Inspection on 11/12/06 for The Old Rectory

This inspection was carried out on 11th December 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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory 22/10/07

The Old Rectory 23/05/07

The Old Rectory 10/11/05

The Old Rectory 16/12/04

The Old Rectory 21/07/04

The Old Rectory 23/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Old Rectory 45 Sandwich Road Ash Canterbury Kent CT3 2AF Lead Inspector Kim Rogers Key Unannounced Inspection 11th December 2006 10:00 The Old Rectory DS0000023705.V301528.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 Old Rectory DS0000023705.V301528.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 Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 45 Sandwich Road Ash Canterbury Kent CT3 2AF 01304 813128 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Rex Slade Cadman Mr Rex Slade Cadman Care Home 40 Category(ies) of Learning disability (40) registration, with number of places The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users over the age of 65 years old are restricted to four (4) whose DOBs are 04/03/1940; 26/04/1939; 24/03/1937; 27/02/1940. 10th November 2005 Date of last inspection Brief Description of the Service: The Old Rectory is a 40 bedded home. The home has been established for over 25 years and provides personal care and support to people who have learning difficulties. The home is on the outskirts of the expanding village of Ash, which has reasonable local facilities. The home has its own transport and there is a major bus route nearby linking the village with Canterbury to the west and Sandwich, Ramsgate and Deal to the east. The building comprises a large house, which has been extended over the years to meet the increasing needs of the service. Accommodation is set over three floors with a good range of both communal and individual space. Activities are provided both within the home and in the community. Service users are supported and encouraged in accessing external activities. The provider/manager also runs another home nearby for 5 service users. The fee for living at this home ranges from £323 to £550 per week approximately. For more information about the fee and what it includes please contact the Provider. Previous inspection reports are available for the Provider. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit was unannounced and carried out by two inspectors over about 7 hours. The Provider/manager, Mr. Rex Cadman, deputy manager, service users and staff assisted in the process. Forty people currently live at the home, and most gave some feedback. People were coming and going in and out of the house and were doing activities with the staff and independently during the visit. The inspectors had a tour of the home, and with permission, some bedrooms were seen. The inspectors spent time with service users, spoke to and observed staff and interviewed and observed the manager and deputy. Service users said they have enough to do. Service users appeared happy and well cared for. Some work was done before the visit including talking to and surveying care managers and relatives. The manager supplied a pre inspection questionnaire, with details of domestic checks and various other data about the home. A selection of records about service users, and some other documents such as staff recruitment files was seen. What the service does well: Service users have opportunities to take part in a variety of activities and some have paid jobs. Staff are long standing and know service users well. Relationships and friendships are well supported. Advice has been sought and followed from health professionals. There is a variety of communal space which service users have unrestricted access to. This allows service users to move around freely and choose where they want to be. Service users said they know who to talk to if they had a complaint and are confident that staff would do something about it. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Rectory DS0000023705.V301528.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 Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Information about the home should be up to date so service users can make an informed choice. Service users cannot be sure their aspirations will be assessed. EVIDENCE: The home has a service users guide which gives information about the home to prospective service users. The guides seen in service users files were dated May 2005 and have some outdated information. It is recommended that this be reviewed and updated. Some service user plans were sampled. Most service users have lived at the home for several years so assessments relating to people who have recently moved in were checked. One service user had an assessment by a care manager that was person centred and identified the person’s aspirations. Others had limited detail and information, which meant aspirations and future goals were missed. The manager was clear that the person centred approach would be adopted and that help and advice was currently being sought. The Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users cannot be sure their changing needs and personal goals will be identified and supported. Communication systems should be developed to increase choice and decisionmaking. More focus on enabling strategies to support risk taking is needed. EVIDENCE: Each service users has a file containing their service user plan. Two files sampled had no service user plan by the home. The manager said that they have a plan and would look into where it was. Some basic information is included in service user plans although personal goals are not always identified and supported. Some plans had conflicting information. The manager said he has plans to introduce more person centred plans. This said, changing needs were particularly well supported for an The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 10 individual. Staff knew how and what to do to make sure the person was as calm and focused as possible. Risk assessments have basic information and need more of a focus on enabling rather than restricting. Some risks