Inspection on 20/02/08 for The Rookery Cottage

This inspection was carried out on 20th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rookery Cottage 07/11/05

The Rookery Cottage 26/07/05

The Rookery Cottage 20/12/04

The Rookery Cottage 17/08/04

The Rookery Cottage 21/03/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Rookery Cottage 249 Shinfield Road Reading Berkshire RG2 8HE Lead Inspector Denise Debieux Key Unannounced Inspection 20th February 2008 10:00 The Rookery Cottage DS0000011353.V357897.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 Rookery Cottage DS0000011353.V357897.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 Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rookery Cottage Address 249 Shinfield Road Reading Berkshire RG2 8HE 0118 987 2278 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) www.milburycare.com Milbury Care Services Ltd Mrs Helen Mary Petty Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2006 Brief Description of the Service: Rookery Cottage is a large, detached, listed building with an extension added at a later date. It is a few miles from Reading town centre and is situated on a busy main road. The house is set back from the road and has a large garden. The home is close to public transport and offers easy access to all local amenities. A range of shops is within walking distance of the home. Rookery Cottage is a residential home for up to six adult service users with a learning disability, some of who have additional mental health needs. At the time of this inspection there was one vacancy. Fees range from £1065.96 - £1317.44 per week. This fee does not include: personal toiletries, clothing, magazines, entrance fees to outings, holidays or hairdressing. This information was provided on 20th February 2008. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes it’s inspection of care services. This unannounced visit formed part of a ‘key’ inspection and was carried out by Denise Débieux, Regulation Inspector. The deputy manager and a senior support worker assisted the inspector during the inspection. The new manager was present for the inspection feedback as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CSCI has received about the service since the last inspection. The people who use this service prefer to be called ‘service user’, therefore this term is used throughout this report. A tour of the premises took place. On the day of this visit the inspector spoke with each of the five service users and four on-duty staff. Prior to the inspection, survey forms were sent to service users, their relatives and/or advocates and to staff employed at the home. Completed survey forms were received from two relatives. Some of the comments made to the inspector and made on the survey forms are quoted in this report. Not all service users are able to communicate verbally and observations of the interactions between staff and these service users were also used to form the judgements reached in this report. The home had completed an annual quality assurance assessment (AQAA) and service users’ care plans, staff training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users, relatives and staff who participated in the surveys. What the service does well: The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 6 Service users are supported and encouraged to make personal choices and decisions about their own lives, to participate in the day to day running of their home and to expand and develop a social life, both inside and outside their home based on their individual interests and hobbies. Service users spoken with told the inspector how they were happy living at the home and that they felt safe living there. Interactions observed between the staff and service users evidenced that the staff are skilled at communicating with all service users and have a good understanding of their individual needs and wishes. Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere. One staff member commented that ‘we feel like a family here.’ One relative commented that: ‘It is what I would call a Happy Home. Every care is given. We thank everyone at the Rookery Cottage and day centres.’ What has improved since the last inspection? What they could do better: On the day of this inspection the inspector was advised that the registered manager had left the home early in 2007, the exact date was not known. Failure to notify the commission of a change to the management of the home is an offence under The Care Homes Regulations 2001 and a requirement has been made that the provider make the required notification in full compliance with Regulation 38 without further delay. The internal management of the home is satisfactory overall but failure of the company to take prompt and appropriate action when health and safety risks are identified is potentially placing service users and staff at risk of harm or injury. Requirements and recommendations have been made that relate to the safety of the environment and the need for an effective and ongoing maintenance and refurbishment programme. The home needs to make sure that staff are aware of the requirements of the Berkshire Safeguarding Adults procedures and additional recommendations have been made relating to medication; the need for a staff team training needs assessment and the use of care staff hours in garden maintenance, especially during the summer months. Please contact the provider for advice of actions taken in response to this The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 7 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 Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate pre-admission procedures in place to ensure that a prospective service user’s needs and aspirations would be fully assessed prior to being offered a place at the home. EVIDENCE: No service users have moved into the home since the last inspection. However, appropriate procedures are in place and, in the AQAA, to demonstrate what the home does well, the manager stated that: ‘The home makes sure that people can decide if they want to live in the home and if it is the right place for them. We identify the needs of the individual from assessment of need and continually review this assessment. New service users are offered introductory visits to the service, service users are involved in and agree to their individual plan.’ Data provided in the home’s AQAA does not identify any service users with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ individual plans are clear and comprehensive including details of needs and goals. They also incorporate the service users’ known or indicated preferences. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Prior to this visit, relatives and advocates were sent survey forms, two forms were returned, with both relatives stating that the home always gives the support or care that their relative needs. One relative commented that: ‘We have always been very happy with the care that our relative receives at The Rookery Cottage and we feel very happy over the years with the way he is looked after by all those who care for him and the others who live with him.’ Care plans for two service users were sampled and were seen to be comprehensive, well set out and easy to follow. Care plans and risk assessments are drawn up with service users and are reviewed on a six The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 11 monthly basis, or more often, if needs change or a new concern arises. The staff document daily notes for each service user to evidence that individual goals and needs are being met. The care plans were all seen to be very individualised and included the service users’ personal preferences and also risk assessments for all activities, with clear guidelines for staff to follow to minimise any associated risks. The home are in the process of introducing a new and more integrated system for documenting care plans and hope to have all service users’ care plans transferred to the new system by April this year. On the day of this visit, service users were seen to be choosing what they did and where they went within the home. Staff were seen to be helpful and offered assistance where needed or requested. It was also observed that staff had a good rapport with service users that were not able to communicate their wishes verbally, where they indicated that they wanted assistance, this was quickly understood by the staff and the assistance provided. In the AQAA, to demonstrate what the home does well, the manager stated that they: ‘Provide an individual plan based on the assessment of need, clearly indicating individualised procedures that may be necessary. The plan is drawn up with the involvement of the service user, family/friends/advocate and relevant agencies as appropriate.’ The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 12 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users have opportunities for personal development and to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. Systems are in place to ensure that service users’ rights are respected. Meals are well-balanced and varied. EVIDENCE: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users spoken with confirmed they could choose what to do, when they wanted, within the limits of staff availability. This was also confirmed by observations made by the inspector on the day of this visit, where it was not possible for an activity to take place immediately, a time was agreed with the service user for later in the day. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 13 One service user has a part time job and is hoping to increase his hours from two to three days a week. Each service user has a weekly activity schedule that is based on his or her known interests and hobbies and includes regular activities at local day service centres. The activity schedules sampled were seen to be varied and included activities both within and outside the home in the local community. One service user spoke with the inspector about the plans that were being made for his birthday later in the week of this inspection. During the day, service users were going out and returning, one service user went for a walk with a member of staff, another service user went to their day centre. It was obvious during this inspection that the staff team are open and flexible and that no two days were the same. All service users plan and take holidays during the year, with support from staff where needed. One service user is hoping to go to Disneyland, Paris this year and staff are supporting the service user with the planning of the trip. In the AQAA, to demonstrate what the home does well, the manager stated that they: ‘Provide Individual Activity Plans; provide Person Centred Plans and facilitate attendance at external learning opportunities. We enable service users to experience a wide range of leisure activities and provide support to continue with existing activities. We provide opportunities within individual activity plans to participate in the local community and provide access to vehicles, assist and support in accessing local transport. Staff support individuals to explore employment opportunities were they so wish. Flexibility in rotas to support chosen activities, choice of external activities brought into the home, provide the support to access annual holiday of individual choices, day trips, ensure activities are support by trained staff, open access (no visiting times) we support the service users to welcome visitors in private or in a chosen communal area, family and friends are encouraged to participate in daily routines (with service user agreement).’ Relatives surveyed both felt that the home always provides the support needed for their relatives to live the life they choose and that the home always helps their relative to keep in touch with them. The menu for the week of this visit was seen to be varied and well-balanced. The inspector was advised that service users plan their meals, with assistance and guidance from the staff where needed. Some service users enjoy participating in the meal preparation and are supported to do so. The home have worked hard and developed photograph and picture cards of different foods, these cards are used to enable service users, who have difficulty communicating, participate in and make choices when planning meals. The lunchtime meal took place during this visit, one service user helped with the preparation of the meal, staff were eating with the service users in the The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 14 dining room and there was a relaxed family atmosphere. Service users later confirmed they had enjoyed their lunch. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance was seen to be provided, where needed, in a respectful and sensitive manner. Policies and procedures are in place for the safe administration and management of medications. EVIDENCE: During this visit two care plans were sampled and it was seen that all health care needs were incorporated into the care plans. Diary notes evidenced that staff take prompt action to deal with any new health problem that may occur and care plans were specific with information for staff to follow when supporting service users to manage any long-term conditions. Appropriate professional advice is sought when needed. The staff are currently working with one service user on losing weight. A dietician referral has been requested via the local GP and staff are waiting for an appointment date. The inspector was advised that, following the appointment with the dietician, a detailed care plan will be drawn up with the service user, based on the advice obtained. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 16 Medication is provided mostly in the blister pack system. The administration of some medications was observed and the medication administration records (MAR) and medication storage were sampled and found to be in good order. There were some creams and ointments that have recently been prescribed and it was noted that the tubes currently in use were not marked with the date of opening. This could mean that the staff continue to use the creams beyond their open shelf life and a recommendation has been made. There have been three incidents of service users missing prescribed medication in the past year. Two of the incidents were due to service users being away from the home and being unexpectedly delayed in their return, thereby missing their medications. These incidents were all investigated by the home’s manager and appropriate steps taken to reduce the possibility of a recurrence. It is recommended that the home set out a clear procedure for all staff to follow to reduce the risk of medication being missed when the service users are away from the home plus the actions staff should take if service users do miss their medications for whatever reason. A recommendation has also been made that the home obtain a copy of The Royal Pharmaceutical Society of Great Britain’s latest guide ‘The Handling of Medicines in Social Care’ and review their current medications policy, procedure and practices to ensure they reflect the new guidelines. In the AQAA, to demonstrate what the home does well, the manager stated that: ‘Individual care/support plans reflect service users’ own choice of when they wish to get up and go to bed. The staffing at the home reflects preferred gender for support of service users. Documented evidence of visits or reports from relevant professionals are maintained for individuals and any recommendations are acted upon. Any aids and adaptations for personal support i.e. bath chair etc. are routinely maintained and serviced. Training records are maintained for staff to ensure support provided to individuals meets the individual’s needs and legal requirements (health and safety, manual handling etc). Service users are supported by staff to attend appointment to relevant health care professionals and any recommendations acted upon. Key workers are chosen by the service user or in the best interests of the service user. Staff attend external training for the administration of medication and staff are routinely reassessed within the home by the home manager/deputy.’ Relatives who returned survey forms both stated that they were always kept up to date with important issues that affected their relative and both felt that the home always meets the needs of their relative. During this inspection, all interactions observed between staff and service users were polite and respectful. Staff never entered service user’s private The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 17 rooms without knocking and waiting for permission to enter. All personal care was carried out behind closed doors. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required policies and procedures are in place to ensure that service users feel their views will be listened to. Policies and practices are in place to protect service users from abuse and neglect but the home needs to review these procedures and ensure they are in line with, and that staff work to, the local, Berkshire Safeguarding Adults procedures. EVIDENCE: The home has a complaint’s procedure in place that is available to all service users, has been individualised to the home and is available in an easy read, picture format. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Multi-Agency Policy and Procedures for the Protection of Vulnerable Adults. Since the last inspection there have been two safeguarding incidents, both identified by staff at the home. In both cases the staff acted promptly and appropriately to ensure the safety of the service users and correctly reported the incidents in line with the local, Berkshire procedures. All staff have received training or updates in the protection of vulnerable adults, this is clearly recorded in the home’s training records. The home are using a new ‘E learning’ system for some staff training which includes a module The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 19 on safeguarding adults. During this inspection the home’s safeguarding policy and procedures and the E learning module were sampled. Both clearly set out the definitions and principles of safeguarding vulnerable adults but neither are fully in line with the local, Berkshire procedures and both indicate that the company’s own management will decide who is to carry out any investigation. Staff spoken with were clear of the company’s own policy and procedure for safeguarding adults but no staff were aware that, where there is any suspicion of abuse that relates to a vulnerable adult in a care home, the concern must be reported to the local authority social services department without delay. The local social services safeguarding team