CARE HOME ADULTS 18-65
Rosemary Cottage Canterbury Oast Trust Highland Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector
Lois Tozer Unannounced Inspection 9th February 2006 09:45 Rosemary Cottage DS0000023516.V283016.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 Rosemary Cottage DS0000023516.V283016.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. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 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.V283016.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 6 People with learning disabilities aged between 18 - 65 years of age. Date of last inspection 21st November 2005 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.V283016.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place between 09.45 and 12.20 on 21st November 2005. At the time of inspection, the registered manager was away, and the team leader and area manager assisted the process, with thanks. There are currently six people living at the home, five residents were in and out of the home during the visit 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, staff consulting residents on their preferences, listening and never dismissing comments, and offering activities that lasted a short period of time, to cater to shorter attention spans. The focus of this unannounced visit was to see what progress had been made with the requirement to improve recruitment processes, and to meet up with service users and seek their opinion of life at Rosemary Cottage. 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); ‘We had fun with the bus again, the ramp got stuck, had to use another homes bus!! It all worked out ok though’. ‘Yes, the staff are good, and I really like it here, I am going to horticulture, which I really enjoy’. ‘Some staff members are driving me and some friends to see Arsenal play football this Saturday, I hope the staff don’t get too tired, I’m really excited about it!’. ‘Yes, I’m fine, and staff are still great, we miss Val the manager and are looking forward to her coming back’. Residents not using speech to communicate indicated that they were happy with eye response to questions and staff translation of individualised signing. One resident showed me how to use the touch screen computer game, which was appreciated. What the service does well:
The home is really well designed for people who have mobility difficulties, and does not restrict any residents in any way. The adaptations and equipment available enhance freedom. Staff are really respectful and really listen to what is being said, by observing body language, eye contact, use of personalised signing, conventional signs and speech.
Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 6 Residents feel comfortable to say how they feel and if they want things done differently, and staff respond in respectful ways, by listening and obliging. Physical disability is not seen as a barrier to having a fulfilling and creative life, staff have used diverse thinking to make people’s dreams and aspirations possible. Residents are involved in day to day chores, some more than others, depending on how much these are enjoyed! All residents have the opportunity to go into the kitchen and be involved in meal, snack and drink preparation. Meals are well presented and mealtimes are relaxed, enjoyable and full of chat between resident and staff. 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.V283016.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 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.V283016.R01.S.doc Version 5.1 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): None of these standards were inspected. EVIDENCE: Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 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): 7, 8, 9, 10, 11 Service users make decisions about all aspects of their lives, being provided with the right level of support. Participation in household activities is well supported. Risk assessments open up service users opportunities to have an active life. All documentation is handled and stored confidentially. EVIDENCE: Service users said, (and staff were observed respecting), decision making was something that they did every day, and that they were aware of what was going on in the home, and how it affected them. Getting involved in house tasks such as cooking and cleaning is encouraged, and staff support residents to maximise their independence. Risk taking is well assessed, and staff use creative though to enable activities to take place safely. Lots of ordinary opportunities are within service users reach because the assessment process aims to enablement. All documentation is kept up to date and is stored securely. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 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): 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: Every resident spends time being engaged with staff, within activities they can manage with little or no support and time socially that helps develop social and communication skills. Activities both within and outside of the home are chosen by residents and are very much enjoyed. Many of the activities within Highlands Farm have a work ethic and dually benefit from residents regular interaction with visiting members of the public. Leisure is taken seriously! A service user was keen to say how he and several friends were going to a major football game in London in a few days, and described other activities that were exciting and unusual. Friends are encouraged to visit, and residents are supported to get to see their friends, and make new friends, in the wider community. Residents know that they have rights and responsibilities, and
Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 12 staff work in a way that enables non-hieratical conversations to take place, enabling residents to exercise their rights of choice easily. Food being prepared appeared attractive and to individual preference. Staff support residents to eat where needed, but ensure that the support is discreet and involves staff partaking of a meal at the same time. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 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 Personal support is always given in the way service users prefer. EVIDENCE: Staff were observed supporting an individual, who, when stating they would like something done differently, were obliging. The service user felt no barriers in advising why this was preferred, and the staff member did not question the reasoning, which was totally rationale. As above, there is a really positive, non-hieratical system of support in place that enables people to feel easy with all levels of personal support and care. Rosemary Cottage DS0000023516.V283016.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, 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. Residents confirm that they are listened to, treated with respect and any concerns raised are taken seriously. There have not been any complaints since the last inspection. Staff received adult protection training in their induction. Resident’s 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.V283016.R01.S.doc Version 5.1 Page 15 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, 28, 29, 30 The house is homely, comfortable and safe. Shared space is open plan and easy to manoeuvre. Adaptations and equipment required by individuals is available. The home is clean and hygienic. EVIDENCE: Rosemary Cottage is purpose built, and is therefore spacious, has windows that provide an easy view when seated, lots of natural light and meets the residents needs. Shared space is open plan, but the way furniture has been arranged, makes a large area feel cosy and homely, but does not impede access for people who are using mobility aids. The home was very clean and sweet smelling. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 Recruitment policy and procedure has improved. EVIDENCE: After a major audit by area managers, the recruitment policy, procedure and support given to managers (who may not have had the need to recruit for considerable periods of time) have been revised. Managers now ensure that they see all the relevant documentation prior to agreeing a start date with a new employee, and have revised the requirements of the Care Homes Regulations (2004 amendment 1770). Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 17 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): 38 Service users know that the management approach of the home is to provide an enabling, supportive and homely environment. EVIDENCE: The manager and staff provide a commendable level of support to the residents, and really understand the importance of the concept enablement. Residents feel included in day to day tasks, and have a say in what goes on. Staff have been coached to see life from the residents perspective, and regardless of level of ability, are totally respectful, supportive and consultative. Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 18 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 X 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 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 X X X X 4 X X X X X Rosemary Cottage DS0000023516.V283016.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action 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. 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.V283016.R01.S.doc Version 5.1 Page 20 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
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