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Inspection on 23/08/07 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 23rd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 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?

Since the last inspection the Manager has successfully applied for registration and is now registered manager for both Severn Cottage and Rose House. There have been a number of improvements. Steps have been taken to reduce risk in the event of a fire for one identified person living at the home and supervision of staff is better evidenced in part. Confidential information is also being managed more appropriately and this better protects the privacy of people referred to in written documentation. Some decorating has also been undertaken but whilst this has freshened parts of the environment the quality is disappointing. A relative said ``the care home is always looking for ways to improve. As far as I am concerned they are doing an excellent job.` Another said that there had been better attention to meeting needs and that the service user had been far happier over recent months.

What the care home could do better:

Three significant requirements for improvement made previously at a random inspection carried out in August 2006, twelve months ago have not been met. Assessment of an admission to the home has shown that not all information relating to the support needs of the service user have been obtained prior to that person moving in. Fortunately to date it appears that the last 3 people to have been admitted are settling well however failure to obtain information has the potential to put both new and current people living at the home at risk. Care plans and risk assessments contain a good deal of information however some significant aspects are missing. As a result of behaviours a service user left Severn Cottage in 2006 and returned home. Relatives and health professionals have raised concerns in questionnaires about the homes ability to manage behaviour that challenges. Records of incidents were assessed and performance is mixed. There is some evidence that some staff respond appropriately and successfully diffuse situations avoiding escalation. However documentation exists where the facts recorded together with the tone illustrate concern about the staff members understanding of the causes of behaviour and how to diffuse rather than escalate behaviours. The evidence also demonstrates disregard for the service users dignity, assessed need and care plan. There have been two medication errors since the last inspection and assessment of medication at inspection have identified shortfalls that need action to ensure service users receive medication as prescribed and that the integrity of medication records can be assured. When in place this will assure that the interests of service users are protected and that the practice of the service is better accounted for. There has been a complaint about how staffing levels are allocated and maintained. The Manager wasn`t clear about how staffing levels are decided and agreed to review this. The complaint has been passed to Telford and Wrekin to investigate. In the absence of water temperature regulators the manager is confident that measures have been taken to protect those most at risk from scalds. However water temperatures, which at times exceed 50 degrees, are in the manager`s words `erratic` and it was agreed that the risk also given short falls in risk assessment documentation is consequently increased. As there is no assurance that all service users only access unregulated water when supervised, this therefore requires further action.

CARE HOME ADULTS 18-65 Severn Cottage & Rose House 4 Forbes Close Ironbridge Telford Shropshire TF7 5LE Lead Inspector Deborah Sharman Key Unannounced Inspection 23rd August 2007 09:00 Severn Cottage & Rose House DS0000020539.V336787.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 Severn Cottage & Rose House DS0000020539.V336787.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. Severn Cottage & Rose House DS0000020539.V336787.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) Mrs Carol Elizabeth Ford Care Home 18 Category(ies) of Dementia (1), Learning disability (17), Learning registration, with number disability over 65 years of age (1) of places Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 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 was not assessed at this inspection but was previously from £446.60 to £474.92. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which means that no one associated with the home received prior notification and were unable to prepare. The Inspector who was accompanied by a second Inspector conducted the inspection over the course of 9.5 hours from 8.30 a.m. The recruitment of staff had been assessed previously on 2 August 2007. Information was gathered in a range of ways both prior to and during the inspection day. This has helped to formulate a judgement about the quality of the service provided. Prior to inspection the Manager provided the Commission for Social Care Inspection (CSCI) with information about the home in an annual return. This complemented information about the service already held by CSCI. In addition CSCI sent questionnaires to service users, relatives and health professionals. These were completed and returned prior to inspection. The content of completed questionnaires along with information already known to CSCI and information within the services annual return to CSCI all helped the Inspector to plan areas for further assessment on site. Unknown to the Inspector the date of the inspection coincided with CARE’s planned 20th anniversary celebrations. Company representatives and family and friends were invited from across the country. Service users day workshops were cancelled and a family forum meeting, buffet, disco and hog roast were all planned. An inspection on top of all this provided the Manager and staff with an additional challenge and thanks are extended for their calm support and