Inspection on 21/11/05 for Rosemary Cottage

This inspection was carried out on 21st November 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemary Cottage 03/10/06

Rosemary Cottage 09/02/06

Rosemary Cottage 28/10/04

Rosemary Cottage 10/05/04

Rosemary Cottage 07/01/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Rosemary Cottage Canterbury Oast Trust Highland Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Mrs Sally Gill Announced Inspection 21st November 2005 09:30 Rosemary Cottage DS0000023516.V256200.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 Rosemary Cottage DS0000023516.V256200.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. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rosemary 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) Canterbury Oast Trust Highland Farm Woodchurch Ashford Kent TN26 3RJ 01233 861510 Canterbury Oast Trust Mrs Valerie Anne Clark Care Home 6 Category(ies) of Learning disability (1), Physical disability (5) registration, with number of places Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 People with learningd disabilities aged between 18 - 65 years of age. Date of last inspection 28th October 2004 Brief Description of the Service: Rosemary Cottage is registered to provide accommodation and personal care for up to 6 people between the ages of 18 to 65 who have a learning or physical disability. The home is owned by Canterbury Oast Trust (COT), a registered charity, and is managed on a day-to-day basis by Mrs Valerie Clark. The home is situated on the grounds of Highlands Farm, the home of the South of England Rare Breeds Centre, and a major tourist attraction in a rural area on the outskirts of the village of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, and approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs, the Home also has transport which can be used for Service Users if they wish and a local bus service passes the farm. The house itself is a modern purpose built property with all accommodation for Service Users on the ground floor. All bedrooms are registered for single occupancy. The Service Users have the use of fully assisted bathroom and shower room (both with WC), and a separate WC. The kitchen is accessible to all residents with support and a large, comfortable lounge/diner has views into the courtyard garden, shared with other adjoining homes. Hallways are wide and have grab handrails where needed. The site itself offers many opportunities for community contact, and specialist facilities such as snozelan and an art department are nearby. The home has access to vehicles to enable residents to get into the wider community. Community activities are a regular feature of life in the home. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place between 09.30 and 16.00 on 21st November 2005. There are currently six people living at the home, five residents were around during the day and gave feedback, all either saying or clearly indicating that the home is a very happy place to live. Observations of staff with the individuals in the home indicated that they all got on very well, and the residents were encouraged to be involved in the all daily aspects of home life, re-planning events that needed transport (the minibus was out of action), and having enjoyable support from a music therapist. Paperwork seen included individual support plans, risk assessments; medication and administration documents, activity and goal records, review notes, staff recruitment files, supervision notes, and menu. A tour of the home took place. The house is a pleasant, well-presented abode, and is joined onto a series of other supported houses in a hexagon shape. All living in the complex shares the central garden. Comments from residents during the inspection included (some are paraphrased); ‘… I love it, it is a good place to live, come and see my new bed, I am really pleased’. ‘I have special food, and its really nice, because it is what I need’. ‘I have lovely staff, a key worker, its fun here’. Positive non-verbal communication between staff and residents was observed, using Makaton signing language to converse and have a joke. A really upbeat, happy atmosphere was evident, and especially at mealtimes, when everyone had a chance to tell each other what they had been doing. What the service does well: Staff support the residents with empathy and knowledge of their specific condition and use gentle encouragement to ensure individual independence is retained. Watching staff support during mealtime, and art and craft session and the hand washing that followed, the residents were totally involved in the process and were actively involved. When residents have raised concerns or needed extra support, staff have listened and acted quickly. Documentation shows a clear line of action where additional professional input has been sought and the outcome for the resident. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 6 The quality assurance programme, although not physically seen, is clearly working, and residents said they like their new bathrooms with hoists attached to the ceiling. Staff are well supported by a competent and approachable senior team, who encourage key workers to be involved in the review process with the resident. 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 Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 8 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 Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 9 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): 1, 2, 5 Statement of purpose and service users guides are available that clearly inform prospective residents about the home. Individual needs are assessed prior to a placement being offered. Each person has an individual statement of terms and conditions of residency. EVIDENCE: The statement of purpose is written in plain English and describes the service offered by the home. The service user guide is simplified and uses symbols to enable understanding. Both documents can be obtained from the home. Each person has a statement of terms and conditions of residency, and this is well presented in a straightforward way, with symbols to enable better understanding. Key workers support residents to understand the content. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 10 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, 8, 9, 10 Individual support requirements, goals, and aspirations are well described in an easy to use individual plan package. Every resident is well supported and consulted to make decisions that are meaningful and relevant to them. Consultation and participation in bigger decisions is well supported. Risks are well managed and the system used is user-friendly. Confidentiality and storage of information is robust. EVIDENCE: The home has an excellent individual planning system, and is able to demonstrate that support plans have been written in consultation with the resident in question. This has been divided into six sections that enable staff to really work with the files to residents benefit, and to find relevant information quickly when needed. Several residents said (or indicated) that they were happy and knew what was going on, and that they were able to have their say. The kitchen has been redesigned to enable all residents to use it safely and do some ‘hands on’ cooking, regardless of disability. Individual risk assessments are well written and state the actions needed to reduce risk. Moving and handling assessments are accompanied by diagrams and are cross-referenced back to the support plans where relevant. Staff really Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 11 understand the system in place, and were able to demonstrate its efficiency without any difficulty. Information is kept up to date and stored safely. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 12 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): 11, 12, 13, 14, 15, 16, 17 Personal development is well supported through activities and events that are enjoyable and also have a therapy value. The residents choose activities within and outside of the home. All are supported to get out into the community and go to places that hold interest. Friendships and family relationships are well supported. Individual rights and responsibilities are well supported. Residents choose a wide variety of fresh food, and staff support with food preparation and eating. EVIDENCE: Personal development is supported through the use of speech and language, physio, and music therapy. Residents enjoy a lot of art-orientated activities, and said that although the mini-bus was out of order, and could not take them to their community based art session, an ‘in house’ session was eagerly anticipated (and later enjoyed). Outings and events are chosen by the residents and those who do not like crowds are supported to access facilities that suit them without raising anxiety levels too high. Documentation and photos showed an active life is had by all. Residents are listened to, and one raised a concern over a facility. This was carefully documented, assessed by an Occupational Therapist and resolved with a new item being purchased, which the resident was delighted with. Daily routines are specified in each Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 13 persons individual plan, and through necessity, often have to follow a strict pattern, but residents feel secure with this. They know what will happen next and have a picture board to show planed activities. Menus are planned with all resident involvement, and lots of the meals are prepared with fresh ingredients. Staff support residents to eat their meals, and do so in a supportive manner that enables individuals to retain independence. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 14 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, 20 Personal support is given in the way that is right for the individual. Health care needs are very well supported. Documentation is robust for both. Medication management is safe and secure; staff are clear on the procedures. EVIDENCE: Individual personal support is clearly documented in the plan. Many residents are supported to use hoists and specialist equipment, and staff receive a full and thorough indication into the personal care needs, shadowing experienced staff prior to supporting alone. Residents are consulted and feel comfortable being supported by the staff team. Lots of evidence was available demonstrating that health care professionals have given input to support people with physical disabilities. Residents were happy to talk about their programs and expressed joy at the positive outcomes they felt from following the exercise patterns. Nursing support to manage individual’s medical conditions had been obtained, and staff had been cleared as competent to support specialist needs. Medication management, policies, and procedures were clearly understood by staff. Storage was safe and secure, and an effective and robust hand-over system was in place. Records were accurate and kept in excellent order. Discussions with staff raised a recommendation that further assessment to enable a resident to take tablet medication more easily. GP directions were in the main clear, but one ointment direction was ‘as directed’. The home had a Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 15 very clear care plan on the use of this cream; therefore, a recommendation to ask the GP to be more specific in directions has been made. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 16 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 Residents know that they will be listened to and their views taken seriously. They feel safe in their home and have a staff team who know about adult protection procedures. It is recommended that the Dept of Health guidance on physical restraint be obtained. EVIDENCE: The complaints procedure is displayed in the home in symbol form, but staff are more integral to making this a live policy. Records show, and residents confirm that they are listened to, treated with respect and any concerns raised are taken seriously. An example of an individual not feeling safe with their own bed was explored, and the action taken to resolve it was swift, the resident kept informed at every stage of reassessment, resulting in a very positive outcome. The complaints policy has been reviewed and is now robust, taking into account external complainants. Staff received adult protection training in their induction, and in discussion, knew what procedures to follow if they felt any level of abuse or neglect were occurring. Procedures to protect resident’s money were seen, were strictly monitored, and were safe. Residents use assessed physical restraints, so it is strongly recommended that the Dept of Health guidance on physical restraint be obtained for reference purposes. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 17 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, 25, 26, 27, 28, 29, 30 The home is comfortable, homely, and safe. Specialist equipment has been updated and enhances individual bedrooms homeliness. Bedrooms are as the individual chooses. Shared space within the home is sufficient, and access to other communal rooms for relaxation can be obtained through integral walkways. Improved telephone access is recommended. The home is clean and hygienic. EVIDENCE: The building is a purpose built environment for people who use mobility aids, and had wide corridors, grab rails, and raised electricity points throughout. The whole house is subtly decorated, and jazzed up with residents photos, artwork and posters of events. The bathrooms have really improved, and fullscale maintenance was taking place on the assisted bath during this visit. Both the bath and shower room have ceiling hoists, enabling much more safe and dignified bathing and toileting. Ceiling hoists have been fitted into bedrooms where needed and this has had a great effect on the space available for wheelchair mobility. A portable hoist is maintained for emergency use. The kitchen has had a full refurbishment, and has been designed to allow residents to join in food preparation safely. A snozlan / relaxation room is available in a communal building joined to the Cottage. A communal telephone for resident use is available in the dining room and the staff admin office, but it is not Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 18 portable, therefore a wireless telephone is recommended, which would enable easier access to residents receiving telephone calls if they are in bed. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Staff have clear job descriptions and understand their roles and responsibilities. Staff are supported to obtain NVQ qualifications. Staff are competent and are available in sufficient numbers to meet residents needs. Recruitment procedures need urgently improving to ensure the safety of all in the home. Staff receive regular supervision. EVIDENCE: Staff know their job roles and are supported with a job description. Induction training covers all aspects of each individuals support requirements, and staff are never left to support alone until both they and the resident feel comfortable. Inductions cover health and safety in depth, the social care aspect is explored separately, but would benefit from greater focus on specific issues and conditions of learning disability. A discussion with the induction trainer took place, and the revised ‘Skills for Care’ common induction standards may be a way of linking a greater service user specific focus into the induction package (www.skillsforcare.org.uk). NVQ training is well supported, with 50 of staff holding this qualification. Staff said that they have regular supervision and it is beneficial. They also said the management team were always available for support and could be called upon for impromptu supervision if needed. Staff files showed that robust recruitment procedures were not being followed, and one staff member had no references obtained prior to commencement. Detailed feedback was left, and an immediate requirement to address and improve this situation was made. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 20 Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 21 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, 42 The home is well run, but the manager must ensure devolved responsibilities are carried out to the correct standard. A quality assurance process (QA) used by the home has had a positive benefit for residents. The health and safety of the home is kept under strict review. EVIDENCE: The manager is open and approachable and has many years of relevant experience, and suitable qualifications. All aspects of responsibility are fully discharged, however, the recruitment process (obtaining references, checking suitability) is devolved to the Human Resource department. As above, there are major shortfalls in meeting the requirements of the regulations, so the manager must ensure that devolved responsibilities are spot checked as a quality assurance process. The QA system within the home is clearly working, as the residents have expressed great satisfaction with their lives and the comment cards from relatives / friends / professionals indicate satisfaction. The home has an excellent environmental risk assessment, broken down into segments and easy to use. A weekly and monthly audit takes place against Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 22 this, keeping the home safe for all. All service certificates were confirmed as up to date on the pre-inspection questionnaire. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 23 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 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 4 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rosemary Cottage Score 4 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000023516.V256200.R01.S.doc Version 5.0 Page 24 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 YA34 Regulation 19 Requirement Revise and make robust the recruitment procedure against Schedule 2 of the Care Homes Regulations (amendment 1770) with immediate effect. Timescale for action 21/11/05 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 3 4 Refer to Standard YA20 YA23 YA24 YA35 Good Practice Recommendations Where swallowing difficulty exists, assess individuals ability to take tablets and record outcome. Request GP be specific with directions for topical ointment. Obtain the Department of Health Guidance for Restrictive Physical Interventions as a guide to good practice. A wireless, portable telephone be purchased for resident use. Formal induction training have greater focus on service user group conditions, linking, where possible to LDAF. Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Rosemary Cottage DS0000023516.V256200.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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