Inspection on 02/11/06 for The Cottage

This inspection was carried out on 2nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cottage 05/02/09

The Cottage 14/02/06

The Cottage 27/09/05

The Cottage 08/03/05

The Cottage 05/08/04

The Cottage 23/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Cottage 51/53 High Street Brightlingsea Essex CO7 0AQ Lead Inspector Kathryn Moss Key Unannounced Inspection 2nd November 2006 10:15 The Cottage DS0000017960.V318666.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 The Cottage DS0000017960.V318666.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. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Address 51/53 High Street Brightlingsea Essex CO7 0AQ 01206 303676 01255 821629 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) Mr Roy Bellhouse Mr Roy Bellhouse Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: The Cottage is a registered care home based in a detached grade 2 listed period property situated close to Brightlingsea town centre. It has six single occupancy bedrooms and two double bedrooms, two communal lounges and a separate dining area, kitchen and laundry facilities, two bathrooms and a shower room, plus additional toilets. The home has front and rear access, with a side parking area and a rear garden. The Cottage provides 24-hour residential care and accommodation for up to ten adults with learning disabilities, both male and female. The home is not suitable for anyone with mobility difficulties as access to the first floor is by stairs only, there are no assisted bathing facilities, and the accommodation does not have level access throughout. The home is jointly owned and run by Mr Roy Bellhouse and Mrs Lynda Bellhouse, with Mr Bellhouse being the registered provider and registered manager. For the purpose of this report, the term ‘proprietor’ has been used to denote information provided by either proprietor during the inspection. Two senior staff are currently completing the Registered Manager’s Award with a view to becoming the managers of the homes: for the purpose of this report the term ‘trainee manager’ has been used to denote either of these members of staff. The inspector was advised that the people living in the home refer to themselves as ‘residents’, and so this term will be used in this report. A statement of purpose and service user guide are available at the home. Current fees at the home range from £400 to £700 per week. The Cottage DS0000017960.V318666.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 that took place on the 2/11/06, lasting seven hours. The inspection process included: • • • • • • Discussion with both proprietors and the two trainee managers; Discussions with two staff; Discussions with three residents and time spent with or observing other residents. An inspection of the communal areas; Inspection of a sample of records; Feedback questionnaires received from two residents and two relatives at the time this report was completed. 28 Standards were covered, and 3 requirements and 12 recommendations have been made. On the day of this inspection, the home was maintained in a good condition. There were 10 service users living in the home: clients were receiving good care and support, and those spoken to enjoyed living at The Cottage and were positive about the staff team. What the service does well: What has improved since the last inspection? In line with recent NHS initiatives, staff from the home had obtained Health Information Files for clients with Learning Disabilities, and the home was in the process of implementing these for residents in order to ensure that full and The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 6 clear health information was available in the home. One senior staff member has taken lead as health facilitator for the home, and plans were in progress to do some specific health awareness work with female residents in the home. The home had provided a resident with excellent support during a recent hospital admission. The staff were in the process of implementing ‘Life Plans’ for residents, incorporating information on life histories, likes and dislikes. These will be good for identifying people’s hopes and aspirations, and will complement the existing care plans. Since the last inspection staff had completed their NVQ training, and the trainee managers had almost completed the Registered Managers Award. Staff had also completed some dementia care training, and had received training in moving and handling. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an admission process that ensures that prospective service users’ needs are assessed (and includes opportunity for them to visit the home), enabling both staff and clients to be confidant that the home can meet their needs. EVIDENCE: The home has a ‘statement of purpose’ and a ‘service user guide’, as required by Regulation. Both were viewed at last year’s inspections, and are available in the home; it was noted that the manager had updated the Statement of Purpose to reflect current staff training. As there had been no new residents admitted to the home over the last year, the assessment of prospective residents could not be fully assessed on this occasion. Procedures were discussed with the manager at the previous inspection, and were considered to meet the National Minimum Standard. The home continues to demonstrate that it is able to meet the needs of the people who it aims to accommodate: this was evident through service user plans, staff training, and discussion with staff and residents. The two trainee managers The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 9 were clear on the needs that the home was able to meet, especially in regard to the constraints of the environment (i.e. not suitable for people with mobility difficulties), and not aiming to accommodate people with behaviour that is too challenging. Both of the relatives who provided feedback as part of this inspection were satisfied with the care provided at the home, with one reporting that ‘our relative is being well looked after, and all their needs are catered for’. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ assessed needs are reflected in their individual plans; any risks involved in daily activities are identified and assessed in order to minimise risks and promote independence. Decision making by service users is supported and encouraged in the home. EVIDENCE: Care plans for two residents were viewed during this inspection, and took the form of an ‘Individual Planning Meeting 6 Monthly Review’ form: these detailed all aspects of daily living (including social, behavioural needs) and described how the person’s needs were met, including what the person could do for themselves. Care plans contained good information on how needs were met: although these primarily focused on the person’s day-to-day needs, the home was in the process of implementing ‘Life Plans’ (Person Centred Planning) for all residents, which included life history work and information on likes and The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 11 dislikes (what made them happy, sad, etc.). The Life Plans should help the home move towards identifying peoples’ ‘hopes and aspirations’, and will complement the existing care plans. Key workers were involving residents and their relatives in the development of these Life Plans. Individual Plans (care plans) are not currently available in alternative formats, and it is recommended that this be explored (e.g. audio or video formats, pictorial versions, supporting Life Plans with photos) to make them more accessible to individuals who cannot read. In both files viewed there was evidence that care plans had been reviewed: however, in one case the last formal review was dated May 2005, and in the other instance although the care plan had been reviewed within the last six months, it had not been updated to reflect recent changes in need following a healthcare issue. There were also ‘Individual Care Plan Progress charts’ showing evidence of additional bi-monthly reviews, but each entry only referred to a couple of issues each review (i.e. did not cover all aspects of the care plans). Staff should ensure that there is clear evidence that care plans have been reviewed at least every 6 months, and whenever needs change. Care plans were supported by appropriate assessments and risk assessments (e.g. re getting out of bath, travelling in vehicles, etc.); not all of these were dated on implementation or regularly reviewed, and staff should ensure documentation is always dated and reviewed. It was clear that residents were supported to take acceptable risks (e.g. going out independently, assisting in the home, etc.) and the proprietor was able to describe how risks had been evaluated, and any safety measures in place. Staff were observed to be alert to risks (e.g. when a resident carried a tray of cups through to the kitchen) whilst allowing people to be independent; this was good to see. On previous inspections it had been noted that the home had a missing person’s procedure. Care plans showed what people could do for themselves and how they communicated. Staff demonstrated that they were able to communicate well with service users, and that they provided residents with information appropriate to their level of understanding. This was shown by the support given to one person with a recent healthcare issue, where staff had explained the issue to them in a way that encouraged them to be as involved as possible in the decisions about their health. Daily notes reflected how people had spent their day, and showed variety and choice of opportunities: it was clear that people were choosing what to do, with several regularly going out to classes that they had chosen themselves. Staff were providing them with appropriate information to make these choices, and regular residents’ meetings encouraged their involvement in decisions about day-to-day life in the home. Two service users attended a ‘speak up for yourself’ self-advocacy group at college; support given to residents to manage their finances was not discussed on this visit. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides flexible daily routines, enabling service users to engage in educational and leisure activities of their choice. Local community resources are well used, and the home supports service users to maintain good contact with friends and relatives. The home provides a varied and healthy diet. EVIDENCE: None of the residents are currently involved in any paid or voluntary employment, although this has previously been explored with some individuals. However, many of them are attending college classes, including some educational classes (e.g. one person attends an advanced computer course at college) and other valued activities and interests (e.g. cooking classes). It was good to see a computer available in the lounge, and used by several of the residents. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 13 The home makes good use of the local community, using local shops and facilities (pubs, etc.), colleges, library, churches, and other leisure facilities. Although the home has its own transport, where able residents also make use of local transport (taxis and buses). For several years now the home has been involved in a local fundraising initiative to raise money for a cancer charity, for which they hold a coffee morning to which local people are invited. The home has raised a significant amount of money through this, with residents being enthusiastically involved in this. The home supports residents to engage in a wide range of leisure and social activities, including going out for meals, watching videos, attending college courses, walks, picnics, trips to the cinema and theatre, etc. On the day of the inspection it was noted that one person had watched a DVD, another had been out shopping, several had college courses (e.g. cookery class), and they were all due to attend a social club in the evening. All residents had been on holiday this year to a Butlins Holiday Camp, going in small groups at different times; the proprietors confirmed that this had been their choice, and had been enjoyed by them all. The home also has access to some beach huts in Clacton, and photos seen showed that these were made good use of during the summer. The home has continued to organise discos at a local church hall at intervals throughout the year, inviting people from other local homes and thereby supporting residents to meet new people and to make friendships. Family contact was recorded on residents’ files, and residents were actively supported to maintain contact with relatives. Staff took several service users to visit families or friends on regular basis, and the home is commended for facilitating this contact. One relative who provided feedback as part of this inspection stated that the staff ‘are always welcoming, warm and friendly’, and both relatives consulted felt welcome in the home at any time, and confirmed that they were kept informed of important matters affecting the resident. It was clear on the day of the inspection that the home continues to promote flexible daily routines, and that residents had choice over where and how to spend their days, and freedom of movement around the house. Many of them assisted in daily tasks and were observed making cups of tea, putting away clean laundry, etc. Although care plans identified household tasks that the person was capable of doing, they did not detail whether residents had any specific responsibility for daily tasks (e.g. for cleaning their rooms, laundry, assisting with meals, etc.). Bedrooms were not inspected on this occasion, but on previous inspections it was noted that some service users had keys to their rooms. One bathroom still had a lock that could not be over-ridden from the outside, and action should be taken to address this. Staff were observed to spend time with residents, to respect their preferred form of address, and to interact with them well and to include them in conversations. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 14 Since the last inspection the home had changed from having a set menu to asking service users for ideas and requests about meals on a daily or weekly basis. Staff felt that this made meals much more flexible, and ensured that meals are residents choices. Meals were recorded in a hard-backed book showing what was served from day to day, including individual variations: residents had been consulted on this, and those who were able had signed the back page to show their consent to their food records being written in a communal book. It was recommended that meal records should also show the vegetables served each day. Records viewed showed a good range of balanced meals being provided, with fresh fruit and vegetables readily available. Residents were complimentary about the meals provided, and were encouraged to assist with shopping and with meal preparation (where able). It was noted that meals were provided flexibly to accommodate different peoples’ routines, and that people could choose where to eat their meals (e.g. some like tea in lounge in front of TV). The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were receiving appropriate support with their personal care, resulting in personal care being well maintained. The home provided support to meet physical and emotional health needs, accessing the necessary medical support and advice to promote service users’ health. The home’s medication practices provided safe systems of storage and administration. EVIDENCE: Care plans reflected individual preferences regarding any support or assistance needed with residents’ personal care. A key worker system was in operation in the home: residents had choice over who their key worker was, and key workers observed on the inspection appeared appropriately matched and were seen to relate well to the resident. It was clear that residents were encouraged to choose their hairstyles and clothing, and peoples’ appearances were individual and age-appropriate. No specific aids or equipment are currently needed in the home, and the home refers individuals for specialist support and advice when needed (e.g. CPN, other healthcare advice, etc.). The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 16 Staff at the home provide residents with good support with healthcare needs, and were alert to healthcare concerns, referring to GPs promptly when necessary and supporting residents with appointments. The home had provided excellent support to one resident throughout an acute healthcare episode, providing 24-hour support during a hospital admission and exploring ways of helping the person understand what was happening. This showed particularly sensitive and dedicated healthcare support, and the home continued to provide appropriate healthcare monitoring and support to this person, liaising with the healthcare professionals involved. Some residents suffered with epilepsy, and it was noted that the home had arranged refresher training for staff in this subject, and maintained records of any seizures. The home had obtained ‘Health Information Files’ for clients with Learning Disabilities (produced by the NHS in partnership with social services), and were implementing a file for each resident to provide a clear health profile. A senior staff member had taken the role of health facilitator for the home, and two staff had attended a two-day course on breast awareness and cervical smear tests for women with learning difficulties, and were planning how to provide the female residents in the home with appropriate information on this subject. This is commended as thoughtful and proactive practice. The home has an Administration of Medication policy that covers receipt, administration, recording and disposal of medication, and refers to controlled drugs and