Care Home: Newlands Cottages (10)

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What the care home does well People are provided with good social and recreational care and support in an informal homely environment. Support is often given on a one to one basis, offering individuals quality time with their key staff. People are very involved with the day-to-day running of the home and have been fully involved in the planning of their lifestyle. The home helps people build upon and develop their independence as far as possible. When a person`s needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to people`s care and support plans. Individuals lead fulfilling lives, both in their home and through being active members of their local community. The home is commended for exceeding some standards, specifically in relation to lifestyle. People are offered many social activities in a variety of ways that are based upon their needs and choices. We received some positive feedback on what the home does well. One person commented "Cheer me up when I`m down". "Treating clients individually" and "encourages clients to be independent where possible and to make their own choices" said a staff. Comments from relatives included; " Tries always to meet ..... needs, I can`t fault that." "The home is very good indeed in coping with and helping resolve difficult attitudes and behaviours." "I` m very grateful to have ...... safe and well and most of all making such a difference to my son`s life." The manager is knowledgeable, experienced and provides good support and leadership. On the whole, people benefit from a stable staff team who have worked in the home for a number of years. Staff clearly understand each person`s individual needs and know how to support them. Their practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The house is comfortably furnished and decorated in a way that reflects the individuality of the people who live there. What has improved since the last inspection? Most areas that needed attention from the last inspection have been addressed. Medication practices have improved. Guidelines for the use of `as required` medication had been put in place to ensure that staff are clear about when and how to administer this type of medication. Procedure now requires that a second member of staff witness medication administration, which further ensures safe practice. Outcome and actions taken on complaints are now recorded more clearly. An electrical safety check on the premises has been completed and the manager has consulted the Environmental Health Department who advised that the home does not require an inspection until 2010. People living in the home now have the option to use the downstairs toilet meaning that their rights are more fully respected and the former restrictive practice of only staff using it has stopped. A more suitable lock has also been fitted to the toilet door. Some essential repairs to the front driveway have been completed; suitable lighting has been installed and the uneven potholes filled in with gravel. The home now has an up to date policies and procedures manual meaning that both current and new staff have access to relevant information and legislation applicable to their work. Some staff training has taken place on safeguarding vulnerable adults, first aid, infection control and crisis prevention. This means that the staff team continue to develop and refresh their skills and knowledge to meet people`s individual needs. What the care home could do better: There are areas where the home needs to improve that mainly relate to the owning organisation and not the way the home is run by the manager. The registered provider could do more to make sure that requirements from our inspections are being addressed and met. The following issues remain outstanding from the last two inspections. Firstly, improvements are still needed so that people have full and accurate information about how much they will pay and what the home provides for the money. The provider`s arrangements for charging people additional costs must be fully reflected in their terms and conditions. We have extended this requirement for a final timeand may consider taking enforcement action if there is another failure to comply. In addition, contracts between the person and their placing local authority must be made available to them in the home. Secondly, the home`s on call procedure needs amendment so that staff have clear guidance on who to contact in the event of a night time emergency and how to summon assistance from a second member of staff when needed. This will further safeguard the welfare of people living and working in the home. Feedback told us that staff experience frustration in getting some maintenance issues dealt with in a timely manner. Previous inspections have also told us that the provider deals with maintenance issues in a reactive rather than a proactive manner. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. Monthly reports concerning the conduct of the home need to be completed. This will show how the organisation monitors the home`s operation and acts upon areas for improvement. As they had not been happening at the required frequency, copies of the monthly regulation 26 visit reports must be sent to the Commission until further notice. The home`s Service Users Guide needs updating so that current and prospective people have full information about the home and the services they can expect to receive. Consensus provides the majority of staff training and certificates for all staff must be kept in the home. This will further demonstrate that staff are suitably trained to meet people`s needs. The registered provider must send a copy of the home`s annual quality assurance plan to the Commission. Based upon the home`s quality management systems and findings, it needs to show what action