Inspection on 19/12/06 for Upton Cottage

This inspection was carried out on 19th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Upton Cottage 07/12/05

Upton Cottage 26/01/05

Upton Cottage 26/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Upton Cottage 18 Bay Road Clevedon North Somerset BS21 7BT Lead Inspector Nicola Hill Unannounced Key Inspection 19th & 27th December 2006 12:00 Upton Cottage DS0000008094.V322693.R02.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 Upton Cottage DS0000008094.V322693.R02.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. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upton Cottage Address 18 Bay Road Clevedon North Somerset BS21 7BT 01275 878601 01275 878601 joanne.paterson@btconnect.com 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) Mrs Hazel Paterson Ms Joanne Paterson Care Home 16 Category(ies) of Learning disability (16), Learning disability over registration, with number 65 years of age (16) of places Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Upton Cottage is a residential home for up to sixteen people with Learning Disabliity. It is family owned and run and is situated close to local amenities. The home has its own minibus for taking residents on outings and on holiday. The accommodation is located over three floors. There is no lift available but some rooms are located on the ground floor for those who are unable to manage the stairs. A large lounge overlooks the Bristol Channel at the front of the building. A second lounge has a large snooker table and the conservatory/dining room is at the rear. A terraced garden at the front has wooden steps leading down to the road. The fees for the home are variable and based on individual assessment. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection of Upton cottage took place over two days to ensure that there was sufficient time to speak with residents and discuss their views about living at home. The first visit entailed looking at documentation and discussing the progress of the home with staff and the manager; very few residents were at home and those who were spoke with the inspector. On the second visit the inspector spoke individually with some residents who had not been available on the first visit. The inspector also observed other residents in and around the home, and the interactions between staff and residents. From the information gathered through this process, the level of service provision at Upton cottage has been assessed as excellent. What the service does well: During the visit the inspector met 15 of the residents, the majority of whom had met the inspector before and were happy to chat. All of the residents appeared settled and happy; the comments made about the home were positive, and the residents were looking forward to Christmas. There were several social activities planned such as a Christmas party to attend, and the home had organised a Christmas meal for staff and residents at a local restaurant. All of the residents who spoke with the inspector were able to relate their individual plans for the holiday, and demonstrated taking individual choices about the Christmas celebrations they wished to attend. The second visit, after Christmas, allowed the inspector extra time to talk to residents about how Christmas was celebrated, and show what presents had been received. The residents appeared very self-confident in the home, and able to take decisions about how to spend their time. The home is very pleasant and welcoming; the staff team discuss the menu with residents who decide what they would like to eat, where possible the home use organic and free range meat and vegetables. The relationship the home has with the local health care providers is good and promotes good health for residents. Residents were able to discuss with the inspector who their doctor was and gave their opinion of him. Upton Cottage DS0000008094.V322693.R02.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 summary of this inspection report can be made available in other formats on request. Upton Cottage DS0000008094.V322693.R02.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 Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. The free admission information is in a format suitable to the needs of resident, and the home use innovative methods to make the information they give meaningful and interesting, i.e. website. EVIDENCE: Upton cottage provides information in a written format and has an accessible website which provides visual information for prospective residents. Currently there are no vacancies at the home; if a vacancy occurs in a double room the manager is aware that no new residents can be admitted to this vacancy. The procedure for admissions to the home allows residents to have a gradual introduction to life at Upton cottage, in addition to a three-month trial period. At the time of the key inspection there were seven male and nine female residents at the home; the age range was from 21 to 71 years old, all the residents were of white UK origin. The residents have individual spiritual needs which are identified as part of the assessment process. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management and staff understand the importance of residents being supported to take control of their own lives, and to encourage and enable them to exercise the right to make their own decisions and choices. EVIDENCE: The inspector reviewed six of the care plans at the home and was able to discuss some of the content with the residents. The manager uses a format of care planning based on the activities of daily living. The care plans also include photographs of the residents and the way they are written indicated that residents are directly involved with the drawing up of care plans, and the identification of their personal needs. One resident spoke about their care plan and confirmed that they had been involved and that it identified what they needed and wanted to do in the future. The review of the care plan with the resident was a very positive event, as it is used as a process to identify achievements as well as future aspirations. The key workers read through Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 10 their plans once they are written, and support residents to sign the agreement to the plans. The inspector and managers discussed the content of the plans and the person centred focus. In addition to the care plans produced by the home, some residents have a person centered plan based on Essential Lifestyle planning, which had been produced at the day centre. The ethos of putting the