to self-medication. Training records were not specifically inspected (see Staffing section): it had been noted at the last inspection that some staff had attended training provided by the pharmacist, and on this occasion the manager stated that new staff shadow experienced staff and are then observed administering medication, but that there is no system in place at present for evidencing that they have been assessed as competent. Most medication is dispensed to the home in a Monitored Dosage System (MDS), and medication is stored in a locked, wall-mounted cabinet. The home does not currently have a controlled drugs cabinet: however, no residents are prescribed any controlled drugs, and the home’s policy states that in the event of a controlled drugs being prescribed, they would seek the pharmacist’s advice. Medication Administration Records (MAR) are pre-printed by the pharmacist with details of each drug to be administered. Medication received by the home was being clearly recorded, but where no new supply had been received, medication carried over from the previous month was still not being recorded. MAR were well completed, with no omissions observed, symbols used consistently for non-administration, and non-prescribed medications recorded. Where medication details had been entered or changed by hand, most entries were signed. Staff are reminded to ensure that records of nonprescribed medication (e.g. supplements) clearly show the dosage to be given, and it is recommended that where the GP changes the dosage of a medication partway through a month, for clarity a new entry of the drug should be made on the MAR. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place for ensuring that service users are listened to and their concerns acted on, and for promoting the safety and protection of service users. EVIDENCE: No complaints or allegations about the home have been received by the CSCI or by the home in the last year. Service users spoken to during the inspection had no concerns about the service they were receiving, appeared confident to speak up if had they any concerns, and were clearly encouraged to express their views. Two relatives who provided feedback both stated that they had not had cause to make a complaint to the home. The home was amending their complaints procedure to reflect the role of the CSCI, and the home has a complaints procedure in pictorial format, which had also been updated (to include photos of the people residents should speak to – e.g. proprietors). The home also had pictorial information on the Protection of Vulnerable Adults (POVA) available to residents, which had also been updated and now included photos of people in the home. Staff POVA training had been provided in-house: the proprietor had delivered this using the Essex Guidance on Abuse Awareness, and had also now obtained a training pack produced by Essex County Council. Certificates on staff files viewed showed evidence of recent in-house refresher training in this subject. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 18 It was confirmed that POVA issues are also discussed in staff meetings and supervisions (e.g. whistle blowing was seen covered in supervision notes), and that staff had completed a unit on POVA as part of their NVQ training. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and safe environment that is well maintained and kept clean and hygienic. Communal spaces promote service users’ independence by providing a variety of homely space. EVIDENCE: The premises were not specifically inspected on this occasion; only communal areas were viewed. It was noted that the decoration of corridors was in process at the time of the inspection, and the home’s maintenance book showed that several areas of redecoration and refurbishment had taken place over the last year, including one bedroom decorated (papered and painted) and refurnished, all beds replaced, and a new fitted wardrobe in another room. Records also showed ongoing repairs, providing evidence that regular maintenance was carried out. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 20 Communal areas were well maintained, were warm and homely, and provided a good range of space (with two lounges, a dining room, and a kitchen). New sofas had been bought for one of the lounges. Shelves had been fitted above radiators in communal areas to prevent risk of scalding from residents’ grabbing hold of the radiator. This was appropriate risk-reduction action in the context of the needs in this home. On the day of the inspection, areas of the home viewed were safe, clean and tidy, with no unpleasant odours. The laundry was not specifically viewed on this occasion, but the proprietor confirmed that facilities remained the same as at the last inspection (i.e. with washing machines capable of wash cycles to meet infection control standards), and that a new top-loading machine had been obtained. It was noted at the last inspection that there were written risk assessments covering the handling of laundry contaminated by body fluids, and a policy describing the home’s procedures for dealing with beds, toilets and incontinence pads. No commodes are used in the home. The home provided appropriate protective clothing, with paper towels and liquid soap available in toilet areas. No specific infection control training had been attended by staff, and this is recommended. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective staff team, with sufficient staff on duty to meet service users’ needs. Recruitment processes supported and protected service users, although action was needed to evidence health checks. Staff demonstrated appropriate qualities and attitudes, and were suitably qualified. Training in appropriate subjects had been made available to staff, but training records needed further development. Although some further action is needed in relation to recruitment and induction processes, based on past evidence the CSCI is confidant that the provider will take action to manage the improvements required. EVIDENCE: Rotas were not specifically inspected on this occasion, but the proprietor confirmed that the minimum staffing is three staff on duty during the day, and one waking/one sleep-in staff at night (plus one on call). However, on this and previous inspections it was noted that there were often more staff present in the home, with staff visiting the home on their days off and with flexible The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 22 staffing arrangements to cover specific activities. This was good to see, and demonstrated staff commitment to the home and the home’s strong ethos of supporting residents to engage in activities. The two proprietors are actively involved in working in the home, and there is a low turnover of staff. Regular staff meetings take place (minutes not viewed on this occasion), and all staff providing personal care were over age 18. Staff were approachable and comfortable with service users, including them in conversations and communicating well with them. Service users appeared to have a good rapport with them. Most staff had been employed at the home for many years and were therefore experienced and had a good understanding of the needs of their service users. All care staff had completed NVQ level 2 (or equivalent), and the two trainee managers had almost finished their Registered Manager’s Award. One new member of staff had started working in the home since the last inspection, and a second person was waiting for their CRB to come back before starting work. Files for these two staff showed completed application forms containing an employment history (including space to record reasons for any gaps in employment), names of referees, and a criminal declaration. Evidence of recruitment for the person who had started work included two written references, evidence of identity and photo, and a CRB/POVA check. There was no statement by the person as to their mental and physical health, as required by regulation, and the manager was advised to ensure that gaps in employment history are fully explained. For the person waiting to start work, there was evidence that residents had been involved in their interview, which was good to see: residents spoken to had enjoyed being part of this process, and felt that their views had been sought. It is recommended that the applicant’s interview responses and residents’ feedback be recorded. The proprietor was aware of the new Skills for Care Common Induction Standards, but had not yet accessed information on these and incorporated these into the home’s induction. The home formerly had a TOPSS induction schedule, but did not appear to have used this with the recently recruited staff member, for whom there was no specific induction evidenced. Learning Disability Award Framework (LDAF) training had not been used within the home, and the proprietors are advised to look into this. The new carer had already attended training in POVA, fire safety and moving and handling since starting working at the home in August 2006. All staff had recently attended these three training sessions, and those spoken to had found the moving and handling session useful. Several staff had recently attended, or were booked to attend, epilepsy and rectal diazepam training, all staff had done a distance learning dementia course, and a refresher course in first aid was planned. Staff training records took the form of individual certificates on files: although the home was starting to compile a summary of training attended by each person, this was not available at the time of this inspection The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 23 and so an overview of staff training could not be easily inspected. To assist the proprietors/trainee managers in monitoring training completed and identifying training needs, it is recommended that a training summary be compiled. Training and Development plans were not specifically discussed: at the last inspection training was seen included in the home’s annual development plan. Monthly individual supervisions sessions take place with staff: sample records showed that these were regularly maintained, with clear records covering appropriate issues; appraisals also take place. There is very good day-to-day support and supervision in the home, with the providers and trainee managers regularly present in the home and working alongside staff. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 24 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately experienced to run the home. The home is run in the best interests of residents, with systems in place for reviewing the quality of care and planning the development of the service. The home has policies and systems in place to promote the health and safety of residents and staff: although action is required relating to maintaining evidence of gas and electricity checks, based on past evidence the CSCI is confidant that the provider will take action to manage the improvement required. EVIDENCE: The proprietor and registered manager has many years experience in this role, and is competent to run the home. He has not achieved the relevant The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 25 qualifications due to plans for the two trainee managers to take on the management of the home next year. In preparation for this they are currently completing the Registered Manager’s Award (including NVQ level 4 in Care). No annual development plan was viewed on this occasion, but it was noted that the home had an annual development plan at the time of the 2005 inspection. The service has a feedback questionnaire for service users and their relatives: this was last used in 2005 and the proprietor stated that a new survey is due to be carried out. A detailed Quality Assurance report was submitted to the CSCI earlier in the year, and this was discussed with the proprietor. It was recommended that the