Care Home: Myrtle Cottage

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What the care home does well People who use the service have a comprehensive assessment prior to admission. Staff interact with people who use the service in a meaningful, appropriate and respectful way. Involvement with the local community and colleges is actively encouraged and supportedA choice of meals is offered in pleasant surroundings with input in choice and preparation from the people who use the service. What has improved since the last inspection? The requirements of the last inspection have been met. There have been changes in the way the monies of people who use the service are handled to ensure they have access to their money whilst being protected from financial abuse. There is a weekly medication audit by senior support staff and a monthly audit by the acting manager. What the care home could do better: The furniture in the sitting room is not appropriate for the needs of the people who use the service. CARE HOME ADULTS 18-65 Myrtle Cottage 123 New Brighton Road Emsworth Hampshire PO10 7QS Lead Inspector Sheila Gawley Unannounced Inspection 19 March 2008 12:30 th Myrtle Cottage DS0000058347.V359605.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 Myrtle Cottage DS0000058347.V359605.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. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Myrtle Cottage Address 123 New Brighton Road Emsworth Hampshire PO10 7QS 01243 370500 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) Dolphin Homes Ltd Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th February 2007 Brief Description of the Service: Myrtle Cottage is a large, detached older style property set within the residential area of Emsworth, Hampshire. The property blends suitably in style with the surrounding properties and has been tastefully converted to provide a suitable home for six younger adults with learning disabilities. There is a large lawn area to the front of the property, surrounded by fencing to ensure privacy and a smaller rear garden. Adequate car parking is provided to the front of the property. Bedrooms have been installed with en-suite facilities and these are tastefully decorated and furnished with service users being encouraged to personalise their room to reflect their interests. There is a spacious, family feeling throughout the home. The fees charged are £900-£934 according to support required. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 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 the people who use this service experience good quality outcomes. This site visit as part of the inspection process took place on 19/03/08. Prior to the visit all files held by The Commission for Social Care Inspection (We) were examined. We were in receipt of the Annual Quality Assurance Assessment (AQAA), which contained all of the information we asked for. The acting manager, who is in the process of applying to the Commission for registration facilitated the inspection and any documents required on the day were made available. Care plans, Medicine administration charts, some policies, procedures and staff files were inspected. We were in receipt of four surveys from people who use the service, two from relatives and one from a key worker. All comments in the surveys were very positive. During the visit people who use the service were spoken to and their opinions sought. All indicated satisfaction with the care and support offered. “ They are very attentive to all needs” “ I feel he has a very full life here” “Support is constant and consistent” The atmosphere in the home was very homely, relaxed and sociable. People who use this service experience good outcomes because they receive care from a well-trained and motivated staff in safe and comfortable surroundings. What the service does well: People who use the service have a comprehensive assessment prior to admission. Staff interact with people who use the service in a meaningful, appropriate and respectful way. Involvement with the local community and colleges is actively encouraged and supported Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 6 A choice of meals is offered in pleasant surroundings with input in choice and preparation from the people who use the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 The individual aspirations and needs of people who use the service are assessed and all have a contract and terms and conditions People using this service experience good outcomes in this area because needs are fully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of comprehensive assessment prior to admission in the care plans including the care management plan from Social and Caring Services. This included information on accommodation, support, family contact, continence specific condition related needs, behaviour and academic skill. Contracts for people who use the service were seen and these coved all aspects of the agreement such as room to be occupied, fees and personal support and services provided. All people who use the service receive information about the home in the Service User Guide. One relative survey commented that the admission process was very well organised and that their daughter settled in very well. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Residents know their assessed and changing needs and personal goals are reflected in their individual plan, they can make decisions about their lives and can take risks as part of an independent lifestyle. People using this service experience excellent outcomes in this area because they are consulted and can make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were examined and the people who use the service were spoken to. The care plans contained a full and holistic assessment and were person centered. People who use the service spoken to stated that they make decisions about their lifestyle and are supported in daily lifestyle choices. These decisions were seen recorded in their care plans, as were wants, aspirations, future goals and plans to achieve these. The individuals are actively encouraged to contribute to and update their care plans and two of the plans inspected showed this. There was evidence of regular review. