Inspection on 09/02/06 for The New Bungalow

This inspection was carried out on 9th February 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 7 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 30/10/06

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 Unannounced Inspection 9th February 2006 12:55 The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 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.V281242.R01.S.doc Version 5.1 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.V281242.R01.S.doc Version 5.1 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 Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The 6 mentally handicapped residents may also have a physical handicap 6 People with learning disabilities aged 18 years of age and over. Date of last inspection 25th July 2005 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 home is a purpose built bungalow which is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Mrs Margaret Hall. The premises are a pleasant, well-presented abode set behind another C.O.T. property and shares a large garden. It is situated in an attractive rural location overlooking Romney Marsh, is set back from the road and is approximately 15 minutes walk from the village shop and 10 minutes from the local pub. A patio has been built to the rear of the house and features a swing seat and garden furniture. Communal areas are limited to one very large lounge and a kitchen diner, but work is planned to extend the communal space and other facilities during 2006. All bedrooms are registered for single occupancy. Staff have their own dedicated sleep-in facilities within the office areas. Access into the wider community relies on the homes transport (the public bus service being reported as infrequent). There is dedicated, wheelchair accessible vehicle for communal use. A woodland management project operated by C.O.T. is situated nearby; this is used for service user work experience and recreational use and is also open to the public. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 9th February 2006 between 12.55pm and 4.30pm. The manager, Mrs Margaret Hall, has been in post since November 2005 and is currently in her probationary period. The manager and staff willingly assisted the inspection process throughout the day. There are currently five people living at the home, feedback was gathered from all residents through observation of activities and interactions with staff. Paperwork seen included individual support plans, risk assessments; medication and administration documents, complaints information, duty rota, and menu. Residents seemed calm, happy, occupied and enjoying life. Staff were offering little activities on a regular basis, and this seemed to be going well. What the service does well: What has improved since the last inspection? Planned activities, such as music, trips out, cooking and so on are displayed pictorially in the lounge for residents to see. This has increased the sense of consultation and inclusion for the residents. The lounge has been rearranged to give a more cosy atmosphere, by bringing furniture together, but still enabling people with mobility difficulties to move about with ease. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 6 Staff have been re-inducted into the correct procedure for administrating medication, and errors have been reduced. The ethos of care has improved significantly, and it is clear that the residents are at the heart of any decision taken. Where staff hold attitudes that are not in line with modern support, the manager is taking steps to address and reeducate. Environmental improvements are planned for 2006, small improvements that have made a difference have taken place already, such as shelving in the laundry room and proper loft access. Care plans have been reviewed, and support for eating and drinking has been improved. 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 New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 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.V281242.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Existing service users needs have been reassessed, but a more person centred approach may highlight individual aspirations. EVIDENCE: All residents have had their needs reassessed, and this is reflected in their care plan. Although needs are well known, and are provided for more fully, development of this standard needs to take place to draw out aspirations for all future service users. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Individual plans have improved significantly, but a greater emphasis on service user consultation needs to take place. Decision-making and participation opportunities have increased. Risk assessments have been reviewed and improved. All information is handled sensitively and stored safely. EVIDENCE: Work has continued to streamline and make relevant service user plans, and these now reflect the level of support and assistance each person needs. Discussion about person centred planning, valuing people and consulting with the residents took place. Using a person centred approach will help the residents really have a say, regardless of impairment, will help direct training needs based on residents own support requirements and will inform the quality assurance process. Drawing out aspirations of the individuals is essential for the ongoing progress of the home. Staff were really supporting people make decisions, especially to do with activities (to participate or not, and to have an alternative) and with eating. The manager reported that residents are using the kitchen more as an activity and this has had a positive impact on an individual’s ability to guide staff to what they desire. Risk assessments are still many pages long, but they are The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 10 salient and do offer action to reduce risk. All documentation has been reviewed, is up to date, and is stored in a safe manner. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 16, 17 Opportunities for personal development have improved. The routines of the house have been reviewed to better respect the rights of the people living in the home. Meals offered promote healthy eating, are enjoyed, and staff give appropriate support. EVIDENCE: As above, changing opportunities within the home, and enabling people to go into the kitchen, has led to greater levels of positive communication, and therefore personal development. Daily routines have been reviewed, and now take into consideration the best time for a person to get up, maybe have breakfast in bed, and get up an hour later. More and more, the residents are being heard and the structures are changing to respond to their preferred way of life. Meal and drink times have improved, and staff have been made aware of using appropriate utensils for giving thickened drinks. Ways of supporting at mealtimes have been reviewed, and are enabling people’s skills, giving them the opportunity to feed themselves. A diverse range of food is being tried, and one resident had a beaming smile, having consumed a beetroot sandwich. A dietician has been approached to give support and advice to further review eating plans, especially in relation to the side effects of various medications. