Care Home: Cotswold Lodge

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What the care home does well There is a relaxed and homely atmosphere. The people who live in the Service say and indicate by their manner that support workers are kind and attentive. People receive the support and assistance they need. Support workers know what they are doing and they have a detailed knowledge of each individual`s needs and preferences. People lead active lives and they are helped to keep in touch with their families.Medication is administered safely and people are helped to promote their good health. Sensible steps are taken to reduce the chance of accidents. What has improved since the last inspection? Minor repairs have been completed to the accommodation. The range of social activities has been extended. Support workers have attended various training courses. What the care home could do better: Some parts of the system used to plan the provision of support and the management of risk are not user friendly. This means that some people might not be able to contribute fully to decisions made in their name. People are not supported to manage their own bank accounts and their own medicines. This means that they do not have the chance to be as independent as possible. There are three support worker posts vacant at the moment. This means that people have to do additional shifts. This can be tiring for support workers who need to have time for themselves. The quality assurance system does not seek the views of members of staff. This means that some contributions might be missed. It does not tell all of the stakeholders what is going to be done to respond to suggested improvements. This might result in some people being discouraged from offering their views in the future. CARE HOME ADULTS 18-65 Cotswold Lodge Coast Road Littlestone New Romney Kent TN28 8SB Lead Inspector Mark Hemmings Key Unannounced Inspection 13th June 2008 09:00 Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cotswold Lodge Address Coast Road Littlestone New Romney Kent TN28 8SB 01797 367453 01797 367453 cotswold.lodge@craegmoor.co.uk www.craegmoor. Co.uk Parkcare Homes Ltd 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) Paul Jones Care Home 8 Category(ies) of Learning disability (0) registration, with number of places Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. The maximum number of service users to be accommodated is 8. 15th June 2006 Date of last inspection Brief Description of the Service: Cotswold Lodge (the Service) is registered to provide accommodation and personal care for eight younger adults who have a learning disability. Most of the people who live in the Service now and the people who are likely to move in, have special communication needs. This means that they do not have easy use of spoken and written words. The premises are a detached two storey house. All of the people have their own bedroom. The property is in a rather isolated position immediately opposite the sea wall. The nearest shops are about one mile away in New Romney. There is plenty of off-street car parking. The nearest mainline railway stations are in Ramsgate and Ashford. There is a bus service that passes near to the Service. The Service has its own transport. The Registered Provider is a private limited company. It runs a number of similar residential care services in the region. People who might want to move in and their representatives can get information from several sources. There is a Service Users’ Guide. This is a brochure that outlines the main things available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account than does the Guide. The Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is available for people to see. The range of fees charged currently for each person’s residence in Cotswold Lodge runs from £1270.00 to £1900.00 per week. The fees paid for some of Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 5 the people are higher. This is because they receive more direct support. The fees cover the cost of accommodation, personal care, meals at home, laundry, in-house entertainment and use of the Service’s vehicles. They do not cover extras such as personal toiletries and meals out. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is Two (2) Stars. This means that the people who use this Service experience good quality outcomes. The commission since 1 April 2006, has developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 09.00 and was in the Service for about six hours. It was a thorough look at how well the Service is doing. We took into account detailed information provided by the Registered Provider in its self-assessment. This is called the Annual Quality Assurance Assessment. Further, we considered any information that the commission has received about the Service since the last inspection. When in the Service, we spoke with three of the people who live there and more generally spent time in their company. This was done to get a first hand feeling of how things run in practice. We spoke with the Registered Manager and with three of the support workers. We looked at some key records and documents. We examined parts of the accommodation and the grounds. There are nine Recommendations at the end of this Report. What the service does well: There is a relaxed and homely atmosphere. The people who live in the Service say and indicate by their manner that support workers are kind and attentive. People receive the support and assistance they need. Support workers know what they are doing and they have a detailed knowledge of each individual’s needs and preferences. People lead active lives and they are helped to keep in touch with their families. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 7 Medication is administered safely and people are helped to promote their good health. Sensible steps are taken to reduce the chance of accidents. What has improved since the last inspection? What they could do better: Some parts of the system used to plan the provision of support and the management of risk are not user friendly. This means that some people might not be able to contribute fully to decisions made in their name. People are not supported to manage their own bank accounts and their own medicines. This means that they do not have the chance to be as independent as possible. There are three support worker posts vacant at the moment. This means that people have to do additional shifts. This can be tiring for support workers who need to have time for themselves. The quality assurance system does not seek the views of members of staff. This means that some contributions might be missed. It does not tell all of the stakeholders what is going to be done to respond to suggested improvements. This might result in some people being discouraged from offering their views in the future. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 9 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 Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 5. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People who might want to move in have their needs for support assessed and their wishes acknowledged. They are told about their rights and responsibilities. EVIDENCE: The Manager says that he will complete an assessment of each prospective person’s needs for assistance. This is done before a decision is made about whether or not the Service can meet the person’s needs. He says that this assessment will be completed in consultation with the person concerned. As appropriate, members of their family will be involved. There have not been any admissions to the Service since the last inspection. However, we looked at an example of the sort of information that will be considered. There was information about the person’s needs for personal support, about their health and about their special communication requirements. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 11 Each person or their representative, receives a written account of the rights and of the responsibilities they accept when they move in. The Manager says that in addition to this, he will spend time with the person to discuss their move. He says that he will explain what is involved and will take the time to answer any questions that the person may wish to ask. The Annual Quality Assurance Assessment says that more attention is going to be given to helping people to access the written information in question. This will involve using a variety of approaches including things such as pictures. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. There are individual written plans of care. People should be more involved in the management of their money. People are helped to not take unnecessary risks. EVIDENCE: The people who live in the Service say and indicate that the support workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important documents. This is because they form one of the means by which people can decide about the support they need. Also, they are a way for them to show their agreement with how this is going to be delivered. The plans are a source of information for staff. This then helps them to provide support in the right way. We looked in some detail at Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 13 three sets of these plans. They contain information about a number of relevant things. For example, there is information about how to help the people say what they want, about how to support them in managing parts of how they go about things and about how to help them with practical things such as getting dressed and using the bathroom. We spoke with three of the support workers about what is in these plans. They have a good knowledge of the needs and wishes of the people concerned and about particular aspects of the support they need. However, parts of the plans are not written in a user-friendly manner. Also, there is a lot of paperwork and various different forms to go through. This will make it very difficult for the people who live in the Service to make a meaningful contribution to how their needs and wishes are recorded. There is a Recommendation in relation to this matter at the end of this Report. All of the people have their own bank accounts. However, the Manager and the Area Manager operate them on their behalf. This means that they do not have the opportunity to use a bank in the normal way. There is a Recommendation in relation to this matter at the end of this Report. The Service holds small amounts of cash for each person. This is done to help them to budget. We looked at one set of the records of the various transactions. The amounts spent were for reasonable things. For example, seeing the chiropodist and buying a trampoline. We could not check if the cash balance for the person is accurate. This is because all of the cash held in the Service is pooled together. When the Registered Provider last added up what should be in this pool, the amount was not accurate. There is a Recommendation in relation to this matter at the end of this Report. People are helped not to take unnecessary risks. For example, they are asked to take extra care when doing things such as crossing the road in safety. We looked at three sets of these risk assessments. They show that sensible consideration has been given to the personal safety of the people concerned. However, parts of them are not written in a user-friendly manner. This might make it difficult for people to take an active part in their preparation. There is a Recommendation in relation to this matter at the end of this Report. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 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): Standards 12, 13, 14, 15, 16 and 17. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People have the opportunity to do occupational and social activities. People are helped to keep in touch with their families. They can spend their days as they wish. Good quality meals are served. EVIDENCE: People are free to do things that interest them. One person does occupational activities that involve them being out in the local community. One person is very interested in gardening. Support workers have helped them establish and maintain a vegetable patch in the garden. The person concerned speaks Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 15 enthusiastically about this activity. The Annual Quality Assurance Assessment says that people will be encouraged to try new and different occupational activities. All of the people are encouraged to help out around the place doing things such as cleaning, laying tables and tidying up. People have the opportunity to take part in social activities. We looked at the records of how often trips out occur in practice for two people. During a three week period just before our inspection, they went out shopping on several occasions, went to a local café, went to the zoo, went out for rides in the vehicles, went out for walks and saw their families. On the day of the inspection, most people went out to the cinema and then in the afternoon some went out for a ride. People say and indicate that the pace of daily life in the Service is