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Inspection on 23/06/05 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 June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

4 Forbes Close offers service users the opportunity to live semi independent lives, taking an active part in on site activities and accessing community resources. Two service users are now in paid employment as well as pursuing college courses and participating in other valued daytime activities. Staff facilitate these opportunities and provide flexible support. Staff and management are to be commended for their role in facilitating and encouraging family support and contact. The new quality assurance process fully involves service users and consists of regular meetings to review each section. Incentives are offered to attend the meetings and this arrangement reflects the importance that the organisation places on obtaining service user views.

What has improved since the last inspection?

Since the time of the last inspection of the home the manager has successfully completed the registration process with CSCI to be the `registered` manager of the home. One service user has moved out of 4 Forbes Close due to increased support needs and associated difficulties. He is now living in a nearby flat attached to Wrekin Cottage. This flat is supported by the manager and staff team at Number 4 and the organisation is seeking a variation to their registration to accommodate the changes. The outcome of this move has proved positive for all service users.

What the care home could do better:

The support of the man living in the flat is not yet being funded appropriately and this is impacting on staffing arrangements. Until the placement is secured the organisation is unable to employ additional staffing. The implications are that existing staff (i.e. the manager and a support worker) are covering additional shifts and agency staff are being used on order to maintain support to all service users. The home will be able to improve this situation once funding is agreed.The inspector would like to thank everyone for their support and hospitality during the inspection.

