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Inspection on 05/12/05 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 5th December 2005.

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 no outstanding requirements from the previous inspection report, but made 11 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

The manager and the staff team are able to offer a flexible and responsive service to service users and look creatively at providing alternatives when the needs of service users change. Risk assessments effectively support changes.

What has improved since the last inspection?

The flat currently occupied by one service user has been reassessed for suitability and another flat has been identified as a result. Work has almost been completed to make this new flat ready for occupancy.

What the care home could do better:

The maintenance of records and essential documentation requires attention by the manager to ensure she meets her responsibilities as the registered manager of the home in this area and ensures that service users rights and the homes responsibilities are made clear. Likewise policies and procedures must be kept up to date and regularly reviewed for accuracy and relevance to the service offered at 4 Forbes Close. Three of the eleven requirements made as a result of this inspection relate to the flat soon to be made available to one service user and will be considered at the time of the variation of registration of the home. The remaining requirements relate to health and safety issues and the production of essential documentation.

CARE HOME ADULTS 18-65 Care ( 4 Forbes Close) 4 Forbes Close Ironbridge Telford Shropshire TF7 5LE Lead Inspector Terry Woods Announced Inspection 5th December 2005 09:30 Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 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.V260538.R01.S.doc Version 5.0 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.V260538.R01.S.doc Version 5.0 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) Jacqueline Ann Hobbs Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2005 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 ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection of 4 Forbes Close took place during the morning of 5th December 2005. The inspector spoke with one service user, the registered manager and the staff member on duty. It is important to read this report in conjunction with the previous one published in June 2005, which was carried out in the afternoon and early evening when all three service users were at home. On this occasion the inspector focussed on documentation and reviewed records in general and more specifically, records, risk assessments and the accommodation of one service user who has recently moved into his own flat. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 6 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.V260538.R01.S.doc Version 5.0 Page 7 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): 1, 2 & 5 The maintenance of documentation identified within this section is poor and in some cases, such as the statement of terms and conditions, may not have been produced at all. EVIDENCE: There have been no recent admissions to the home. A room however has become vacant following one service user moving into his own flat. The flat is physically a part of the Wrekin Cottage unit although this had been made independent and is managed and staffed from 4 Forbes Close. The manager reported that two prospective individuals have shown an interest in moving to the home from other areas within the local ‘CARE’ service (Cottage and Rural Enterprises Ltd) and will be considered and assessed for suitability. One service user in residence said that they would want a female person to share with them this time, due to issues of incompatibility with the previous male resident. This will also increase the number of residents that the home is registered to take from three to four. In this case the Commission for Social Care Inspection will expect an application to vary the registration from the home prior to any further admissions being made. It was noted that initial discussions have already taken place between the Commission for Social Care Inspection and ‘CARE’ management. A basic needs assessment review has been completed in respect of the service user living in the flat. This however was compiled as part of a funding review request presented to Social Services for additional support hours. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 8 The home’s statement of purpose needs to be amended fully to take into account the use of the flat as a part of the provision at 4 Forbes Close. It is also noted that this document still makes reference to the National Care Standards Commission as the regulatory body. There are contracts in place between the placing authority and the organisation in respect of service users, but the manager and staff member had no knowledge of a statement of terms and conditions being made available between the home and each resident. The existence of this document is particularly relevant with regard to the service user in the flat who has experienced major service changes in recent months. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 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 the following standard(s): 6&9 Service users are supported to take risks while receiving the support they need. EVIDENCE: Recently reviewed risk assessments are in place to support one service user to move to a second, more appropriately positioned and ‘fitted out’ flat in terms of maintaining the kitchen, carrying out personal laundry and keeping the bathroom clean. A risk assessment to support one service user on a self-catering holiday, which took place in May of this year with two staff, was also seen. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 10 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): 17 The meals at the home are good offering choice and variety to promote a balanced diet. The system for monitoring and recording food consumed throughout the home is inconsistent EVIDENCE: The main meal of the day is provided on site in the dining hall. The menu sets out two choices on offer and one service user confirmed this and was able to report on both dishes and of the selection that she was to make. She also spoke of the use of the microwave oven for snack type meals at home in the evening. A record of food was available concerning the two remaining service users at 4 Forbes Close. The manager reported however that such records concerning the service user in the flat were taken by him and kept in his own ‘filing system’. She was reminded of her duty to keep a record of food consumed in the home, which must include that of the service user in the flat. It was suggested that a small lockable single drawer filing cabinet within the flat area might be the solution to prevent records ‘going missing’. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 11 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): 20 Generally a safe and effective system for the administration of medication is employed with correct records kept. There is no policy in the home concerning the administration of Prescribed As Needed (PRN) medication EVIDENCE: The two service users at 4 Forbes Close do not have prescribed medication. The individual in the flat however has his administered from the medicine cabinet at 4 Forbes Close. This is taken over to him each evening together with the required dosage for the following morning for him to self medicate. An assessment of this process has been completed by the service user’s ‘GP’. A letter was seen from the ‘GP’ confirming that in his professional opinion the described process is safe and appropriate for this particular service user. Records were seen to be well kept. Advice was sought from the inspector with regard to installing an appropriate and lockable medication cabinet in the flat given the ‘home alone’ situation of the service user. The use of such a cabinet must be risk assessed and only installed if it is determined to be safe, particularly as the service user is unsupervised for long periods of time. Prescribed As Needed (PRN) medication such as paracetamol is used at the home. There are guidance documents from the Royal Pharmaceutical society Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 12 and the Telford and Wrekin Primary Care Trust however the home does not have a policy with staff guidance specifically for 4 Forbes Close and in respect of those in residence. The manager has attended a course leading to the certificate in the safe handling of medicines. The support worker has also signed up to this programme and has completed two of the five modules. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 13 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 The complaints book format is inappropriate and not service user friendly The home does not have its own Abuse / Adult Protection Policy on site EVIDENCE: There have been no complaints received by the Commission for Social Care Inspection during the past twelve months. The complaints book showed three complaints received by the home in 2005. The detail reported that these were appropriately managed by ‘CARE’. Letters of satisfaction from the complainant also supported the outcome of one complaint. The complaints book is inappropriately set out and contains too much detail. The confidential content is such that it requires secure storage. The inspector noted that the complaints book was removed from the home at the beginning of the inspection and confirmed by the manager as being empty. This was returned later with details of the three complaints dating back to May 2005. The manager was able to describe a more appropriate format to adequately record sufficient detail, which would clearly identify the outcome and action taken. It is also noted from conversation with staff that the identified complaints book is not currently used to record service users’ concerns. The home has a copy of the Multi Agency Adult Protection Policy however the manager could not produce the home’s own policy on Adult Abuse or that of the ‘Care’ organisation. The manager and support worker both completed training with regard to the Protection of Vulnerable Adults in September 2002. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 14 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 The ‘flat’ environment is being improved to an acceptable standard that will meet the individual service user’s needs EVIDENCE: It is noted that there had been no changes to the home since the time of the last visit. There were shortfalls identified at the previous inspection in this standard, which related to the flat and not 4 Forbes Close. These have been addressed by identifying an alternative flat in closer proximity and in full view of the main bungalow. This inspection therefore focussed on the progress being made to the new flat. With the flat being supported by 4 Forbes Close it is noted that the new site is now fully in view and overlooked and anyone entering or leaving the flat could clearly be seen. As a security measure and prior to the service user moving in an appropriate lock is to be fitted to the door leading from the cottage to the flat. It is noted that whilst this must prevent anyone entering the flat uninvited, this is a fire exit for people in the Wrekin Cottage unit and the local fire officer must approve the fitting of any security device. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 15 The front door is also a fire exit and it remains difficult to establish what would happen if the service user went out of his front door at night after the evening check to secure the premises at 2100 hrs has been made. The arrangements for emergency support are through the use of the telephone. The numbers to ring are written down although these are not clear and the manager and support worker was not able to immediately recognise them. The kitchen in the new flat has been refurbished to best utilise the space available. Hot water is supplied to the flat via the heating system of the Wrekin Cottage unit. The hot water temperature at the sink and wash hand basin is not controlled locally and a risk assessment is needed and a process of monitoring in place to ensure the service user’s safety. The cooker had been removed and a microwave oven made available for use with support. A new fridge with a small freezer compartment has been installed and the plumbing had been completed to accommodate a new washer / dryer. The bathroom is in the process of refurbishment. Tiling, the arrangements for showering and the covering of the radiator remain outstanding. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 & 35 It remains difficult to establish whether the level of support afforded service users is adequate given that the general philosophy of the home is heavily biased towards promoting independence. EVIDENCE: Through comments made by the manager it is evident that staff work flexibly to ensure that service users receive the best quality of service. There is also evidence on the rota with regard to 4 Forbes Close that this is the case. ‘CARE’, however have been unable to recruit permanent staff to support the service user in the flat and use agency workers for this provision despite additional funding being made available. The rota confirmed that this arrangement provides 1-1 support for two hours during each evening and for five hours on Sunday afternoon. 2-1 support is also provided for three hours on Saturday afternoon to go shopping and the manager said that one staff member would stay for an additional two hours but this was not reflected on the rota. The remainder of the time after Day Services is spent home alone. There is a ‘home alone’ agreement in place concerning the service users and a lone working risk assessment has been completed for supporting them in the community. There is however no lone working policy in place with regard to the flat for the support and protection of both the staff member and the service user. The inspector discussed the need for a risk assessment to be Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 17 completed and dependant on the outcome, control measures put in place to include possibly a ‘walkie talkie’ device or panic button / alarm installed The ‘Care’ staff training record showed that both the manager and the support worker have benefited from a comprehensive programme provided by the organisation. Recent courses include moving and handling, equal opportunities, relationships and sexuality and basic first aid refresher. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 41 & 42 Current management changes are impacting negatively on the manager’s responsibilities within the home. EVIDENCE: The manager informed the inspector on the day that she is being made redundant in February 2006. The organisation must provide the Commission for Social Care Inspection with full details of any proposed changes to the environment that will affect the current registration of 4 Forbes Close. Again it was noted that discussions have already taken place between Commission for Social Care Inspection and ‘CARE’ management. Health and safety issues have been addressed throughout the report and requirements made as necessary in the relevant standards. Samples taken concerning the records, policies and procedures kept at the home as previously identified reveal that attention is needed to bring them to the standard required by the Care Homes Regulations 2001. (See Standards 1, 5, 17, 20, 22, 23 & 33) Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 19 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 2 3 x x 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 2 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Care ( 4 Forbes Close) Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 2 2 x DS0000020539.V260538.R01.S.doc Version 5.0 Page 20 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 YA1 Regulation 4 Requirement The home’s statement of purpose must be reviewed and amended fully to take into account the use of the flat as a part of the provision at 4 Forbes Close. The home is required to provide all service users with a written statement between the home and each individual setting out the terms and conditions of residence. The home is required to keep a record of food consumed in the home, which must include that of the service user in the flat. The home is required to provide a policy and staff guidance concerning Prescribed As Needed (PRN) medication The home is required to provide complaints record in a more appropriate format, which is service user friendly, adequately records sufficient detail and clearly identifies the outcome and action taken. The Abuse Policy must be updated to reflect current adult protection arrangements and DS0000020539.V260538.R01.S.doc Timescale for action 09/01/06 2 YA5 5.b 09/01/06 3 YA17 17.2 Schedule 4.13 13.2 12/12/05 4 YA20 12/12/05 5 YA22 17.2 Schedule 4.11 12/12/05 6 YA23 13 (6) 25/07/05 Care ( 4 Forbes Close) Version 5.0 Page 21 7 YA24 23.4.b 8 YA24 13.4.c 9 YA24 13.4.a 10. YA32 18 (1) (a) 11. YA33 18 (1) (a) procedures and a copy kept in the home. The home must ensure that any security device fitted to a designated fire exit is approved by the local fire officer The home must ensure that the arrangements in the flat for emergency support are clear and easy for the service user to understand The home must ensure that the hot water temperature at the sink and wash-hand basin in the flat is risk assessed and a process of monitoring the temperature is in place to ensure the service user’s safety. 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 working policy to ensure appropriate support and protection for staff and service users. 12/12/05 12/12/05 12/12/05 18/07/05 18/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA17 YA23 Good Practice Recommendations It is recommended that a small lockable single drawer filing cabinet is kept within the flat area to securely store records It is recommended that both the manager and support worker complete a training course update with regard to the Protection of Vulnerable Adults2002. Care ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 22 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 © 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 ( 4 Forbes Close) DS0000020539.V260538.R01.S.doc Version 5.0 Page 23 - 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!