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Inspection on 21/05/07 for The Cottage

Also see our care home review for The Cottage for more information

This inspection was carried out on 21st May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The organisation continues to make improvements to the environment, with evidence of an on-going maintenance and re-decoration programme. No requirements were made at the last inspection.

What the care home could do better:

The people living in the home have contributed financially towards their holidays and some have purchased their own furniture. The manager followed the right procedures, agreeing this with the social worker and family, if applicable. However the documentation given to the people living in the home, such as the Statement of Purpose, Service Users` Guide or contract does not mention that they may be asked to contribute and needs to be amended to ensure that they know exactly what is included in their fees and what is not.The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 The area of risk management was discussed at this inspection. Whilst it is recognised that the home is trying to enable `normal` living, there are some areas, which should be assessed for risk to ensure that the staff know exactly how to keep the people living in the home and themselves safe. Some issues have been risk assessed but it was felt that this area needs some additional work. The risk assessment process could also be used to explain any restrictions placed on the rights of individuals to ensure that these are reviewed and remain in their best interest. The manager is asked to assess the safety of the present medication systems and record the action taken. The staff should be assessed periodically to check that they are administering medication safely. The manager will need to keep the staffing levels under constant review and assessment to ensure that the people living in the home are safe in the event of a fire evacuation, that the needs of people becoming older and less mobile are met and that the high level of activities and community based trips continues if people stop attending external day services. Up to date the supervision of staff has been an informal process and it is recommended that this be given more structure, with records being kept. The organisation needs to familiarise itself with current legislation to ensure that the people living in the home are kept safe. This includes a more robust recruitment procedure and awareness of the new Safe Guarding Adults policies. Staff must not start working with the people using the service until they have been checked against the Protection of Vulnerable Adults list. Staff training needs to be improved to ensure that the staff are receiving the mandatory Health and Safety training and attending courses specific to the needs of the people living in the home.

CARE HOME ADULTS 18-65 The Cottage 20 Oulton Road Stone Staffordshire ST15 8DZ Lead Inspector Sue Jordan KEY Unannounced Inspection 21st May 2007 10:00 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 DS0000005077.V336330.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 DS0000005077.V336330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Address 20 Oulton Road Stone Staffordshire ST15 8DZ 01785 811918 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) RMP Care Mrs Dorothy Tarpey Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06/01/06 Brief Description of the Service: The Cottage is a registered care home, which accommodates Adults with a Learning Disability. At present there are six ladies living in the home. The home has six single bedrooms, with access to toilet and bathroom facilities. The home is domestic in style and provides comfortable clean accommodation. The outside area is secure. The home is within walking distance of Stone town centre and there are local shops, take-away, hairdressers, public houses and an off licence/delicatessen within a few paces of the home. The people living in the home are integrated into the local community. The registered manager is Dorothy Tarpey, who also manages the home next door. The fees charged are from £427 to £527 per week. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and quarter hours. This was a ‘key inspection’ and the core standards were assessed. The methodologies used were: A day of preparation before the inspection, including scrutiny of the preinspection questionnaire completed and returned by the manager, and the six questionnaires completed by residents and six by relatives. During the visit, the inspector met and spoke to all of the people living in the home and a member of care staff was interviewed. The owner called in for an informal chat and feedback was given to the general and registered managers. Observations were made of staff and service user interaction and non-personal care tasks and lunch was taken with some of the people living in the home. The medication systems were checked and a walk round the home taken. Some of the people living in the home showed the inspector their bedrooms. Three residents’ care records were checked and the records of three new staff employed since the last inspection, including recruitment and training documents. The service users financial records were also checked. This is the first inspection since January 2006. What the service does well: The home provides an integrated service to the people living in the home. The ethos is that the people using the service will have all the benefits and rights normally expected and enjoyed. As a result, the home is domestic in style and close to the town of Stone, which the people living in the home go to regularly to enjoy the local facilities. The people living in the home enjoy varied daytime activities. Some attend Local Authority day centres, whilst others are supported to do things of their choice by the staff in the home. The people living in the home are supported to be as independent