Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 21/08/08 for Severn Cottage & Rose House

Also see our care home review for Severn Cottage & Rose House for more information

This inspection was carried out on 21st August 2008.

CSCI found this care home to be providing an Adequate service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

CARE HOME ADULTS 18-65 Severn Cottage & Rose House 4 Forbes Close Ironbridge Telford Shropshire TF7 5LE Lead Inspector Deborah Sharman Unannounced Inspection 21st August 2008 09:00 DS0000020539.V370321.R01.S.doc Version 5.2 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 DS0000020539.V370321.R01.S.doc Version 5.2 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. DS0000020539.V370321.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Severn Cottage & Rose House Address 4 Forbes Close Ironbridge Telford Shropshire TF7 5LE 01952 433653 01952 432209 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) www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Manager post vacant Care Home 18 Category(ies) of Dementia (1), Learning disability (17), Learning registration, with number disability over 65 years of age (1) of places DS0000020539.V370321.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2007 Brief Description of the Service: Severn Cottage and Rose House is part of a small complex providing care to adults with learning disabilities. The site comprises of 2 large houses both providing 15 places, a smaller bungalow providing 3 places (4 Forbes Close). 4 Forbes Close supports semi independent living with minimal staffing to reflect the support needs of the people living at the home. There are 3 bedrooms, a lounge/diner, and communal bathroom with toilet, a separate toilet and shared kitchen. The home is well placed for access to local services, and amenities, in Ironbridge and Madeley. The registered Manager is responsible for both Severn Cottage and Rose House and this is now reflected in the home’s registration with the Commission for Social Care Inspection. The current range of fees for service users start at £650.00 per week. DS0000020539.V370321.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One Inspector carried out this unannounced key inspection between 9.15 am and 7.15 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. In addition prior to inspection we sent surveys out to people who live at Severn Cottage, to staff who work there and to independent health professionals who provide their services to the home. We received completed surveys from 3 staff members, one professional and three people who live there. We are not currently sending surveys out to relatives in order to comply with data protection legislation. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. The acting manager was available throughout the inspection to answer questions and support the inspection process. We were not able to meet any relatives during inspection as many live at a distance from the home. However we were able to see records several complements about service quality made by numerous different families. DS0000020539.V370321.R01.S.doc Version 5.2 Page 6 We were able to talk to staff including new staff and met and spoke to most people who live in Severn Cottage. We assessed in detail the care provided to one person using care documentation and observation. We also sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises and we were able to observe the care of residents during this time. At the end of the day, we were able to see how staff respond to behaviours that challenge when one resident became agitated. All this information helped to determine a judgement about the quality of care the home provides. What the service does well: What has improved since the last inspection? Staffing levels have significantly improved with additional care and cleaning staff having been employed. A number of new staff are waiting to start. Some people are provided with additional one to one funding by their Local Authorities to meet specific needs. How this is organised is now accounted for well and this represents a significant improvement. The Acting Manager has developed a lot of new systems to improve how people’s medication is being administered. This better ensures people receive their medication as prescribed and that medication is managed more safely and accountably. Recorded verbal complements from relatives indicate their increasing satisfaction with the service provided and that improvements are recognised. One relative is recorded as having said that X is ‘much happier’, with his needs being met ‘especially activities and work’. Three different relatives are recorded as having commented on the improved décor and atmosphere within the home. DS0000020539.V370321.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. DS0000020539.V370321.R01.S.doc Version 5.2 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 DS0000020539.V370321.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area was judged to be adequate at the last inspection. Nobody new has moved in since the last inspection so we were unable to judge these standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nobody has moved in to Severn Cottage since the last inspection. We were therefore not able to make a new judgement about how new people are supported to choose and move in to Severn Cottage. Brochures and other written information to help people decide whether to move in are available and have been recently reviewed. However as the registered manager has left employment since this time and as the weekly fee is not stated, further amendments and additions are required to ensure that up to date information is always available to people who may enquire about the service provided. DS0000020539.V370321.