching television. It was reported that activity plans had been drawn up for the service users and these were currently waiting to be typed up. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) 19 and 20 One service user’s psychological health needs were not being met, however action now being taken should have a positive impact on the service user’s emotional wellbeing. The medication procedures ensured that medication was being dealt with safely and discretely. EVIDENCE: Staff at the home were endeavouring to get advice form the specialist health care team to assist them in meeting the health and psychological needs of one of the service users whose needs were not currently being successfully met. The specialist health care team had apologised for the difficulties the home had had in getting a response from them. At the time of the inspection things appeared to be moving forward for the service user affected. Issues of medication and behaviour management were now on the way to being addressed. Members of the specialist health care team visited the home during the inspection. The home had a good medication procedure. Service users keep their medication securely in their own rooms. All service users require support to administer their medication, but by keeping it in their rooms privacy and confidentiality are maintained. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 14 Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) 23 The service user’s finance procedure protects service users from financial exploitation. EVIDENCE: The inspector looked specifically at the system in place to safeguard service users finances. The home holds money on behalf of all the service users. The acting manager had changed the procedure for this on coming into the home. The procedure she described was satisfactory and the amounts held tallied with the records, however there was no written procedure. The acting manager agreed to write up the procedure now in use. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 standard(s) 24 and 30 The standard of the environment in the home is good, providing the service users with an attractive and homely place to live. EVIDENCE: One of the service users gave the inspector a tour of the communal areas of the home. The house was decorated and furnished in a comfortable and homely manner. It was clean at the time of the inspection and attention was being paid to hygiene, with a high standard being maintained. Two of the service users showed the inspector their bedrooms and expressed satisfaction with these. Both required minor repairs, which were brought to the acting manager’s attention. Service users were seen to have personalised their rooms to their own taste. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 The staff training programme aids staff in being able to meet the needs of service users, but this could be enhanced by further training in working with people who have challenging behaviour. EVIDENCE: The acting manager explained that the staffing level had been reduced since the last inspection, although it was now back to the original level, of three staff on duty during daytime hours, due to the behaviour issues currently being dealt with. The staffing level had been agreed with the Commission for Social Care Inspection’s predecessors at the time that the home was set up. It should not be reduced without consultation and agreement with the Commission for Social Care Inspection. The home does not currently use agency staff. Members of the team cover any shortfall in hours due to vacancies, annual leave or sickness. The inspector spoke with a member of staff and the acting manager about staff training. They were satisfied with the training they had had and what was on offer. The previous week there had been training on the protection of vulnerable adults from abuse run by the manager of another home in the group, and first aid, food hygiene, medication, and breakaway and restraint was also mentioned as having been received. Given that the home works Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 18 specifically with service users who have challenging behaviour, it would be expected that more training in relation to this would have been delivered. Monthly staff meetings and staff supervision sessions are being held. Notes are kept on these. The way in which a service user’s challenging behaviour was being worked with indicated that more training is needed in this area. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 Once a new manager is appointed this would alleviate the detrimental affect the lack of a permanent manager is having on service users and the staff team. Despite an awareness of health and safety matters within the staff team, lapses were noted. EVIDENCE: The home has been without a manager since summer 2004. Staff morale was reported as being low as two managers had come into post during that time but only stayed for a very short while. Interviews had been held a few days before the inspection and it was hoped that the successful applicant would accept the post. In the meantime a member of staff who had been working elsewhere in the organisation was acting as manager. A member of staff commented that they thought the staff team had managed well during this period and had maintained standards. They reported that there had been Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 20 support from the directors and that they always felt supported by, and could rely on the other team members. They were still very keen that a manager be appointed and a sense of stability reinstated. The service user who showed the inspector around the home was able to explain what the fire alarm call points were and what they would do if they heard the fire alarm. It was noted that radiators did not have covers on them. No risk assessment regarding this could be found at the time of the inspection. The home needs to ensure that one is in place so that service users are not at risk of being hurt by hot surface temperatures. Although there were lockable cupboards for cleaning chemicals, the inspector observed a bottle of cleaning solution in the bathroom. There was awareness from the acting manager that this should have been locked away and the matter was rectified. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 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 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 2 3 x 2 x x x Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rose Cottage Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 22 no 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 6 Regulation 12 (1) (a) 13 (7), 15 (1) Requirement Where required service users care plans must give clear and comprehensive guidelines and strategies for working with that individual service users challenging behaviour. The steps involved must be particularly detailed if restraining the service user is a possible outcome. All areas of potential significant risk should be identified and upto-date risk management strattegies set in place (and documented) that are regularly reviewed. A programme must be deveoped, with support from the specilist health care team, to ensure that an identified service users physical and emotional needs are being met. Timescale for action 15 July 2005 2. 9 13 (4) (b) 15 July 2005 3. 19 13 13 13 15 (1) (4) (6) (1) 17 June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 23 Rose Cottage 1. 2. 3. 4. Standard 11 and 14 14 35 42 Service users recreational, educational, social and personal developemnt activities and opportunities should be further developed. The acquasition of a vehicle for the home should be considered. Staff should be given more training on working with service users whose behaviour they find challenging. There should be risk assessment in place in relation to the possibility of service users becoming injured by hot radiator surfaces. Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Cottage H54 S12072 Rose Cottage V223099 150405.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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