Inspection on 05/01/06 for Rose Cottage

This inspection was carried out on 5th January 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rose Cottage 28/06/06

Rose Cottage 23/09/05

Rose Cottage 27/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Rose Cottage Rose Cottage Church Road Mersham Ashford Kent TN25 6NT Lead Inspector Julian Graham Unannounced Inspection 10:25 5 and 6 January 2006 th th Rose Cottage DS0000023535.V266314.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 Rose Cottage DS0000023535.V266314.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. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rose Cottage Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rose Cottage Church Road Mersham Ashford Kent TN25 6NT 01233 502223 rosecottage@counticare.co.uk Counticare Limited Andrew Shore Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd September 2005 Brief Description of the Service: Rose Cottage provides accommodation for a maximum of four people with a learning disability aged between 18 and 65. The premises consists of a spacious cottage situated in the rural village of Mersham. The local pubs and village shop are a short walk from the home. There is a public bus service to the larger towns of Ashford, Hythe and Folkestone. The home has a large secluded garden and access to country walks. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately six and a half hours over a two day period. All four residents were spoken to individually, two in the privacy of their bedrooms. The inspector looked around the building and a number of records were inspected. Staff were observed either directly or indirectly as they were going about their work, and three were spoken with individually. Some time was spent with the manager in discussion regarding the running of the home. Some of the requirements from the previous inspection have been addressed. However, some requirements relating to medication and the environment have remained outstanding now for over twelve months, which is of concern. Revised timescales have been set, and must be met. Otherwise, the commission will take enforcement action. What the service does well: What has improved since the last inspection? Staff now know the procedure to follow in the event of a complaint being made and where to make the record. They also know what action to take if an allegation of abuse is made. Training on adult protection remains a requirement of this report, however. All staff now have an up to date Criminal Record Bureau check. Key workers are now meeting with their key residents each month to check how they are getting on, and whether anything needs to change. The dining and office areas have been redecorated. Rose Cottage DS0000023535.V266314.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. Rose Cottage DS0000023535.V266314.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 Rose Cottage DS0000023535.V266314.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): 5 Improvement has been made with regards to clarifying what additional charges residents may be asked to bear. EVIDENCE: The Service User Guide has been amended to make clear what additional charges residents may need to bear over and above what is included in the fees. This includes a statement confirming that these charges do not include staff entry fees to events in the community. This now needs to be reflected in the contract. There have been no new admissions to the home since the last inspection. Rose Cottage DS0000023535.V266314.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): 6,8,10 The Life Planning system is generally clear and consistent, although residents’ personal goals are not being adequately reflected in the plans, and need updating and closer monitoring. Residents participate in the life of the home. There needs to be a proper office to ensure that information given by residents is confidential and to ensure the safe keeping of confidential records. EVIDENCE: A sample of Life Plans was looked at, which contain a lot of detailed information regarding residents’ strengths and needs. Staff are also keeping track of what residents do during the day, with regards to household activities and when they go out. There was evidence of six monthly review of the Life Plans. Personal goals need updating, however. One was dated 20/01/04, for example, and the goal was achieved some time ago. This resident spoke of a particular wish to do some voluntary work in an Older Person’s Home, and the manager agreed that this was a goal which the home will be helping the resident look into and achieve. Staff were seen supporting residents in participating in the life of the home, for example, in doing their own laundry. One resident was observed making a cake with help from a staff member. Residents were seen exercising their rights to freedom of movement around the home. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 10 Since the last inspection, the office location has changed with a view to making this room private. At present, however, it remains open and on a through route, thereby compromising confidentiality of information and the security of records. A timescale of two months has been given to provide a suitable wall and lockable door to this room. A staff member was conducting an inventory in one of the resident’s bedrooms, when the resident was out of the house. The inspector discussed this with a senior team leader and later on with the manager. It is a recommendation of this report that residents are consulted about staff going into their rooms, and are always given the opportunity to be there when this needs to occur. Rose Cottage DS0000023535.V266314.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): 12,14,17 Residents are supported in taking part in a range of social, educational and leisure activities, mainly during the week. Weekends are less busy. Meals are varied, with choices available. EVIDENCE: As noted on the previous inspection, two of the residents have a busy schedule of day activities primarily centred at the Martello day centre where a wide range of activities are provided. The other two residents combine sessions at the Martello with other activities based around the home, and the local community. Additional staff are scheduled to work on three evenings a week to enable residents who want to, to go to social events at the Martello, the Special Olympics and to the local pub. Activities records for the residents during the weekends again showed fewer activities being offered and undertaken, and staffing levels over the weekend period must be kept under review, with additional staff deployed to ensure residents’ needs and wishes are met. A third staff member is rota’d to work every other Saturday to allow for residents going out more. Menus were viewed, and looked interesting and varied. Staff said that alternatives are available should any resident not want Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 12 what is down on the menu. Cooked breakfasts can be provided at weekends. A resident said he liked the food and has plenty to eat. Rose Cottage DS0000023535.V266314.