hold the responsibility for coordinating and monitoring any action and for deciding who should lead any investigation. A requirement has been made that the home review their procedures and staff training and ensure they are in line with, and that staff are aware of and adhere to, The Berkshire Safeguarding Adults Multi-Agency Policy and Procedures for the Protection of Vulnerable Adults. In the AQAA, to demonstrate what the home does well, the manager stated that they: ‘Provide a clear and effective complaints policy and ensure all service users are aware of its existence and how to use it. Complaints are dealt within a specified time frame. Provide robust procedure for responding to any suspicion, allegation or evidence of any type of abuse. Provide a Whistle blowing policy. Provide appropriate training to staff for any necessary physical intervention. Clear recording of service user finances following company procedure. Monthly Service Reviews and unannounced inspections.’ Relatives surveyed both stated that the home always responded appropriately if they or their relative raised concerns about their care. Service users spoken with indicated that they knew who to talk to if they were not happy and that they felt safe living at the home. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The location and layout of the home is suitable for it’s stated purpose. The provider needs to develop and implement an effective and ongoing programme for the planned maintenance and renewal for the fabric and decoration of the premises. The lack of an effective system for carrying out required maintenance and repair work is not satisfactory and is placing service users and staff at risk of harm or injury. EVIDENCE: The Rookery Cottage is a large, detached, listed building with an extension added at a later date. The house is set back from the road and there is a large communal garden to the rear, side and front of the property. Individual accommodation is provided in six single bedrooms, with four being on the first floor and two on the ground floor. Communal areas include a large lounge/dining area, a kitchen and three shared bathrooms. Service users spoken with expressed their satisfaction with their individual bedrooms, which were all seen to be personalised with their own possessions. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 21 The home was toured during this visit. The furniture and furnishings were seen to be generally of a good quality and specialist equipment is provided, if needed by the service users. Service users confirmed they had been involved in the choosing of colour schemes for their own bedrooms. A number of rooms at the home have been redecorated since the last inspection and a total refurbishment of the kitchen is due to commence in the next two weeks. There were a number of environmental concerns that came to light during this inspection. At the last inspection in September 2006 it was identified that the bathrooms were in need of refurbishment and it has been highlighted by the home that one of the baths needs to be replaced by a shower to increase service user choice and reflect their preferences. To date this work has not been carried out. The maintenance folder evidenced that work required, although reported by the staff at the home, has not been carried out in a timely fashion, with the staff having to repeat requests and spend unnecessary time away from the care of the service users in chasing these repairs, some of which have been identified as posing a risk to service users. For example: • There is a large crack in the bowl of the toilet in the ‘big’ bathroom on the first floor. The crack was first reported to the company’s maintenance department on the 16th January 2008. The crack is now so severe that it has been risk assessed by the home that the toilet is not safe for use, both because the toilet could break during use and because of the crack being a potential source of infection and the staff have had to put the toilet out of service as unsafe. To date this has not been repaired and the home have not been notified of a date for repair. • There is a broken window in the kitchen. The staff have boarded the window to ensure that there is no risk to service users or staff and the window was reported to the maintenance department on the 2nd November 2007. To date this has not been repaired and the home have not been notified of a date for repair. • Approximately 18 inches of tumescent strip has come away from one of the fire doors leading out of the kitchen. This was reported on the 2nd November 2007. To date this has not been repaired and the home have not been notified of a date for repair. • The home have identified that a number of radiators pose a risk to the service users as they are very hot and uncovered. The need for radiator covers was reported on the 8th October 2007. To date this has not been addressed and the home have not been notified of a date for work to start. • The vinyl floor covering in one service user’s bedroom is torn and has been temporarily repaired with silver duct tape. Whilst protecting the service user from trips temporarily this is not an acceptable long-term The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 22 • solution, has a very poor appearance and is below the standard expected in a registered care home. This was reported by the home on the 23rd August 2007. To date this has not been addressed and the home have not been notified of a date for the flooring to be replaced. The home identified and reported that the premises were overdue for their 5 yearly electrical wiring checked. Workmen came on the 8th February to carry out the checks but were called away and had to leave before completing the work. The home have not been advised of the date this work will be completed and the home are without a required safety certificate. In addition to the above: the home are aware that they need to have paper towels available at hand washing points for the staff. The inspector was advised that they have purchased the dispensers but, with the exception of the kitchen, are still waiting for them to be fitted. On touring the home and grounds, in addition to the need for the bathrooms to be refurbished, it was seen that the paint is flaking away