person first in person centered planning means that not all of the residents will fit into a certain style of plan i.e. Essential Lifestyle Plan, as these tend to be more suitable for people who are more independent. The manager is attending a training course next year which includes person centered approaches to care planning and will use any relevant information to enhance the care plans currently in use. In respect of decision-making the inspector spoke to residents who were able to tell the inspector about what choices they made about the holidays and which social events they had chosen to attend. On the first visit to the home, all the residents had been invited to attend a Christmas party in the evening. Some residents chose to go and were able to talk about the clothes they were going to wear and who they were going to see; other residents chose to stay at home. The inspector also observed on the second visit that one resident who is autistic and has no verbal communication, chose to attend the day centre as it was part of their normal routine. The resident also expressed to a member of staff what they wanted put in their lunchbox. The staff member used visual prompts to support the resident making choices. The storage of information at the home meets the required standards, and as part of induction, confidentiality of information is impressed on staff. There have been recent concerns raised by the day centre about the home not being willing to share confidential information. The manager stated that information was given to the day centre on a need to know basis. The inspector advised that the manager meet with the day centre manager and devise and information sharing protocol which will meet the need for confidentiality and also the duty of care the home has to ensure relevant information is known by other care providers. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home understands the importance of enabling young adults to achieve their goals, follow their interests and be integrated into community life and leisure activities. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are very flexible and residents can make choices in major areas of their life. EVIDENCE: All the residents have an individual file, which identified their individual needs and choices. Within the files there are daily activities planned and these are linked to the day centres where residents are supported with individual activities. One resident stated that they felt that their needs were listened to and that they could actually discuss anything directly with the manager who would be responsive. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 12 The residents at the home all attend meaningful daytime activities outside the home this may be day centres, colleges, social groups or employment. The inspector was able to observe residents making choices about attending daytime activities; at time of the site visits some residents exercised choice about attending day centres. The community life of residents at Upton cottage is taken seriously and activities are planned at the weekend and in the evenings so that residents have a stimulating lifestyle. Some of the residents are very independent and are able to access the town centre independently. Some residents have taken up the introduction of free bus passes whilst others prefer not to travel by bus. Opportunities for employment have been taken up by some residents who receive appropriate remuneration for this. The activities the home support include swimming to promote good health, and everyone has a summer holiday. Many of the residents also are still involved with families and have family visits or go to visit families over the weekend. Two service users currently live together as couple, and the home staff and residents respect their right to this relationship, and their rights to privacy. Residents were able to discuss with the inspector arrangements made to visit relatives over the Christmas holiday period, and talk about presents they had purchased for their families. The inspector was told by one resident how the staff at home take them to see their elderly mother, and help to purchase appropriate gifts. The residents choose to take on different levels of responsibility within the home, some residents helped lay the tables for meals, make cups of tea for visitors and other residents, load and unload the dishwasher; whilst others are happy to detect responsibility for their personal rooms. The menu choices available are based on resident preferences and these are discussed individually or in small groups. The inspector was able to observe an evening meal served at the home, the vegetables were fresh and the meal was well presented and appetising. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff ensure that personal support is flexible, consistent, and responsive to the changing needs of the residents. EVIDENCE: There is evidence in personal files of care assessment and reviews carried out by North Somerset Council Social Services, the meetings identified any action to be taken. Case tracking through the daily record and health care notes confirmed that the action had been taken. Each resident has a detailed plan of support needed for personal care, and where necessary keyworkers assist residents with showering/bathing. The residents confirmed that they attended various appointments with dentists and named their local doctor. The staff are available to support the resident to attend the doctor or hospital appointments, and regularly offer to support residents who need a hospital admission. The manager also ensured that there are links to specialist services through the community learning disability team and that where possible the specialist service has come to the home to see people in their own environment. In particular this has worked Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 14 with a resident who is involved with the challenging behaviour team. This resident has autism and was very demanding of staff time and could be aggressive toward other residents. The staff team, manager, resident and health staff have all working together to modify the difficult behaviours so that it is acceptable to the other residents. The local pharmacist supplies the residents’ medication in a unit dosage system. The pharmacist also carries out a yearly medication review for each resident; this is in addition to the reviews by the GP and consultant psychiatrist. The medication system at the home was accurate with well-kept records – the new drug trolley has allowed for all medication to be stored in one place. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The complaints procedure is widely distributed and is highly visible within the service. Residents and others associated with the service demonstrate a clear understanding of how to make a complaint. EVIDENCE: The inspector reviewed the complaint book and noted that there had been no complaints received by the home since last inspection. The residents were aware that they were able to make complaints but all felt that they could raise them directly with the manager and that they would be listened to and action taken. They were also aware that sometimes the complaints they made, particularly about other residents, would not always be able to be resolved fully to their satisfaction, and it was case of everybody just trying to get on. All staff have received training in abuse awareness, and there have been no incidents in this home. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a very pleasant safe place to live; where rooms are shared it is only by agreement. Residents are encouraged to personalise the bedrooms will stop the home is well lit, tidy and clean, and smells fresh. EVIDENCE: The inspector did not undertake a tour the premises, however the areas of the home visited by the inspector were clean and well maintained, and there were no obvious health and safety hazards. Upton cottage is a comfortable and welcoming home with large accessible communal areas, which residents use if they wish to. The manager has also undertaken an audit of the bedrooms and communal areas, and has identified certain areas for redecoration or repair. The manager employs contract cleaners, who work in the home on a daily basis, and has ensured they have undergone CRB checks. The laundry facilities at the home are suitable for residents to use under supervision. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 17 Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a well-developed recruitment procedure; recruitment of good quality care is seen as integral to the delivery of an excellent service. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. EVIDENCE: The manager at Upton cottage has managed to retain her staff team and to provide stability to the residents. The staff rota indicated sufficient staff on duty. During the week at the busiest times there can be three staff on duty to ensure that residents are supported with personal care to allow them to go to their daily activity. The inspectors were able to read the staff files held at the home. It was noted that the recruitment process is very good and provides a safeguard when recruiting staff. The staff files also indicate that there is quite a lot of training available to staff and that they receive regular supervision. It is suggested to the manager that both supervisor and the supervisee sign notes to indicate agreement of their content. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 19 The manager has now made links with several training providers and informational resources so that there is some on-site training available for staff, which enables them to care more effectively for specific residents need e.g. autism. The manager has implemented a new induction system, which meets the new common induction standards. The manager has been proactive in sourcing the new standards, presented in a file for each new staff member, from a national training organization and is currently working through the files with staff. There is an option for staff to be issued with a certificate on completion of induction and staff can retain their files as evidence of competence. Two of the full-time staff are currently undertaking NVQ 3 qualifications at the local college. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualification and experience to run home and meet its stated aims and objectives. These include the service specific good practice areas, implementing current legislation and providing a role model to staff. EVIDENCE: The manager continues to lead the staff team to support the residents to achieve a good quality of life. She is available 24 hours to either in person or by telephone, and this is both to residents and staff. The manager has signed up to attend further training, the Higher Professional Diploma (LDAF) through ARC. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 21 The staff team at Upton Cottage have been supported to attend training courses, and also to develop themselves in the their knowledge and skills so that they are able to progress in the care industry. The manager has also been active in planning quality audits on the home in order to identify areas of development. Linked to these developments is the business planning, and the investment in the home to provide a good standard of fixtures and furnishings for the residents to enjoy. The records held for residents’ cash were checked and found to be mostly accurate. The manager discussed a request from North Somerset Social Services that residents be assisted to make wills. If this is to be achieved then an independent advocate must be sought who has no connection with the home in case any residents wishes the home to be a beneficiary. The inspector advised to consult with Ann Overthrow (North Somerset Council) for advice before requesting the independent advocates from social services. The inspectors looked at the following health and safety records to ensure compliance with the Health and Safety at Work Act. For the implementation of fire safety at the home a new system has been implemented which is easy to follow and achieve. There was evidence that all essential checks had been completed and that staff training was up to date; the home also has a fire safety risk assessment in place. Staff have received statutory training; the yearly manual handling training update for staff had not been completed as none of the residents need assistance with moving and handling, however it is included in the training plan for the coming year. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 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 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 YA37 YA38 Good Practice Recommendations The manager meet with the day centre manager and devise and information sharing protocol, which will meet the need for confidentiality and also the duty of care, the home has, to ensure other care providers know relevant information. Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Upton Cottage DS0000008094.V322693.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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