CARE HOME ADULTS 18-65
Care ( 4 Forbes Close) 4 Forbes Close Ironbridge Telford Shropshire TF7 5LE Lead Inspector
Sue Woods Key Unannounced Inspection 30th May 2006 02:45 Care ( 4 Forbes Close) DS0000020539.V292347.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 Care ( 4 Forbes Close) DS0000020539.V292347.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. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Care ( 4 Forbes Close) 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) Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Number 4 Forbes Close (Now known as Rose Cottage) 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. There is currently no registered manager for the home. Management responsibilities are being carried out by the current manager of Severn Cottage, reflecting the forthcoming change of registration. Information is shared with service users in the service user guide and during house meetings that are held on a regular basis. The current range of fees for service users living at Rose Cottage is from £446.60 to £474.92. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of 4 Forbes Close (now known as Rose Cottage following consultation with service users living at the home) was carried out 30th May 2006 from 2.45 pm until 6.30 pm. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector spoke with both service users living at Rose Cottage and a staff member, the acting manager and two parents who were visiting the home at the time of the inspection. The inspection also involved a review of records including care plans, rotas and health and safety information. The acting manager of Rose Cottage was supportive and fully cooperative. Prior to the inspection the inspector visited the main office on site on 23rd May 2006 to review staff files and training records that are currently kept centrally. What the service does well:
Service Users enjoy living at Rose Cottage. They lead full and active lives with minimal staff support. Staff are responsive to individual needs and offer flexibility in their working hours to accommodate activities. Staff files are well organised and CRB disclosures are reviewed and updated on a regular basis. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Now that management arrangements are in place and a full staff compliment has been achieved a system of regular and recorded supervision should be introduced. Following discussions at the time of the site visit it was agreed that the fire evacuation risk assessments would be reviewed and updated with the manager obtaining information from the fire officer (if possible) to support the plan. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 7 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 ( 4 Forbes Close) DS0000020539.V292347.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 Care ( 4 Forbes Close) DS0000020539.V292347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An effective admissions process is in place to ensure that the home will be able to meet the assessed needs of service users admitted. Service users have statements of terms and conditions that outline the cost of the service and what they get for their money. EVIDENCE: There have been no recent admissions to the home although the process of ‘trial visits’ has started to introduce a new person to live at Rose Cottage. The introductory process is well planned and follows a format successfully used at another home managed by CARE. Service users currently living at Rose Cottage said that they are being fully involved and consulted. The newly implemented person centred planning process ensures that individual needs and wishes are identified and plans are implemented around these. These plans would be used for any new admissions top the home. Care ( 4 Forbes Close) DS0000020539.V292347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are identified and met through effective person centred plans. Service users are involved in all decision-making processes. Risk assessments safely support service users however one assessment may not fully cover all eventualities in the event of a fire. EVIDENCE: The care plan reviewed contained information relating to health and personal support needs, goals and activities. The content of the plans was reflected in the individual conversation held with the service user. One service user spoke to the inspector at length and explained how she is involved in all decisions made that affect her within the house. She said that she is involved in ‘house meetings’ and always decides what she eats. Both service users have definite ideas of whom they would like to share their house
Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 11 with and it was positive to note that the manager was listening to these wishes. The manager stated that service users now have a key worker and following discussions with the parents of one service user it was agreed that this would improve communication in the future. Risk assessments were seen to be in place and the manager stated that she would ensure that personal risk assessments are kept on individual files. There was evidence that all risk assessments had been reviewed by the assistant home manager, however through discussions it was identified that one risk assessment should be further reviewed as there were doubts raised about the effectiveness of the fire evacuation plan. The manager committed to do this without delay. (See requirement standard 42). Care ( 4 Forbes Close) DS0000020539.V292347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users participate in the community-based and in house activities allowing them a good quality of life. EVIDENCE: One service user spent time with the inspector telling of her work placement and college course. She also spoke of being able to relax in the evenings watching the soaps and doing her jigsaw puzzle. The service user said that things are ‘fine at home’ and spoke positively about the woman that she shares a house with and the person who came for a trial stay. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 13 The service user is currently looking forward to her forthcoming holiday to Wales and discussed staffing support for this holiday with the home manager during the inspection. One service user returned form a trip to her family home over the bank holiday weekend. She stated that she had enjoyed her time away and spent time with her family unpacking and sorting things out in her room. The activity record of the service user case tracked reflected a variety of activities that included seeing friends. Both service users manage their own money. Care files contain records of foods eaten. During discussions with one service user it was identified that staff support service users to have a healthy diet. The service user stated that she had enjoyed a curry last night. The minutes from house meetings reflected that both service users had agreed not to buy sweets and cakes for a while in order not to be tempted by them in the house. This was confirmed during discussions with the service user. Care ( 4 Forbes Close) DS0000020539.V292347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person centred and flexible support enables service users to access health care appointments with appropriate records kept. . EVIDENCE: Care files detail any health care needs of service users and appointments are recorded. Both service users are currently enjoying good health and do not require any regular medication. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Effective adult protection procedures ensure that the agency operates in the best interests of service users. The new complaints policy and procedure will provide an effective record of complaint investigation and monitoring. EVIDENCE: The inspector spoke with the operations manager prior to the inspection who detailed the new Abuse Policy and how he had referred to it while making a recent referral to the adult protection team. The manager of the home had knowledge also of this new policy and had obtained a copy of the multi agency adult protection guidelines. On the day of the inspection the manager had received training in relation to the new complaints policy and procedure. She was able to detail new arrangements in relation to the recording and investigation of complaints. The old complaints book will now be replaced with a new one to ensure confidentiality of information in the future. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good, providing service users with a warm, safe and homely place to live. EVIDENCE: All areas of the home seen by the inspector were well decorated and clean. No hazards were identified. Bedrooms were personalised and communal areas were well-organised and contained evidence of in house hobbies and pass times. For example the jigsaw on the table in the lounge. Records suggest that personal protective equipment is purchased for the home and cleaning products are stored securely and appropriate documents to support their use were available for review. Service users had keys to their rooms and one service user had secured her room before she want away. Both service users had front door keys. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 17 Service users have jointly purchased a direct telephone line and an agreement to pay for this was seen on the care file reviewed. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have benefited from flexible staffing levels within the home. Service users benefit from staff receiving good training opportunities. Staff will benefit from a system of regular recorded supervision with their manager or senior. Robust recruitment and selection procedures protect service users. EVIDENCE: The inspector spent time talking with the staff member on duty at the time of the inspection and the manager of the home. Both were positive and enthusiastic about their roles. The training record of the other member of staff working at Rose Cottage was reviewed and found to contain up to date information demonstrating the staff member had participated in all essential mandatory training. Discussions with the staff member on duty reflected also that she had good access to training opportunities and a document on the wall reflected forthcoming training events that she was booked onto.
Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 19 The member of staff on duty had not received formal supervision from her manager however felt well supported by the assistant manager who is based at the home. It was evident through conversations that communication between staff at the home was good and service users had access to staff at all times for help and support. Staff files were reviewed on 23rd May. All files reviewed contained all essential information and the administrator was well organised and in the process of updating staff CRB disclosures. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An open approach from staff and managers and full consultation enables service users to feel well supported by managers and staff. Managers and staff have implemented and maintained systems to safeguard service users. EVIDENCE: Since the registered manager of the home was made redundant Rose Cottage has been managed by the manager of Severn Cottage and this arrangement is to continue when the two houses will form one registration. (Subject to receipt of an appropriate variation of registration application). The manager has supported the assistant manager to review all paperwork In line with that used at Severn Cottage and there is evidence that this process is well under way. Improvements to recording and monitoring especially of health and safety requirements was noted and care plans are more person
Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 21 centred. Some duplication was noted and it was recommended that unnecessary paperwork be removed. There was evidence that risk assessments are used to support activities and the manager is requesting that individual risk assessments are placed on individual files. One fire evacuation risk assessment is in need of review following information shared at the time of the inspection. The manager committed to do this as a priority.(see standard 9). COSHH data sheets and risk assessments were available for review. Only limited COSHH products are used supporting the independence of the service users. Fire safety checks are carried out at appropriate intervals. The manager is to remove all disused paperwork to avoid confusion. Service users are fully consulted in all aspects of the running of the home. Conversations with service users and staff and through review of minutes of house meetings all confirm this. Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 22 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 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 2 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 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x 3 2 x Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 23 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 YA42 Regulation 13 Requirement The manager must review the fire risk assessment for one service user to ensure a safe evacuation route would be available in the event of a fire. Staff must receive regular, recorded supervision with their manager or senior at least six times a year. Timescale for action 08/06/06 2 YA36 18 (2) 21/06/06 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 YA41 Good Practice Recommendations It is recommended that unnecessary or duplicate information is removed to avoid repetition or confusion Care ( 4 Forbes Close) DS0000020539.V292347.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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