CARE HOME ADULTS 18-65 Care (Forbes Close) 4 Forbes Close Ironbridge Telford TF7 5LE Lead Inspector Sue Woods Unannounced 23 June 2005 13:00 rd 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 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 Stationary 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. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Care (Forbes Close) Address 4 Forbes Close, Ironbridge, Telford, Shropshire, TF7 5LE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01952 433653 01952 432209 CARE (Cottage and Rural Enterprises Ltd) Jacqueline Ann Hobbs Care Home 3 Category(ies) of Learning Disabilities (3) registration, with number of places Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 29th November 2004 Brief Description of the Service: Number 4 Forbes Close is part of a small complex providing care to adults with learning disabilities. The site comprises of 2 large bungalows providing 14 and 16 places respectively, a smaller bungalow providing 3 places (4 Forbes Close), a ‘workshop’ and a communal dining room. 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, 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 of the home is Ms Jacqueline Hobbs. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of 4 Forbes Close took place during the late afternoon and early evening of 23rd June 2005. The inspector spoke with service users, the acting residential services manager and the staff member on duty. The inspector reviewed records and risk assessments of one service user who has recently moved into his own flat. What the service does well: What has improved since the last inspection? Since the time of the last inspection of the home the manager has successfully completed the registration process with CSCI to be the ‘registered’ manager of the home. One service user has moved out of 4 Forbes Close due to increased support needs and associated difficulties. He is now living in a nearby flat attached to Wrekin Cottage. This flat is supported by the manager and staff team at Number 4 and the organisation is seeking a variation to their registration to accommodate the changes. The outcome of this move has proved positive for all service users. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 6 What they could do better: The support of the man living in the flat is not yet being funded appropriately and this is impacting on staffing arrangements. Until the placement is secured the organisation is unable to employ additional staffing. The implications are that existing staff (i.e. the manager and a support worker) are covering additional shifts and agency staff are being used on order to maintain support to all service users. The home will be able to improve this situation once funding is agreed. The inspector would like to thank everyone for their support and hospitality during the inspection. 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. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Service users are confident that they will get on with any new admissions to the home as they feel ‘listened to’ and take an active part in the service user focussed process. EVIDENCE: Although there have been no recent admissions to the home there are plans for the vacancy at number 4 following a service user moving into his own flat to be filled. CARE has a procedure for advertising the vacancy and asking interested parties to ‘apply’ to be considered for the place. Service users told the inspector that they are going to be involved in this process and are putting together details of whom they would like to live with. The procedure has been previously reviewed by the inspector at a satellite care home and it had proved effective. Prospective service users have the opportunity to visit and stay at the home before a final decision is made. Service users living at the home are fully involved in this process. Both service users are looking forward to another woman moving in to fill the vacancy. The homes statement of purpose was seen readily available at the home but was not reviewed by the inspector as it is acknowledged that it will be reviewed to include current accommodation arrangements and details of the homes variation of registration. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Service users lead full and active lives while receiving the support they need. EVIDENCE: The inspector spoke at length with service users living at 4 Forbes Close both in a group discussion and individually. Care plans were not formally reviewed however service users were able to tell the inspector about the content of their plans including daily and weekly routines. Service users gave numerous examples of how they are consulted about decisions of daily living and were happy to say that they went shopping together on Saturday mornings and then spent time doing domestic tasks in the afternoon. Service users also spoke of future plans to access new courses at college and identified that the manager and staff member help them to review their plans. Service users informed the inspector about how they share their views in relation to the service that they receive. One service user spoke of attending quality assurance meetings and another spoke of her relationship with the manager and staff enabling her to share her feelings and thoughts. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 10 One service user was able to move into a flat of his own and the inspector reviewed the risk assessments in place to support this move. It was positive that the assessments were enabling although it was acknowledged that they needed to be continually reviewed to ensure all risks are identified and appropriate safeguards identified and implemented. Service users spoke positively about having their own bank accounts and enjoyed their weekly trip to make withdrawals. Both stated that they manage their own money and are supported to budget for the week. Two service users have bus passes. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16 Service users are enabled to participate in the community-based activities that they enjoy allowing them a good quality of life. Service users value the homes commitment to promote and encourage and develop family relationships as they are enabled to maintain contact by visits or by letter. EVIDENCE: On the day of the inspection service users were preparing for a sponsored bike ride taking place the following day. It was positive to see that everyone was excited about the event and raising money for the ‘amenities fund’. Service users informed the inspector that they were planning a picnic lunch and a visit to the pub afterwards. One service user was particularly excited about being asked to speak about the event on the local radio station. The residential services manager and the staff member on duty detailed how they had re-established contact with the family members of one service user Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 12 and detailed the positive impact this is having on him. Discussions detailed that staff had approached the situation with sensitivity and understanding. In addition to this work staff also support other service users to develop the contact that they have with their family members. CARE organises family forums where staff can question management about the services offered and discussions with staff and service users detailed events such as charity auctions and themed evenings where family and friends of service users are invited to share the events. There is also a self-contained flat where family and friends can ‘stop over’. Service users told the inspector that they had not decided what they wanted for tea and stated it depended how they felt later as to what they ate. Service users told the inspector that they had enjoyed their holiday to Weymouth in May. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 Service users privacy and dignity is maintained as staff offer personal care and support in a discreet and sensitive manner. EVIDENCE: During the inspection staff were observed to offer personal care and support in a discreet and sensitive manner. During private discussions service users informed the inspector that they were very happy with how staff supported them and felt that they could talk to them if they had a problem. There is evidence that staff have worked additional hours to ensure that service users receive all of the support they need. This demonstrates the commitment of the staff team to the service users that they support. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Management demonstrate an awareness of the referral to POVA procedures and are competent to use them appropriately to protect service users. EVIDENCE: Service users felt that they were safe living at 4 Forbes Close and were able to talk to staff if they had a problem. Through discussions it was evident that leading up the crisis which led to one service user moving out of the house, staff had picked up that ‘all was not well’. The incident that followed was appropriately referred to the Protection Of Vulnerable Adults process and appropriate action was taken to safeguard all service users involved. The following requirement was carried forward from the last inspection of the home but not reviewed on this occasion.It will therefore be carried forward and reviewed at the time of the next inspection of the home; ‘The Abuse Policy must be updated to reflect current adult protection arrangements and procedures’. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 The standard of the environment within the home is good, providing service users with a warm, safe and homely place to live. The flat currently occupied by the third service user does not have adequate facilities to support his needs and as a result he is vulnerable. EVIDENCE: Service users stated that there had been no changes to their home since the time of the last inspection. At the time of the inspection one service user was living in a flat attached to Wrekin Cottage. It is not currently part of the registration of 4 Forbes Close however it was visited by the inspector given that the team at Number 4 are supporting the service user to live there and it had not been inspected as part of Wrekin Cottages recent inspection visit. The flat had been personalised with the service user’s belongings. He told the inspector that he liked the colour scheme throughout his home. A couple of concerns relating to the suitability of the flat however were raised. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 16 Given that the flat is supported by 4 Forbes Close it was noted how isolated the front door was. It would be difficult for anyone to see who was entering or leaving the flat and staff felt that the service user was vulnerable as a result. Also the door leading from the cottage to the flat is a fire door and thus cannot be locked. This means that someone could enter the flat uninvited. It was difficult to establish what would happen if the service user went out of his front door at night after the evening check to ‘lock the door’ had been made. There was also a lock on his lounge door which could result in the service user getting locked out if he went to the bathroom at night. Arrangements for emergency support need formalising. Risk assessments are available to support issues raised although do not cover this issue. The kitchen in the flat was in need of refurbishment to best utilise space available. The cooker had been disabled and a new fridge was required. If this flat is to be used consideration must be given to all issues raised above and also the increase in staffing to ensure appropriate support and monitoring is implemented. Formal arrangements for ensuring that any requirements made during the fire officers inspection are shared with the appropriate manager. It was noted that there were no laundry facilities within the flat. Current arrangements to use the on site facilities are proving time consuming and staff input is required. This arrangement must be reviewed and additional staffing made available to support the service user to go and do his washing or a machine be installed in his flat to promote his independence. (The on site laundry facilities were not reviewed for suitability at the time of this inspection). The shortfalls identified in this standard relate to the flat and not the main house. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36 Time and quality of support to service users is being compromised by the current constraints placed upon the staff team. Effective supervision and monitoring enables staff to feel well supported. EVIDENCE: Through comments made by staff and service user it was evident that staff work flexibly to ensure that service user receive the best quality of service. Recent changes in relation to the service user moving into the flat have impacted considerably on the staffing levels. CARE has been unable to recruit for staff to support the service user in the flat as the funding has yet to be agreed. Everyone agreed that this was ‘sometimes difficult’. This arrangement must be resolved without delay especially as community visits currently require 2:1 support. There is evidence on the rota that some shifts are covered by agency staff and it was positive to note that there was consistency in who was sent. Staff support agency staff and the staff member on duty stated that the manager does an induction with agency staff. The staff member on duty stated that she felt well supported and supervised. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,42 The systems for service user consultation are good with evidence suggesting that their views are sought and acted upon. The manager is approachable and supportive, having a positive impact on staff and service users The lack of an appropriate lone working policy could make staff and service users vulnerable. EVIDENCE: Since the time of the last inspection of the home the manager has been registered with the Commission for Social Care Inspection. The manager was not on duty at the time of the inspection but from comments made by senior managers, staff and service users it is evident that she is committed to her role and has been proactive in developing care plans and writing risk assessments. Service users found the manager to be ‘nice’ and easy to talk to. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 19 The new quality assurance process fully involves service users and consists of regular meetings to review each section. Service users stated that they had just been supported to complete questionnaires. The acting service manager stated that service users were offered incentives to attend the meetings and attendance has improved since a bottle of wine and a takeaway afterwards has been introduced. This arrangement reflects the importance that the organisation places on obtaining service user views. Through discussions both service users knew what the quality assurance meetings were all about and stated that they had contributed to the meetings. The content of the quality assurance programme was not reviewed at the time of this inspection. Following discussions with the staff member on duty it was identified that a lone working policy should be developed specifically for when working with the service user living in the flat. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 4 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 4 3 x Standard No 31 32 33 34 35 36 Score 3 2 x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Care (Forbes Close) Score 4 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 2 x E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 23 Regulation 13 (6) Requirement The Abuse Policy must be updated to reflect current adult protection arrangements and procedures. The flat currently occupied by one service user must appropriately meet his assessed needs. Suitable facilities must be available for service users to store food that requires refridgeration and to wash clothes. There must be sufficient staff, with relevant experience, on duty at all times, to adequately meet the needs of all service users. The home must develop and implement a lone workingpolicy to ensure appropriate support and protection to servic eusers and staff. Timescale for action 25/07/05 2. 24 23 (1) (2) 08/08/05 3. 30 16 (2) (g)(f) 18/07/05 4. 32 18 (1) (a) 18/07/05 5. 42 18 (1) (a) 18/07/05 Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 22 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 Good Practice Recommendations There were no recommendations made as a result of this inspection. Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Shrewsbury SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Care (Forbes Close) E56 S20539 Forbes Close V221517 UAI 230605 Stage 4.doc Version 1.30 Page 24 - 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!