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. People’s needs and goals are met. The home has a plan of care, which tells staff how to meet their needs. People are asked about, and are involved in, all aspects of life in the home. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Written guidance available to staff about the person we case tracked tells staff essential information to help them care appropriately. All areas of immediate need are addressed, are written in a respectful, positive manner and consider the wishes, preferences and abilities of the resident. How staff should support the resident to overcome the barriers imposed on her by dementia is particularly effective. We could see that guidance has been implemented within the environment to overcome the visual perceptions that can cause DS0000020539.V370321.R01.S.doc Version 5.2 Page 11 anxiety in a person with dementia. We could also see other ways in which care guidance is adhered to in order to promote other aspects of the service users well being. She was dressed in her favourite colour, with a handbag to match. She has had difficulty obtaining shoes to fit her and she has been taken to buy hand made shoes in her favourite colour. The care plan states that she likes to carry significant photographs with her. She showed us that she had these in her handbag. We could see that her funding authority has recently reviewed her needs by telephone. Risk assessments have been carried out recently to minimise a number of hazards specific to the person whose care we looked at. All but one member of staff had signed these to indicate they are aware of what is expected of them to minimise the identified risks. Again her dementia is considered, ‘due to X’s visual perception difficulties associated with dementia, bath mats need to be the same colour as the floor. Otherwise X may see the mat as a hole and decline to stand on it’. The main omission in care planning is reference to equality and diversity issues. For example written information informs staff that the person whose care we looked at is Church of England faith. There is no further reference to this so staff are unaware of what this means to her and what, if any support she may require with this aspect of her life. Gender care issues are considered but have limitations and this is explored further under Standards 18 – 21. We looked at the risk of this person being scalded as we were informed that the Organisation is still seeking quotes to regulate water temperature, 12 months after this was first raised. The Acting Manager assured us that given the persons dementia, that regulators have been fitted to the basin in her bedroom. The risk assessment does not account for this but concentrates on the fact that she has been taught about water temperature safety to minimise ant risks. We queried the validity of this given the ladies current condition. However, the Manager demonstrated that since July 2008, she has ensured that the water temperatures are monitored as an additional precaution. The risk assessment should be reviewed. Residents choices are respected. We can see how residents influence the menus, activities that they do and how the home is decorated. Residents are beginning to give permission formally for staff to administer medication to them where they are unable to administer them selves. Although it is time consuming, the manager stated her intention to continue to pursue this with the resident who has dementia understanding that on some days she is very lucid. This demonstrates that the manager understands the principles within the Mental Capacity Act. The minutes of residents meetings encapsulates how residents are influencing how the home is managed when they refused to hold a meeting offered by staff because they wanted to watch Dr Who on the television instead. Recorded complements from five relatives also tell us that they are satisfied with how the service is other meeting peoples needs. DS0000020539.V370321.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. People have healthy, well-presented meals and snacks, at a time and place to suit them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plan of the person whose care we looked at in detail tells staff what her preferred activities are. It also describes how, with the onset of dementia new activities can cause anxiety. We observed how she was supported to get ready to go out to her usual day care and she was very happy to do so. From records we could see how during July she went out for a walk to different places in the locality on eight occasions including to a café, for an ice cream, DS0000020539.V370321.R01.S.doc Version 5.2 Page 13 for a meal out and to tourist attractions in the Ironbridge area on two occasions. An activity system has been newly developed where residents can do an activity of choice once per week, on their identified morning. We saw this working and we saw one resident talking to staff about the activity he might choose to do. Work experience opportunities are particularly positive for residents at Severn Cottage and the manager and staff are to be commended for their proactive approach to this. One resident in February 2008 completed a six-week work experience placement in a school library. Someone else works once per week in the CARE Ironbridge café, ‘Crumbles’ in Madeley High street. A third resident has worked for many years in a local charity shop and one resident who has most recently moved in told us that he has just started to work one day per week at the local hospital League of Friends shop. He said he was enjoying it and was looking forward to going the following day. When we arrived we saw a resident busy cleaning the glass in the communal areas of the home and