has been taken to improve the quality and delivery of services for people. Good practice areas for the service to consider are outlined as follows. That refresher training on person centred planning and autism is arranged for both regular and agency staff. This will ensure that they are up to date with current developments and ways of working with people who have specific needs. A relative, carer or advocate commented "I just feel sometimes, some of the staff does not have the training in autism." The food budget for the home has remained the same for five years. Consensus should therefore consider an increase that reflects general inflation costs and the changed dietary needs for some people living in the home. CARE HOME ADULTS 18-65 Newlands Cottages (10) 10 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS Lead Inspector Claire Taylor Key Unannounced Inspection 29th & 30th January 2008 10:15a Newlands Cottages (10) DS0000025818.V357689.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 Newlands Cottages (10) DS0000025818.V357689.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. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Cottages (10) Address 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) 10 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS 01883 349 507 01883 349 507 newlands.cottages@btinternet.com THF Care Estates Limited Dana Thompson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th March 2007 Brief Description of the Service: 10 Newlands Cottage is registered with the CSCI to provide personal support and accommodation for up to three younger adults with moderate learning disabilities. It is one of a number of homes operated by Consensus. Dana Thompson continues to be the registered manager of the home where she has been in operational day-to-day control for over four years. This older style semi-detached cottage is situated on a small rural housing estate in between Coulsdon and Caterham. The home is within easy walking distance of a local parade of shops and a popular country pub. The home is also on a main line bus route, which has good links to Caterham and Croydon. Built over twostories the cottage comprises of three single occupancy bedrooms, two relatively small but comfortable lounges, a large open plan kitchen and dining area, ground floor office, two WC’s and a bathroom. The laundry facilities are located in the garage and are shared with the neighbouring cottage; also owned by Consensus. Both the front and rear gardens are relatively well maintained. Fees range from £1,200 to £1,500 per week and were correct at the time of this inspection. Newlands Cottages (10) DS0000025818.V357689.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. The home is managed in conjunction with no.8 Newlands cottages for which a separate report is available. There are therefore similarities in this inspection report as there are for the adjoining cottage. The documentation is almost the same, as both homes are run together on the same site and share the same manager and staff group. Additionally, the two cottages have the same registration category and are owned by the same organisation, Consensus. All registered services are required to complete an annual quality assurance assessment (AQAA). This is a self-assessment that the provider must complete once a year to show how well they are meeting outcomes for the people using their service. The completed AQAA provided us with good information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. Prior to this visit, the home also had an additional random inspection on 3rd August 2007 and again, some of the findings are included. Care records for two people were looked at. A selection of other records that the home must keep was seen, and there was a look round the building. Two people living in the home were met during the course of the visit. The manager assisted with the inspection and discussions also took place with some of the staff. The three people who live in the home, three staff and two relatives also gave their views about Newlands through written comment cards. We would like to thank all those for their time and contribution to this inspection. What the service does well: People are provided with good social and recreational care and support in an informal homely environment. Support is often given on a one to one basis, offering individuals quality time with their key staff. People are very involved with the day-to-day running of the home and have been fully involved in the planning of their lifestyle. The home helps people build upon and develop their independence as far as possible. When a person’s needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to people’s care and support plans. Individuals lead fulfilling lives, both in their home and through being active members of their local community. The home is commended for exceeding some standards, specifically in relation to lifestyle. People are offered many social activities in a variety of ways that are based upon their needs and choices. We received some positive feedback on what the home does well. One person commented “Cheer me up when I’m down”. “Treating clients individually” and “encourages clients to be independent where possible and to make their own Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 6 choices” said a staff. Comments from relatives included; “ Tries always to meet ..