to service users are apparent but have not been assessed. There is no record of when a risk last occurred. Reviewing documentation needs to improve. The manager agreed to review and update all plans and archive the outdated information. Some service users have communication needs and communicate in very individual ways. Some service users have had the support of a speech and language therapist. There were no communication assessments or guidelines in service user plans sampled so there was no description of what different signs and gesture mean. The Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area for service users is good. This judgement has been made using available evidence including a visit to the service. Service users have opportunities to take part in activities and events in the community and at the home. Relationships are well supported. Service users responsibilities and rights are recognised. Service users enjoy a varied healthy diet and enjoy meal times. EVIDENCE: Service users told the inspectors about a range of activities and events they take part in. Service users take part in activities at the home and in the community. Individual activity planners were seen in service user plans. Records showed that service users choose to do things each day and have the support they need. Some service users have paid jobs. Others would like jobs and this should be supported and planned for. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 12 Staff have use of a minibus and car enabling access to the wider community. Some service users go out alone and use public transport. Relationships are well supported. Service users said they have their friends and family to stay and are supported to stay in touch. Service users have unrestricted access to the kitchen although the laundry is kept locked. The manager agreed to review this restriction to ensure that it is the least restrictive option available. Some service users have a key to their bedroom and some do not. Some do not have a lock fitted. The manager said that some service users choose not to have a key. This should be regularly reviewed to ensure service users are regularly given the option. Locks should be fitted as rooms become vacant. The home employs a cook who prepares the meals. Service users all eat together and enjoy mealtimes. Service users said the food is good and they can access the kitchen for drinks and snacks. The Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users know their personal care and health needs will be met. Medication practice is unsafe placing service users at potential risk. EVIDENCE: Personal care needs are recorded in service user plans, some in more detail than others. Most service users are independent with personal care. Service users looked well cared for and relatives spoken to confirmed this. Some bathrooms do not have locks fitted and some double rooms had no screening. This should be addressed to ensure privacy. There was evidence of advice being sought and followed from health professionals. Records of health appointments are kept. There were good health records in one service user plan sampled. This could be improved with the introduction of health assessments and individual health action plans. The main medication storage is adequate but administration practice and their records are currently poor. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 14 The storage of oxygen is not in line with guidance and this should be addressed. Training for staff in medication practice is limited and no competency assessments are carried out. Staff are double dispensing medication and signing to say a medication has been taken when it has not been. There was no note made of medication taken much later than the time stated. Some ‘when needed’ medication instructions are ambiguous. Some hand written entries on medication administration records are not detailed enough. Some medication is not labelled. The manager agreed to organise staff training in safe medication practice. The home still requires a drug fridge as recommended at the last inspection. The Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users are confident their complaints will be listened to and acted on. Staff must be competent in recognising and reporting abuse to safeguard service users. EVIDENCE: The home has a complaints policy and has had no complaints since the last inspection. The manager said he tries to deal with any issues at an early stage so. Service users said they would speak to staff if they had a problem and are confident staff would act. The manger is appointee for some service users. He has taken steps to try to relinquish this responsibility by asking care managers and relatives but this has been unsuccessful. This is not an ideal situation; ideally service users should be supported to be their own appointee following the necessary assessments. Service users financial records were checked. Records were in order with receipts and regular checks. Most service users are in debt and this was discussed at length. The manager subsidises the ‘preserved rights’ clients to ensure they do not miss out on opportunities for a good quality lifestyle. The manager is challenging the ‘preserved rights’ status on service user behalf. Four staff files were sampled. It was evident that these staff have had no training in how to safeguard vulnerable adults. It was evident that some staff do not know how to record, report and respond to possible abuse. The The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 16 manager agreed to address this. A file note indicated a disclosure had taken place, but had not been reported appropriately. The Old Rectory DS0000023705.V301528.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,30 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Some parts of the home are safe and homely and other parts need improving especially bathrooms. Most service users are happy with their rooms although some bedrooms need improving. The home is generally clean. EVIDENCE: Some parts of the home are in good order and some are not. The manager is well aware of this and has a development plan to improve the home. At present some service users have to go through a double room to get to their single room. There is a plan to reduce the number of double rooms. There is currently no plan to meet standard 24.3, which requires that there should be a maximum of 10 people sharing a staff group, dining area and other common facilities by 1 April 2007. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 18 Communal areas are spacious and varied so service users can choose where to spend time. There are no restrictions imposed on communal space. The garden is spacious and easily accessible to service users. There is restricted access to the laundry and this should be reviewed to ensure it is the least restrictive option. Some bedroom wardrobes are kept locked and this should be kept under review. An over bed light in one bedroom had exposed wires. The manager agreed to address this that day. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Staff competency is not assessed and staff are not adequately supervised. Recruitment checks must be more robust to protect service users. Gaps in statutory training should be addressed. EVIDENCE: Most of the staff are longstanding and know service users well. It was evident that some staff work long hours, up to 81.5 hours a week and have not signed out of the Working Times Regulations. Staff files were sampled and showed that staff have attended some statutory training. Some shortfalls were noted in fire training and safe moving and handling. Staff competency is not regularly assessed and this was discussed with the manager. Supervision is currently not in line with the minimum standard. There is currently no training plan or matrix to monitor training. In one of the four staff files sampled one staff had only one reference, one had no POVA check, none had proof of identity and some of the staff had started in post before a CRB check had been received. None had a contract of employment or job description. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 20 The lack of proper recruitment checks currently places service users at risk. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 21 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): 37,39,42 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. The home is adequately run. An effective quality assurance system needs to be developed underpinned by service users views. Staff must be competent in fire procedures to ensure service users health and safety. EVIDENCE: The manager/provider has owned and run the home for about 25 years. The manager is working towards an NVQ qualification at level 4 in management. The manager was observed communicating and interacting with service users and staff appropriately and positively. The home seeks the views of service users, relatives and other stakeholders. An action plan to improve the home should be produced based on these views. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 22 Some incidents have occurred at the home. The home must ensure that notifiable incidents are reported to CSCI. Following a recent review of legislation the fire risk assessment needs updating. The manager said a fire officer has visited the home recently and given some advice. The recording of fire drills should have more detail including the names of staff taking part, how long the drill took and any action that needs taking. Without this the inspectors were unable to establish which staff had taken part in a drill and which had not. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 23 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 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 1 X X 2 X The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 24 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 YA24 Regulation Requirement Timescale for action 30/11/07 23(2a,b,d,j) To continue with the action plan on shared rooms and redecoration, particularly of the middle floor. (Previous requirement with timescale of 31/12/05 then 30/04/06 but not yet reached) 12 12,13 Make safe the over bed light in one service users bedroom. Develop an action plan on the intention to meet standard 24.3, ensuring the home is organised into clusters of up to 10 people by 1/04/07. Ensure medication administration and record keeping is in line with the standard. Staff must be trained and competent in medication practice. Ensure staff are competent in recognising and responding to suspected abuse. 2. 3. YA25 YA24 31/12/06 01/04/07 4. YA20 13 31/03/07 5. YA23 12,13 31/03/07 The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 25 6. YA20 13 The storage and administration of oxygen must be safe and in accordance with guidance. Ensure that the required recruitment checks are carried out before staff start work. 31/12/06 7. YA34 12,13 31/01/07 8. YA6 12,13,15 Standards, 6,7,9,16. Develop 30/04/07 care plans and risk assessments (by person centred planning/ developing communication systems) to ensure personal goals are supported. Ensure risk assessments and care plans are regularly reviewed. Develop a quality assurance system based on service users views and opinions. Ensure staff are competent in fire procedures. Review the home’s fire risk assessment. Ensure that persons working at the home do not act as agent/appointee for service users. 30/06/07 9. YA39 24 10. YA42 23 31/03/07 11. YA23 20 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations That the home purchases a lockable drug refrigerator with temperature display for the storage of fridge line medication. Outstanding from last inspection. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 26 2. 3. YA37 YA1 The registered manager actively seeks to obtain his NVQ4/ RMA award. Outstanding from last inspection. Review and update the service users guide so prospective service users have the information they need. The Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Kent and Medway Area Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Old Rectory DS0000023705.V301528.R01.S.doc Version 5.2 Page 28 - 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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