helping residents less able than her self with small tasks. Talking with her clearly showed that this role is important to her and provides a huge amount of self-esteem. The Acting Manager is aware that there has been some dissatisfaction amongst some residents with some of their day activities that take place on the CARE Ironbridge site. Recent reviews of this have however taken place with people being given the opportunity to say what they want to do. Minutes were available to us to confirm this and new timetables were due to be drawn up reflecting people’s preferences on August 25th 2008. Menus show how residents influence meal choices. Meal times are flexible and work around individuals. For example we saw one resident eating his breakfast after everyone else. Staff are aware of peoples individual dietary needs such as how to prevent choking when there is an identified risk and where drinks to be thickened. We were aware that a resident telephoned her mother and that residents are free to do so as they wish. DS0000020539.V370321.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. People generally receive personal support from staff in the way they prefer and want although there is capacity to improve gender care. Physical and emotional health needs are met most of the time because the home has procedures in place that staff follow. The care home supports people with medication in a safe way although some steps should be taken to improve this further. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents present as well groomed and their personal style is evident in the way they dress. We saw staff encourage residents to go to their room when personal support was required, promoting privacy and dignity. The female resident whose care we assessed is prone to waking in the night and can be incontinent. At times there is only a male staff member available on the premises at night. The manager has found the policy about gender care unhelpful. It states female carers where possible should provide intimate care DS0000020539.V370321.R01.S.doc Version 5.2 Page 15 but does not define this further for effective translation in practice. In the absence of additional funding, the acting manager has tried to write a protocol, which balances the service users sensibilities and staffing limitations. The manager agrees that the outcome is inadequate and although this has not yet affected the service user, potentially it will. According to the protocol the choices are to swap staff with Wrekin Cottage in the middle of the night, which momentarily would leave one or both houses un staffed whilst staff walk across the road. The alternative according to the protocol is for the male staff member to partly clean the resident, which is unsatisfactory given her assessed skin vulnerabilities and dignity. Support with this is needed from senior managers as care and safety could be compromised. Good guidance is available to help staff to meet resident’s health needs. From records we could see that routine and changing health needs are frequently met for the service user whose care we tracked (chiropody, dental, thyroid monitoring, swallowing assessment, occupational therapy assessment, medication reviews plus a diagnosis of epilepsy as staff pursued changes that they noticed) From records we noticed that this service user had experienced pain on passing water early in August 2008 and records requested ‘can you get a Dr appointment?’ We agreed with the acting manager there was no evidence of medical advice being sought until symptoms were recorded again 8 days later. The Acting Manager explained that out of hours medical advice had been sought and we agreed that she could submit the Doctors report as evidence to us after the inspection. At the time of writing nothing has been received. We also noted from records that the service user has been recalled for a cervical smear but the decision was taken with the GP not to pursue this, given the level of distress it causes the service user. On reflection given that this is a key health need we feel that the decision making remit for this should be extended and a ‘best interest’ meeting should be held. The acting manager has worked hard to improve medication systems to ensure safety and accountability. She demonstrates a good understanding of the required national standards and has achieved a lot in a short time. Medication training for new staff has been reviewed and when fully implemented will be robust. The Acting Manager agreed to develop a tool, which will assess and assure the ongoing competency of all staff to administer medication. She has met with the Doctor to agree a schedule of medication review dates for each service user and a verbal complement about this is recorded from the Doctor. The Doctor has authorised in writing protocols for the administration of some ‘as required’ medications and the acting manager is aware of the need to develop this further. We audited stocks of diazepam held for the service user whose care we were assessing. We found 50 to be in stock on the premises. Records show us there should have been 48. From this we could see that staff are not recording DS0000020539.V370321.R01.S.doc Version 5.2 Page 16 whether they were administering one or two of the tablets in accordance with prescribing direction. Failure to record this could lead inadvertently to the service user receiving an overdose. A stock check audit has been newly introduced and is in its infancy but should help to demonstrate that medications are being managed responsibly. DS0000020539.V370321.