Care Home: Cashel Cottage

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What the care home does well Each person has had a full assessment of their needs prior to moving into the home. This ensures that the home is able to meet individual needs. Each person has a written contract outlining the terms and conditions. The home has a Statement of Purpose which provides people with information about the service.Cashel CottageDS0000028392.V378065.R01.S.docVersion 5.3Each person has an individual care plan, which is kept under review. Support plans detail how specific needs are to be met. Each person has specific individual risk assessments in place to minimise any potential risks. People are supported to attend day services, which are owned and run by Valued Lives. People are able to access both the local and wider community. People have the opportunity to take part in community activities such as attending the local church, with support. Where possible, people are supported to visit their families and friends. Staff report that they support people to make telephone calls, send postcards and letters, if they wish to do so. Care plans provide information on how an individual prefers to have their personal care delivered. Evidence demonstrates that people are supported to attend health care professionals as and when required. Medication records are completed properly. Medication is regularly `stock checked`. Staff receive training in medication before they are able to administer independently. There is a complaints policy and procedure in place. The home has a complaints log; however it was noted that no complaints have been received since the last inspection. Policies and procedures are in place to safeguard the people living at the home. Guidance is provided to staff members, in the event that they witness inappropriate practice which may affect service users. We found the home to be clean, tidy and hygienic. The home was in keeping with other properties in the area. Staff members told us that there are sufficient staff on duty to meet the needs of the people living there. All staff working at the home have a National Vocational Qualification (NVQ), or are working towards achieving the qualification. New staff receive an induction into the service and are provided with mandatory training. The registered manager is appropriately qualified to run the home. Health and safety policies and procedures are in place to make sure that people remain safe. What has improved since the last inspection? At the last inspection four requirements and nine good practice recommendations were made. Two requirements have been met in full. There has been good progress made on the remaining two. The majority of the good practice recommendations have been addressed or are in good progress of being met. Care plans sampled showed some improvements have been made. Individual files contain person centred plans, which staff members have started to complete. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Recruitment records were examined and showed that all required checks are completed prior to a person commencing work. Staff members are now receiving regular support through one to one supervision. Annual appraisals have taken place. We noted that there were not any objects obstructing access to the wash hand basin by the shower. The toilet roll was not seen to be stored in the kitchen area. There has been some progress made with regard to monitoring quality assurance within the home. Mrs Bottoms told us that an audit of the service will now take place annually. This is due to commence in December 2009. What the care home could do better: Epilepsy profiles and management plans must be kept at the home for reference. Management audits must take place monthly and records kept. Consideration should be given to improving the safe keeping of people`s finances. Key inspection report CARE HOME ADULTS 18-65 Cashel Cottage 39 Raffin Lane Pewsey Wiltshire SN9 5HJ Lead Inspector Pauline Lintern Key Unannounced Inspection 25th November 2009 09:50 Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Cashel Cottage Address 39 Raffin Lane Pewsey Wiltshire SN9 5HJ 01672 563710 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) Steven@StevenAbbott.wanadoo.co.uk Mrs Jane Abbott Mr Patrick Jones Mrs Jane Abbott Mr Patrick Jones Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2008 Brief Description of the Service: Cashell Cottage is a care home registered for four people with learning disabilities. It is run by Valued Lives, which is a private organisation, which operates 5 care homes for adults with learning disabilities. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by one of the registered persons, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Cashel Cottage is in Raffin Lane, Pewsey. The town of Pewsey offers a range of amenities. The market towns of Marlborough and Devizes are within 15 minutes’ drive and the larger towns of Salisbury and Swindon are easily accessible. The organisation has a number of vehicles used by the people who live in the homes and they contribute towards the costs. Valued Lives also operates Harlequins, which is a day service used by most people who live in the homes for at least part of each week. They pay a small weekly sum towards this. Recently Valued Lives have bought a farm, which offers more opportunities for day time occupation. All bedrooms at Cashell Cottage are on the first floor. There is one shared bedroom. The bathroom is also upstairs. There is a small bedroom where staff sleep in. Communal space is on the ground floor. There is a sitting room and dining room, which was being used as a sitting room for one person at the time of the inspection. There is also a large garden. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. The unannounced key inspection took place on 25/11/2009. The inspection took place between 9.50 am and 3.45 pm. We were assisted throughout the inspection by Mrs Bottoms who is the deputy manager of Cashel Cottage. All of the people who live at Cashel cottage were at home when we arrived. Three people were later supported to their day services by a member of staff. One person remained at the home for the duration of our visit. During the day we spoke to two members of staff and were able to obtain their views on the service. Surveys were sent out to both people using the service and staff members although no feedback has been received from them. We asked the home to complete an Annual Quality Assurance Assessment., known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year and about their plans for the future. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. At the end of our visit we reported our findings to Mrs Bottoms. The judgements contained in this report have been made from all the evidence gathered during the inspection; including the visit to the service and takes into account the views and experiences of people using the service. What the service does well: Each person has had a full assessment of their needs prior to moving into the home. This ensures that the home is able to meet individual needs. Each person has a written contract outlining the terms and conditions. The home has a Statement of Purpose which provides people with information about the service. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 6 Each person has an individual care plan, which is kept under review. Support plans detail how specific needs are to be met. Each person has specific individual risk assessments in place to minimise any potential risks. People are supported to attend day services, which are owned and run by Valued Lives. People are able to access both the local and wider community. People have the opportunity to take part in community activities such as attending the local church, with support. Where possible, people are supported to visit their families and friends. Staff report that they support people to make telephone calls, send postcards and letters, if they wish to do so. Care plans provide information on how an individual prefers to have their personal care delivered. Evidence demonstrates that people are supported to attend health care professionals as and when required. Medication records are completed properly. Medication is regularly stock checked. Staff receive training in medication before they are able to administer independently. There is a complaints policy and procedure in place. The home has a complaints log; however it was noted that no complaints have been received since the last inspection. Policies and procedures are in place to safeguard the people living at the home. Guidance is provided to staff members, in the event that they witness inappropriate practice which may affect service users. We found the home to be clean, tidy and hygienic. The home was in keeping with other properties in the area. Staff members told us that there are sufficient staff on duty to meet the needs of the people living there. All staff working at the home have a National Vocational Qualification (NVQ), or are working towards achieving the qualification. New staff receive an induction into the service and are provided with mandatory training. The registered manager is appropriately qualified to run the home. Health and safety policies and procedures are in place to make sure that people remain safe. What has improved since the last inspection? At the last inspection four requirements and nine good practice recommendations were made. Two requirements have been met in full. There has been good progress made on the remaining two. The majority of the good practice recommendations have been addressed or are in good progress of being met. Care plans sampled showed some improvements have been made. Individual files contain person centred plans, which staff members have started to complete. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 7 Recruitment records were examined and showed that all required checks are completed prior to a person commencing work. Staff members are now receiving regular support through one to one supervision. Annual appraisals have taken place. We noted that there were not any objects obstructing access to the wash hand basin by the shower. The toilet roll was not seen to be stored in the kitchen area. There has been some progress made with regard to monitoring quality assurance within the home. Mrs Bottoms told us that an audit of the service will now take place annually. This is due to commence in December 2009. What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 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 Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgment has been made using available evidence including a visit to the service. The home has a Statement of Purpose, which provides people with information about the service. Nobody has moved into the home for a number of years. There is a procedure in place for new admissions, and for assessing whether the home can meet a persons needs before they move in. EVIDENCE: The home has a Statement of Purpose, which provides the reader with information about the service. It details how to make a complaint if necessary, although the contact details for CQC need to be updated to provide current information. All people who use the service have lived at Cashel Cottage for a number of years. It was therefore not possible to look at the admission process in practice. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 10 At the previous inspection a good practice recommendation was made. This was recommending that all contracts are signed by either the person living at the home or their representative to ensure that peoples interests were safeguarded. This had not been actioned at the time of our visit, however Mrs Bottoms reported that she would ask relatives to read and sign the documents when she next saw them. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has an individual care plan, which is kept under review. Person centred plans have been introduced and staff have begun to complete them on behalf of the people they support. Staff members may benefit from attending person centred planning training to provide a better understanding. People are supported to make decisions about how they choose to live their lives. Potential risks are assessed and kept under review. EVIDENCE: Each person has a care plan in place, which has been kept under review. Little action has been taken to address the good practice recommendation we made that people living at the home or their representative sign the care plan to Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 12 show that they have been involved in its development. We noted that one care manager had signed an individuals care plan. However, the others remain unsigned. Mrs Bottoms confirmed that she will ask families to read and sign the plans if they agree the contents, when she next sees them. We noted that care plans detail all aspects of the persons life such as disposition, comprehension, behaviours, mobility, health needs, spiritual; needs, medication, personal hygiene, personal care and dietary needs. Care plans identify preferred activities, contact details for friends and family. Some progress has been made in relation to person centred plans. However they have not yet been fully completed. Mrs Bottoms explained that key workers are working their way through the plans. Communication dictionaries are in place, but have not yet been completed. Mrs Bottoms told us that they have plans to hold four monthly review meetings with the key worker, the person they support, Mrs Abbott and herself. The plan is that communication dictionaries will be completed at these meetings. The meetings will also provide the opportunity to review each person’s care plan, risk assessments and enable people to express how they feel about the service provision and the development of the home. We discussed that the staff team may have to explore methods and approaches to enable them to aid peoples communication. We asked if staff have attended training in person centred planning. Mrs Bottoms told us that this was included within the recent care planning and report writing training, which staff attended. We do feel that it may be beneficial to staff to attend further, external training. Care plans demonstrated how people are empowered to make choices within their life. For example one care plan stated X will choose meals from the menu cards. Mrs Bottoms explained that most people they support choose to only spend time in their bedrooms when they retire. Most people prefer to sit in the communal areas of the home with their peers. Some restrictions were in place, due to changes in one persons recent behaviours. We discussed the need to ensure that deprivation of liberties safeguards guidance is followed and that the persons best interests have been fully represented. Mrs Bottoms confirmed that this would be actioned. We looked at individual risk assessments and noted where one person had been presenting some challenges this had been assessed in various situations. This ensures that the person remains safe, whilst maintaining their independence where possible. Risk assessments are kept under review and regularly monitored. All staff members sign to confirm that they have read and understood the risk assessments. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 13 One persons behavioural management plan had been updated by Mrs Bottoms and Mrs Abbott on 30/10/2009, but had yet to be agreed by the community nurse. As mentioned previously the community nurse was due to visit the home the following day to review and agree the plan. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the 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 access to a variety of activities within the local and wider community. Links with families and friends are maintained. People have established routines and choice making is promoted. Menus are flexible and varied. EVIDENCE: Each person has a weekly activity planner within their care plan. We saw that people attend Valued Lives day services, Harlequins, where they partake in various activities such as arts and crafts, jabadeo, light exercise, puzzles, computer work and church singing. One person told us that they enjoyed going to work (Harlequins) every day. We saw in care plans that people can access, shopping, swimming, nature walks, bingo, gardening and trips to the library if they wish to do so. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 15 One person was observed playing with their Lego, when we visited. Staff told us that they also enjoy cutting out pictures. One persons file stated which activities they enjoyed but reminded staff that they may need to offer support and encouragement with some activities such as light exercise. One person told us that their hobby was collecting models of cars and buses. Staff told us that the person had been disappointed when the local toy shop had recently closed. The person they support had been a regular visitor to the shop and had enjoyed making purchases there. Staff members are currently exploring a similar resource. We noted that peoples spiritual needs were being met. Mrs Bottoms told us that ladies from the local church visit Harlequins every Tuesday and practice singing and participate in arts and crafts with service users. Mrs Bottoms added that the people living at the home are fully included within the service at church and are encouraged to participate fully with musical instruments and hymn singing. One member of staff reported that he had taken one person Christmas shopping on a one to one basis. He reported that extra staff are deployed if needed to enable activities to take place. Mrs Bottoms told us that people had been making Christmas decorations at Harlequins and that they were now keen to put up the homes Christmas tree. We discussed how contact is maintained with families and friends. We noted in one persons daily notes that staff had supported them to make a telephone call to their relatives. People are supported by staff to send letters and postcards also. Staff members support people to visit their families and friends when required. People are able to keep in touch with their friends at the day services. We looked at the menu for the current week and saw that it was varied and healthy. The main meal is generally in the evening, with people taking a packed lunch to Harlequins. We noted that on Sundays a roast is prepared. Mrs Bottoms showed us the menu cards that are used for people to make choices regarding the menu. People living at the home are involved in the food shopping. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the 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 support in the way they prefer. People have access to healthcare professionals when required. Policies and procedures are in place relating to medication. However, consideration must be given to the safe storage of both daily medication and controlled medication, if it is prescribed. EVIDENCE: Within the AQAA it states service users are encouraged to be as independent as they are able or want, and are encouraged or assisted to express the individuality and choices. Where possible and appropriate, service users are able to choose appropriate staff to support them. Care plans detail how people prefer to have their personal care delivered and how staff can promote their independence. We saw that one persons plan states that they are able to wash their body but need assistance with washing their face. Another person needs some guidance when selecting their clothes Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 17 as they have been known to become obsessional about certain items of clothing, which can cause distress. People are encouraged and supported to wear makeup and jewellery if they wish to do so. One person’s care plan reminds staff that the person does not like to wear lipstick, as they will wipe it off. Evidence demonstrates that people have access to appropriate health care professionals when needed. This includes GP, dentists, psychologists, occupational therapists, community nurse and the chiropodist. We saw that each person had a completed Health Action Plan. A health plan had also been completed by the community nurse, which identified areas for action and stated who would take responsibility for actioning them. Records show that annual health checks are carried out by the GP. Letters are kept on file to show that the GP has agreed to over the counter medication being administered. We noted that one persons epilepsy profile and management plan was not within their care plan. Mrs Bottoms explained that the community nurse had reviewed the plan and had probably taken it with her following her visit. We asked that the home ensure that such plans are always available for staff reference and recording. We did note that there was a record of seizures within the plan for staff to complete. Mrs Bottoms reported that most staff have received training in the use of invasive emergency medication. We asked that a refresher course be arranged and that written confirmation of attendance and competence be sought. As mentioned earlier in this report, behavioural guidelines were in place and had been updated by Mrs Abbott and Mrs Bottoms. Risk assessments were in place to support the plan; however ideally this needs to be agreed with the community nurse. We saw that the home have developed new comprehensive forms for recording incidents and accidents. Mrs Bottoms reported that she reminds staff of the importance of recording all incidents and accidents to enable management to evaluate events. As part of the inspection process we looked at the arrangements for managing medication. The home has a medication policy and procedure in place. Mrs Bottoms explained that medication was currently being held in an alternative locked place, due to the lock on the medication cabinet being broken. We asked that this be repaired or replaced as soon as possible to ensure safe storage. At the previous inspection we recommended that the home to purchase a cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. This has not Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 18 yet been actioned as the home currently does not hold any controlled medication. Medication administration records were completed properly and medication is stock checked weekly. All medication coming into the home or leaving the home is signed in or out. No one living at the home currently self medicates. We discussed how staff are monitored to ensure that they remain competent when dealing with medication. Mrs Bottoms told us that both herself and Mrs Abbott will observe staff at various times to ensure they are still competent. We recommend that a competency form is developed and used annually with each member of staff. This should then be kept within individual training files. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to enable people to enable people to raise concerns if necessary. Overall people are safeguarded from any form of abuse. However consideration should be given to improving the safe keeping of peoples finances. EVIDENCE: The home has a complaints policy and procedure. Guidance of raising concerns and making a complaint is also in the Statement of Purpose. Contact details for CQC need to be updated. The home now has a complaints log, which will record any complaints, actions taken, outcomes and timescales. We noted that no complaints have been recorded in the log since the last inspection. Within the AQAA it states that the home has not received any complaints in the last twelve months. One referral has been made to the safeguarding team. This was investigated and concluded appropriately. The home has guidance available about the safeguarding procedure in Wiltshire. We looked at staff training records and noted that one member of staff had not completed training in safeguarding since 2007 and another person last attended training on 18/1/08. We advised that all staff members Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 20 should receive refresher training on safeguarding protocols and procedures. The refresher training should be at least two yearly. This will ensure that all staff are aware of all forms of abuse and the action that is