annual review of quality in the home should demonstrate that the home has systems in place for auditing practices and procedures and for reviewing whether annual objectives have been met. The proprietor was exploring ways of identifying how staff strengths could be used to achieve specific tasks in the home (e.g. a current project to deliver guidance in women’s health issues to three of the service users). The home’s health and safety policy was satisfactory, but still did not show the person responsible for the management of health and safety in the home, and it was recommended that this should be added. Since the last inspection staff had received training in moving and handling, which is commended; however, the home still did not have a specific written moving and handling policy/ procedure, and should develop this to clarify what is/is not permitted of staff in relation to the moving and handling of people and loads within the home. Appropriate risk assessments were in place, but needed to be reviewed. A good kitchen hazard analysis and risk assessment was displayed in the kitchen (although these needed to be dated), plus kitchen cleaning rotas. Staff had received training in health and safety issues, but not all staff training records were inspected on this occasion (see previous section). The home maintained records of the servicing of utilities and equipment: evidence was seen that fire equipment (alarms and extinguishers), had been serviced this year, but the electrical installation certificate was out of date, and a current gas safety/servicing certificate could not be located during the inspection. This needs to be addressed. The home maintained evidence of fire drills in the home’s diary, including who attended: it was recommended that the home implement a clearer system for showing when drills take place in order to be able to more easily monitor whether all staff have attended sufficient drills. Internal testing of fire alarms and emergency lighting records showed checks every few months during 2005; the proprietor stated that this had been recorded in the home’s diary during 2006, and that a new record book had now been obtained. There were clear records showing that hot water tap temperatures had been checked each week, and that central hot water storage temperatures were monitored (via the kitchen hot tap temperature) to ensure they remain over 60°C to prevent risk of Legionella. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 2 X The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 YA34 Regulation 19, schedule 2 Requirement The registered provider must ensure that checks carried out during the recruitment of staff including obtaining a statement by the person as to their mental and physical health. The registered person must ensure that all staff are appropriately trained. This is particularly in regard to demonstrating that new staff have completed an induction that meets the specification of the Sector Skills Council (i.e. Skills for Care). The registered person must ensure that utilities (gas and electricity) are appropriately maintained, and that evidence of this is available in the home. Timescale for action 31/12/06 2 YA35 18 31/12/06 3 YA42 13 and 23 31/12/06 The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 28 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 YA6 YA6 Good Practice Recommendations The registered person should ensure that there is clear evidence that all care plans have been reviewed at least every 6 months, and whenever needs change. It is recommended that the registered person explore options for producing Individual Plans (care plans) in alternative formats (e.g. audio or video formats, pictorial versions, supporting Life Plans with photos, etc.) to make them more accessible to individuals who cannot read. [N.B. this also applies to progressing work to produce key policies in alternative formats – reference NMS 8 and 42] It is recommended that residents’ care plans also detail any specific responsibility for daily tasks (e.g. for cleaning their rooms, laundry, assisting with meals, etc.). It is recommended that bathroom doors be fitted with suitable locks that can be over-ridden from the outside. This is a repeat recommendation. [Ref also NMS 27] It is recommended that records of meals served also show the vegetables served. It is strongly recommended that the registered person ensure that the competence of staff to administer medication is assessed and recorded. It is recommended that, where no new supplies of a medication are required from the pharmacist, any remaining medication carried over from the previous month be clearly recorded on the MAR. This is a repeat recommendation. It is recommended that individual staff training profiles (records) be maintained and kept up-to-date, and that these include details of all training attended by staff (formal and informal). This is a repeat recommendation. It is recommended that the registered person monitor and review whether the objectives and goals of the home’s annual development plan have been achieved, and that this information is incorporated into a report on the review of the quality of care in the home. This is a repeat recommendation. The home’s Health & Safety policy should include details of person(s) responsible for health and safety within the home. This is a repeat recommendation. DS0000017960.V318666.R01.S.doc Version 5.2 Page 29 3 4 5 6 7 YA16 YA16 YA17 YA20 YA20 8 YA35 9 YA39 10 YA42 The Cottage 11 YA42 12 YA42 It is strongly recommended that the home develop a clear written policy/procedure relating to the moving and handling of people and objects. This is a repeat recommendation. Risk assessments should all be signed, dated and regularly reviewed. This is a repeat recommendation. The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 The Cottage DS0000017960.V318666.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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