… needs, I can’t fault that.” “The home is very good indeed in coping with and helping resolve difficult attitudes and behaviours.” “I’ m very grateful to have …… safe and well and most of all making such a difference to my son’s life.” The manager is knowledgeable, experienced and provides good support and leadership. On the whole, people benefit from a stable staff team who have worked in the home for a number of years. Staff clearly understand each person’s individual needs and know how to support them. Their practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The house is comfortably furnished and decorated in a way that reflects the individuality of the people who live there. What has improved since the last inspection? What they could do better: There are areas where the home needs to improve that mainly relate to the owning organisation and not the way the home is run by the manager. The registered provider could do more to make sure that requirements from our inspections are being addressed and met. The following issues remain outstanding from the last two inspections. Firstly, improvements are still needed so that people have full and accurate information about how much they will pay and what the home provides for the money. The provider’s arrangements for charging people additional costs must be fully reflected in their terms and conditions. We have extended this requirement for a final time Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 7 and may consider taking enforcement action if there is another failure to comply. In addition, contracts between the person and their placing local authority must be made available to them in the home. Secondly, the home’s on call procedure needs amendment so that staff have clear guidance on who to contact in the event of a night time emergency and how to summon assistance from a second member of staff when needed. This will further safeguard the welfare of people living and working in the home. Feedback told us that staff experience frustration in getting some maintenance issues dealt with in a timely manner. Previous inspections have also told us that the provider deals with maintenance issues in a reactive rather than a proactive manner. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. Monthly reports concerning the conduct of the home need to be completed. This will show how the organisation monitors the home’s operation and acts upon areas for improvement. As they had not been happening at the required frequency, copies of the monthly regulation 26 visit reports must be sent to the Commission until further notice. The home’s Service Users Guide needs updating so that current and prospective people have full information about the home and the services they can expect to receive. Consensus provides the majority of staff training and certificates for all staff must be kept in the home. This will further demonstrate that staff are suitably trained to meet people’s needs. The registered provider must send a copy of the home’s annual quality assurance plan to the Commission. Based upon the home’s quality management systems and findings, it needs to show what action has been taken to improve the quality and delivery of services for people. Good practice areas for the service to consider are outlined as follows. That refresher training on person centred planning and autism is arranged for both regular and agency staff. This will ensure that they are up to date with current developments and ways of working with people who have specific needs. A relative, carer or advocate commented “I just feel sometimes, some of the staff does not have the training in autism.” The food budget for the home has remained the same for five years. Consensus should therefore consider an increase that reflects general inflation costs and the changed dietary needs for some people living in the home. 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. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 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 Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate We have made this judgement using a range of evidence, including a visit to this service. Information about the service must be readily available so that people and those close to them can decide whether the care home can meet their support and accommodation needs. Good arrangements are in place for assessing people’s needs so that staff know how to support them. Contracts still need improving so that people have full, accurate information on how much they will pay and what the home provides for the money. EVIDENCE: The same three people have lived at the home for a number of years and there have been no new admissions. The owning organisation, Consensus has clear policies and procedures in place regarding admission; they also ensure that any new person would be central to the process when moving to the home. Detailed needs assessments were available for the three individuals and had been updated each year. This means that staff have accurate information to support people’s needs. We looked at care records for two people and they did not have a copy of the home’s Service Users Guide. The guide needs improving so that it contains all the relevant information about the home and reflects the changed ownership. There remains an ongoing issue with the home’s individual contracts and terms and conditions. People who use the service are expected to make additional payments for some services and individuals must be given accurate Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 10 information about such extras. Contracts sampled at both this inspection and the random visit on 3rd August 2007 had not been reviewed or amended to include the necessary information. In addition copies of contracts between each person and their placing authority were still being held at the owning organisation’s head office. These must be made available to people in the home as they outline the full terms of occupancy including other arrangements for holiday costs for two individuals. As well as their own fares, people using the service pay the full cost of expenses incurred by staff who accompany them on community based social, leisure or recreational activities. For example, admission fees, meals out, and travel cards are all considered ‘additional costs’ that are not covered by the basic price of each person’s placement. With the exception of travelling to the farm, people also contribute towards fuel expenses for the home’s own vehicle when going out socially. Although ‘petrol rate’ costs are included in the contract, the provider’s arrangements for charging people for other ‘extras’ is still not reflected in their terms and conditions. In addition the contract needs amending for accuracy as it makes reference to the former ‘National Care Standards Commission 2000’. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People who use the service have individual plans of care that clearly show how they are supported to achieve their personal goals. People are consulted and given opportunities to influence how the home is run. People are supported to take risks that promote their independence as well as their safety as far as possible. EVIDENCE: We looked in detail at two people’s care and support plans. Staff work closely with each individual, their family and significant others, to ensure their preferences are responded to appropriately and the people important to them are involved with the planning of care. Staff use a variety of ways to help individuals make a worthwhile contribution. Support is often given on a one to one basis, offering people quality time with their key worker staff. Reviews are carried out monthly by keyworkers to evaluate whether goals and objectives are being met for each person. Records seen focus on asking what has worked for the individual, where there is progress, achievements, concerns and Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 12 identifies action points. The manager explained that person centred plans were due to be developed with each individual. We saw an example of a blank format that the home plans to use. As staff attended training with Croydon Council on person centred planning some years ago, it would be good practice if refresher training were arranged. Daily care records and discussion showed that staff support service users to make decisions about their lives as far as possible. Through regular house meetings, relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We sampled some records of meetings. Recent discussions centred on people’s choices for outings, house security and plans for a birthday celebration. Risk plans are reviewed by staff regularly and show that action is taken to lessen risk; the process is managed positively to help people to lead the life they want. Individual assessments covered the full range of assessed risks and matched the needs of each person. Examples included using public transport, taking medication and managing money. Detailed management strategies and interventions are in place for individuals who may behave in a way that puts themselves or others at risk of being harmed. These had been updated as changes occur. For example, staff were closely monitoring one person’s behaviour patterns due to a recent change in their emotional needs. Records showed that any limitations on freedom, choice or facilities are always in the person’s best interests and that the individual understands and signs in agreement of any limitations. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People lead their chosen lifestyle and have the opportunity to make the most of their abilities. Planned around their needs and preferences, people benefit from a choice of recreational activities which ensures a fulfilling lifestyle both within the home and local community. Relationships with family and friends are well supported and daily routines ensure that people’s individual rights’ and responsibilities are respected. People have healthy, well-presented meals and snacks, at a time and place to suit them. EVIDENCE: We looked at records related to lifestyle for two people. The home places a strong emphasis on community presence in a way that is directed by the person using the service. The service is committed to ensuring that people are enabled to make choices and are able to live fulfilling and active lives. People’s preferences with regard to daily routine and how they spend their leisure time Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 14 is respected. Care plans had good information about what activities each person likes to take part in and how staff should support them. People are supported to follow their chosen interests and hobbies. For example, one person has a keen interest in golf and Crystal Palace football club. Daily records showed that they regularly play golf and go to football matches. People are assisted to plan their social diary every week and each month, this includes their personal choice for a social event. Recent events had included trips to Dickens World, Thorpe Park, music concerts and festivals, Chislehurst Caves and a football competition. In addition, holidays are planned well and arranged according to each individual’s preference. A creative holiday planner was seen for one person that included a variety of pictures to supplement the written text. It covered areas such as whether the person wanted to go alone or with someone; the type of holiday they preferred and how long they would like to go for. This enabled staff to support the person to make the right choice of holiday. One individual spoke about their recent holiday to Disneyland and that the best part was “swimming with the dolphins”. Other holidays have included a skiing trip for two people and a weekend camping. People who live in the home are able to access Tandridge Hill Farm during their weekdays. This farm is owned by Consensus and provides opportunities for individuals to develop their educational, vocational, and practical life skills through animal care, gardening, horticulture, and art and crafts. One person commented however “ I cannot always go to the farm when I want to