Inspection on 22/10/08 for Wrekin Cottage

This inspection was carried out on 22nd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wrekin Cottage 04/07/07

Wrekin Cottage 08/09/06

Wrekin Cottage 17/05/06

Wrekin Cottage 28/10/05

Wrekin Cottage 07/06/05

Wrekin Cottage 05/01/05

Wrekin Cottage 23/06/04

Wrekin Cottage 16/02/04

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Polesworth Group 70 Long Street

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10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Wrekin Cottage Forbes Close Ironbridge Telford Shropshire TF7 5LE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Sharman     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Wrekin Cottage Forbes Close Ironbridge Telford Shropshire TF7 5LE 01952432065 01952432209 nicky.rowe@care-ltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Nicola Ann Rowe Type of registration: Number of places registered: CARE (Cottage and Rural Enterprises Ltd) care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 16. The registered person may provide the following category of service only: Care Home Only (Code PC). To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: - Learning Disability (LD 16). Date of last inspection Brief description of the care home Cottage And Rural Enterprises (Limited) is a registered charity established in 1966. The Company has communities nationwide and its headquarters are based in Leicester. Care Ironbridge is a residential development that occupies a small cul-de-sac in the Ironbridge area of Telford. The development was purpose built and is situated close to local amenities and is a short journey from Telford Town Centre. Wrekin Cottage was individually registered with the Commission for Social Care Inspection in September Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 16 Brief description of the care home 2006 as part of a wider plan to modernise and develop the service. Changes to its registration mean that the home is now registered to provide accommodation and personal care to a maximum of sixteen adults with learning disabilities below the age of 65 years. Wrekin cottage is set in beautifully maintained and attractive gardens. In addition to the cottages on site service users have access to workshops, a community centre, communal dining room and games area. Weekly fees are explained in the Service User guide. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality Rating for this service is 2 star. This means the people who use this service experience good quality outcomes. One Inspector carried out this unannounced key inspection on 22 October 2008 over 8 hours between 9.00am and 5.00pm. We arrived before people went to day services so we were able to meet and talk to some of the people who live at Wrekin Cottage. The manager and assistant manager were available to support the inspection process. As the inspection visits were unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as key. These are the National Standards, which significantly affect the experiences of care for people living at the home. Care Homes for Adults (18-65 years) Page 6 of 30 Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting manager completed this document and returned it the commission on time. We sent surveys out to people who live at the home, people who work at the home and professionals who have contact with the home. We received completed surveys from two staff members and two people who live there. We are not currently sending surveys out to relatives to comply with data protection. During the course of the inspection we used a variety of methods to make a judgment about how service users are cared for. We assessed in detail the care provided to one person who lives at Wrekin Cottage using care documentation. We also looked at some aspects of care provided to other people. We did this by looking at care records and by talking to staff, the manager and people who live there. It was also very useful to talk to a visiting relative about her perception of the quality of care and the quality of life enjoyed at the home. We also toured the premises and sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. All this information helped to determine a judgment about the quality of care the home provides. Current weekly fees are six hundred and thirty pounds. What the care home does well: What has improved since the last inspection? What they could do better: We found that sufficient steps had not been taken to prevent people from being at risk of scalds from unregulated hot water. Before we left the premises we had been given a firm assurance that this would be addressed. We received written confirmation the following day and a copy of a works order to demonstrate that this work will be carried out within six weeks. We identified one situation in which a persons prescribed medication was not, according to the manager, meeting her needs and symptoms had continued for some time since the medication had been prescribed. This situation should be reviewed with the Doctor. The organisation should also take steps to ensure that in the event of safeguarding situations where vulnerable people are at risk, that communication between the Care Homes for Adults (18-65 years) Page 8 of 30 various on site services improves to ensure people are sufficiently protected. A fire risk assessment carried out by an external consultant has identified some actions needed for improvement and has made some recommendations. Some but not all of these suggestions have been implemented. We noted that an additional smoke detector is required along with steps to keep an extraction fan free of lint to reduce the risk of it combusting. The organisation should support the service to assess its own performance. This could be achieved by using the quality assurance framework and carrying out regulation 26 monitoring visits more regularly, the outcomes of which should be brought together to drive ongoing improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We have not been able to fully judge quality as there have not been any new admissions to Wrekin Cottage. The Manager has demonstrated that she understands steps she will take to ensure she complies with her legal and best practice obligations. Brochures about the home are up to date and available for new applicants to help them to decide whether to move in. Evidence: Nobody new has moved in to Wrekin Cottage since we last inspected or since the registered manager has been in post. Since the last inspection, the organisation has applied to us to increase the number of places available from 15 to 16. This was approved in August 2008. Applications for this place are currently under consideration. In the meantime one person has chosen to leave Wrekin Cottage to live closer to her family. We could see that she was supported with