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there have been two complaints made, one by a family member in January 2008 about the quality of chiropody, missing laundry and the none collection of glasses from the optician. The other complaint was from a social worker about lack of supporting evidence of progress in respect of a person whose care was being reviewed. Judging complaints was an unwieldy and time-consuming process as not all records were available or available in one place. However, although the process and outcomes were not s transparent as they could have been to the absence of some elements of the recording process, it appears that matters were looked into well and were resolved in a timely way. Conversely it was very positive to read 12 verbal complements that had been noted from a range of people since June 2008. DS0000020539.V370321.R01.S.doc Version 5.2 Page 18 There are ongoing concerns about inappropriate behaviours of one resident that are emerging as a trend and are putting female service users and since inspection other people at risk. These incidents have been reported and pursued with the Local Authority and Police under Safeguarding Protocols. We could see that risk assessments are in place to protect the resident we case tracked from such behaviours. A meeting with the local authority is planned for September to look at how the person’s needs are being met at Severn Cottage and how the service user himself, other service users and others can be best protected. At inspection we reminded the Acting Manager to inform us under Regulation 37 of all incidents pertaining to protection, even where these may be off site, as there are often repercussions for the safety of those living within the regulated setting. We queried with the manager two notifications we had received about the welfare of service users. These related to sustaining bruising to the jaw and in another incident an assault between service users. These happened prior to the current manager being in post. She undertook to look into both matters after the inspection and provide the information prior to writing this report. At the time of writing nothing has been received. Most staff have undertaken training in the protection of vulnerable adults and places are booked for those who haven’t. As referred to earlier gender care policy and practice must be reviewed to ensure staff are clear about what is expected of them, to ensure care is not compromised and to protect both staff and service users equally. The previous registered manager who resigned recently from post is still the appointee for some service users. This must be addressed and where possible alternative arrangements should be made as it is not ideal for the manager to take on this role. It is positive that where they are able to, some people look after their own money and have a lockable facility in their bedrooms to keep their money safe. Where people need support to look after their money, records are accountable and a daily check system has been newly introduced to further safeguard service users monies. We are told that no service users have been restrained. Towards the end of the inspection we were able to see that staff responded appropriately to a service user who agitation was escalating. The manager made herself available and supported staff and the service user, leading by example. DS0000020539.V370321.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. Quality is good. People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Steps have been taken to ensure that the environment meets people’s specific needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Severn Cottage like their home and they like their bedrooms. In surveys they tell us the home is either ‘always’ or ‘sometimes’ clean. At the time of this unannounced inspection it was very clean. In recorded complements relatives have commented on improvements in the décor and residents were involved in choosing colour schemes that are lighter and brighter. Decorating has been carried out to a good standard. DS0000020539.V370321.R01.S.doc Version 5.2 Page 20 We looked at how the environment is meeting the needs of the person whose care we tracked. We looked at her bathroom. Adaptations have been made to the environment particularly in her bedroom and bathroom to accommodate changes in visual perception brought on by dementia. For example the bath is white. Red tape has been put on the bath so she can see the edge of the bath. Walls are painted red as this is both her favourite colour and differentiates the wall from the fixtures and fittings clearly. A chair lift is available in the bathroom to facilitate safe use of the bath as described in the care plan. The toilet is opposite her bedroom and has a picture on the door to tell her it is the toilet. Radiators are covered and windows are restricted for additional safety. We also looked at her bedroom. This is identified by a photo on the door and is effectively personalised in her favourite colour and reflects hobbies and interests. Red tape identifies the commode, which is also available in the bedroom. The mattress is protected to meet identified continence needs. We found it particularly thoughtful that a poster of the resident’s favourite football team has been placed over a large mirror in the bedroom. This is because staff know that reflections in mirrors can be frightening for her. The manager agreed that in spite of having purchased a carpet cleaner, a slight urine odour was detectable in the bedroom and said that despite a new cleaning programme, it was difficult to manage this. We suggested that the carpet is removed and replaced with flooring that is homely but more readily cleanable. Bedrails are built into the bed. The manager said they are not used. We advised she put a protocol in place to ensure that all staff including any new or agency staff are aware of this so they are not inadvertently used as a restraint. DS0000020539.V370321.