needed. All staff members are provided with a leaflet which provides guidance in the event that they should witness inappropriate practices affecting people being supported by Valued Lives services. They are also given a card to carry with them that identifies who they are and what their role is. It also provides a contact number where people can discuss any incidents if they wish to do so. We discussed the use of physical intervention. Mrs Bottoms confirmed that a three day training course (BILD accredited) has been booked for December 2009. Any holds or techniques will then be incorporated into care plans/risk assessments if necessary. Records will be kept of any circumstances / situations where it has been necessary to use the holds or distraction techniques. As part of the inspection process we sampled monies held by the home on behalf of the people living there. All cash and records balanced. We discussed how safe keeping of peoples money might be improved. Mrs Bottoms said that she will look at alternative options. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 home provides a clean, comfortable and safe environment for people to live in. EVIDENCE: As part of the inspection process we toured the premises, which were found to be clean and tidy. Within the AQAA it states that the garden has been refurbished since the last inspection. Mrs Bottoms explained that new fencing has been erected and the front of the patio has been improved. She added that there are plans to decorate the hall, stairs and landing to make the area lighter. We found the home to be in keeping with other homes in the area. The home is comfortable and homely, with pleasant soft furnishings and plenty of Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 22 seating. The home has converted the original dining room into an additional lounge, which is used by one person. This room has a television and a settee for them to use. The kitchen is small but compact and contains all necessary appliances. The washing machine is sited in the kitchen and the drier is kept in the garage. Bedrooms were found to be personalised with ornaments, toys, pictures and photographs. Mrs Bottoms told us that they were planning to re-decorate bedrooms when the hallways have been completed. We found all areas of the home to be clean and hygienic. Wash hand facilities had pump action anti bacterial hand wash. Gloves and aprons were available for staff to use. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are properly recruited, inducted, trained and supervised. EVIDENCE: Since the previous inspection the home have not recruited any new staff, however new staff have been recruited to work at Harlequins. Staff members told us that generally there are two staff members on duty and one member of staff sleeping in during the night. When day trips are taking place, extra staff are deployed to support people. Within the AQAA it states all staff has an NVQ level 2 or are working towards it. Staff are encouraged to self develop and given opportunities to enhance their skill levels in order to meet service users needs One member of staff we met told us that they have an NVQ level 2 and are currently working through their NVQ level 3. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 24 As part of the inspection process we examined four staff recruitment files. We found them all to be in order. Evidence showed that each person had completed an application form including a declaration that they were physically and mentally fit. Checks had been carried out with both the Protection of Vulnerable Adults (POVA) First and The Criminal Records Bureau (CRB) before they commenced their employment. Proof of identity and two satisfactory references were also obtained. We saw that new staff complete an induction period. Mrs Bottoms showed us the new Passport to Care induction programme, which has now replaced the old induction format. The Passport to Care uses the Common Induction Standards and covers all aspects of the role and responsibilities. Part of the induction covers equal opportunities, diversity, values and confidentiality. Within the induction period new staff receive mandatory training including fire awareness, health and safety, basic food hygiene, medication administration and abuse awareness. As mentioned previously we noted on individual training records that some staff were in need of refresher training in safeguarding. We saw that training is provided in specific area such as autism, dementia, Downs syndrome and challenging behaviour. This year the follow training courses have taken place or have been arranged; moving and handling, care planning and report writing, Bipolarity, sexuality, autism, first aid and physical intervention (3 days). Mrs Bottoms told us that staff are also provided with 12 Red Crier booklets. These are knowledge work books on various subjects. Once staff have completed the workbooks they are returned to Mrs Abbott who then checks them and staff are awarded a certificate to confirm they have passed the exercise. We looked at the supervision records of four staff members. We saw that staff receive regular supervision. Mrs Bottoms explained that each supervision focuses on a certain area of the work such as nutrition, care planning, risk assessments, manual handling etc. Whilst we thought that this was a very good idea, we would also like to see evidence that staff had the opportunity to discuss all aspects of their role during their one to one time. Mrs Bottoms reported that other discussions do take place and are recorded on separate sheets. This was not evident in the recent supervision notes. Mrs Bottoms told us that all staff members have now received an annual appraisal and Mrs Abbott and Mrs Bottoms would be spending time collating the comments received from staff. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the 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 registered manager is suitably experienced to manage the home. Further action needs to be taken to ensure peoples views are reflected in the homes quality assurance system and development plans. Monthly management audits need to be completed. Policies and procedures relating to health and safety are in place. EVIDENCE: Mrs Abbott is the registered provider for Cashel Cottage. She is also the registered manager. She has many years experience of working with people with learning disabilities. Mrs Abbott holds a learning disability nursing qualification. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 26 Mrs Abbott and Mrs Bottoms were both working towards their NVQ level 4 in Management; however the training company ceased trading. This has now resulted in Mrs Abbott and Mrs Bottoms undertaking the Management and Leadership qualification with alternative trainers. At the last inspection a requirement was made which related to establishing and maintaining a system for reviewing at appropriate intervals and improving the quality of care at the home. We also asked that the system would evidence consultation with service users and their representatives. Mrs Bottoms told us that they will be distributing satisfaction surveys during December 2009. Once comments have been received a development plan will be put in place. We asked Mrs Bottoms to ensure that the quality audit and the development plan be specific to Cashel Cottage and not generic across other Valued Lives homes. We also discussed the need to ensure that the views of the people living at the home and their representatives are sought and evidenced. Mrs Bottoms told us that they have questionnaire to give out to people visiting the home such as the community nurse, care managers and relatives. We appreciate that as stated in the AQAA, the home has developed new quality assurance documents and seeks the views of services users and others. However as the document has not been fully implemented we will extend the timescale for action, but the requirement remains as not fully met. We saw that new management audit forms have been developed, however none have been completed yet. Mrs Bottoms reported that Mrs Abbott would be completing the first one the next day. We reminded Mrs Bottoms that the forms need to be available for inspection if required. At the time of our visit the electrician was at the home completing an electrical test (PAT) on all of the small electrical appliances. We looked at health and safety documents including environmental risk assessments and health and safety checks. All were up to date and regularly reviewed. Staff receive training in moving and handling, fire safety and basic food hygiene. Regulators are fitted to hot water outlets, restrictors are on first floor windows and all radiators are guarded. Toxic materials are locked away and have the necessary accompanying data. There was a detailed fire risk assessment; however we noted that it was in need of reviewing as it was dated 01/09/2008. Regular fire checks take place and fire instruction is given to staff members. Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 x Version 5.3 Page 28 Cashel Cottage DS0000028392.V378065.R01.S.doc Are there any outstanding requirements from the last inspection? YES 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 YA39 Regulation 24 (1)(5) Requirement The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The system shall provide for consultation with service users and their representatives. In order to comply with this requirement the registered person must obtain the views of people in the home and make sure that any service developments are based on these views. Some progress has been made, however this requirement remains unmet in full. New timescale 25/02/2010 2. YA19 12 (1) (ab) Epilepsy profiles and management plans must be kept at the home to ensure that staff can access them at all times. Management audits must be DS0000028392.V378065.R01.S.doc Timescale for action 25/02/10 25/11/09 3. YA39 26 25/01/10 Version 5.3 Page 29 Cashel Cottage completed monthly and records made available. 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 YA5 Good Practice Recommendations It would be good practice for a representative to sign the contract on behalf of a person who is not able to sign so that their interests are safeguarded. This recommendation remains unmet. Each person who lives in the home or their representative should sign the care plan to show they have been involved in developing their plan. This recommendation remains unmet. 2. YA6 3. 4. YA6 YA20 Communication dictionaries should be fully completed along with person centred plans. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed so that any controlled drugs that are prescribed can be stored safely. This recommendation remains unmet. The Statement of Purpose should contain the correct contact details for CQC. That all behavioural management plans are agreed with the relevant people. The staff should receive further training about person centred planning and person centred practice to help them to work in a more person centred way and meet people’s diverse needs. DS0000028392.V378065.R01.S.doc Version 5.3 Page 30 5. 6. 7. YA1 YA9 YA35 Cashel Cottage 8. YA39 The Annual Quality Assurance Assessment submitted to the Commission should contain information about the specific outcomes for people in this home as well as overall service developments. This recommendation remains unmet in full. Consideration should be given to arranging for refresher training for all staff in the use of invasive emergency medication. The lock on the medication cupboard must be replaced or repaired as soon as possible to ensure safe storage. The manager should develop a form to monitor annually staff competencies when handling medication. All staff should undertake refresher training with regard to safeguarding people, at least every two years. The fire risk assessment must be reviewed and updated. The home should ensure that money and valuables of services users are deposited in a safe place. 9. YA19 10. YA20 11. 12. YA20 YA23 13. 14 YA42 YA23 Cashel Cottage DS0000028392.V378065.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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