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Personal support has been reviewed and has highlighted that further review (staffing, facilities) is needed. Healthcare is well supported, and action noted by healthcare professionals followed up. Many aspects of medication management are safe, but some points need improving. EVIDENCE: A review of the way people are supported has taken place, and this has changed the way utensils are used at meal times, has prompted an occupational therapist review, and will lead onto the need to increase staffing establishment as the changing needs of the service users are identified. The manager has this in hand, and is systematically obtaining professional needs assessments so care management teams can reflect on the support requirements of the individual. Healthcare and access to general facilities (optician, dentist, GP etc) is well supported. Residents seem calmer and more self assured, so mental health would appear to be well supported too. Medication management has some strong points, and the manager has been quick to remedy poor practice as it has arisen. The medication storage has been relocated, and is in a better placed spot. Improvements needed are that secondary dispensing cease immediately, medication returns book is retained by the home, all prescription medication must be kept with the pharmacist’s directions, relocate the change to directions for an individuals medication and The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 13 seek permanent change to directions from the GP, the timing of ‘checking in’ medication needs to be kept under review (to enable sufficient time for errors to be rectified), and gaps in administration records need to be closed with appropriate codes and actions as soon as possible. The policy and needs to be reviewed to reflect this. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The protection of service users from physical and emotional harm is in place, but financially, some processes leave service users vulnerable. EVIDENCE: Staff have received adult protection training, and understand the various forms abuse can take. The manager is focused on supporting staff to see unwitting abusive behaviour, and this has improved the outcomes for service users, enabling them to have more freedom in their lives. Residents have individual bank accounts for their direct payments, which is excellent, however they are managed by ‘chip n pin’ facilities, which is very risky, as no individual account holder can keep their details secret and self manage. The manager needs to review this with the senior management team, and find a solution that protects both resident and the staff who have to withdraw money on the service users behalf. On the plus side, all withdrawals are strictly accounted and documented in a bound ledger, and all statements are rectified on a quarterly basis. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The home is comfortable, homely, and safe. Bedrooms are highly personalised and seem to be enjoyed by the individuals. Shared space is limited to one large room, but meets all the resident’s needs and is well maintained. Adaptations that have been assessed as necessary for physical movement have been implemented. Improvements in both bathrooms have been identified as required, but no date of commencement has been made; this has placed a limitation on who can use the bath. EVIDENCE: The home is a purpose built bungalow with all facilities over one floor. Staff take the lead responsibility for domestic chores, but residents are now starting to join in and be part of these activities. The bathroom was identified, prior to June 2004, as needing refurbishment as it does not meet service user needs. The bath itself has a rough surface where the enamel has worn away. The physical structure of the room makes accessibility difficult for persons who need to use a hoist. The ceiling has some discolouration. The shower room remains uninviting, as it has no windows and a darkly stained floor. The finances and planning permission for this and an increase in communal space has now been identified, and this work is due to take place in 2006. Bedrooms and other parts of the house are in generally good order, and redecoration of communal rooms will take place in the refurbishment. Two The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 16 residents have clubbed together and purchased a wheelchair with a motor assisted wheel, and breaks. Getting around the grounds and tackling the hills is now much easier. The home is clean and hygienic. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 A training audit has taken place, but further focus on training from the residents perspective would be beneficial. EVIDENCE: The manager has conducted a training audit, but from a health and safety and service requirements let position, but not, as yet, from a service user led position. This was discussed, and, in line with the person centred approach, this should be considered. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 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 X 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 1 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X X X X X X X The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 20 YES 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 YA6 Regulation Requirement Timescale for action 01/06/06 2 YA9YA23 3 YA20 4 YA20 12, 14, Using a person centred 15, 17, 18 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. 13 Previous requirement, timescale extended from 01/09/05; Risk assess service user access to money using the ‘chip & pin’ facility, taking action to remedy if required. 13 Reference to the Royal Pharmaceutical Society of GB guidelines; Cease secondarily dispensing medication. 13 Reference to the Royal Pharmaceutical Society of GB guidelines; Retain records of returned medication on the premises – 01/03/06 All prescription medication is kept with its pharmacy direction label 01/03/06. Review medication policy and procedure 01/04/06. Documented authorisation to change directions to medication be relocated. Directions to be DS0000023568.V281242.R01.S.doc 01/04/06 09/02/06 01/04/06 The New Bungalow Version 5.1 Page 21 5 YA35 14 18 6 YA39 24 changed through GP ASAP 01/03/06. Previous requirement, timescale extended from 01/11/05, 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; Develop an inclusive, robust, quality assurance monitoring system against the elements of this standard. 01/06/06 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations Internal competency assessment for all staff who administer or manage medication. Review timing of ‘checking in’ of new months medication. Keep sticky bottles away from other medication. The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The New Bungalow DS0000023568.V281242.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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