from the exterior walls of the building, more marked at the rear, and window frames and doors are in need of redecoration. One gutter at eye level was totally blocked and in need of clearance. The house is situated on a busy main road. In order to protect the safety of the service users, the entry to the front driveway has been fitted with a gate and numbered keypad. Although the actions identified by the home set out that this gate should be kept shut at all times when not in use, comments received prior to inspection indicated that this does not always happen and the gate was open when the inspector arrived on the day of this visit. The home must ensure that, where a risk to the safety of service users is identified, all staff ensure that any measures put in place to reduce these risks are adhered to at all times. There are large broken tree branches on the ground in the back garden awaiting removal. The inspector was advised these branches broke off the tree last summer and concern was expressed then by the staff regarding the safety of the trees and the possible need for them all to be pruned. The provider must arrange for a risk assessment of the garden to be carried out, by someone suitably qualified, to ensure that all areas of the gardens that the service users can access are safe. A number of environmental requirements have been made. As a matter of priority the provider needs to review the current maintenance system and develop and implement an effective and ongoing programme for the planned maintenance and renewal for the fabric and decoration of the premises. It is understood that the registered provider is not the landlord of the premises but it must be recognised that, as the registered provider, Milbury Care Services Ltd are required by the Care Homes Regulations 2001 to ensure that the The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 23 premises are at all times kept in a good state of repair both externally and internally and that external grounds are provided that are safe for use by the service users and appropriately maintained. The home have identified that, in the next 12 months they would like to focus on ways to improve the garden with service user involvement, and would like, amongst other ideas, to develop a sensory garden. It is recommended that, once plans are drawn up with the service users, the provider engage external contractors to carry out the work. It is also recommended that the provider make alternative arrangements for the lawns to be maintained during the summer so that care staff hours are not used for this work. In the AQAA, to demonstrate what the home does well, the manager stated that they: ‘Provide a home that is well located to access local facilities and transport networks and is fit for purpose. Provide all service users with their own personal space in a self-contained single room, with suitable furniture and fittings and encourage/support to add their own personal belongings that reflect their culture, beliefs and personalities. Ensure that fire and safety requirements are adhered too. Ensure those service users with specialist needs have their needs assessed by the appropriate professional. Provide comfortable and fully accessible communal facilities that reflect service users needs and preferences.’ Laundry facilities are sited on the ground floor with washing and drying machines suitable for the needs of the service users at the home. On the day of this visit the home was found to be warm and bright with a homely atmosphere. The staff and service users work together to maintain a good standard of housekeeping. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 24 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a staff training and recruitment programme which is designed to ensure that service users are supported by competent and qualified staff and that, as far as reasonably possible, they are protected from harm. EVIDENCE: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. The morning (7.30am – 2.30pm) shift is covered by three care workers, three care workers cover the afternoon/evening shift (2.30pm – 9.30pm) and the night staff consists of one waking care worker and one sleeping on the premises and available if needed. As mentioned earlier in this report, the gardens are large and mostly laid to lawn. At present the staff have no external, professional help with the routine maintenance of the garden and the care staff try to take on that added responsibility, with some help from the service users where they are able and if they wish to participate. However, this added responsibility takes the care staff away from their normal duties working with the service users, especially with keeping the lawns mowed during the summer and a recommendation has been made. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 25 In addition to the manager, there are a total of eleven care staff, of whom six are full time, one is full time bank and four work part time. Five members of staff hold a National Vocational Qualification (NVQ) level 2 in care, almost meeting the requirement for at least 50 of care workers being qualified to NVQ level 2. The home have recently interviewed for staff vacancies and are hoping that a recent recruit will begin working at the home as soon as the necessary recruitment checks have been completed. When needed to cover sickness or annual leave the home employ staff from a local agency, the inspector was advised that these staff are always those that have worked at the home before and are known and liked by the service users. At the previous inspection, staff recruitment records were assessed and found to meet the required standard and included all necessary pre-employment checks. Since that time there have been no new staff recruited to the home. For this reason recruitment records were not checked on this occasion. The manager demonstrated a sound knowledge of current recruitment legislation and the company have a robust policy and procedure in place. Service users are invited to sit in on recruitment interviews and their views are taken into account when decisions are made to employ. Staff induction covers all mandatory training and the inspector was advised that staff are supervised until they have completed