Inspection on 13/07/05 for The Old Rectory

This inspection was carried out on 13th July 2005.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory 05/05/09

The Old Rectory 09/05/07

The Old Rectory 02/05/06

The Old Rectory 14/12/05

The Old Rectory 16/12/04

The Old Rectory 14/04/04

The Old Rectory 12/07/02

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

CARE HOME ADULTS 18-65 The Old Rectory Stubb Lane Brede East Sussex TN31 6ES Lead Inspector Jeanette Denereaz Unannounced 13 July 2005 08:30 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 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 Stationary 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 H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address Stubb Lane Brede East Sussex TN31 6ES 01424 882600 01424 882066 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Parkcare Homes Limited Mrs Kelly Lisa Mendis-Gunasekera Care Home 13 Category(ies) of Learning disability (LD) 13 registration, with number of places The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of residents to be accommodated must not exceeed thirteen 2. The people accommodated will be between eighteen and sixty five years on admission Date of last inspection 16 December 2004 Brief Description of the Service: The Old Rectory is registered to accommodate thirteen adults with learning disabilities. The property is set in extensive grounds close to the village of Brede near Rye. Whilst Brede offers some amenities the village of Westfield approximatley two miles away is used for shops and post office facilities. The property is a three-storey building and service users accommodation is now on all floors. The proerty is owned by Parkcare Homes Limited, which in turn is owned by Craegmoor Healthcare Limited. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector arrived on the 13th July 2005, to undertake an unannounced inspection and found the acting manager was on annual leave and was informed that a senior support worker was the person in charge in his absence. The senior support worker was late and did not arrive until 9.30am, the inspection began but the senior support worker indicated she had very little knowledge of the management of the home. The Inspector decided that this was a wasted exercise with the answer to most questions of ‘I don’t know’. The Inspector left the home and informed the senior support worker that she would return on Monday 18th July 2005 when the acting manager would be back to work. The Inspector informed Mary Preston the Regional Director of the finding at the brief visit on the 13th July 2005, and was reassured that action would be taken to ensure that adequately experience and trained staff would be in the home until the acting manager returned. The Inspector returned to the home on the 18th July 2005 at 9.00 and met with the acting manager and a full inspection was carried out including a tour of the home. The acting manager had returned from annual leave, but there was no formal handover, and he could not access confidential information which was kept locked and the keys had not been left, as directed, in the safe. The keys arrived when the senior support worker arrived at 10.30am. Residents and staff at home were spoken to during this inspection. What the service does well: What has improved since the last inspection? Progress on redecoration was evident in the main hallway, and areas have new carpets and the lounge has some new furniture. There are plans when the redecoration is finished to re-carpet the hallway and stairs. The redecoration to the entrance and hallway has made the home look more welcoming and homely. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 6 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 H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 standard(s) 1,4 & 5 The home has a comprehensive policy and procedures for the admittance of new service users. EVIDENCE: The home has vacancies and the acting manager has been pursuing prospective residents. The prospective residents are over 40 years of age, which is appropriate for this home; he has met with the individuals, their families and care managers. The acting manager assured the Inspector that the home’s policy and procedures will be followed. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 standard(s) 6,7 & 8 The service offered to most of the residents is at an acceptable standard. However, the home is not meeting the changing health and lifestyle needs of one resident. EVIDENCE: The home will be introducing the Person Centred Planning (PCP) system when care plans are reviewed, beginning with the three residents when they move into The Cottage. PCP is an individualised care plan, and as the name suggest the plan is designed around the person. This is an important area for the home to be developing, as the care plans seen by the Inspector had not been reviewed since 2002. Also healthcare information on residents was not up to date. The resident that has returned to the home from hospital is now mostly in a wheelchair, her bedroom has been moved to the ground floor, and there are plans to convert a staff room into a shower room. But it is evident that the home is not meeting her immediate and changing needs, and the home and terrain is not suitable for a wheelchair user. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 11,13,14 & 17 The home offers many opportunities for educational and leisure activities, in the community, but the in-house day service needs to be reviewed and ensure that it is offering what the service residents want. EVIDENCE: The daily activities for residents are varied and include college and day centre opportunities. This inspection took place at the start of the college summer holiday and therefore there were more residents at home. The home has a day service co-ordinator and facilities for an in-house day service, but the coordinator was out driving the mini-bus and very little activity was taken place within the home. The acting manager discussed with the Inspector that a review of the in-house provision is needed, and with some residents becoming less able and inactive and the in-house facilities need to reflect their needs and wishes. A cook provides the catering of the home, and the main meal of the day is in the evening. The inspector did not see the evening meal, but the refrigerator and freezers were inspected and found to be full and in order. The home records that residents have had a meal, but not meal or changes to the menu. It has been recommended on previous inspection that the food eaten should be The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 11 recorded and the home had planned to produce a pictorial menu board. This has not yet been formulated. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 standard(s) 18,19 & 20 It was apparent that the majority of the residents’ healthcare needs were being managed, but the lack of communication between the staff team could leave residents vulnerable. One resident’s personal and healthcare needs are not being met appropriately because the home does not have the facilities or the expertise. EVIDENCE: The acting manager has reviewed, and rewritten the medication policy within the home, and doing so decided to move the medication into the main office, because there is more space and all the documentation in now centralised. The concerns the Inspector has with the home is not meeting the needs of one resident, this is also shared with the Community Learning Disability Team (CLDT) and the resident’s care manager. The facilities and the layout of the home is not suitable for a person using a wheelchair, and the fact she does not have access to a shower or bath is totally unsatisfactory. There is written report by the night staff that on the 29/6/05 that the resident became quite distress in the night, there was no evidence that this information had been acknowledged or acted upon. The Inspector enquired about the handover from the night to day staff, and was informed that this does not always happen, and this was the situation on the day of the 13ty July inspection, the staff member required to met and The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 13 handover from the night staff was off sick. This was more evidence of the lack of communication and team working between the staff. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 standard(s) 22 & 23 Residents are supported to raise concerns, and the home has a comprehensive complaints policy and procedures in place. EVIDENCE: The home has a detailed complaints policy and procedures. Since the last inspection there have been no complaints made. The majority of the staff team have received relevant training on protecting vulnerable adults from abuse. There has been concerns raised by a resident regarding the care of his wife, who is also a resident, the concerns were discussed with them and their care manager was also involved in the discussions, and the conclusion was the outcomes are satisfactory for the resident. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,27 & 30 The majority of residents live in a homely, comfortable and safe environment. But the home is not a safe environment for one resident whose needs have changed, and where the layout and design and facilities do not promote her independence. EVIDENCE: The home is clean and all bedrooms were inspected and were found to be adequate and some are personalised by the residents and their families. There are still decorating to be completed, but the areas that have been completed are very homely with new carpets and furniture. The Old Rectory is large house, and is not suitable for a resident with severe mobility issues. There are adequate bathroom and showers, but they are all situated on the upper floors and the home does not have a lift. The acting manager informed the Inspector that there are plans to convert a staff room into a shower room for the resident now living on the ground floor, but at the present time she is only offered strip washes, and this is not satisfactory. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 & 36 The supervision of the staff within the home is not robust or regular, and therefore residents do not benefit from a well support of informed staff team. There is a need for the both day and night staff to communicate with each other and for all the staff to become one team, working together for the benefit of the residents. EVIDENCE: It is evident that the staff within the home are not working together as a team for the best interest of the residents. The acting manager confirmed he is aware, and has plans for the staff to work in teams supporting one another and sharing their skills. The supervision of the staff has not been regular, and this includes the supervision of the new staff recently employed. As with other Craegmoor homes, The Old Rectory has recently employed overseas staff, and one resident informed the Inspector that he couldn’t understand the staff when they speak to each other in their own language. This had been brought to the attention of senior staff, and the staff members have been spoken to. The acting manager must be more aware and promote meaningful communication between the staff, and the night staff input must be reviewed and physical handover should be established everyday to ensure a continuity of information for the well being of residents. There should be a system to acknowledge that information given by staff has been received and actions taken. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 & 42 In the absence of the acting manager the home is not managed properly and there is no leadership. This results in practices do not promote and safeguard the health, safety and welfare of the residents. EVIDENCE: On the first day of this 13th July inspection a senior staff member had came in on her day off to undertake the medication, whilst the senior with the responsibility for the home in the absence of the acting manager arrived late for her duty, when she did arrive she had very little knowledge of the management of the home. However, on the second visit when the acting manager was on duty, and it is evident that he is working hard to improve the performance of the home, and since the last inspection improvements have been made, with the reviewing of many practices and procedures. Whilst the residents made positive comments about the staff team, there is evidence of poor communication between the staff and management, and this situation leads to poor outcomes for residents. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 18 It is evident that the home did not undertake a comprehensive re-assessment of needs of the resident whilst she was in hospital. Her physicals needs have changed and are not being met within the home at this present time. Health and Safety records including fire drills were found to be in order. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 1 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 1 x x 3 Standard No 11 12 13 14 15 16 17 2 3 3 2 x x 2 Standard No 31 32 33 34 35 36 Score 1 2 x x x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Old Rectory Score 1 1 3 x Standard No 37 38 39 40 41 42 43 Score 2 1 x x x 3 x H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 20 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. Standard YA6 Regulation 15(1) See Schedule3 (1)(b) Requirement It is required that Senior Management ensure that the service can meet current and changing needs, which includes treatment and rehabilitation for the resident now with mobility and health issues. This should include a review of the individuals placement. It is required that Senior Management consult the resident if changes are made to the statement of purpose to enable the resident to participate within of the homes activities. This is in connection to the changing needs of one residents mobility and health issues. It is required that Senior Management ensure that staff enable residents to have the opportunites to maintain and develop social, emotional and independent living skills and if a residents mobility and health deteriorate and they are not fully involved with the home, there should be a review of the suitability of the placement. It is required that Senior ensure that the in-house day service is Timescale for action Immediatel y 2. YA8 24(3) Immediatel y 3. YA11 16(2)(m) Immediatel y 4. YA14 16(2)(m) (n) 1/10/05 Page 21 The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 5. YA18&YA19 12(4)(a) 6. YA24 13(4)(a) 23(2)(a) 39(h) 7. YA27 23(2)(j) 8. YA31 18 19 accessable to all residents and they have a choice in the range of appropriate activities. This to include the more elderly residents. It is required that Senior Management ensure that the healthcare and physcial needs of the resident with deteriorting mobiity and health needs are recognised and to assess if the home can meet these changing needs. It is required that the home is accessible and safe for all residents. This is in reference to the design and terrain of the home, which is unsuitable for a person using a wheelchair. There is a need to assess if the home can meet the changing needs of the resident who now spends more time in a wheelchair. It is required that the Senior Management provide all residents with bathroom faciliites which meet their assessed needs and offer sufficient personal privacy. This refers to the resident who now has a bedroom on the ground floor and can only have strip washes, until a shower room is built. The arrangment at present is not meeting her immediate needs. It is required that the Responsible Individual/Senior Management ensure that staff have clearly defined job descriptions and work as a team to promoted the aims of the home and good outcomes for residents. The acting manager to provide evidence to the CSCI of the new teams, the proposed rotas and seniors responsbilites including the night staff. 1/10/05 1/10/05 1/10/05 1/10/05 The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 22 9. YA32 YA37 18(1)(a) 10. YA36 12(5) 18(2) 11. YA38 12(5) It is required that the Responsible Individual/Senior Management ensure that in the absence of the manager the senior staff in the home has the competencies and qualities to meet the needs of residents and have the knowledge of the home to assist vistors and Regulationary Bodies when visiting the home. It is required that the Responsible Individual/Senior Management undertakes supervision with all the staff team at least six times per year. This was an immediate requirement from the last inspection It is required that the Responsible Individual/Senior Management ensure that the approach of the home creates an open, positive and inclusive atmosphere. This is in reference to the low staff morale and lack of team working within the home. 1/11/05 1/10/05 1/11/05 12. 13. 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 YA17 Good Practice Recommendations It is recommended that photographs of meals served would encourage residents who have no reading ability to make a more informed choice of the meal they would like on any given day. The Old Rectory H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 H59-H10 S21256 The Old Rectory V231382 130705 Stage 4.doc Version 1.40 Page 24 - 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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