Inspection on 02/06/06 for Rose Cottage

This inspection was carried out on 2nd June 2006.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rose Cottage 05/09/07

Rose Cottage 24/11/05

Rose Cottage 15/04/05

Rose Cottage 18/11/04

Rose Cottage 19/07/04

Rose Cottage 12/06/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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 Nick Morrison Unannounced Inspection 2nd June 2006 09:00 Rose Cottage DS0000012072.V290866.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 Rose Cottage DS0000012072.V290866.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. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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 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) Wessex Regional Care Limited Miss Trudy McKnight Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Rose Cottage provides a residential service for up to four people who have a learning disability and have behaviour that is challenging to service providers. The home is in a rural location. The home has a vehicle for service users to get out and about. There are currently three service users living at the home. Rose Cottage is a bungalow with four single bedrooms, a sleeping-inroom for staff, a lounge, kitchen and dining area, utility room and office. There is a bathroom and a shower-room each with a toilet. 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 DS0000012072.V290866.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, 2/6/06 and 5/6/06, during which time the Inspector toured the premises, spoke to all service users and all staff who were working as well as the Manager. All relevant records referred to in the report were seen and case tracking was used for two of the three service users. 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. Rose Cottage DS0000012072.V290866.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 Rose Cottage DS0000012072.V290866.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): 2 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users benefit from having their needs assessed prior to admission. EVIDENCE: Assessments were seen on each service user’s file. These had been completed prior to people moving into the home and were comprehensive assessments covering the full range of need areas. The new manager has identified that these assessments are now out-of-date and need to be updated. Rose Cottage DS0000012072.V290866.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): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Service users would benefit from having up-to-date care plans that they had been involved in devising and reviewing. They would also benefit from support to make their own decisions and to take planned risks. EVIDENCE: The home has a comprehensive care planning process in place that covers the whole range of service users’ needs. Plans were written clearly and notes were kept on a daily and weekly basis against each plan. However, the care plans were out of date and, according to the manager, did not correspond with the current needs of service users. Two of the three service users had not had their care plans reviewed in the last year. The care plan for the third service user was in the process of being updated during the inspection. Previous care plans were not person-centered and this had been recognised by the new manager. The new care plan written with one service users was of good quality and he had been involved in writing it. The manager plans to re-assess all three service users and develop personcentred plans with each of them. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 9 Service users spoken with were not aware of their care plans and had not been involved in reviewing them. Service users had not been encouraged to make decisions in the past. The new Manager reported that care plans had restricted decision-making, for example, they were not even able to have access to drink-making facilities. A token reward system is in place that means that service users have to achieve a certain number of ticks before being able to do certain things. Staff spoken with and the new Manager were not happy about this system and it is to be discontinued. The new Manager is aiming to develop the service so that it treats service users in a more “adult” manner. The new care plan seen clearly recorded how the service user makes decisions and what support he requires to do so. Risk assessments were in place where a degree of risk had been identified. However, these were out of date and had not been reviewed for a long time. One risk assessment, aimed at supporting a service user to use the community safely, had not been reviewed since October 2003 despite the fact that there had been significant incidents occurring within that time. The new Manager had identified this as an issue and all risk assessments are to be reviewed in June. Rose Cottage DS0000012072.V290866.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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Service users have a good diet but would benefit from more activities, increased participation in the community and from more opportunities to develop relationships with people outside of the home. Service users’ rights have not been fully respected by practices in the home in the past. EVIDENCE: Activity records in the home showed a limited range of activities available to service users. Wherever possible service users were supported on a one-to-one basis to engage in activities, partly because they had different interests. Activities involved going to the pub, going to the garden centre, going into Southampton to do shopping and going swimming. Service users spoken with said they would like to do more activities and staff spoken with said that there should be more activities to interest service users more. One member of staff said that service users were supported and motivated to do more activities. The new Manager recognised that the activities within the home need to be developed. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 11 Despite going to some community venues such as the pub and the sports centre, staff said that service users were not really part of the local community. They did not know people locally and did not really mix with anyone. This is affected by the remoteness of the home and the lack of any real local community. Service users in the home are not supported to vote. Involvement in the community was used as part of a token reward system operating in the home. Service users were able to go out into the community if they had accumulated enough ticks on their chart for behaving in the way staff wanted them to. This way of working with service users was restrictive and the new Manager and some other staff were not happy with it. The Manager said this approach is to be faded out in the next few weeks. Two service users had contact with family members. One spoke to his mother each night on the phone and also went to stay with her occasionally. Another service user had been supported to make contact with her sister who she had not seen for a number of years. The home had involved a local advocacy service in arranging this. Other than this, none of the service users were able to identify anyone outside of the home as being a friend. The only people described as friends were staff and other people living in the home. Service users had keys to their rooms and all said that staff knocked on their bedroom doors before entering. Staff supported service users well and did not talk over them but involved them in conversations. Service users were not able to open their own mail; staff did this. All staff and service users were very complimentary about the food in the home. A new five-week menu had just been introduced and was based on the known preferences of service users as well as on their individual health needs. Service users had been involved in designing the new menus. Fresh food was used as far as possible and nearly all meals were prepared from scratch. There had been some recent progress in involving service users in meal preparation. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 12 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 20 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users benefited from their personal and health needs met appropriately and were protected by the home’s medication policies and practices. EVIDENCE: Personal support was provided in private and staff spoken with were very aware of the need to maintain privacy and dignity when providing personal care. Service users spoken with said that staff supported them appropriately and sensitively. Gender preferences were considered as far as possible. A new keyworking system is currently being introduced in order to try to maintain consistency of care. The health needs of service users are regularly monitored and clear records are kept. Service users had regular visits to the GP, dentist, chiropodist and other healthcare professionals as necessary. Service users spoken with confirmed that they regularly visited health professionals. Information was available to staff about the mental health needs of service users and regular input from the Psychiatrist and Community Nurse supported this. The medication system in the home was good. Policies and procedures had recently been updated and there was ongoing input from a Pharmacist. Staff involved in administering medication attended a twelve-week course. Good, Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 13 clear records were kept of all medication administered and there were clear audit trails for all medication going into and out of the home. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 14 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 and 23 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users were protected by the home’s policies and practices regarding abuse and their views were listened to and acted upon. EVIDENCE: All service users spoken with were clear about how to make a complaint if necessary and records showed that all service users had used the complaints procedure in the past. The records also showed that complaints were responded to as quickly as possible. The system for recording complaints was inappropriate in that it did not contain information on the outcome of each complaint and also because all complaints were recorded in a Complaints Book that was available to all staff and service users. Some of the complaints contained information that should have been kept confidential. The new Manager rectified this during the inspection and introduced a new process for recording complaints. All service users were involved in a house meeting once a week and could also have oneto-one meetings as well or instead if they preferred. The new Manager had introduced a new standing agenda for house meetings that covered menus, rooms, decoration and activities. In addition, each meeting emphasised the complaints procedure and the standards that service users could expect from staff. Staff received training in responding to instances of suspected abuse and staff spoken with were clear about their responsibilities within this. The home had a clear policy in place with regard to potential abuse. The company had introduced an Abuse Alert System in January, but it had not been implemented Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 15 in Rose Cottage. The new Manager is aiming to implement it fully by the end of June. Financial records regarding service users’ money showed gaps and did not meet with the requirements of the company’s own procedures. The new Manager had identified this and reorganised the system so that it protects service users fully now. There were some entries from earlier in the year that caused concern and the Manager is to investigate these. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Service users benefited from a clean, hygienic, comfortable and homely atmosphere. EVIDENCE: Rose Cottage was homely and comfortable throughout. The house is bright and airy and all parts are accessible to all service users. Furniture in the home was of good quality and well maintained. Service users spoken with said they felt the home was comfortable and provided enough space. The home was also clean and hygienic throughout and procedures were in place to maintain cleanliness and hygiene. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Service users benefited from being supported by competent, trained staff and were protected by the home’s recruitment policies and practices. EVIDENCE: One member of staff spoken with had been working in the home for a month but there was no Induction record available for her. She said she had done some induction work with the previous Manager but said it was not finished. The new Manager is introducing a new Induction and Foundation training system that links to the NVQ2 qualification. All new and existing staff will be expected to follow this new process. Recruitment records demonstrated that the home aimed to employ staff with relevant skills and experience. The recruitment practices within the home were generally good and records showed that all pre-employment information was in place prior to staff starting work. The one exception was that one member of staff had a reference supplied in Polish. The Manager who appointed her let her translate the reference herself, which was inappropriate and should have been addressed at the time. According to the company’s development plan the home’s training audit should have been completed in January of this year but this had not yet happened. The new Manager is aiming to have this completed by the end of June. The Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 18 company has an ongoing training programme and staff in the home said they had completed relevant training. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: The home has suffered over the past year from ineffective management. A number of issues including care plans, risk assessments, financial records, responding to difficult behaviour, activities, staff supervision and appraisals, training, risk assessments and Health and Safety had remained largely unaddressed throughout that time. The Inspector was concerned that the company had not recognised the ineffective management of the home earlier and dealt with it before it became as bad as it was. The company had put a new Manager in place who is the Registered Manager of one of their other homes. She is working in Rose Cottage for thirty hours a week at present. She has demonstrated very effective management in the home she came from and the Inspector was impressed with the start she has made at Rose Cottage in just two weeks. She has identified most of the issues referred to in this report and has developed an action plan to address all of them without delay. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 20 There had been a lack of quality assurance systems implemented in the home, despite the company having a clear policy and procedures about how the process should work. Since the previous Manager left, the new Manager, along with company directors, has undertaken a quality audit in the home that also involved the service users and staff. This has been useful in identifying deficiencies in the home and creating a plan for development. The company has clear processes for the ongoing management of quality issues and the new Manager is adhering to it. Health & Safety issues have not been addressed over the past year. Workplace risk assessments were all out of date and there were no COSHH assessments in place, despite one member of staff had developed a rash after using a cleaning product in the home. The new Manager has identified a member of staff to act as the home’s Health & Safety Representative and he will attend the company’s monthly Health & Safety meetings. The Manager is in the process of updating all the Health & Safety records and practices and ensuring the home meets the Health & Safety targets of the company. Monthly fire drills had taken place along with weekly inspection of equipment. Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 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 2 3 4 5 Standard YA6 YA9 YA16 YA37 YA42 Regulation 15 13 12 8 13 Requirement All care plans must be updated and reviewed regularly All risk assessments must be updated and reviewed regularly The rights of service users must be respected The company must appoint a permanent Manager to the home Workplace risk assessments and COSHH assessments must be put in place. Timescale for action 09/09/06 09/09/06 09/09/06 09/09/06 09/09/06 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 Refer to Standard *RCN Good Practice Recommendations Rose Cottage DS0000012072.V290866.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hampshire Office 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 DS0000012072.V290866.R01.S.doc Version 5.1 Page 24 - 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!