their induction, with new staff being supernumerary for the first two weeks and only shadowing established members of staff. In October 2006 the Skills for Care organisation introduced new, mandatory common induction standards, as there have been no new staff at the home since these new standards were introduced it was not possible to assess the home’s compliance. The new standards were discussed with the manager and a recommendation has been made that the home obtain a copy of the new standards and guidance from the Skills for Care website and check that their own induction procedure follows the new standards. The training records seen showed that the home also provides additional training in autism, non-violent crisis intervention and the administration and handling of medications. Some, but not all, staff have attended training in working with people with epilepsy. It is recommended that the home carry out a training needs assessment for the staff team as a whole, taking into account the care needs of the current service users e.g. autism; epilepsy; visual impairment. This will enable the home to plan for all staff to be provided with training to help them work with and provide care to the current service users. The need for staff training in local adult protection procedures has been addressed earlier in this report and a requirement made. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 26 In the AQAA, to demonstrate what the home does well, the manager stated that: ‘Staff have clear roles and responsibilities, staff are appropriately trained and qualified, and we have a robust recruitment policy and practice adhering to relevant current standards and legislation. All staff are supervised and appraised on a regular basis and staff are paid to attend training. All staff have defined job descriptions and understand their roles and responsibilities which are linked to achieving individual service users goals. Staff are familiar with and comply with General Social Care Council standards. Training certificates/induction/LDAF/ training and development plans demonstrate that staff are qualified to meet service user needs.’ Service users spoken with said that the staff listened and acted on what they said. To the survey questions: ‘Do the care staff have the right skills and experience to look after people properly?’ and ‘Does the care service meet the different needs of people?’ both relatives answered ‘always’. One member of staff commented that the company were very good at providing training and felt that the training gave them the skills they needed to do their work. Interactions observed between the staff and service users evidenced that the staff are skilled at communicating with all service users and have a good understanding of their individual needs and wishes. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 27 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The internal management of the home is satisfactory overall but failure of the company to take prompt and appropriate action when health and safety risks are identified is potentially placing service users and staff at risk of harm or injury. EVIDENCE: On the day of this inspection the inspector was advised that the registered manager had left the home early in 2007, the exact date was not known. Failure to notify the commission of a change to the management of the home is an offence under The Care Homes Regulations 2001 and a requirement has been made that the provider make the required notification in compliance with Regulation 38 without further delay. The new manager of the home has been in post since April 2007, having transferred from another home within the same company. To date the The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 28 commission have not received an application for the new manager to become registered, the manager stated that her application was being prepared and would be filed shortly. The manager has four years experience working as a home manager and has been working with people with learning disabilities for the past fourteen years. Relatives who returned survey forms stated that they were always kept up to date with important issues affecting their relatives. One relative commented: ‘The manager is doing a good job.’ Service users’ views are sought on a regular basis and the service users attend the monthly staff meetings if they wish to. Monthly visits by a representative of the responsible individual take place as required. The company carry out regular surveys which seeks the views of service users. The report of last year’s survey was seen at this inspection, it was noted that the service users had also commented on the need for refurbishment of the bathrooms, although this work has yet to be planned (see the previous section on ‘Environment’). The new manager had completed an AQAA prior to this inspection. The AQAA was detailed and the majority of the requested information had been included. In order to demonstrate what the home does well for these standards, the manager stated that they: ‘Provide service users with a well run home with an effective manager that respects the individual’s rights and ensures their best interests are safeguarded. Service users’ views underpin monthly monitoring and annual service reviews; policies and procedures are in place to ensure the health, safety and welfare of service users are protected.’ The home have policies and procedures in place to protect the health and safety of service users and staff. The staff at the home are aware of and work to these policies and report any risks identified at the home. However, as detailed in the ‘Environment’ section of this report, although the staff report any safety issues in line with the company procedures, there is an unacceptable delay or failure on the part of the company to take prompt and appropriate action. A number of requirements have been made regarding these concerns. A requirement has also been made that the staff follow the measures in place to protect the service users from the risks presented by the busy road at the front of the home. All necessary health and safety checks are carried out by the staff at the home with documentary evidence seen of daily checks of fridge and freezer temperatures and the latest fire risk assessment (April 2007) was sampled. The home’s AQAA indicated that all required safety certificates are in place with the exception of the electrical wiring safety certificate. The need for the electrical wiring safety check to be carried out has been addressed earlier in this report and a requirement made. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 29 All interactions observed between the staff and service users were inclusive, caring and respectful. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 30 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 3 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 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 2 X 2 X 3 X X 1 X The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 YA23 YA35 Regulation 13(6) Requirement The home must review their policy, procedures and staff training in the protection of vulnerable adults and ensure that they are in line with, and that all staff are aware of and adhere to, The Berkshire Safeguarding Adults MultiAgency Policy and Procedures for the Protection of Vulnerable Adults. In line with the home’s own risk assessment and current measures in place to reduce the risk to service users from the busy road at the front of the house and from vehicles entering the grounds of the home, all staff must ensure that the front gate is kept shut at all times when not in use. In order to ensure that the health and safety of service users and staff is protected, the provider must review the current maintenance system and put measures in place to ensure that any maintenance work is carried out within an acceptable time frame. DS0000011353.V357897.R01.S.doc Timescale for action 20/05/08 2 YA24 YA42 13(4)(a) 20/02/08 3 YA24 YA42 23(2)(b)(c) 23(2)(o) 20/03/08 The Rookery Cottage Version 5.2 Page 32 4 YA24 YA42 23(2)(o) 5 YA24 YA42 6 YA24 YA42 The provider must arrange for a 20/03/08 risk assessment of the garden to be carried out, by someone suitably qualified, and make arrangements for any identified work to be carried out to ensure that all areas of the gardens, that the service users can access, are safe. 23(2)(b)(d) In order to ensure that service 20/03/08 users live in a homely, comfortable and safe environment, the provider must carry out an assessment of the home, internally and externally, identify all items/areas in need of repair or renewal and make arrangements for the work to be carried out. 23(2)(b)(c) In order to ensure that the 20/04/08 23(2)(o) health and safety of service 23(4)(c)(i) users and staff is protected, the provider must ensure that action is taken to address the following outstanding maintenance requests: • The crack in the toilet bowl in the ‘big’ bathroom on the first floor. • The broken window in the kitchen. • The repair/replacement of the tumescent strip to the fire door leading out of the kitchen. • The making safe of uncovered radiators. • The replacement of the damaged floor covering in the bedroom identified during the inspection. • The completion of the overdue electrical wiring safety check. • The fitting of paper towel holders in all areas used for staff hand washing. • The removal of the broken DS0000011353.V357897.R01.S.doc Version 5.2 Page 33 The Rookery Cottage 7 YA37 38(1)(2) branches on the ground in the rear garden. The registered provider must notify the CSCI that the registered manager of the home has left and the arrangements that are in place for the management of the home in the absence of a registered manager, as set out in Regulation 38 of The Care Homes Regulations 2001. 20/03/08 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 2 Refer to Standard YA20 YA20 Good Practice Recommendations It is recommended that creams and ointments be dated upon opening to ensure that they are not used beyond their stated open shelf life. It is recommended that the home set out a clear procedure for all staff to follow to reduce the risk of medication being missed when the service users are away from the home, plus the actions staff should take if service users do miss their medications for whatever reason. It is recommended that the home obtain a copy of The Royal Pharmaceutical Society of Great Britain’s latest guide ‘The Handling of Medicines in Social Care’ and review their current medications policy, procedure and practices to ensure they reflect the new guidelines. It is recommended that a quality assurance system is put in place, at an organisational level, to monitor the effectiveness of the current/reviewed maintenance system and to ensure that maintenance work is carried out without the staff at the home having to spend time away from their work with the service users chasing for updates. It is recommended that, once plans are drawn up with the service users for improvements to the garden facilities, the provider engage external contractors to carry out the work. Brought forward from the previous inspection of 19/09/2006. DS0000011353.V357897.R01.S.doc Version 5.2 Page 34 3 YA20 4 YA24 5 YA24 6 YA24 The Rookery Cottage 7 YA24 8 YA33 9 YA35 10 YA35 The bathrooms need refurbishing in the near future and a shower facility installed to offer a choice to the service users. It is recommended that the provider develop and implement an ongoing programme for the planned maintenance and renewal of the fabric and decoration of the premises in order to ensure that service users live in a homely, comfortable and safe environment. It is recommended that the provider make alternative arrangements for the lawns to be maintained during the summer so that care staff hours are not used for this work. It is recommended that the manager obtain a copy of the Skills for Care mandatory common induction standards and check that the home’s own induction follows these new standards. It is recommended that the home carry out a training needs assessment for the staff team as a whole, taking into account the care needs of the current service users e.g. autism; epilepsy; visual impairment. This will enable the home to plan for all staff to be provided with training that directly relates to the needs of the current service users. The Rookery Cottage DS0000011353.V357897.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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