Inspection on 07/06/05 for Wrekin Cottage

This inspection was carried out on 7th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wrekin Cottage 22/10/08

Wrekin Cottage 04/07/07

Wrekin Cottage 08/09/06

Wrekin Cottage 17/05/06

Wrekin Cottage 28/10/05

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 09/07/2008.

CARE HOME ADULTS 18-65 Care Ironbridge Forbes Close Ironbridge Telford TF7 5LE Lead Inspector Sue Woods Unannounced 7 & 9th June 2005 15:00 th h The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Care Ironbridge Address Forbes Close, Ironbridge, Telford, Shropshire, TF7 5LE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01952 432065 01952 432209 CARE (Cottage and Rural Enterprises Limited) Care Home 30 Category(ies) of Learning Disabilities (30) registration, with number of places Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 5th January 2005 Brief Description of the Service: 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. Severn and Wrekin Cottages are registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of thirty adults with learning disabilities. The cottages are set in beautifully maintained and attractive gardens. In addition to the cottages, service users have access to workshops, a community centre, communal dining room and games area, which are all provided, on the main site of this development. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in two parts, day 1 to visit Severn Cottage and day 2 to visit Wrekin Cottage. Both visits took place during the late afternoon and early evening. Standards were assessed over the two cottages and this report incorporates the findings from both visits. Over sixteen service users spoke with the inspector, in private and during group discussions. Eight staff, including the deputy manager of Severn and the manager of Wrekin also contributed to the inspection, which lasted a total of six hours. What the service does well: What has improved since the last inspection? Through discussions with staff it is evident that staff morale and support has improved over recent months. Opportunities for activities have also increased, possibly as a result of improved staffing levels but also due to the development of the person centred planning approach to service delivery. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 The home is proactive at reviewing assessed needs and identifying where and how individual needs can be met. This allows service users choice in receiving an individualised service. EVIDENCE: One service user has just moved to Wrekin Cottage from Severn Cottage. The manager detailed that he visited for tea and activities prior to moving in. Care plans and other documentation had been sent to Wrekin Cottage and the manager was in the process of reviewing and redeveloping his care plan. The move had taken place following consultation with the social worker and the family after it had been identified that Wrekin Cottage might better be able to meet the service users identified support needs. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 Care plans detail individual needs and goals to enable service users to lead full and active lives while receiving the support they need. EVIDENCE: Severn Cottage The care plan for one service user was reviewed in detail by the inspector and discussed further with the deputy manager and the staff, including the key worker. The plan demonstrated that the changing needs of the service user had been identified and plans actioned in order to meet those needs. There was evidence also that the service user’s family, appropriate health care professionals and funding bodies have been consulted and involved in reviews and in the development of the care plan. Through discussions with a number of service users both in a group situation and in private it was established that service users are consulted in decisions relating to their care and social activities. One service user spoke of residents meetings and another service user stated that he enjoyed doing the homes weekly shop. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15 Staff enable service users to identify personal goals and then offer flexible support to achieve them. As a result service users have opportunities to achieve their ambitions and aspirations. EVIDENCE: Severn Cottage Opportunities for social activities detailed in care files and displayed on the notice board in the office were numerous. Staff were particularly enthusiastic about supporting service users to re-establish (where appropriate) and develop family relationships and this was particularly evident when reviewing the file for one service user. Staff showed the inspector a newsletter produced with the service user on a regular basis to send to a family member in order to ensure he remained up to date on developments and achievements. It was also positive to note that family members had assisted staff to produce a life storybook of pictures from the family album. This has proved a valuable resource as the service users health needs mean that she can recollect past events even though she gets confused with recent ones. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 11 Wrekin Cottage Through discussions with staff and the manager of the home it was evident that service users had opportunities to access community resources and staffing was flexible to enable one to one support. On the day of the inspection one service user had been to purchase new trainers. Staff spoke of the success of recent holidays and others spoke of the planning processes for forthcoming holidays. All staff stated that they had been involved with risk assessments to support the activities. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The home operates a good value base recognising service users rights to privacy. The systems for the administration of medication are generally good however errors in the recording process and the retaining of out of date medication potentially place service users at risk. EVIDENCE: Severn Cottage Service users told the inspector that staff always knock before entering their bedrooms and felt that they had adequate privacy given the size of the home. All service users opened their bedroom doors with the use of a key and were seen to secure them afterwards. Staff had committed to undergo training to introduce new communication methods and strategies to support a service user who has been diagnosed with dementia. They spoke of her ‘condition’ with sensitivity and supported difficult times of the day with protocols to ensure consistency for the service user. A review is scheduled for 21/06/05 to agree the need for waking night support for one service user. The home committed to apply for a variation of registration to continue to support the named resident. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 13 Wrekin Cottage Following recent Regulation 37 notifications in relation to medication errors the inspector reviewed the new procedure for medication administration and recording. The new procedure had been introduced to all staff during a training day and in addition all staff had signed to say that they had read and understood the policy. However upon review of the medication administration records gaps were identified. Given the level of training provided the residential service manager stated that any future recording errors would be dealt with through the homes disciplinary procedures. Likewise a review of the medication cabinet identified that some medication was out of date. The manager and acting residential services manager discussed what action they were going to take as a result of these findings. It was positive to see that he protocol for administering paracetamol had been implemented with the support of the local GP. CARE had applied for increased funding to support one service users evening support needs however it had been agreed that this was not necessary. The manager stated that a referral had been made to a continence nurse for input relating to the same individual. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Management demonstrate an awareness of the referral to POVA procedures and are competent to use them appropriately to protect service users. EVIDENCE: Severn Cottage On the day of the inspection the deputy manager informed the inspector in writing of an incident that had taken place that had been referred appropriately to POVA. (The referral form was seen). Safeguards had been implemented until a meeting takes place to discuss the way forward. All service users spoken to at the time of the inspection stated that they felt that staff listened to their concerns and problems. Some service users identified particular staff that they had a good relationship with. It was later identified that these staff were usually the key workers. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,30 Considering the number of people living at each cottage service users are provided with a ‘homely’ and comfortable place to live. EVIDENCE: Severn Cottage Four service users asked the inspector to see their rooms. All were found to be clean and tidy. There were photos of family and friends on the walls and all rooms had been personalised. One service user told the inspector that she had chosen the lovely pink paint and matching duvet and curtains. One service user said that he had had a new carpet and double-glazing in his window. Severn Cottage have numerous pets and the inspector observed service users attending to them. Various adaptations have been made to the environment to support the increasing support needs of one service user, including a bath seat and a handrail. Although the inspector did not see these items the deputy manager stated that they had been fitted following an Occupational Therapy Assessment. The bathrooms had been painted red, as this is a colour that the service user identifies with. Other service users commented that they too liked the colour. Wrekin Cottage environment was not formally reviewed on this occasion. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 Staffing is arranged flexibly to best meet the care and support needs of service users. However there are occasions (at Wrekin Cottage) when staffing levels are not adequate to support all service users. EVIDENCE: Severn Cottage Staffing levels were reviewed as part of this inspection due to previous requirements. Severn Cottage now has a full staff team and staff who spoke with the inspector were enthusiastic and well motivated. The rota reflected that there is always a minimum of two staff on duty (although it was noted that some shifts are not yet covered) and this level increases at key times to allow activities and outings to take place. Staff felt that staffing levels were enabling of processes and upon review of activity sheets it was evident that service users have opportunities to undertake leisure activities and one service user can be accommodated if he doesn’t wish to attend the day services. Staff spoke with the inspector of their additional roles. One staff member is looking to set up a gym and another is coordinating services for a service user with increased care and support needs. Staff training has been arranged to support the increased care needs of one service user. The deputy manager detailed the Evaluation, Success Objectives (ESO) process and stated that it has been well received by staff. It is carried out 6 Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 17 monthly and incorporates staff aspirations as well as discussing learning opportunities and needs. One staff member reflected positively on the process. Supervisions are held monthly. The supervision file of one staff member was reviewed by the inspector and demonstrated that sessions are held regularly. Supervision contracts are completed for all staff and a monitoring sheet demonstrates the process is effective. Additional support was identified for one service user and has been implemented. Staff felt this had impacted positively on the service and the individual. Wrekin Cottage Staff on duty at the time of the inspection spoke in detail with the inspector. All staff stated that they felt well supported by the acting manager and received regular and recorded supervision. One staff member detailed his induction and identified that he had just received his appointed person first aid certificate. The manager outlined the need for a risk assessment to support that two staff must attend to the service user in the flat (attached to the cottage). Staffing levels must be reviewed as a result of this requirement as there are occasions when there are only two staff on duty and some service users require constant supervision due to medical care needs. There is only one member of staff on duty for a half hour period in the mornings. The home states that there must be a minimum of two staff on duty at all times. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 Current management arrangements are proving effective with staff feeling well supported and able to respond to individual care needs effectively. EVIDENCE: One staff member at Wrekin cottage detailed his delegated responsibilities for water temperature checks and recording. An incident reported to CSCI was discussed with the manager and paperwork reviewed. An action plan completed following the incident stated that a risk assessment should have been developed and implemented. This had not happened. The inspector requested this should be done immediately and a copy sent to CSCI for review. Feedback for staff at the time of the inspection identified that the cottages are benefiting from strong management support. Although there are no immediate plans to register either of the home managers the inspector acknowledged Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 19 their efforts and enthusiasm. CSCI has agreed current interim management arrangements until August 2005 when they will be reviewed. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 20 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 x x x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 4 x x Standard No 31 32 33 34 35 36 Score 3 3 2 x 3 4 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Care Ironbridge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 2 x E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 21 yes 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. 1. Standard 33 Regulation 18 (1) (a) 19 Requirement The home must have sufficient staff on duty at all times to meet the assessed needs of service users (as per findings of a risk assessment). Timescale for action 11/07/05 2. 39 24 (1)(a) The manager must seek the (b) (2) (3) views of service users, families, advocates and professionals about the service provided at CARE Ironbridge and provide a quality assurance system. NOT REVIEWED ON THIS OCCASION 12, 16, 23, 26, 13, 19, 24, 37 10/10/05 3. 40 The manager must ensure that 10/10/05 policies and procedures outlined in the National Minimum Standards for Younger Adults are developed and implemented and that staff and service users are involved in their development. NOT REVIEWED ON THIS OCCASION The administration of medication must be recorded on all occasions. 11/07/05 4. 20 13 (2) 5. 20 13 (2) Unused or out of date medication 11/07/05 must be returned to the chemist. Version 1.30 Page 22 Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc 6. 42 13 (2) (c ) Risk assessments must be developed and implemented if identified in an action plan following an incident to ensure future safeguards are in place to protect service users and staff. 12/07/05 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 Good Practice Recommendations There were no recommendations made as a result of this inspection. Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Shrewsbury SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Care Ironbridge E56 S20540 Care Ironbridge V221508 UAI 100505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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