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 Staff have a good understanding of residents’ support needs. The medication cabinet is not appropriately located. Staff’s competence in administering medication has still to be assessed, and not all staff have had suitable training in medication, therefore potentially putting residents at risk. EVIDENCE: Most of the staff have known the residents for many years, and it was evident that staff know the support needs of the residents very well. Staff confirmed that they aim to support the residents in being more independent and to assist them in learning new skills. There was evidence to show that referrals have been made to the speech and language therapist, and two residents are now on the waiting list. Behavioural guidelines have been updated since the last inspection. It was encouraging to hear that one resident, who can find going out into the community difficult at times, is now able on certain occasions to go out supported by just one staff member, as opposed to two. Records are being well maintained regarding all medication received, administered and disposed of. However, medication continues to be stored in the laundry room which is not a suitable location. This room contains the tumble drier, which can make the room very hot. Timescales have been given to move the cabinet to the office, and to make this room suitably secure. In addition, some staff continue to require suitable medication training, and an Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 14 internal competency assessment to demonstrate sound understanding remains outstanding. These matters must be attended to promptly and within the revised timescales, otherwise enforcement action will be taken. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Improvements were noted in staff’s understanding regarding complaints and abuse procedures. EVIDENCE: There was evidence to show that since the last inspection, the manager has ensured that staff understand how to respond to an allegation of abuse and when a complaint is made. Both staff who were interviewed on the day of inspection were clear on these matters. The company’s policy and procedure on abuse is essentially good, although some minor amendment is necessary for greater clarity. A suitable recording format is now available for when complaints are made, which includes a record of the action taken and the outcome. A course has been booked in February for those staff yet to attend training on abuse. Rose Cottage DS0000023535.V266314.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): 24,26,28 Improvements to the environment continue to be made, but the lounge remains in need of upgrading and refurbishment. EVIDENCE: Since the last inspection, the dining area and office have been redecorated and have also changed places. The intention is to enclose the office with the addition of a false wall and lockable door, and a timescale has been set for this, and must be met. (See section on individual needs and choices.) A revised timescale has also been set for the total upgrading and refurbishment of the lounge, which remains outstanding. This includes replacing the furniture, which, as noted in previous reports, is very old and unsuitable. An audit of residents’ bedrooms has been undertaken as recommended from the last inspection, and where furniture and fittings have been identified, these now must be supplied in line with individual needs and wishes and subject to risk assessment. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36 A stable group of staff, combined with a good team spirit, is benefiting the residents. Staff will benefit from undertaking training in key areas of their work. A more rigorous approach towards ensuring staff fully complete their induction programme is needed. Staffing levels at weekends need to be kept under regular review to ensure residents’ needs and wishes are met. EVIDENCE: A senior team leader and a support worker were interviewed in private, and demonstrated understanding of their role and responsibility, and support the main aims and objectives of the home. The manager, who was described by staff as being supportive and approachable, is providing regular supervision. Staff were seen to be working well together and a good team spirit was apparent. The manager said that the company’s training prospectus for 2006 has recently become available, and during the course of the inspection, places for staff to attend were being applied for. The induction programme for two staff has still to be fully completed, and this is unsatisfactory. A short revised timescale has been set for this and must be adhered to. As required from the last inspection, all staff now have been CRB checked. No new staff have been employed since the last visit. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 18 Staffing levels during the week appear satisfactory, as staff are supporting residents in line with their wishes. The number of staff deployed during the weekends needs to be kept under review. See Lifestyle section of this report. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 The residents and staff benefit from the clear management of the home. EVIDENCE: The manager is hoping to complete the Registered Manager’s Award in a few months’ time. He attends training courses from time to time to update his knowledge. The staff team are well co-ordinated and remain motivated to provide a good service. The manager said that changing the location of the office has made it easier for him to fulfil his administrative duties. The openness of the office, however, is still presenting difficulties, which hopefully will be lessened once this area is made more private. A timescale for achieving this has been set and must be adhered to. Residents’ views are being sought through the daily chats with them, and now also through the more formal meetings with their keyworkers. Specific questions are asked in each session about the service provided, and their responses recorded. Rose Cottage DS0000023535.V266314.R01.S.doc Version 5.0 Page 20 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 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 3 x 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 x 2 x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 2 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 x 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rose Cottage Score 3 x 1 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x x x DS0000023535.V266314.R01.S.doc Version 5.0 Page 21 yes 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 Standard YA20 YA20 Regulation 13 13 Requirement The medication cabinet to be moved to a suitable and secure location. Staff to receive suitable training on medication. (Timescale of 01/05/05 not met.) Action plan detailing dates of training to be supplied to the commission. Staff competence on handling and administration of medication to be assessed and suitably recorded. (Timescale of 01/05/05 not met.) Adult abuse policy to be amended as advised. Lounge to be upgraded, including the provision of new furniture. (Timescale of 14/11/06 not met.) Action plan to be submitted to the commission detailing when these works are to be submitted. Ensure office area allows for confidentiality, privacy and security of records. Staffing levels at weekends to be kept under review, and additional staff deployed as needed. New staff to complete their DS0000023535.V266314.R01.S.doc Timescale for action 20/01/06 06/03/06 3 YA20 13 06/02/06 4 5 YA23 YA24 13 23 06/02/06 06/03/06 6 7 YA24 YA33 23 18 06/04/06 06/01/06 8 YA35 18 06/02/06 Page 22 Rose Cottage Version 5.0 9 YA35 18 induction (Timescale of 27/10/05 not met.) Staff to be updated on all core training as planned. 06/07/06 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 YA6 YA7 Good Practice Recommendations Residents’ personal goals to be updated and closely monitored. Staff to only enter residents’ bedrooms with the express permission of residents. 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