CARE HOME ADULTS 18-65
Victoria Cottage Victoria Cottage 37 St Andrews Road Bedford Beds MK40 2LW Lead Inspector
Carol Mitchell Unannounced Inspection 23rd November 2005 09:15 Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Victoria Cottage Address Victoria Cottage 37 St Andrews Road Bedford Beds MK40 2LW 01234 271225 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) Victoria Cottage Limited Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The maximum number of peoople that can be accommodated at the home is 14. The home shall only admit service users between the ages of 18 and 65 years. The home shall only admit service users whose primary assessed need is a learning disability. The home may also admit up to 2 service users who have a physical disability in addition to their learning disability. Any service users who have physical disabilities in addition to their learning disabilities must be provided with a bedroom on the ground floor. 17th May 2005 Date of last inspection Brief Description of the Service: Victoria Cottage is located within a pleasant residential area close to the local park and the town centre. The home is registered to provide for fourteen residents with learning disabilities, two of whom may also have physical disabilities. Most of the residents go out during the day to various day care activities, although day care is provided at the home for some residents. The accommodation is provided on two floors, with single rooms on the first, and a shared room on the ground floor. Each bedroom has a wash basin, and a call bell. Eight of the bedrooms have en suite shower facilities, with two of the rooms sharing the shower and toilet. There are additional toilet and bathing facilities. Communal rooms on the ground floor comprise a lounge, dining room, and an all weather conservatory. To the rear of the building is a well maintained and accessible garden with an enclosed fish pond. There is some parking provision to the front of the house. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on 23rd November 2005. At the time of inspection twelve people were living in the home, and three were present during the inspection. (Residents attend various day centres and are often out during the week.) The inspector spent some time with the three residents who were at home, looked at their records, and looked around some parts of the building. The inspector also spoke to the manager and three members of staff, and checked a sample of staff files. The inspector is very grateful to everyone living at the home, and to all of the staff, for their help with this inspection. What the service does well:
People living at the home are supported by staff who are kind to them. Staff help people living at the home to do as much for themselves as possible. A member of staff said, “Residents have a rota for things like polishing which they enjoy. They make their own lunches now. We used to do that for them.” “We help them to do things for themselves, we encourage and support. We help if they can’t manage.” Staff are not allowed to work at the home unless they have been checked first, and when new staff start work someone works with them to make sure they learn about how to support the residents properly. The home has written plans so that all of the staff can read about how to support and communicate with residents. For example different sounds made by a resident are described in the notes to help staff understand what the resident is trying to say. Staff care about doing a good job, and they receive lots of training and good support. People living at the home, and their families are listened to. Residents have their own meetings. The meetings are useful. For example, a resident’s room was decorated after the resident said they would like this done at a meeting. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 6 The manager of the home is very friendly, and she says that “her door is always open”. The manager wants to keep on making things better for people living at the home and always tries very hard to do this. What has improved since the last inspection? What they could do better: Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 7 The people living at the home have their medicines checked safely by staff who have been trained for this. However there were some problems with the written information kept about medicines. Therefore, just to be safe and to tidy up the records, the manager arranged for all the medicines and the information kept about medicines to be checked by the home’s pharmacist two days following the inspection. Work has been done to make the Statement of Purpose and Service User Guide better. (These are papers giving information about the home). The manager is going to try and improve these papers again by making picture book versions, in case this will help some people who may wish to live at the home in the future. The work done on the support plans for residents needs to carry on to make sure that the notes are kept in the most organised way. When members of staff write in the plans the date and time should be written down as well. It is good that a decision has been made about how to provide curtains in one bedroom following the last inspection. The things needed for this job now need to be sorted out as soon as possible. The manager said that the resident contracts are going to be checked to make sure that all of the right information is in these. 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. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 People are carefully assessed before they go to live at the home, so that they can be sure that the home will be able to meet their needs. EVIDENCE: The home has produced detailed and comprehensive Statement of Purpose and Service User documents. Further work is being done to produce picture book versions with limited text to suit the needs of some prospective residents. There have been no recent admissions to the home. The needs of the three residents present during the inspection had been assessed and recorded in detail. Residents have statements of terms and conditions, and the acting manager is currently checking that the content of these is in line with the relevant standard. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Staff write plans about the support needed by people living at the home. Therefore, staff have useful plans to use, and residents can be sure that they will be supported, and their needs will be met. EVIDENCE: Support plans are written for residents, and residents or authorised family members are involved in the planning process. Risks have also been assessed, considered, and recorded for each resident. Staff have received training about Person Centred Planning. Informative support plans were in place for the three residents present during the inspection. These included advice for staff regarding how to interpret, often non-verbal, communications from residents, how to offer choice, how to prevent or manage certain behaviours, and how to maximise independence. A staff member described going shopping with a resident who has difficulty speaking, and explained how she interprets communications to make sure that the resident exercises their choice regarding what is bought. Plans had been reviewed, and staff have received training on the review process.
Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 11 Regular residents meetings are held, are chaired by a resident and minutes are taken. Questionnaires about the running of the home have been sent to residents’ families. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People living at the home are able to personally develop because the manager and staff care about them and make sure that they are supported properly, and that the right opportunities are available. EVIDENCE: Work has been done to improve the activities available in the home, and these are now much more age specific than previously. Any activities better suited to children have been replaced by other equipment and kits. For example residents can make wooden stools, decorate egg cups, and make picture frames and bird boxes. Records are kept of how residents prefer to spend their time, and a note is made of any activities done and whether they were enjoyed or not. On the day of inspection residents were enjoying aromatherapy foot massages, and one resident was relaxing during her sensory time with gentle music and bubble lamp. Most residents attend various day care facilities during the week. Where this has not been possible due to the home’s transport difficulties, the programme usually followed at the day centre is provided as much as possible at the home.
Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 13 A new vehicle for the use of residents had been purchased the day before inspection, and delivery of this was expected during the week following inspection. Families are welcome at the home, and informal feedback, and that from questionnaires has been positive regarding how the home is run. Residents often spend time with families, quite often enjoying weekend leave. Residents have keys to their rooms, and privacy curtains are hung where these are needed. The two residents who share a room enjoy doing this, and arrangements are made so that visitors can be received in private when required. In conversation, attentive staff referred to names, which residents prefer to be used to address them. Staff also discussed ways in which choice is respected, and independence is promoted, even when verbal communication is difficult or absent, and the level of achievable independence is minimal. For example, when a drink is served, one seriously disabled resident is helped to go to the kitchen herself so that she can be involved in the choice and making of the drink as much as possible. Other residents take part in the running of the home, such as sharing cleaning duties and attending to their own laundry. There is a 4 weekly menu at the home, and a hot meal is provided in the evenings. Pork casserole was the evening meal on the day of inspection. Staff described how residents with communication difficulties tell them that they would rather have something different, or at a different time. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Staff are trained and knowledgeable about the needs of people living at the home, and make every effort to make sure their health needs are met. Therefore residents can be sure that they will be supported in the right way for them. EVIDENCE: Staff were able to talk in detail about the support and care required by specific residents. They also knew about the support plans, which had been written with helpful detailed information. Staff were able to describe how they give support in the preferred way, for example how to support a resident when choosing clothes to buy and wear. Residents present during the inspection were calm, relaxed, and communicating with staff readily. Details of specific emotional and physical needs or medical conditions are detailed in individual plans. Residents are taken to any health appointments such as visits to hospital or dentist, and a record of these and any family doctor visits is made. Staff have received training in the administration of medicines, and residents are given any medication in an organised way. However, some of the sheets
Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 15 on which medicines are listed needed checking by a pharmacist to make sure that all of the instructions for medicines needed every now and then were detailed enough. Such information was recorded in the support plans. Some medicines listed on the sheets are no longer needed by residents and so this needed checking too. On the day of inspection, the Acting Manager arranged for the home’s pharmacist to visit the home to check all the medicines and sheets 2 days after the inspection. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The manager and staff know that residents at the home are the most important people. The staff care and have been trained. Therefore people living at the home can be sure that they will be listened to, and that they will be protected from abuse. EVIDENCE: A complaints procedure is displayed, and this is explained at each meeting held for residents. Some residents are able to write down any worries for the attention of staff, and all residents are encouraged to talk to family members or staff if there are concerns. Every 3 months, stakeholder meetings are held and these are often attended by the parents of residents. Questionnaires have also been sent out. There have been no recent complaints. Most of the staff have now received training regarding abuse and the protection of vulnerable adults. One staff member has completed the training for trainers so that future training and updates for staff will be made easier. When questioned, staff were able to describe what they would do if they ever have a concern about the practice of another staff member. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 The home is kept warm and clean, and is decorated when necessary. This means that people feel comfortable living at the home. EVIDENCE: The home is clean, warm, and comfortable. There is a lounge, dining room, and all weather conservatory, and these rooms were being used by residents on the day of inspection. The dining room, front hall, and conservatory are due to be redecorated soon. A programme of redecoration is followed, and a bedroom, bathroom, and staff office have recently been decorated. New furniture has been purchased for the lounge and dining room. The bathroom adjacent to the shared room was seen, and this has been decorated in a warm colour. A resident who uses the bathroom chose the colour. The bath is able to accommodate the everyday use of a hoist, and there is a spa attachment. Residents rooms are decorated according to their wishes, and residents keep personal belongings in their rooms.
Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 18 A staff member with specific responsibility for cleaning duties has been employed. All areas seen on the day of inspection were clean and hygienic. On the day of inspection, the manager replaced equipment needed for staff hand washing and drying where this is required. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People living at the home can be sure they will be well supported because the manager and staff care about them. The staff have been trained, and are well supported in their work. EVIDENCE: Staff spoken to were knowledgeable about the residents and how to support them. They had been received National Vocational and other training, and felt well prepared for their work with residents. Staff seen working with residents were gentle and calm, and residents smiled at them and communicated with them readily. Staff meetings are held, staff receive supervision sessions, and work is being done to finalise the method to be used for annual staff appraisals. Handovers for staff are held at the beginning of shifts, and staff spoken to felt well supported. Proper checks, including references, are made before anyone is employed at the home. New staff are interviewed and receive induction training. Staff do not work alone until the manager decides they are ready for this. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Residents benefit from living in a well run home because the manager works hard and in an organised way. Staff are trained and supervised, and residents are listened to by the manager and staff. EVIDENCE: The manager and staff have worked hard to address the issues raised during the last inspection. Training and supervision are being given high priority at the home. Training needs have been assessed, and a monitoring system has been set up so that staff needing particular training are less likely to be overlooked. An administrator has been employed and this means that the manager will have more time to supervise staff, check things are being done properly, and be more available to residents and others. The style of management is open and friendly. Residents feel comfortable and able to communicate with the manager and staff. The manager is open to
Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 21 suggestions and strives to maintain and improve standards. She is soon to commence the training for Registered Managers of care homes. Staff have received fire and manual handling training. The company trains trainers in some areas so that training is easier to give and monitor. A review of risks to residents has been undertaken, and the risk assessments have been recorded. Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 3 3 x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Victoria Cottage Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x DS0000044185.V268077.R01.S.doc Version 5.0 Page 23 no 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. Refer to Standard Good Practice Recommendations Victoria Cottage DS0000044185.V268077.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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