as possible, including the management of their own finances and medication if appropriate. All of the relatives are happy with the support provided to their relatives and comments included: The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 6 “My relative has now been a resident for six years and it is good to see how she has developed and become increasingly independent over this period”. “My relative’s life experience has been enhanced since moving to RMP Care. She is very happy, so I’m happy. My thanks to Rose, Paul and the management and staff”. “I feel that my relative is safe and in good hands with all the staff.” “Each person living in the home is treated as an individual and they are all made to feel equal and important in ‘the family’. Any issues that arise are dealt with quickly, efficiently and with love”. The people living in the home are given guidance about keeping themselves safe. Family relationships are supported and people are enabled to forge friendships. Appropriate professional support is obtained to advice and provide guidance regarding personal relationships. The people living in the home are involved, as far as possible in the day-to-day decisions. This includes deciding the décor and planning their meals. They are encouraged to take part in the household tasks, including cooking and keeping their own rooms clean and tidy. One of the people living in the home likes to work in the garden. The people living in the home have an annual holiday. Health needs are closely monitored and access to health professionals arranged as required. Emotional needs are addressed with care and sensitivity. There have been no complaints about the service delivered at The Cottage and the people living in the home know who to speak to if they’re unhappy. What has improved since the last inspection? What they could do better: The people living in the home have contributed financially towards their holidays and some have purchased their own furniture. The manager followed the right procedures, agreeing this with the social worker and family, if applicable. However the documentation given to the people living in the home, such as the Statement of Purpose, Service Users Guide or contract does not mention that they may be asked to contribute and needs to be amended to ensure that they know exactly what is included in their fees and what is not. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 7 The area of risk management was discussed at this inspection. Whilst it is recognised that the home is trying to enable ‘normal’ living, there are some areas, which should be assessed for risk to ensure that the staff know exactly how to keep the people living in the home and themselves safe. Some issues have been risk assessed but it was felt that this area needs some additional work. The risk assessment process could also be used to explain any restrictions placed on the rights of individuals to ensure that these are reviewed and remain in their best interest. The manager is asked to assess the safety of the present medication systems and record the action taken. The staff should be assessed periodically to check that they are administering medication safely. The manager will need to keep the staffing levels under constant review and assessment to ensure that the people living in the home are safe in the event of a fire evacuation, that the needs of people becoming older and less mobile are met and that the high level of activities and community based trips continues if people stop attending external day services. Up to date the supervision of staff has been an informal process and it is recommended that this be given more structure, with records being kept. The organisation needs to familiarise itself with current legislation to ensure that the people living in the home are kept safe. This includes a more robust recruitment procedure and awareness of the new Safe Guarding Adults policies. Staff must not start working with the people using the service until they have been checked against the Protection of Vulnerable Adults list. Staff training needs to be improved to ensure that the staff are receiving the mandatory Health and Safety training and attending courses specific to the needs of the people living in the home. 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 DS0000005077.V336330.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 The Cottage DS0000005077.V336330.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home’s documentation does not clearly explain the rights and expectations for the people living in the home, particularly with regard to any financial contributions they may be asked to make. This needs to be made clearer to ensure that the people living in the home can make an informed choice. EVIDENCE: A copy of the Service Users Guide is given to each of the people living in the home and the organisation has developed a Statement of Purpose. The Statement of Purpose was reviewed on 24/10/06 and it clearly sets out the objectives and philosophy of the service supported by a Service user Guide. It clearly states the needs that the home can support and those they would not be able to admit. However it needs to be checked to ensure that it is a current reflection of the service provided. For example, the people living in the home have paid for their holidays and two have purchased their bedroom furniture. Although the manager followed correct procedures, agreeing this with the social worker and family if applicable, the home’s documentation does not clearly explain that the people living in the home may be asked to contribute, in what circumstances and how much will be paid for by the organisation. This information is not included in the home’s contract either. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 10 The people living in the home were all referred by the Local Authority and the organisation receives copies of their assessments and contracts before they move into the home. Prospective residents are offered ample opportunity to visit the home before moving in. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 11 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, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to take control of their own lives. The records in the home could be improved to provide better evidence of any decisions made for their safety or protection, which restrict or limit their rights. EVIDENCE: Each of the people living in the home has a care plan and where possible they are involved in their development and review. They are holistic in approach covering all aspects of a person’s life, physical, emotional and social. Some of the documentation has been created using pictures to enable the people living in the home to understand it. Where possible the people living in the home are supported to manage their own finances and one person does this successfully. Others are enabled to be as independent as possible, even if this is only storing their money individually or accompanying the staff when they go to the bank for their personal The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 12 allowance. The same system is used for the storage of medication, giving the people living in the home a sense of control over their lives. The people living in the home regularly meet with the manager and staff to discuss any household issues or things that may be bothering them. They also plan their holidays or trips out. One of the relatives said in a questionnaire sent to the Commission for Social Care Inspection before the inspection: “My relative has now been a resident for six years and it is good to see how she has developed and become increasingly independent over this period”. Risk management was discussed during this visit. Although some risks have been identified and assessed there are further areas, which require a risk assessment. The manager was advised that individual medication and finance arrangements should be included in a risk assessment. Presently the individual person’s risk assessments are all recorded together. It is recommended that the information be separated into issues; identifying the risk, the measures taken to control that risk and the action expected from staff. The balance of rights to risks was discussed with the managers and they demonstrate that in practice they support people to take appropriate risks. This needs to be supported by better record keeping. Any limitation or restriction placed on the rights of a person living in the home should be clearly justified and recorded and it was recommended that this be done within a risk assessment format so that it is open to regular review and not ‘set in stone’. The people living in the home have been given some guidance about keeping themselves safe and this includes telling the staff when they are going out and where they are going. Where appropriate the people living in the home have signed their understanding of this. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 13 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, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is committed to the principles of inclusion and promotes, and fosters good relationships with neighbours and other members of the community, helping the people living in the home to feel a part of the local area. EVIDENCE: The people living in the home are supported to integrate into the local community. They use local sports facilities, go to the pubs and cafes and use the local shops. Some of the people living in the home attend Local Authority day centres, whilst others go to college. The people use the local bus service and everyone has a bus pass. There is a weekly drop in centre, which some attend on a regular basis. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 14 The people living in the home have become a part of the local community in Stone. The people living in the home are encouraged to continue with their hobbies within the home, which includes knitting and tapestry making. The people living in the home can make use of the televisions and music centres in their bedroom if they require privacy or they can mix in the communal areas. One person has a computer. Staff encourage the people living in the home to be involved in household tasks including shopping for their food, preparing their meals, cleaning their bedrooms and gardening. Each person has an activity plan. One relative said in a questionnaire sent to the Commission for Social Care Inspection before the inspection: “ My daughter’s life experience has been enhanced since she moved to RMP”. Another relative said: “Occasionally, insufficient staff means that my relative has to join other residents at a different home”. The staffing levels were discussed with the manager and staff and it was confirmed that individual outings are rare due to the amount of staff on duty during the day. This will need to be kept under review, particularly as the people living in the home get older or choose to stop attending external day centres. Activities, trips and holidays are usually taken in small groups. Family relationships are supported and people are enabled to forge friendships. Appropriate professional support is obtained to advice and provide guidance regarding personal relationships. Observations were made of positive interaction between staff and the people living in the home. They are included in all conversations and their views and opinions listened to. The people living in the home were seen to make their own decisions as to where they wanted to be, what they ate and how they spent their time. Annual holidays are arranged. This summer some are going to Butlins, whilst others are going to Wales. The people living in the home are consulted on a daily basis as to what they wish to eat the following day. The manager is very conscious of the need for healthy eating and therefore weight is monitored and the people living in the home are encouraged to eat healthy options. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 15 One of the relatives expressed concerns about this issue within a Commission for Social Care Inspection questionnaire. This was discussed with the registered manager and she said that although healthy eating plans are in place, some staff think that they are being ‘kind’ by offering big portions. It was suggested that this be included in risk management and discussed with staff members within staff supervision. The home also supports a person needing to maintain their weight and another with swallowing difficulties. A speech and language therapist has attended this person. The lunch provided during this visit was healthy and nutritious. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to healthcare and remedial services and staff make sure that they are encouraged to be independent, have regular appointments and visit local health care services. EVIDENCE: Comprehensive records are kept of health needs and the action taken to support these. The people living in the home are supported to access local health facilities including general practitioners, dentist, chiropodist and opticians. People have been supported through serious surgery. One of the relatives said in a questionnaire completed and sent to the Commission for Social Care Inspection before the inspection: “My relative has recently had cataracts removed from both eyes and the care received from the carers at RMP was excellent. They supported her emotionally and physically throughout”. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 17 Another said: “We were particularly pleased with the support given when her Mother died”. Discussions with the registered manager and the people living in the home indicated that this support continues. The people living in the home are enabled to maintain their own identity and choose their own clothes. The people living in the home are encouraged where possible, to be involved with their medication administration and storage. The home uses a monitored dosage system and has good links with a local pharmacist, who also provides the staff training. Some of the people living in the home use homely remedies such as vitamins and the registered manager is concerned that the pharmacist will not allow them to record this on the administration charts. The manager was advised to ask the general practitioner to sign individual homely remedy protocols. It is recommended that the staff complete the ‘Safe Handling of Medicines’, module based training, which is comprehensive and informative in detail. The continuing competency of staff should also be checked regularly. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home know who to speak to if they are unhappy and their relatives are confident that they are kept safe. The organisation has not kept up to date with current legislation about the safeguarding of adults and needs to ensure that its practice is supported by robust policies, including the safe recruitment of staff. This will ensure that the people living in the home are not placed at risk of harm or abuse. EVIDENCE: There have been no complaints made either to the home, the organisation or the Commission for Social Care Inspection about the service provided at the home. The people living in the home were asked if they knew who to speak to if they had a complaint or concern and all confirmed that they did. One said: “I would go and see Dottie, (care manager) or staff if I was unhappy”. One relative said in a Commission for Social Care Inspection survey: “Each resident is treated as an individual and are all made to feel equal and important in ‘the family’. Any issues that arise are dealt with quickly, efficiently and with love”. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 19 The people living in the home are asked at every house meeting whether they have any concerns and if they know whom to see with problems. There have been no allegations of abuse or Vulnerable Adults referrals. The manager needs to update the policies and procedures in line with the new, Safe Guarding Adults procedures. It is not clear as to whether all of the staff have been trained to recognise abusive situations and how to respond. The manager needs to familiarise herself with the legislation regarding the Protection of Vulnerable Adults First list and the need to check all prospective staff before allowing them to work in the Home. One relative said in a Commission for Social Care Inspection survey: “I feel that my relative is safe and in good hands with all the staff.” Another said: “The staff try to do the best they can, always. My relative could not be in a better home, it is excellent”. Individual arrangements for the management of personal allowances are made for each person living in the home, dependent on their ability. Receipts and comprehensive records are kept for those people fully supported, whilst the remaining people sign on receipt of their money. The manager was advised to record these arrangements in a risk assessment. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home benefit from a clean and comfortable environment. EVIDENCE: The home provides a clean and homely environment for the people living there. Each person has their own bedroom and all of the people in an upstairs bedroom have access to an upstairs toilet. The bedrooms are individualised and personal, full of each person’s possessions. Three of the people living in the home proudly showed the inspector their bedroom. Two bedrooms have been created on the ground floor for two people living in the home with mobility difficulties. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 21 The home is well decorated and maintained and where possible the people living in the home are consulted about how a room is to be decorated and what colour scheme is to be used. Regular fire drills take place and one of the people living in the home explained what to do in that event. The lounge, dining room and kitchen are communal and domestic in style and there is an outside courtyard area, which is presently being improved by pots and tubs planted by the people living in the home. The home is situated within walking distance of Stone town centre and the local amenities. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff employed at the home are kind and caring and dedicated to the people living in the home. The recruitment and training arrangements do not fully safeguard the people living in the home. EVIDENCE: RMP Care has six registered care homes and employs twenty-five support workers in total. The rotas are arranged so that staff may work between two of the houses. In The Cottage, one member of staff is employed throughout the day in the morning and two in the afternoon/evening. One member of staff sleeps in the house throughout the night. The managers will need to keep this under constant review and assessment to ensure that the people living in the home are safe in the event of a fire evacuation, that the needs of people becoming older and less mobile are met and that the high level of activities and The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 23 community based trips continues if people stop attending external day services. The home does not use agency staff. One relative said in a Commission for Social Care Inspection survey: “My relative is looked after very well. The staff are so friendly, it is a very happy place to visit”. Observations during this inspection confirmed this and the staff met appeared kind and caring with a commitment to the ethos of the home. The staff have regular team meetings, which are recorded. The files of the last three staff employed were checked during this inspection. Some concerns were noted and shared with the managers. All three staff started work before they had been checked against the Protection of Vulnerable Adults First list and their Criminal Records Bureau disclosure being received. Although the general care manager stressed that staff would have been supervised, she was informed that staff must not start work before they had been checked against the Protection of Vulnerable Adults list. In one case, only one reference had been received, whilst in another the references were not written directly for the organisation. This does not allow the organisation to assess whether the candidate has the qualities needed to meet the needs of the job description. The general care manager said that she also made telephone calls to some of the referees to support the written references, but this was not recorded. One of the prospective staff members had not completed their full employment history and this had not been checked at interview. The organisation has a good health questionnaire in place but in one case this was not available. All staff had a contract. The organisation must ensure that it’s recruitment policies comply with current Protection of Vulnerable Adults legislation and the Care Homes Regulations. Staff must not work with the people living in the home until they have been checked against the Protection of Vulnerable Adults First list, all elements of the information listed in Schedule 2 have been obtained and the employer is satisfied as to the authenticity of the references. This will ensure that the people living in the home are fully protected. The training records available during this inspection did not indicate that the staff are receiving mandatory training at induction and the subsequent recognised frequencies. There was no written evidence of an induction based on Skills for Care and no evidence that training specific to learning disabilities and associated needs had been given. The general care manager said that some training is delivered informally but this is not recorded. When asked a staff member said that her induction had comprised of ‘shadowing’ other experienced members of staff and that she had only attended medication training. She had worked for the organisation for twenty months and any The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 24 mandatory training received was during her previous employment. She did confirm that the registered manager had given her some guidance on the management of seizures and that she supported her to do her job. The general care manager said that the records were not up to date and that she would develop a training matrix and send it to the Commission for Social Care Inspection. The pre-inspection questionnaire did not contain information about National Vocational Qualifications and how many staff had achieved level 2 or above. The general care manager also said that she had recently been in touch with the Local Authority and was in the process of organising more training courses. The general care manager recognised that up until very recently staff supervision had not been delivered in a formal structured way. She has recently attended supervision training and confirmed plans to implement a staff supervision programme. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is planned to be user focused and works in partnership with families of people living in the home and professionals. The managers are developing systems that monitor practice and compliance but more work is needed in this area to ensure that the people living in the home are safely supported and protected. EVIDENCE: Dorothy Tarpey, who is registered with the Commission for Social Care Inspection, manages the home. She has worked with the organisation for many years and demonstrates a commitment to the ethos of the home and the individual rights of the people living in the home. She does not intend to The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 26 undertake the Registered Managers Award. She has a very ‘hands on’ approach and the systems management is mostly the responsibility of the general manager, Loraine Lawton. There is a family feel to the home and the owner is also actively involved on a daily