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is good. People are supported by an effective staff team who understand and do what is expected of them. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents, we spoke to or who have completed surveys for us, tell us they are happy with the staff. Staff we spoke to were happy and new staff appreciated a structured induction and confirmed a robust application process which included being shown around by people living on the CARE site. Comments in staff surveys tell us there has been concern about staffing levels and this has affected staff morale. The new acting manager is very aware of this and has secured an additional 80 staff hours. A new deputy manager started the week of inspection as did a ten-hour cleaner which is a new post. DS0000020539.V370321.R01.S.doc Version 5.2 Page 22 We looked at how 2 new staff had been recruited and found all pre employment checks to have been carried out in a timely way to ensure their suitability to work with vulnerable adults. A well planned months induction programme was also in place and was being adhered to for the new staff we looked at. We looked at staff rotas and can see that residents provided with additional funding to pay for personal care and activities are receiving this. This is now being managed transparently and represents a huge improvement. Staffing levels are adequate but when staff newly appointed start in post, 3 - 5 staff will be on duty at all waking times and this will be a big increase from the 2 to 3 currently. The manager must make it clear on the rota whether she is working as part of the care staffing ratio or supernumerary as a manager. Senior managers should provide her with guidance as to how she should divide her working week, to ensure there is sufficient time to manage and develop the service and that expectations are clear. All staff are satisfied with the training opportunities available to them. A nominated person has responsibility for the training programme which is well structured, well recorded, ongoing and up to date. Staff present as competent demonstrating the effectiveness of the training provided. Ninety one percent of staff are trained to national minimum levels and there has been no disciplinary proceedings against staff. Complements received verbally in June and July have been recorded and reflect well on the staff team. A recorded verbal complement from a relative tells us ‘pleased to see Y happy and calm and thanked the staff for their hard work’. Another relative complemented the staff team for the atmosphere. A third relative referred to the growing confidence of a resident adding satisfaction with the cottage and the staff team. A fourth relative is recorded as having said they understand how hard the staff work to ensure service users needs are met. A tradesman commented on the positive interaction between residents and staff and said he would like to live there. DS0000020539.V370321.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. The new acting manager has only been in post a short time, has made significant improvements but could not demonstrate full fire safety compliance to ensure peoples safety. This has the potential to put people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager resigned in July 2008. The acting manager who has worked in other roles at CARE for 2 years and in the care profession for 13 years has now been appointed to post permanently and needs to apply to us DS0000020539.V370321.R01.S.doc Version 5.2 Page 24 for registration without delay. Staff speak highly of her. We were told she leads by example and we were able to see this too. She presented as highly motivated, knowledgeable, experienced and organised and very keen to demonstrate improvements she had made in a short time. She has undertaken a range of training in the last 12 months to update her knowledge and skills. She has NVQ 4 in Care which she needs to be manager but she is aware that she also needs to obtain the Registered Managers Award to fully qualify her for her new role. She described feeling well supported by the staff team, her peers and her managers. She has prioritised improving outcomes for service users and has been successful. Areas of management (and some aspects of health management) must now be prioritised for improvement before the service can be considered as providing a good service overall. Freezer temperatures continue to be recorded as too warm without remedial action being taken. Inappropriate cold storage risks food borne illness amongst service users. The acting manager who is relatively new did not know when a food safety inspection was carried out by Environmental health and records were not available to assure us of this. It is unclear what the organisation is proposing to do about the regulation of water temperature, as messages are contradictory. Risk assessments tell us that no one is at risk as they have all been taught water temperature safety and yet we are assured that 12 months on the provider is seeking quotes to install thermostatic regulator valves. Until the position is clearer, the requirement has been left as unmet. Environmental risk assessments could not be located as the office was being moved around. The acting manager offered to send them on to us. We agreed to this if they could be provided prior to writing this report. At the time of writing nothing has been received. Data sheets are available for hazardous substances but the information on them has not been used to carry out risk assessments. Positively however staff are receiving in house training in the use and application of chemical products used on the premises. Not all complaints records were held together and the acting manager had to search all over the