relaxed and unhurried. While they have considerable choice about how to spend their day, there are broad expectations about some of the things they will do. For example, they are expected to adopt reasonable personal practices such as not going to bed too late so that they are then too tired to do things the next day. People are helped to keep in touch with members of their families. Family members and friends are welcome to call to the Service at any reasonable time. People go to visit family members sometimes with assistance from a support worker. The records show that most people have regular contacts with their families. The Manager in consultation with the person concerned, keeps in touch with family members. This is done so that they know how things are going. People say and indicate that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant experience. There is a choice of dish available at each meal time. At lunch and dinner there is a main meal and then people can have something different if they prefer. We looked at the records of the meals actually served. These are not accurate because they do not reflect the alternatives. There is a Recommendation in relation to this matter at the end of this Report. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People are helped to support themselves. This includes using health care services. There are shortfalls in a part of the medication administration arrangements. EVIDENCE: People are assisted in ways that are right for them. For example, some people need more personal space than do others. Or another example is that some people need more support than do others when choosing clothes that are right for the weather at the time. Support workers are courteous in their manner and they respect each person’s individuality. People say and indicate that they can rely upon support workers to be there when they are needed and to be approachable. We observed support workers giving people the time they need Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 17 to express themselves and then responding in a helpful manner to their requests. People are assisted to maintain their health. Support workers are alert to the need to identify occasions when someone is becoming unwell. This is so that medical assistance can be sought promptly. Since the last inspection, people have been supported to consult with family practitioners and other medical personnel. People are encouraged to promote their good health. For example, there is evidence that some of the people have been supported to manage their weight. This includes one person using an exercise bike in their bedroom. Also, people are helped to attend for regular check ups with the dentist. All of the people have their medicines handled by the Service. There is evidence that medicines are checked when they are received into the Service to make sure that they are correct. They are then stored securely and in an organised manner. The support workers who dispense medicines know what they are doing. They have been assessed to ensure that they follow a clear procedure. This is designed to ensure that each person takes the right medicine at the right. We looked at six sets of records relating to the medicines dispensed. There were no errors. In more detail, we looked at two medicines in particular. This was done to check that the record of their use matched the stock that was left in the store. Again, we did not find any errors. Some people might be able to do more to manage their own medication or to do bits of the process. The Manager says that he is going to look into this so that people can be offered any support they need. There is a Recommendation in relation to this matter at the end of this Report. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. There is an easy to use complaints procedure. The wellbeing of people is safeguarded. EVIDENCE: There is a written complaints procedure. This has pictures and it is quite straightforward so as help people when using it. The procedure explains how the people who live in the Service and other interested parties can go about raising a concern. Since the last inspection, the Registered Provider has received one complaint from a third party. This concerned an allegation that some support workers were not attending to their duties. We looked at how the complaint was sorted out. We found that the Manager followed the Registered Provider’s written procedure and that the matter was promptly investigated. We noted that there was no evidence to support the allegation. People say and indicate that they feel safe living in Cotswold Lodge. The Registered Provider has a written policy and procedure that tells support workers what to do if they become concerned about someone’s wellbeing. For example, if someone is being bullied or having their freedom limited without good cause. We spoke with three support workers about this matter. They are Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 19 aware of what to look out for and who to contact if they become concerned. They say that they have seen or heard anything to worry them. Indeed, they are confident that the people who live in the Service are safe and well supported. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. People live in a generally comfortable setting that promotes their independence. The kitchen is clean and well equipped. There is a separate laundry. EVIDENCE: Most areas of the accommodation are decorated and furnished to a normal homely standard. There are some exceptions. In the corridors there are places where carpets are stained. In the dining room, the linoleum flooring is scratched and worn. In this area and just by the kitchen door, there is a very worn fitted mat. In the lounge, part of the ceiling is stained and bowed. In the first floor bathroom, the radiator cover is loose and its shelf is chipped and Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 21 discoloured. There is a Recommendation in relation to these matters at the end of this Report. The road that leads to the Service runs alongside the sea wall. It is mainly gravel. It is very uneven. In places it is almost impassable. The premises are fitted with an automated fire detection system. This provides a high level of fire safety protection. The Registered Provider has prepared a fire risk assessment. This has been done to ensure that the fire safety system works as intended. The assessment was completed in 2005 and there is no evidence that it has been updated since. The Manager is going to look into this to see what the Registered Provider