basis. The management team need to ensure that the good practices and the valuable work undertaken with the people living in the home is supported by the relevant robust procedures, which meet current legislation. Discussions were had as to how the organisation can balance the homely atmosphere and ethos in the home and at the same time maintain compliance. In the first instance, the management team need to ensure that they are familiar and stay up to date with the current requirements of the law. The Home sends out Quality Assurance questionnaires to health professionals to obtain their opinion about the service delivered at the home and the registered manager undertakes an annual audit of the quality. The organisational policies and procedures are based on the National Minimum Standards and are reviewed by the manager every year. The people living in the home are involved in regular house meetings where their views are listened to. The managers were fully co-operative with the inspection process and responded positively to the discussions during the feedback session. They demonstrated a keenness to meet the requirements and make improvements to some of their management procedures and practices. The people living in the home were actively encouraged to be involved in the inspection and their privacy with the inspector respected. The management team need to ensure that safe working practices are enabled and compliance with the requirements identified during this inspection will assist in this process. This includes more robust risk management, delivery of the mandatory, Health and Safety training to staff and safe recruitment procedures. The Home itself is well maintained, although the manager is asked to ensure that the home’s fire risk assessment meets current legislation and includes individual fire evacuation procedures for each person living in the home during the day and through the night. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 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 3 3 X 2 X 2 X X 2 X The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 5 (1b, c) Requirement The information provided to the people living in the home or prospective residents must be clear as to the fees, what is included, what they may be asked to contribute and in what circumstances. This will allow them or their advocates to make an informed choice. Timescale for action 01/08/07 2 YA23 13 (6) The organisation must familiarise 01/07/07 itself with and comply with the current legislation about the safeguarding of adults, which includes the training and safe recruitment of staff to ensure that its practice is supported by robust policies. This will ensure that the people living in the home are not placed at risk of harm or abuse. The organisation must ensure that it’s recruitment policies comply with current Protection of Vulnerable Adults legislation and the Care Homes Regulations. Staff must not work with the people living in the home until they have been checked against DS0000005077.V336330.R01.S.doc 3 YA34 19 (1abc, 5) Schedule 2 01/07/07 The Cottage Version 5.2 Page 29 the Protection of Vulnerable Adults First list, all elements of the information listed in Schedule 2 have been obtained and the employer is satisfied as to the authenticity of the references. This will ensure that the people living in the home are fully protected. 4 YA35 18 (ci, 1a) The staff employed at the home 01/08/07 must receive training appropriate to the work they are to perform, and applicable to the needs of the people living in the home. This will ensure that the people living in the home are at all times suitably supported and the promises outlined in the Statement of Purpose maintained. 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 YA5 Good Practice Recommendations The home’s contract with the people living in the home should be reviewed and amended to ensure that the information for them is clear and accurate, especially with regard to any financial contributions or expectations and what the home will provide. This will enable the people living in the home to make informed choices. Any limitation or restriction placed on the rights of a person living in the home should be clearly justified and recorded. It is recommended that this be done within a risk assessment format so that it is open to regular review and does not permanently restrict the person, unless it can be clearly demonstrated that it continues to be in their best interests. It is recommended that the home strengthen their risk management recording to ensure that the people living in DS0000005077.V336330.R01.S.doc Version 5.2 Page 30 2 YA7 3 YA9 The Cottage 4 YA20 5 YA33 6 YA36 the home are kept safe and that the staff understand the action they need to take. The manager is recommended to strengthen medication procedures in the home, by completing individual risk assessments for self-administration and storage arrangements, asking the general practitioner to sign homely remedy protocols and ensuring the continuing competency of the staff administering the medication. This will ensure that all aspects of medication practice fully safeguard the people living in the home in all eventualities. It is recommended that the manager keeps staffing levels under constant review and assessment to ensure that the people living in the home are safe in the event of a fire evacuation, that the needs of people becoming older and less mobile are met and that the high level of activities and community based trips continues if people stop attending external day services. It is recommended that staff supervision be formalised and carried out in a more structured way to ensure that they are fully familiar with the needs of the people living in the home and the expectations of the organisation. The Cottage DS0000005077.V336330.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 - 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. 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