her decision over a period of time and had a number of get togethers with her peers to mark her moving on. Currently then there are two vacancies. We can see from the managers annual return to us that she understands steps she should follow to ensure applicants are supported to make Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: an informed choice about moving in. Discussion showed that she is also aware of the need to consider the views of people already living there. Brochures available to new and existing residents have been updated since the last inspection and therefore give people more and accurate details about living there. For example care and accomodation fees are now clear as is information about a range of things people are expected to fund themselves. Contracts for people currently living there have not however been reviewed and updated. The one we looked at dates back to 2004. We have reminded the manager about this and of the need to ensure new residents are issued at the time of admission with an up to date contract that is explained and signed by all parties. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. Evidence: People are pleased with the care they receive. This is evident from completed surveys, discussion with people who live at Wrekin, discussion with a visiting relative and sight of minutes of residents meetings and care review meetings. No concerns were expressed in surveys returned by people living at the home. In one survey a resident wrote, I like it here and the residents and the staff. When touring the building a resident told us that he likes living there as he can go out alot. Another resident said, its nice here. A visiting relative was effusive in her praise of the service provided. She described how Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: all of her sons complex needs are met and how essential Wrekin Cottage is for his health and wellbeing. She said he would present enormous challenges if his quality of life changes. She said the decorating and the buildings might need doing but the quality of input and understanding of a man with such complex needs is superb. She said to see him as happy as he is is wonderful. She is pleased that he sees Wrekin Cottage as his home and that he is speaking up for himself in a way that he never did. She summarised the care as absolutely superb. Minutes of house meetings show us that these forums are used to consult people living there about how the home is run and that communication is two way between residents and staff. We looked at another residents care by auditing documentation. Care planning and risk assessments are in place and they adequately support her care by giving staff sufficient guidance. They are written positively and recognise the persons strengths and abilities aswell as her needs. They are reviewed in a timely manner to ensure that any changes can be incorporated. To improve, they could better consider equality and diversity, her goals and aspirations and should describe prescribed medications. Also we could not see that she had been involved in developing their own care plan. Care review meetings are held regularly with the person concerned and their family. Minutes of these show us the person is happy with their care, likes living in Wrekin Cottage and that there are no unmet needs. Thermostatic valves are not fitted in bedrooms so water temperature cannot be controlled. These temperatures are not being tested so the risk of scalds in relation to the vulnerabilities of the residents are not known. To date there have not been any accidents. However ten people are self caring in the morning as the two staff on duty are fully occupied with four residents who need support. Supervision therefore is minimal and the risk higher than it might normally be. As this is an outstanding requirement from the last inspection we have received written confirmation that thermostatic valves will be fitted within six weeks to address assessed risk. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. Evidence: One person that we met whilst walking round the home told us that he likes living at Wrekin Cottage because he can go out alot to the cinema and for meals. He said he had been to the cinema the night before this unannounced inspection. People who live at the home told us in surveys they can do what they want to do in the day time, evenings and at weekends. We looked at the care of one person using care documentation. Care records show us Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: that she takes part on a daily basis in things she enjoys doing. This is supported by evidence in financial records and minutes of care review meetings held with her and her family. She is quoted as telling the meeting that she enjoys going swimming, horseriding, out for lunch and going to the cinema and that she also enjoys her work placement at a local cafe. Advice we gave at the last inspection to learn more about one persons belief system has been followed. The care plan more adequately describes his back ground and familys life principles. Staff seem to be better aware of this than they were last year. We can see that residents are supported to attend places of worship. The manager has described this in her annual return to us and financial records show where residents have made a financial offering when they have attended a church service. People who live at Wrekin Cottage enjoy their holidays away. This year there have been several opportunities with some residents having been away more than once. It is positive that there is such a wide choice available and that people either go on their own with a member of staff or in small groups of two. This year there have been holidays to Eurodisney, Minehead, Spain, Scotland, Exmoor, The Calvert Trust and to a Haven holiday camp site. A holiday arranged for one resident fell through and he still needs this years holiday which we were assured would be before Christmas. There are good relations between residents families and staff and the people whose care we looked at enjoy regular contact with their families. Residents are involved where possible in grocery shopping which was done on the morning of this inspection. Three residents have joined a slimming club and have been supported to achieve their goals. We can see from records that one resident has lost eleven pounds in weight in 3 months and a second resident this year with the help of the slimming club and staff has lost 2 stone and eight pounds. This is a very significant achievement. The decision to move the club away from the local community and onto the CARE Ironbridge site however is a little introspective and contrary to the principles of social inclusion. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The care home supports people with their medication in a safe way. Evidence: All the evidence available to us indicates that peoples health and personal care needs are met well. A relative is exceptionally pleased with how her sons very complex health needs are being met and the Manager described being commended by his medical consultant. The relative also described how her son is supported with his personal care in a way that meets both his dignity and promotes his good health. We looked at health and medication records for the person whose care we had chosen to look at in detail. We chose to audit her care given the complexities described to us. We could see that she is being supported to have monthly and three monthly blood tests to monitor a health condition. We could also see that she is well supported to attend routine dental and optical health screening to ensure changes in health can be Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: detected and treated early. Staff are noticing other changes and are seeking medical appointments to receive advice and treatment about these. We looked at her medication. We could see that all prescribed medications were available for her. We audited records and counted tablets and could see that these tallied correctly. This assures us that she has been receiving her prescribed medication accurately promoting both her health and her safety. We identified from care records that this person is experiencing regular bouts of sickness. The manager told us that domperidone medication prescribed as required in December 2007 for sickness is not being administered as it unrealistically depends on the resident being able to anticipate and report feeling sick. The medication therefore and the underlying reasons for continued sickness should have been reviewed with the Doctor. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. The organisation must ensure that people are safeguarded by improving communication between the various on site services at CARE Ironbridge. Evidence: There have been no complaints made to the service or to us about the service. There have been five adult protection investigations affecting people who live at Wrekin Cottage. Two happened prior to but have been resolved and concluded since the last inspection. Three, one of which was a repeat of a previous incident have taken place since the last inspection. None of the incidents directly related to the management of the care home as they happened in none regulated day care settings on site. Most were incidents between service users with the latter centering concern on neglect by a staff member employed at Wrekin Cottage but covering a shift in one of the other houses on site at the time of the concern. All matters were appropriately reported and investigated. The allegation against the staff member was substantiated and this has resulted in dismissal. A risky situation was repeated in day services because of a breakdown in communication. Whilst this was not directly attributed to Wrekin Cottage, the manager has agreed that a written protocol is required to reduce Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: risks to service users from communication breakdown between the various services on the CARE Ironbridge site. In a completed survey, a staff member has told us that there is currently a lack of communication between different departments and it seems that this example substantiates this statement. All staff have received training in adult protection matters with most having completed this recently. Five staff however did this training in 2003 and 2004. The manager agreed they would benefit from refresher training and policies and procedures have changed since this time. At the last inspection we were concerned that people living there were inappropriately funding staff expenses when staff were accompanying them in the community. Steps were quickly taken to remedy this and financial records show that residents are no longer meeting staff expenses. We found one instance where a resident has recently funded paint to decorate their bedroom. The manager confirmed the staff member had done this in error and the sum would be reimbursed. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Work is needed to ensure the premises are adequately decorated throughout and that current problems resolved to provide people living there with a well maintained home. Evidence: Steps have been taken to improve the decor in some communal areas of the home such as the lounge, a corridor and a bathroom. Other communal areas particularly bathrooms are outdated and scruffy with damage to some tiling and walls. They are not pleasant and homely places in which to relax. There is no plan to improve these areas. Odours were found to be better managed at this inspection. Infection control practices have improved and the manager secured a grant to support this. A machine to clean floors has been purchased with the monies provided. There have been and are some structural problems. Before inspection damage to the roof led to a leak in the kitchen. This put the kitchen out of action for a few days. The safety of electrics in the kitchen were checked prior to its reuse. Currently there is a Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: known problem with damp possibly from under the property. This has lead to staining on a carpet and damage to an internal wall. The causes are being investigated. The electrical safety has been checked, remedial works carried out and a compliance certificate is awaited, we were assured. Steps have not been taken to sufficiently assess or manage risks to residents from hot water. Assurances have now been obtained that this matter will be managed and we have received confirmation in writing that monies have been identified, authorised and a works order with plumbers has been placed. One resident showed us his bedroom. He is very pleased because a vacancy has enabled him to move from a first floor to a ground floor bedroom. This is much more suitable for him. There are no concerns about how the environment meets the needs of other residents. We found it to be suitable for the person whose care we looked at in detail. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by an effective staff team who understand and do what is expected of them. Evidence: New staff are recruited safely and are supported to learn their role in a robust induction. Speaking to the manager we heard a visiting relative say about new staff, the way you train them up is marvellous. Staff are motivated and present as competent and well supported. As outlined earlier in this report under Protection Standard 23, when staff performance did not meet expectations and put people at risk action taken was swift and decisive. One staff member told us that there is a great training programme that is carried out to a high standard. This person said they have regular contact with their manager and regular supervision. A second staff member said that the training is excellent and that they also meet regularly with their manager. They told us that they believe they cater to all the needs of all service users and that they excel in all areas. Looking at the training records we can see that a high percentage of staff have done Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: most training courses. The team has exceeded the national minimum target for those who hold a nationally recognised care qualification. The manager agreed that some staff would benefit from refresher training ie those who did adult protection training in 2003 and 2004 and that a number of staff have not done training in subjects to equip them to know and understand peoples specific needs. However in spite of this we have not identified any concerns about the way in which these peoples needs are being met. Feedback has been very positive. We looked at supervision records and could see that staff are receiving regular supervision. Some however are receiving supervision more regularly than others and the service should ensure that all staff are receiving the minimum frequency. For example in the last 12 months one night staff member has received 3 rather than 6 supervisions plus an appraisal of performance. Another night staff member who has been in post for 4 months has not received formal supervision yet. The service has reduced its dependency on agency staff and this provides better continuity of care for people. There is currently one staff vacancy which has been recruited to and in the meantime is being covered by existing staff. Most people living at Wrekin Cottage are very able and can carry out their own personal care. The manager is therefore satisfied with current staffing ratios. Some residents receive funding for their local authorities for additional one to one care. How this is managed is better evidenced this year. There is a separate rota which accounts for how these hours are used for the benefit of the people. This rota shows us that when staff contracted to provide this one to one care take annual leave, that the additional care is not provided. The manager explained that the funding does not include a contingency to cover staff absence. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately on a day to day basis in the interests of the people who live there. It has more strengths than areas for improvement. Evidence: On a day to day basis Wrekin Cottage is well managed and Wrekin Cottages operational managers are feeling more positive about support that has been available to them recently. The manager has completed her Registered Managers Award and is now therefore appropriately qualified for her role. Without exception everyone has praised how she manages the service. One staff member who feels blessed to work at Wrekin Cottage described her as brilliant and approachable. A second staff member told us that overall this is a great place to work and Im happy to be part of the Wrekin team. A third staff member described her as an excellent residential manager. All except one of the previous requirements fell within her remit to action and have been deleted as Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: satisfactorily addressed. The one which on the day of inspection wasnt met related to satisfactory water temperature regulation. The Interim Service Manager has provided assurance that this will be actionned and we have received a copy of a works order as confirmation that remedial works will be undertaken within six weeks. At this inspection the manager was able to provide better evidence that the property and equipment within it is being serviced regularly to ensure its safety. Unlike last year, most certificates we requested on this occasion were available. We were assured that the safety of the electrical infrastructure has been tested, remedial work carried out recently to ensure safety but the certificate is not available as one is to be provided for the whole site when all buildings are completed. A fire risk assessment has been carried out by a company contracted to do so. A number of medium and low risk hazards and few high risk areas were identified from this. Most suggestions have been actionned it seems. However a cleaning routine is needed still to prevent combustible fluff building up in the extractor fan and it is recommended in the report that a second smoke alarm is provided in a corridor. The interim service manager again provided assurance that this will be prioritised for action by the maintenance man. Tools to help the service identify its own shortfalls or areas for action are not sufficiently in place. There has been no progress with quality assurance and regulation 26 visits by the organisation to ensure quality are not taking place every month. In the ten months of 2008, there have been five regulation 26 monitoring visits. The organisation is being reactive rather than proactive in the management of the service. However, there have been changes to senior management and positive changes are taking place slowly. Managers and staff in Wrekin feel better supported than they have before and they are confident that this will continue. The home is managed well on a day to day basis, people speak highly of the manager and the staff, there has been good progress in meeting previous requirements overall and people who live there experience a good quality of life. On this basis given that the strengths outnumber the areas for improvement we feel able to conclude that Wrekin Cottage provides a good quality service. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The Registered manager must ensure that one persons prescription for domperidone is reviewed with the prescribing medic and that medical advice is sought about ongoing sickness. This is to ensure that prescribed medication appropriately meets the persons needs to promote their good health. Also to ensure the underlying reasons for ongoing sickness are investigated. 28/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 23 The provider should ensure that a written protocol is developed and agreed to improve communication between all on site services in the event of a safeguarding incident. A plan should be developed to identify time scales to update and improve decor in communal areas of the home Page 28 of 30 2 24 Care Homes for Adults (18-65 years) especially bathrooms, shower rooms and toilets. 3 39 Regulation 26 monitoring visits should be carried out monthly. The outcomes should be used to actively influence the development of the service. Steps should be taken to ensure that all recomendations from the November 2007 commissioned fire risk assessment are acted upon. 4 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. 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