intends to do about this. He is also going to check that the assessment has been sent to the Kent Fire and Rescue Service. This needs to be done so that its adequacy can be confirmed. There is a Recommendation in relation to this matter at the end of this Report. The local Department of Environmental Health last called to the Service. It says that the food handling arrangements in the Service are to a “good standard”. We looked at the kitchen. It is clean and well equipped. There is a system to make sure that foods are used within their best-by dates. There is also a system to make sure that the refrigerators are cold enough to store foods safely. Sensible steps are taken to promote hygiene. For example, there are different chopping boards for use when preparing uncooked meats. The laundry is equipped with a commercial washing machine and dryer. People are encouraged to do their own laundry, but in practice most rely upon support workers to organise this for them. The arrangements used work well. Each person has a sufficient supply of clean and presentable clothes from which to choose. There are new regulations that have been introduced to ensure that used water does not leak back into the main pipe-work. The Registered Provider is going to check with the local water supply company to make sure that it complies with these provisions. This will be done by 1 August 2008. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There are enough staff on duty to make sure that people get the support they need. Security checks are completed on staff. Support workers know what they are doing. EVIDENCE: There are four support workers on duty during the day and the evening. At night time, there are two support workers on duty in the Service. During the week, the Manager works normal office hours. There is also an administrator and a handyman who work part time hours. Often they help out with driving the vehicles so that support workers can have more time to be with the people who use the Service. There is no cook or housekeepers and so support workers have to run the house as part of their general responsibilities. We asked two of the people who live in the Service if there are enough staff on duty. They say that there is and that they get all the support that they need. We asked three Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 23 support workers about the staff cover. They also think that it is adequate to enable them to give people the support and attention they need. There are three vacancies for support workers. At the moment, these shifts are being filled by people doing overtime. The Manager says that it has proved difficult to recruit new support workers. The Registered Provider needs to address this matter. There is a Recommendation about this at the end of the Report. There is an on-call system. This means that someone senior can be contacted for advice out of office hours. The Registered Provider completes a number of security checks for new support workers. These include checking the person’s identity and their employment history, seeking references and obtaining a police check. This is done to ensure that they are suitable and trustworthy people. No new support workers who remain in post, have been appointed since our last inspection. The Annual Quality Assurance Audit says that the people who use the Service are actively involved in the recruitment process. This entails them meeting applicants so that they can say if they want someone to come to work in their home. New support workers receive introductory training before they work without direct supervision. After that, they are provided with ongoing training. The Manager says that there is a number of compulsory subjects that should be completed in the first year. These include things such as first aid, health and safety, food hygiene, administering medication, supporting people who express themselves through difficult behaviour, infection control, the safeguarding of vulnerable adults and fire safety. We looked at the training undertaken by two support workers who have worked in the Service for more than one year. Both of them have completed all these training courses. We examined parts of the skills and knowledge of three support workers. They have a good knowledge of the individual needs of people for support. For example, they know how people prefer to express themselves and we saw them using their expertise to good effect. We asked about safeguarding people’s welfare. They know what to do if they become concerned about something. We also asked about food safety. They are aware of the importance of good hygiene and give examples such as washing hands and storing perishable foods properly. The Manager says that he is confident that all of the support workers have the skills and knowledge they need. Of the nine support workers employed in the Service seven of them have acquired a relevant National Vocational Qualification. Two people are studying for a higher National Vocational Qualification. These qualifications are designed to help support workers provide high quality support for people who live in residential care settings. The Annual Quality Assurance Assessment says that all new support workers will be encouraged to study for the qualification. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 24 Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. People who use the Service experience good quality outcomes. This judgement has been made using available evidence including a visit to the Service. The Service is reliably managed. The quality assurance system does not collect enough information. People’s health and safety is promoted. EVIDENCE: We have registered the Manager. This means that he has showed us that he knows what he is doing. He has a recognised management qualification. He intends to study for a second qualification. This is important because it is designed to add to his skills to enable people to receive the support they need. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 26 There are various systems used to promote good team-work. These include handover meetings at the beginning and end of each shift. Also, there are staff meetings. The last one took place in May 2008. The records show that relevant things were discussed. These include scouting out new social activities that might interest the people who use the Service. Another involves plans to extend the menu to respond to suggestions made by people at a recent house meeting. Support workers say that there is good team work. We saw plenty of evidence of this. Support workers check out with each other who is going to do what, with whom and when. Also, they plan their work in advance so that they use their time to the best effect. For example, they know who needs the most support when they go out and they organise their availability to respond to these needs. Several things are done to consult with people about how well the Service is running. These include informal everyday discussions and more organised house-meetings. All of the people who live in the Service are invited to attend these meetings. They can raise any subject they like. We looked at the records of the last meeting that took place in June 2008. A good deal of the meeting was used to discuss what social activities would be welcome. The way the records are written show that people are actively involved. For example, one person asked in an indirect way if there is a café at a proposed activity. The support workers were able to pick up on what was meant and they reassured the person that drinks and snacks are available at the event. In addition to this, the Registered Provider asks relatives to complete yearly satisfaction questionnaires. We looked at the four completed questionnaires held in the Service. The relatives concerned say positive things about the Service. One person summarises the general mood when they observe, “I am pleased with my son’s care and treatment at Cotswold Lodge. The manager is of a great help to me and always keeps us informed. The staff always are friendly and never make me feel I am a burden when I phone them up”. However, members of staff are not included in this process. Also, there is no system to tell stakeholders what is going to be done to respond to any suggested improvements. There is a Recommendation in relation to this matter at the end of this Report. The Registered Provider completes a formal review of the Service once a year. This involves someone calling to the Service and checking out in detail how things are going. They look at things such as the individual plans of care, the standard achieved by the accommodation, staffing issues and health and safety matters. The most recent review was completed in August 2007. A small number of improvements were recommended. One of these involved the provision of colour coded chopping boards in the kitchen. There was a written note that showed that the Manager attended promptly to this recommendation. The Registered Provider’s Area Manager calls to the Service about once each month to see first hand how things are going. The records show that these visits are taking place as intended. Also, they show that a suitable range of Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 27 practical things that make a difference people’s quality of life are being are being reviewed. Regular checks are completed to ensure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells and periodic more detailed checks completed by a contractor. There are unannounced fire drills. There are records that show that careful consideration is given to the support each person needs to get out of the building if there is a fire. Each member of staff attends an annual fire lecture. However, there is no system to ensure that each member of staff has been regularly assessed as knowing how to operate reliably the Service’s fire safety procedure. This is very important because the actions taken by staff largely determine the level of fire safety protection available in the Service. The Manager says that this matter will be addressed by 1 August 2008. The electrical installation and the gas-fired appliances have been certified as being in a safe-worthy condition. In relation to the former, we noted evidence that a recommended improvement has been promptly sorted out by the Registered Provider. We looked at the record of accidents and other untoward events that have occurred in the Service this year. There is nothing exceptional in their nature or frequency that needs us to make any further enquiries. The Registered Provider has a system that means that important things called “critical events” are recorded fully so that they can be examined. This is done so that steps can be taken to prevent them happening again. Part of the Registered Provider’s checks of the premises is done to ensure that there are no hazards that might cause someone to have an accident. The Manager says that no such problems have been identified. We did not identify any particular hazards. We noted that things like bleaches are stored securely when not being used. Hot water is temperature controlled to help prevent someone being scalded. Windows above the ground floor are restricted so that they do not open too wide. This is done to help prevent someone falling or getting stuck. Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 YA9 Good Practice Recommendations The Registered Provider should develop further the steps that have already been taken to present individual plans of care and risk assessments in a user-friendly way. The Registered Provider should explore what steps can be taken to enable people to operate their own bank accounts. The Registered Provider should ensure that all people have a separate cash balance kept in the Service for their personal spending allowances. The Registered Provider should ensure that all alternatives to the main dishes provided at lunchtime and for dinner are recorded. The Registered Provider should explore what steps can be taken to enable some people to become more involved in DS0000023397.V365302.R01.S.doc Version 5.2 Page 30 2. YA7 3. YA7 4. YA17 5. YA20 Cotswold Lodge the administration of their medicines. 6. YA24 The Registered Provider should repair the damaged ceiling in the lounge, clean the stained carpets, replace the worn mat and repaint the stained radiator cover. The Registered Provider should review its current fire safety risk assessment. It should submit a current assessment to the Kent Fire and Rescue Service. The Registered Provider should take the steps necessary to recruit to the three support worker posts that are currently vacant. The Registered Provider should develop its quality assurance system so that members of staff are included. Also, it should devise a system for informing stakeholders what has been said about the Service and how any suggested improvements are going to be put into effect. 7. YA24 8. YA33 9. YA39 Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cotswold Lodge DS0000023397.V365302.R01.S.doc Version 5.2 Page 32 - 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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