Inspection on 30/10/06 for The New Bungalow

This inspection was carried out on 30th October 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The New Bungalow 15/05/07

The New Bungalow 09/02/06

The New Bungalow 25/07/05

The New Bungalow 19/01/05

The New Bungalow 03/06/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The New Bungalow The New Bungalow Forge Hill Aldington Ashford Kent TN25 7DT Lead Inspector Lois Tozer Key Unannounced Inspection 30th October 2006 12:50 The New Bungalow DS0000023568.V303534.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 New Bungalow DS0000023568.V303534.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 New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The New Bungalow Address 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) The New Bungalow Forge Hill Aldington Ashford Kent TN25 7DT 01233 721222 Canterbury Oast Trust Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: The New Bungalow is registered to provide accommodation, personal care, and support to a maximum of six people with learning disabilities who may also have a physical disability. The premises is in a rural location and is a purpose built, single story bungalow which is approximately 15 minutes walk from the village shop and 10 minutes from the local pub. It is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Mrs Margaret Hall. Staffing is provided based on the assessed dependency support requirements of each service user. Two ‘sleep in’ staff provide cover at night. Communal areas are being extended. Currently there is one very large lounge and a kitchen diner. All bedrooms are registered for single occupancy. Staff have their own dedicated sleep-in facilities within the office areas. The home provides transport for all service users. There is a wheelchair accessible decked area to the rear of the premises and access to paved woodland walks nearby. Fees currently start from £1167.31 per week with additional costs being met by the service user for hairdressing, toiletries and chiropody. The New Bungalow DS0000023568.V303534.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 on 30th October 2006 between 12.50pm and 6.15pm. The manager, Mrs Margaret Hall, staff and service users assisted with the process. Six people live at the home, and five gave some feedback. People were coming and going in and out of the house from a trip to a local town. The manager gave a tour of the home. The bathroom has recently had a new bath that is right for the service users needs. The shower room had not been improved and was really dank. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well: What has improved since the last inspection? What they could do better: New people need to have their needs and aspirations assessed before they move in. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 6 People need to be able to have a say. Communication plans need to be in place. Staff need to remember to concentrate on what they are doing, and not speak over the people they are helping. Service users need to have greater control and better safeguards over their money. Staff need to develop their understanding of person centred planning to support people to say what they really want out of their lives. The way medication is managed needs to be safer, and some people may be able to do some of the administration themselves, with the right support. The shower room needs improvement because it is damp and smelly. Some smells in the house need to be got rid of. Staff need help to learn how to do person centred planning and skills teaching. They need the sort of training that helps them understand people who have learning disabilities can achieve lots of things, with the right sort of support. Only a few documents are in simple language and have pictures. Service users are not having a say in how the home develops. 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 New Bungalow DS0000023568.V303534.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 New Bungalow DS0000023568.V303534.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): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure their needs and aspirations will be assessed. EVIDENCE: New service user needs and aspirations have not been appropriately assessed. Discussion has taken place between the manager and the former care provider, and some brief notes on a scrap of paper have been made. These notes did not reflect respectful attitudes towards personal preferences. A documented review of changing support needs took place 9 months prior, but that reflected the previous placement. There was no evidence that the service user was consulted and aspirations had not been assessed. As such, there is no baseline to base future care or to support and retain independence. A risk assessment relating to the funding of night support had been thoroughly conducted. Trial visits had taken place and minor environmental adjustments had been made prior to the person moving in. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans need to take a person centred approach involving each individual. Service users are not fully supported to make decisions for themselves. Risk management needs to promote people to live a more independent lifestyle. EVIDENCE: The service user plans have not been developed in consultation with the individuals. Some plans are written in the first person, and some are really positive, instructing support staff to increase service user involvement in daily activities. Others do not explore if the person could be involved in personal care, and state they ‘cannot’ do a particular personal task. These outcomes are based on subjective opinion, not assessment. Service users involvement The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 10 to develop personal goals is key to this standard. There was little evidence that a previous requirement to develop person centred approaches to care planning has taken place. Time orientation and confusion is mentioned as a support need, however, at the time of the site visit, preparations for Halloween were being undertaken, whilst Christmas carols were playing, and service users being told that Christmas was soon. Staff must be aware of how their actions impact on people. There are no communication assessments, or plans being used, for people who have additional communication needs. The importance of such plans was evidenced in an example where a picture of an activity motivated a service user. Despite this, there are no pictorial plans in place. There are service user meetings planned for the future, but no communication strategy in place to help people with additional needs have a say. Only two staff have had communication training (Makaton). A risk assessment has taken place to explore night-time staffing levels, showing clear reasoning how the decision was made. Other documents in the care plans have identified potential risks or support needs, but do not explore solutions that enable service users development. Examples of this were found in the assessment of self medication and in managing behaviours. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are available, but it is not clear how service users have participated in the decision making. This is evidenced in community presence, daily routines and food. Some service users have regular contact with family and friends. Service users are offered a healthy diet. EVIDENCE: Everyone has some organised occupation most days. Its not clear if people with communication needs are fully aware what activities will come next, as no pictorial planner is in use. An individual (who is able to read) has their full week activities displayed in writing in a communal area for their easy reference The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 12 and to help with orientation. It is not clear how people have chosen the activities that they are scheduled for. In house activities with staff need revision to make sure they are age appropriate and are conducted in a respectful manner. Everyone is supported to get out into the wider community. Because of the very rural location, unaccompanied trips out are not possible. There is usually enough staff to help people go to places they seem to enjoy. The level of consultation and supported decision-making given to service users who have communication needs is poor. People are assumed to like or dislike activities based on staff individual interpretation, but none of this is documented to help new staff provide options. Relationships with family members and friends is well supported for some people. Previous feedback from families had said that the home was welcoming. Friendships within the organisation are supported through various social activities, but particular friendships are not noted or promoted, especially for people with communication needs. Some service users enjoy lots of participation in the home’s daily routine – such as washing up, housework, shopping. Others have little or no participation. Care plans do not offer an explanation of these differences. Mealtime support has improved, and better adaptations have increased people’s ability to self-feed. A wide range of good quality food is provided. Some people choose what goes on the menu. Some meals are displayed in picture form. People who need support to eat and drink are reasonably supported, but staff must be aware not to loose concentration on the service user during these times. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Personal support needs are detailed, but do not routinely encourage people to increase independence. Physical health needs are well met. Emotional health could be better supported. Medication management needs to be reviewed to increase service user involvement and improve on safety. EVIDENCE: Service users preference in support has been partly assessed through observations. Support to promote independence in dressing and other personal care duties was not evident. Some documentation is conflicting and should be reviewed. A service user said staff are nice and that they have a The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 14 key worker they like. Discussion with the manager around personal care raised the need for better consultation and assessment to take place. The home takes action to support service users healthcare requirements. Generally, records to support healthcare are up to date. Limited communication plans (and staff training), conflict with the assessed needs stated within care plans. Medication is stored and administered centrally. Few assessments for personal control are in place, those that are say a person cannot take any control. Generally, medication administration records are in order, but some errors had taken place that should have been picked up and dealt with as per the homes policy. The manager was not sure of correct procedure and should obtain further training. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. Consultation and communication methods need improvement so service users can better give their views. Awareness of adult protection and preserving dignity needs improvement. EVIDENCE: There is a complaints procedure, and this contains some pictures. As people who have communication difficulties do not have communication plans, it is not convincing that their views could be sought or listened to. Staff say that they get to ‘know’ what the service user wants, but this does not help new staff, who may miss clues, as individual communications are not documented. Service users rely on their families to advocate for them, there are no independent advocates. There have not been any external complaints in the past 12 months. Some staff have had adult protection training. Observations showed that staff need to be more aware of their actions to preserve service user dignity and account for their adult status. A previous requirement to make safe the way service user money is withdrawn from their bank accounts has not been met. This leaves the service users vulnerable and potentially short of cash if the The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 16 manager was absent from the home. The internal system of handling money on service users behalf is accountable. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 17 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 adequate This judgement has been made using available evidence including a visit to this service. The home is comfortable and homely. There is an odour of urine and damp, but generally the home is clean. EVIDENCE: The home is having improvements and an extension at the moment. The lounge is very large, but is made cosy and homely. The bath has recently been replaced with one that suits the service users needs. Staff have made the room a pleasant area to be. Generally, the home is clean. The shower room is dank and smells unpleasant. It is in general use, and is the only place one service user wishes to bathe. It really needs addressing, and has been identified by the organisation as an area for improvement for several years. The floor is scheduled to be replaced, but there is no date set. There is an odour of urine in some areas. The home has no continence policy. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not always supported in a respectful manner. Recruitment processes protect service users, but do not involve them in the process. Staff training provision has not been inclusive of the assessed and developmental needs of the service users. EVIDENCE: Observation of staff indicated that they were kind and caring, but could treat service users in a child like manner. Equality and diversity is not being promoted in the written care plans, therefore is not being transferred to practice. Some support observed needs review to improve on dignity and respect. About 40 of staff have NVQ certificates. Only two have had any Makaton training, and service users would benefit from increased staff competency. The manager has Makaton skills, but does not use signs with all The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 19 non-verbal service users, therefore, is not encouraging a signing culture. Staff spoke about personal issues to each other while supporting service users. They seemed unaware that their actions and practice did not reflect the code of conduct or statement of purpose. The latest staff file showed that the appropriate pre-recruitment checks had been carried out. Recruitment taking place at the time of the visit did not involve service users in the process. Induction is now linked to the common induction standards for care, but still does not cover working with people with a learning disability. Service users cannot be assured that they will be supported to develop increased independence in a way that is right for their particular need. The majority of training has been provided at a health and safety level, and not from the service user needs and development point of view. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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. There is little evidence to support the involvement of service users in the development of this service. Health and safety provision is generally good, but some improvements are necessary. EVIDENCE: The manager has been in post for about 1 year. There is no current application for registration. There have been some improvements for service users, but still more are needed. Person centred planning has not taken place and communication with service users has not been a priority. The manager The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 21 aims to start service user meetings, but needs to develop a range of means by which all residents can be involved. Because communication and consultation with every service user is poorly facilitated, effective quality assurance monitoring measures cannot be achieved. Particular policies and procedures that stand out as necessary in this home are not in place; therefore do not inform best practice in the support of individuals. When carrying out quality assurance, it is essential to collect service user opinion, using all available methods. The manager must improve the internal monitoring system to improve and develop the service. Generally, environmental safety is provided, and service users can get around inside their home safely. The laundry area is not wholly accessible to service users, and they are not well supported to use this area much. Some shortfalls were identified in relation to fire safety and these were discussed with the manager for action. The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 1 X X 2 X The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard YA2 YA6 Regulation 14, 15 Requirement Timescale for action 01/01/07 01/02/07 3 YA7 4 YA9 New service users individual aspirations and needs must be assessed. 12, 14, Previous requirement, 15, 17, 18 timescale extended from 01/06/06 Using a person centred approach, development of comprehensive care and support plans that are specific to each individuals strength and needs, and identify their aspirations and goals for the future. 12, 15 Standards YA 7 & 8 Consult with service users about their life choices and improve methods of communication used. 13 Standards 9 & 23 Previous requirement, timescale extended from 01/09/05 and again 01/04/06; Risk assess service user access to money using the ‘chip & pin’ facility, taking action to remedy if required. 13 Previous requirement, timescale extended from 09/02/06 Reference to the Royal Pharmaceutical Society of DS0000023568.V303534.R01.S.doc 01/02/07 01/01/07 5 YA20 01/11/06 The New Bungalow Version 5.2 Page 24 6 7 8 YA20 YA30 YA30 13,18 16 23 GB guidelines; Cease secondarily dispensing medication. Review all medication practices and policy. Eradicate the odour of urine Submit plan for improving the shower room facility. Take remedial action to make it less repellent. Previous requirement, timescale extended from 01/11/05 and again 01/06/06, Induction training to cover the needs of the people being supported, i.e. LDAF. Audit the training provision against the assessed needs of the service users and provide training to meet the needs accordingly. Previous requirement, timescale extended from 01/12/05 and again 01/07/06; Develop an inclusive, robust, quality assurance monitoring system against the elements of this standard. 01/01/07 30/11/06 01/01/07 9 YA35 14 18 01/01/07 10 YA39 24 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 New Bungalow DS0000023568.V303534.R01.S.doc Version 5.2 Page 26 - 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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