site for them. The Fire Service carried out an inspection in October 2007. They considered fire precautions in Severn Cottage to be satisfactory but that Rose House is not fully compliant with fire regulations. Their concerns included the need to review fire precautions / measures to reduce the risk of fire, measures in relation to the means of escape, that doors leading onto the hallway from bedrooms and the sitting room may not be fire doors and that the fire risk assessment is not considered to be suitable and sufficient. With the acting managers help we could not find a fire risk assessment for Rose Cottage. The only information available to us showed (like the water regulators) that quotes are still being sought for fire doors. Furthermore fire drill records could not be DS0000020539.V370321.R01.S.doc Version 5.2 Page 25 located. This appears to be unsatisfactory and we have informed the Fire Service of our concerns. Quality assurance systems to help the manager to assess and plan the homes performance have lapsed. The acting Manager said she has a keen interest in quality assurance and is aware of the need to resurrect this to support the homes development. Regulation 26 monitoring visits are being carried out and state in February 2008 that all CSCI actions are complete. Progress has been made but not all improvements required have been met. The new Acting Manager completed the annual return (AQAA) and demonstrated good insight into what the home does well and what they have improved. We would advise that the AQAA is used next time to explicitly outline how requirements we have made for improvement have been met, as this has been overlooked and is a missed opportunity for improvement. DS0000020539.V370321.R01.S.doc Version 5.2 Page 26 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 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X DS0000020539.V370321.R01.S.doc Version 5.2 Page 27 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. Standard YA6 Regulation 14 (1) (a, b, c)15 Requirement The home must receive all information relating to the support needs of a service user prior to them moving in (unless the admission is an emergency) Requirement issued 31.8.07 with time scale for completion of 11.9.06 and not met. Not assessed August 2008 as no new admissions. Timescale for action 21/08/08 2. YA20 13(2) Steps must be taken to improve systems relating to the administration of medication to ensure that people living at the home receive their medication as prescribed and that records accurately reflect practice. This will reduce the risk of error and therefore promote people’s health and welfare. New requirement arising from this inspection August 2007. Much improved August 2008, minor areas for improvement at August 2008. 21/08/08 3. YA42 23(4) Steps must be taken to ensure DS0000020539.V370321.R01.S.doc 21/08/08 Page 28 Version 5.2 the following: Adequate precautions against the risk of fire Reviewing fire precautions To ensure as far as practicable that people living at the care home are aware of the procedure to be followed in case of fire. New requirement arising from this inspection August 2007. Not met August 2008. 4. YA42 13(4) Steps must be taken to adequately protect service users from the risk of scalds from excessive unregulated water temperatures. New requirement arising from this inspection August 2007. Not met August 2008. 21/08/08 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 YA1 Good Practice Recommendations The Statement of Purpose should be amended to reflect the change in manager since its last review. The weekly fee should be included in the Service User Guide. New good practice recommendation arising from this inspection August 2008. 2 YA18 Gender Care policy and practice should be reviewed to ensure staff and managers know what is expected at all DS0000020539.V370321.R01.S.doc Version 5.2 Page 29 times and service users preferences and welfare are promoted without compromising safety, dignity or care. New good practice recommendation arising from this inspection August 2008. 3 YA19 Where service users are not able to make informed decisions about health care / treatment, best interest meetings should be held to ensure their rights, interests are considered and promoted. New good practice recommendation arising from this inspection August 2008. 4. YA22 Documentation relating to complaints received should include a full account of the nature of the complaint received, the investigation process, response to the complainant and outcome. All documentation relating to complaints should be available to the Manager and for inspection. New good practice recommendation arising from this inspection August 2007. Not met August 2008. 5 YA39 Effective quality assurance and quality monitoring systems, based on seeking the views of service users living at Severn Cottage should be implemented to measure success in achieving the aims of the home and to address any assessed shortfalls in service provision. New good practice recommendation arising from this inspection August 2008. 6. YA42 Fridge and freezer temperatures should be monitored and recorded at least daily and remedial action should be taken where temperatures do not comply with recognised safe ranges. New good practice recommendation arising from this inspection August 2007. Not met for freezer temperatures August 2008. 7 YA42 Using data sheets available for hazardous products held on the premises, full assessments of risk should be carried out and should be kept under review. New good practice recommendation arising from this inspection August 2008. DS0000020539.V370321.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000020539.V370321.R01.S.doc Version 5.2 Page 31 - 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!