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 10 Risk assessment is in place and people who use the service are allowed to take risks, Needs are addressed in a person centred way, those able to take care of personal needs are allowed to do so. Risks associated with needs or behaviours are clearly documented, as are management strategies. Equality and diversity issues are identified and addressed. People who use the service are free to use public transport following risk assessment. The AQAA states that people who use the service are regularly consulted on life in the home via meetings. Friends and relatives are surveyed every three months and it also states that staff respect privacy of people who use the service and that they are encouragied to carry a key to their bedrooms, open their own mail or see medical professional in private if requested. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16,17 People who use the service are able to take part in age, peer and culturally appropriate activities and are part of the community. They engage in appropriate leisure activities and have appropriate personal, family and sexual relationships. The rights of people who use the service are respected and responsibilities recognised in their daily lives. People using this service experience good outcomes in this area because they can participate and contribute to the local community. This judgement has been made using available evidence including a visit to this service. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 12 EVIDENCE: Areas of development and interest are identified in care plans and people who use the service are encouraged to achieve this. They are actively encouraged to go out into the community. One person who uses the service said she enjoyed out for coffee and cake and today was going to the optician for new glasses. The acting manager is seeking to recruit and activities coordinator for the evenings so that people who use the service can be supported to go out to evening activities such as trips to the pub. The communal areas of the home are bright and comfortable and people who use the service were observed coming in after college and other activities and relaxing into a homely routine. There was evidence of hobbies in bedrooms such as music. The kitchen is domestic in style. There is a varied menu in place and people who use the service are consulted on this by having a weekly meeting and deciding on a cooking rota. Mealtimes are relaxed and flexible and one person who uses the service was seen to have a late lunch as she had been sleeping late, others were observed participating in the cooking of the evening meal. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 13 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): 18-20 Residents receive personal support in the way they prefer and require and residents’ physical and emotional health needs are met. Residents can retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. People using this service experience good outcomes in this area because the resident directs personal support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal support required is noted in the care plans and residents spoken to confirmed they receive support as they wish. Information is available on any specific condition and any healthcare need is clearly deatailed in care plans.There was evidence in the plans of improvement in behaviour since admission to the home. Staff spoken to stated that the home is run in the interests of the residents and is very friendly. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 14 Medicines are appropriately received, administered and recorded. Medicine administration charts inspected were up to date. Controlled drugs were appropriately stored and recorded. People who use the service are actively encouraged to manage their own medication. There are two people who use the service who self medicate at present; both of these have lockable spaces in their rooms. Risk assessment was evident in care plans to ensure this could be undertaken safely. The home is supported in the management of medicines by a local pharmacy. Medicines are administered according to the policies and procedures which are readily available to staff. There is a weekly medication audit by senior support staff and a monthly audit by the acting manager to further ensure the health and safety of people who use the service. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 15 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): 22,23 Residents feel their views are listened to and acted on. Residents are protected from abuse, neglect and self-harm. People using this service experience good outcomes in this area because they are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The views of people who use the service are sought on a day-to-day basis and in meetings. There is a complaints procedure in place and all people who use the service receive a copy. The people who use the service and the relatives and key worker surveyed commented that they would be able to complain and that complaints and concerns would be addressed. Any comments or complaints made to the home are recorded. There are policies and procedures in place for safeguarding adults and staff training is up to date. Staff receive safeguarding adults training in induction. There is also a whistle blowing policy. Staff are aware on how to report concerns or allegations. Staff files had evidence of training and supervision. Physical intervention is not used at the home and the financial affairs of people who use the service are monitored with stringent recording procedures which prevent finanacial abuse. These procedures are now in place in response to a previous allegation. Staff do not have access to the personal identification numbers of people who usethe service. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 16 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): 24, 30 Residents live in a homely, comfortable and safe environment. The home is mostly clean and hygienic. People using this service experience good outcomes in this area because they live in a homely, comfortable, safe and well maintained environment but there are some shortfall in the provision of clean communal furnishings. This judgement has been made using available evidence including a visit to this service EVIDENCE: People who use the service live in a comfortable and homely environment. All bedrooms are ensuite and are personalised. One bedroom downstairs did not have any floor covering in the ensuite toilet. The acting manager stated that this is work in progress. The home was generally neat, clean and free from offensive odours, there is a comfortable sitting room and dining room domestic in nature. The seating in the sitting room consists of leather sofas with deep button detail. The deep Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 17 depressions made by the buttons make them unsuitable for use in this situation, as they are difficult to clean. Many depressions had food trapped and some buttons were missing. There is further fabric seating which is looking grubby. Fabric must be treated so as to be easily cleanable so as not to prevent a risk of infection to people who use the service. There are suitable kitchen and laundry facilities. There is a small area of kitchen counter edging missing. This needs to be replaced to prevent the spread of infection. People who use the service expressed satisfaction with their surroundings and facilities. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 18 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): 32,34,35,36 People who use the service are supported by competent and qualified staff and are protected by the homes recruitment policy, practices. Staff supervision and training is up to date. People using this service experience good outcomes because they are supported by an effective staff team. This judgement has been made using available evidence including a visit to this service EVIDENCE: The staff team were motivated and supported the people who use the service in an encouraging manner. The staff communicated with service users as equals. Staff are well informed about individuals needs and are committed to achieving the best outcomes for people who use the service. There is a mandatory trainiing programme in place and all staff receive induction. National Vocational Qualification level 2 and 3 is undertaken and also condition specific training such as that on epilepsy and the autistic spectrum. There is a robust recruitment procedure in place. Staff files inspected contained a Criminal Records Bureau Clearance and POVA check, two Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 19 references, application form with employment history. People who use the service meet candidates at interview and their views are sought as to the suitability of a candidate. All staff receive a job description and full terms and conditions and monthly supervision is in place. All staff receive a copy of the General Social Care handbook and are expected to adhere to the principles contained within it. People who use the service spoken to and comment cards expressed satisfaction with the approach of staff to the care and support required. One relative commented “ We are happy with the care, help and assistance give,”. Another commented “Staff appear well trainedv and have very good interpersonal skills.” Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. People who use the service benefit from a well run home and are confident their views underpin all self-monitoring, review and development by the home. Health safety and welfare are protected and people who use the service benefit from competent and accountable management. People using this service experience good outcomes because the home is run in their best interest. This judgement has been made using available evidence including a visit to this service. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 21 EVIDENCE: There is not a Registered Manager at present and the acting manager is applying to the Commission for registration. He has completed an National Vocational Qualification Level 4 and the Registered Manager Award is near completion. He facilititated the inspection and had up to date policies, procedures and documents as required. Annual surveys sent to seek the relatives to seek their views on the quality of the service provideed. This self-monitoring allows the management to identify where procdures can be adapted to meet the changing needs of people who use the service. Results of this process were seen and comments were positive, scored good and excellent in all areas “ Very friendly and helpful at all times”, Health and safety matters are addressed as they arise and regular checks made to ensure the health and safety of all service users and staff. The organisation is made aware of shortfalls in maintenance in the fabris and furnishings of the building. Staff are trained in COSHH, Health and Safety, Fire, Food Hygiene, Moving and Handling, and First Aid. This is monitored by the manager. The home is maintained and areas which relate to electrical safety, boiler maintenanace, equipment servicing are documented. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 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 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 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 4 X X X 3 X X 3 X Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations Sitting room furniture to be of a type easily cleanable to prevent the spread of infection. Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 24 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 Myrtle Cottage DS0000058347.V359605.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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