cooperation. The day however did provide Inspectors with an additional and unexpected opportunity to talk to a large number of relatives about their perception of and satisfaction with the service provided. Inspectors gathered information by talking to service users informally and observing practice for an hour at breakfast time. The buffet lunch provided Inspectors with the opportunity to speak to the mother of a service user recently admitted about the admission process to the home. Inspectors also talked to a group of three service users in a more structured way in the afternoon. Inspectors also toured the premises, observed the administration of medication to one service user and looked at the care provided to two service users in detail. Other records relating to the management of the home were assessed too such as medication, accident and incidents, staff meetings, training, complaints and maintenance. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 6 What the service does well: People living at Severn Cottage and Rose House and their relatives are satisfied with the service provided. Relatives feel that it is homely and safe and all gave examples of how happy their relative is who lives there. One comment was ‘My son is totally happy’. Another stated ‘‘my daughter is very happy living at CARE and that is my main concern.’ Relatives are aware of areas requiring improvement but still feel that overall the service provided is excellent. One service user said ‘we have high standards’. Care plans generally provide staff with sufficient guidance in most significant areas and health outcomes for service users are good. Health care professionals are also satisfied that health issues are managed satisfactorily including some complex health matters. Comments include: • • ‘‘Looks after our daughter for all her needs’ ‘They give the best service possible within their means. There is always a happy atmosphere and plenty of both work and leisure for my daughter. ‘Everybody living here are all well cared for, get good food and all go on holiday every year. • The environment, which needs some general refurbishment currently, meets service users needs and one person living there described herself as ‘comfy and cosy’. What has improved since the last inspection? Since the last inspection the Manager has successfully applied for registration and is now registered manager for both Severn Cottage and Rose House. There have been a number of improvements. Steps have been taken to reduce risk in the event of a fire for one identified person living at the home and supervision of staff is better evidenced in part. Confidential information is also being managed more appropriately and this better protects the privacy of people referred to in written documentation. Some decorating has also been undertaken but whilst this has freshened parts of the environment the quality is disappointing. A relative said ‘‘the care home is always looking for ways to improve. As far as I am concerned they are doing an excellent job.’ Another said that there had been better attention to meeting needs and that the service user had been far happier over recent months. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 7 What they could do better: Three significant requirements for improvement made previously at a random inspection carried out in August 2006, twelve months ago have not been met. Assessment of an admission to the home has shown that not all information relating to the support needs of the service user have been obtained prior to that person moving in. Fortunately to date it appears that the last 3 people to have been admitted are settling well however failure to obtain information has the potential to put both new and current people living at the home at risk. Care plans and risk assessments contain a good deal of information however some significant aspects are missing. As a result of behaviours a service user left Severn Cottage in 2006 and returned home. Relatives and health professionals have raised concerns in questionnaires about the homes ability to manage behaviour that challenges. Records of incidents were assessed and performance is mixed. There is some evidence that some staff respond appropriately and successfully diffuse situations avoiding escalation. However documentation exists where the facts recorded together with the tone illustrate concern about the staff members understanding of the causes of behaviour and how to diffuse rather than escalate behaviours. The evidence also demonstrates disregard for the service users dignity, assessed need and care plan. There have been two medication errors since the last inspection and assessment of medication at inspection have identified shortfalls that need action to ensure service users receive medication as prescribed and that the integrity of medication records can be assured. When in place this will assure that the interests of service users are protected and that the practice of the service is better accounted for. There has been a complaint about how staffing levels are allocated and maintained. The Manager wasn’t clear about how staffing levels are decided and agreed to review this. The complaint has been passed to Telford and Wrekin to investigate. In the absence of water temperature regulators the manager is confident that measures have been taken to protect those most at risk from scalds. However water temperatures, which at times exceed 50 degrees, are in the manager’s words ‘erratic’ and it was agreed that the risk also given short falls in risk assessment documentation is consequently increased. As there is no assurance that all service users only access unregulated water when supervised, this therefore requires further action. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 8 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. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 9 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 Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 10 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, 4. Quality in this outcome area is adequate on the basis that service users and relatives are currently satisfied with the admission process. However short cuts have been taken and this does not assure that the home can be fully satisfied that it can meet the needs of service users it admits into the service. This has the potential to put new and current service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessment of procedures followed for the admission of a new service user shows the family of the service user to be satisfied with how ‘sensitively’ the process was managed and the service user confirmed he is settling well. However the Manager could not evidence that the regulations and National Minimum Standards had been met. A copy of the Social Workers assessment had not been obtained, the Manager had not visited the new service user pre admission and had not carried out her own assessment of need. The service user did have the opportunity for a ‘trial run’ by staying at the home for a week and this is regarded by the home as an assessment stay. However, there was insufficient assessment of suitability prior to inviting the service user to move in for a week with other service users. Existing permanent service users gave a mixed response about whether Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 11 their views had been sought about the suitability of the new service users but largely agreed they had been consulted adding they were ‘alright about it’. Care plans and risk assessments for the new service user had been developed a week after the service user moved in. Given that the assessment stay was two months prior to this it would have been useful to have completed this prior to his moving in to ensure that sufficient information was available to staff in a timely manner. At the time of inspection however there was good evidence of staff adhering to the plan of care. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 12 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 adequate. Care plans and risk assessments address most of peoples’ significant needs and provide appropriate care guidance to staff. People living at Severn Cottage and Rose House appear to be satisfied with how they make choices and decisions about their lives but the development of person centred care would help to improve this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with service users indicated general satisfaction with the choices they make on a day-to-day basis such as rising and retiring times and choosing clothes to purchase and wear. Service users categorically told inspectors that staff choose holidays but later they acknowledged that this is in discussion with them based on their preferences and desire to try and experience new places. Service users are able to choose whether to attend workshops during the day and temporary placements have been made at Severn Cottage to facilitate these needs and wishes. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 13 Care plans contain detailed information based upon a range needs and abilities and staff were seen to be implementing care plans in respect of two service users case tracked. Care is reviewed and this includes all significant parties but there was a mixed response from service users as to the level of involvement they have in care planning. There is no reference within care plans to staffing levels or how identified additional needs are to be met. Spiritual and cultural needs are also not included. However a relative who did not believe she had been involved sufficiently in reviews said she believed in this past year there had been more attention to meeting needs rather than doing what fits in best with CARE. Risk assessments that are now held on service users individual files are in place to address a range of hazards but two sampled did not reflect the risk for those individuals. Furthermore the need to assess / provide guidance re unregulated water temperatures is not an appropriate control measure. The Manager said that this assessment had been carried out but that the risk assessment had not been updated to reflect this. Fire evacuation risk assessments could not be located for a service user case tracked who had not cooperated during a fire drill. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 14 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 overall. Levels of activity appear to have reduced slightly over the last year but Service users continue to participate in community and in house activities allowing them a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager explained that the menu is devised around service users favourite options. Service users told Inspectors that they like the meals, that alternatives are available and that they can help themselves to snacks and drinks. Service users as well as the Manager said that two service users have a soft diet. Most relatives spoken to praised the meals but one queried whether there is sufficient fruit, vegetables and healthy options especially with regard to desert alternatives. Food stocks were assessed and fruit and vegetables were in plentiful supply. Menus show that salad and vegetables are regularly on the menu although mid day desert choices available are not included on the menu. However the Inspector has observed that fruit and Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 15 yoghurts are provided in addition to a selection of more traditional ‘stodgy’ deserts. Service users described the activities that they enjoy taking part in – walks, shopping, housework and the pub. Other service users described having attended a recent showing of a film at the cinema. Relatives are generally satisfied with the level of opportunities for activity available. One relative commented ‘some weekends are a bit quiet’. Activity levels for this service user (who receives additional funding to support activity) were assessed. According to records activity levels had declined since September 2006. The Manager agreed that this was likely given staffing problems but added that record keeping suffers when staffing is short. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 16 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. Personal care and health needs are met helping people to maintain good health. Medication systems require improvement to protect service users from the risk of error and to ensure that medication is administered as prescribed to maximise peoples’ opportunities to stay and feel well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The health history and needs of the service user whose care was case tracked are included in a care plan. Detailed records show that these have been acted upon and followed up where necessary. In the last 12 months the service user has attended two dental appointments but no other health screening for optical or aural health for example. All service users appear exceptionally well groomed and all with individual styles and accessories. Service users are satisfied that the bathing facilities available provide them with choice and meet their needs. Where support is Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 17 required with personal care, this is provided in private. A relative has commented that at times laundry is mixed up and his / her relative sometimes wears another persons underwear. A service user told the Inspectors that another service user before has worn his jumper but that this happens infrequently. The service is not able to fully demonstrate that service users are always receiving their medications as prescribed. Records show several gaps for different service users. For one service user records had been signed when perusal of medication stocks showed a tablet not to have been administered on two consecutive days. This service users medication is scheduled differently to the others. It is also collected by staff rather than being delivered to the home and is not being checked in to the premises in the usual way. These factors heighten the risk of error. There have been two medication errors since the last inspection, one where the staff member could not locate the medication, did not seek advice and therefore did not administer it and another where the manager was distracted and gave medication to the wrong person. Records of investigation into these incidents were not available and the Manager was unaware of any having been completed. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 18 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 adequate overall although performance is mixed. Complaints systems need to be evidenced more transparently to show that complaints to the service are managed effectively. Action is taken where vulnerable adults are at risk but work is required to improve understanding and responses to peoples’ behaviour to ensure their safety, wellbeing and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users asked said they feel safe living at Severn Cottage and Rose House. All know how and who to raise concerns with. One service user said she had raised a concern and it had been dealt with very well. A relative said that ‘I have always been listened to but not always seen action’. Another said he had not needed to complain but would be able to find out how to and a third said ‘this issue (complaints) was recently discussed because prior to this point it was difficult to understand the channels of communication and where responsibilities lay’ Two complaints believed to be about care support are noted in the complaints log for September 2006 but documentation referred to could not be located for the first. The Manager who was not aware of the details of the complaint believed the complaint letter, investigation and response to be held at Head office. Records were better available in respect of the second complaint Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 19 investigation however this complaint was made verbally and the issues raised are not noted. Unless the Manager is fully aware of the nature of the complaint and the outcomes it will not be possible for her to ensure improvements are made. Likewise this information was not satisfactorily available as it should be for inspection. Furthermore the Commission for Social Care Inspection has received an anonymous complaint in respect of levels of support to those with additional needs. This is being looked into by the Contracts Department of the Local Social Services and staffing levels were assessed at this inspection. See ‘Staffing’. There have been two adult protection incidents, which have followed due process after being appropriately reported by the home. The Manager believes these to have now been satisfactorily investigated and resolved. In addition the home’s annual return declares the restraint of a service user in 2006. This had not been reported under Regulation 37 to CSCI, records could not be located at inspection and there was confusion surrounding whether what happened constituted restraint or not. Without the record this could not be clarified. Inventories are in place to protect service users possessions and financial record keeping is appropriate. Financial activity is not routinely being signed by two staff however to protect the interests of both staff and service users. Behaviour management is mixed. One relative, one social care professional and one health professional have explicitly indicated in response to CSCI that there are issues in respect of behaviour management: 1. ‘I would say the service fails to support clients who exhibit difficult behaviours and fails to investigate fully the cause of the clients deteriorating behaviour’ 2. ‘Unsure whether staff would have relevant experience or training to meet the needs of clients who might challenge services’ 3. ‘Reasons for behaviour not being fully explored before residents are excluded’ Inspection shows that there is some evidence that some staff responds appropriately and manage to successfully diffuse situations avoiding their escalation. However documentation exists where the recorded facts together with the tone illustrate a number of areas for improvement. These include understanding the causes of behaviour, how to diffuse rather than escalate behaviours and how to promote service users dignity, respond to assessed need and adhere to aspects of the care plan. Clear behaviour guidance was not included in the plan of care. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 20 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 overall. The premises provide service users with comfortable accommodation that meets their current requirements. The need to upgrade areas of the home to ensure the ongoing provision of a good environment for people living there is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal living areas are comfortable and homely. Service users like their bedrooms and one service user described her accommodation as ‘comfy and cosy’. Bathing facilities are functional but are not so cosy and require attention to ensure a more homely feel. Effort has been made to adapt the environment to meet changing needs. For example grab rails have been supplemented with red stripes to increase their visibility for a service user and a commode provided for night use to promote independence and dignity. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 21 There have been no major changes to the premises since the last key inspection and a tour of the premises showed no obvious hazards. All fire doors were closed, radiators guarded to avoid burns and upstairs windows restricted. Water from a basin in a ground floor toilet did not run warm. This compromises infection control during hand washing. Toilet paper and soap needed replenishing in some areas and the carpet at the top of the stairs of Maple corridor in Severn Cottage was stained and uneven posing a potential trip hazard. Cigarettes and a lighter belonging to a staff member were found to be unattended on top of a paper towel dispenser in the kitchen. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 22 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, 36. Quality in this outcome area is adequate overall. People who live at Severn Cottage and Rose House like the staff and appreciate their approach and support. Staff who are well trained are being better supported and this provides for a more cohesive team for people who live there. There is insufficient assurance that staff are robustly recruited or provided in adequate numbers to meet service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training systems are robust and records held support an effective rolling training programme. Training records were sampled for two staff and they show that comprehensive training including refresher training has been provided throughout the employment of staff and throughout 2007 to date. The Manager has improved evidencing supervision so it was disappointing that records were not available for one staff member. However detailed records were available for a second staff member and the Manager is on target to have provided a minimum of six supervisions within 12 months for this staff member. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 23 Service users like staff and their approach was observed to be respectful and consultative. Relatives have praised the lengths that staff have gone to in order to meet service user needs. The Inspector observed a staff member signing to offer choices to a service user. • • ‘The staff are very dedicated. If there is a new skill required i.e. makaton signing the staff make a point of acquiring that skill’ Another relative said ‘X and Y have gone on courses and taken great effort to gain all the knowledge they can – and apply it’ In their feedback to CSCI relatives are consistently less happy with staffing levels and consistency. Comments from 5 relatives include: • ‘There are times my daughter needs extra help in domestic and social skills. These are not always catered for because of staff shortages. Staffing levels can cause a problem at times’ ‘Support depends on what staff are on duty, good staff keep leaving’. To improve: ‘They could keep regular staff by paying them a better salary.’ Could improve by ‘by maintaining permanent staff more readily and depending less on agency / casual staff’ ‘We feel our daughter would benefit from closer 1 to 1 help with personal care. With staff changes happening quite frequently (in our opinion) it is difficult to judge the quality of the staffing’ ‘There are times when visiting that it is not easy to find a member of staff even though the door is open and residents are sitting around’. Referring to agency staff: ‘who on one occasion did not know where my relative was, who she was, or even where her room was. What if there had been a fire’ • • • • Since inspection and in response to these comments the Manager has said that agency staff are rarely used. None permanent staff known as ‘bank’ staff are used on a temporary basis to cover the absences of permanent staff but are employed by CARE. In the homes annual return to CSCI the manager explained ‘we are bringing in more bank staff in order to cover our rotas’. CSCI received a complaint prior to inspection about how staffing levels are allocated and maintained. The complaint was passed to Telford and Wrekin to investigate. The Manager wasn’t clear about how staffing levels are decided and agreed to review this. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 24 Recruitment is usually robust. Assessment on this occasion showed that whilst all pre employment checks had been carried out in a timely manner for one staff member action had not been taken in response to the receipt of unsatisfactory information. Guidance available to Managers in these circumstances is lacking. The signatory responsible agreed. This fails to appropriately protect service users. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 25 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. Service users feel well supported by Managers and staff. Performance however is mixed and areas have been identified where action is required to better promote the smooth running of the home and the safety of those people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager, who is newly registered as responsible for both Severn Cottage and Rose House feels well supported by her immediate Manager, has almost finished her studies that will qualify her for her role and has undertaken on going vocational training to update her knowledge and skills. Staff meetings are held regularly and the frequency increased during a difficult period for the team. The minutes of the staff meetings show that they are service user Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 26 focussed and that direction and leadership is provided to the staff team. Relatives who spoke to the Inspector described the Manager as ‘quietly strong’ and said that they have confidence in her. Four relatives said that they feel that the Manager and her team provide an excellent service. A service user said ‘I’ve learned to be independent. Its getting better and better. We’ve got high standards.’ Another service user said it’s ‘excellent and good. Not poor. I like it’ Service user meeting minutes and regulation 26 visit records were both available for March 2007 with none more recently available. Regulation 37 notifications are provided to CSCI but had not been for the restraint of a service user, which took place in 2006. Quality assurance surveys, which seek the views and feedback of service users, are conducted nationally annually and have just been published for 2006. These are collated for Ironbridge CARE community as a whole and satisfaction with Severn Cottage and Rose House cannot be separately determined. Maintenance and safety records for gas and electric wiring and appliances were available. Fire drill records showed two service users not to have responded appropriately and risk assessments to manage this risk could not be located. Cigarettes and a lighter belonging to a staff member had been left accessible on top of a paper towel dispenser in the kitchen. Fridge temperatures, which at times are excessive and unsafe, are still being monitored weekly rather than daily although the Environmental Health Officer identified this for improvement earlier this year. A well-stocked first aid box is available and all staff are trained in first aid. Water temperature faults were reported between 19.4.06 and 1.8.07 on 5 occasions with no record of remedial action taken. Water temperatures from water outlets accessed by service users range at times from 50 to 55 degrees and the risk of scalds exists. Discussion with the manager shows she believes action has been taken to minimise risk to the two most vulnerable service users e.g. staff run their baths and others she said have been trained to check temperatures first but agreed that the ‘erratic’ nature of water temperatures increases the risks. A risk assessment for scalds for the service user case tracked was sampled and acknowledges that temperature regulators are not fitted. It is not a control measure to state that the service user will be assessed. The Manager said the assessment and temperature training has been carried out but that the risk assessment has not been updated. Relatives mentioned the need to improve administration within the home. The need for improvement in this was evidenced throughout the inspection and the manager agreed. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 27 Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 28 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 1 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 3 X X 2 X Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 29 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. Timescale for action 30/08/07 2. YA6 15 All essential information relating to the support needs of a service user must be available for reference at all times Requirement issued 31.8.07 with time scale for completion of 11.9.06 and not met 30/09/07 3. YA9 13 (4) Risk assessments must be carried out to support all identified behaviours and activities. Requirement issued 31.8.07 with time scale for completion of 18.9.06 and not fully met. 30/09/07 4 YA20 13(2) Steps must be taken to improve systems relating to the administration of medication to ensure that people living at the DS0000020539.V336787.R01.S.doc 30/08/07 Severn Cottage & Rose House Version 5.2 Page 30 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. 5 YA23 13(8) On any occasion on which a 30/08/07 service user is subject to physical restraint, the registered person must record the circumstances, including the nature of the restraint and report this without delay under Regulation 37 to CSCI. New requirement arising from this inspection. 6 YA24 13(4) Steps must be taken to ensure that flooring provided is not a trip hazard. New requirement arising from this inspection. 30/09/07 7 YA33 18 (1) (a) Staffing levels must reflect the assessed needs of service users. Requirement issued 31.8.07 with time scale for completion of 11.9.06 and not met. 30/09/07 8 YA34 19 Sch 2 (2)(a)(b) In the event of receipt of 30/08/07 information relating to a prior criminal conviction steps must be taken to ensure the person is fit to work at the care home to protect vulnerable adults as far as possible. New requirement arising from this inspection. 9 YA42 23(4) Steps must be taken to ensure the following: • • Adequate precautions against the risk of fire Reviewing fire precautions 30/09/07 Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 31 • 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. 10 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. 30/08/07 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 YA22 Good Practice Recommendations 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. 2 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. Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Severn Cottage & Rose House DS0000020539.V336787.R01.S.doc Version 5.2 Page 33 - 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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