because there are not enough staff that can drive to take me, or pick me up.” Records for this person showed that they were not going to the farm as often as they used to. Discussion with the manager confirmed that there was a lack of drivers and that the home was in the process of recruiting new staff to address this inequality. People are supported to be independent and involved in all areas of daily living in the home. During this visit, people were supported to shop locally for their chosen food items and one person went into Croydon for a haircut. Records showed that individuals take responsibility for shopping, planning meals, and meal preparation. People plan their own weekly menu chart and can eat their meals at flexible times that fit in with their routines and social lives. The completed AQAA told us “We also have one SU who has recently chosen to become vegetarian and we support this individual to choose a balance diet and follow his wish to be vegetarian.” However, feedback from staff highlighted that there was not always enough money to buy sufficient fruit and vegetables. The registered provider should therefore consider a review of the home’s food budget, as it has remained the same amount for over five years. A suitable increase should reflect people’s changed dietary preferences and general inflation costs. Care records include details about each person’s social network and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. Written feedback from relatives told us that the home always keeps them up to date with important issues. “We have been told of all significant developments” Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 15 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, 19 and 20 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. The home’s medication practices are well organised to ensure safety and consistent treatment and support for each person. EVIDENCE: People are supported and helped to be independent and can take responsibility for their personal care needs. Care records and discussion showed that staff listen and take account of what is important to each person. Survey responses from all three people confirmed that staff always treated them well. We saw that good information about healthcare needs is available in people’s individual care plans. People are supported to access routine health appointments and any other checks that they may need. This includes regular contact with GPs, Consultants and other health care professionals as necessary. E.g. chiropody, psychologist, optician and dentist. Records are completed for any medical appointments that individuals attend and include details of any required follow up action. This shows that the staff team monitors healthcare needs closely Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 16 and takes action to address any changes. The completed AQAA identified plans for improvements in the next 12 months as, “For all Sus (service users) to have Individual Health Plans that are shared with all health care professionals” Records showed that staff are trained to administer medication. Medication was stored correctly with up to date records kept for its receipt and disposal. Previous concerns around medication practices have been addressed. Sampled administration charts were signed and accounted for. The organisations procedure requires that a second member of staff witness medication administration, which further ensures safe practice. Guidelines for the use of ‘as required’ medication had been put in place to ensure that staff are clear about when and how to administer this type of medication. An appropriate healthcare professional carries out regular reviews to ensure that individuals receive the correct medication regime or treatment where necessary. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. Arrangements for complaints and protection from abuse are well managed and ensure that people who use the service feel listened to and safe. EVIDENCE: People spoken to knew who to talk to if they were unhappy. Written feedback from two relatives also confirmed that they knew how to raise a complaint. Individuals are provided with regular opportunities to voice their views or concerns. This is achieved through group meetings every two months and organised contact with their keyworkers. The service has a complaints procedure that is clearly written and easy to understand. Each person had been given a summary of the complaints procedure which they had signed receipt for. Since the last inspection there have been no complaints about this service. Outcome and actions taken on previous concerns had been recorded in the complaints book. Records confirmed that staff are properly inducted on abuse awareness and the home’ policies and procedures regarding the protection of vulnerable adults. The home has a copy of the local authority’s safeguarding adults procedures. We saw a training plan which showed that the manager and staff majority received training on safeguarding vulnerable adults in December 2007. Plans were in place for the remaining staff members to attend. The manager explained that she was awaiting training certificates from Consensus. Other training around dealing with physical and verbal aggression has also been arranged for staff as needed. Discussions with staff confirmed that they were aware of their responsibilities to respond in the event of an alert. Since Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 18 the last inspection, an incident was reported to the Commission for Social Care Inspection under the remit of safeguarding vulnerable adults. The home acted promptly to report the incident to the relevant external agencies and followed the correct procedures. Records showed that the outcomes from the referral meeting were managed well by the home. i.e. necessary changes were made and actioned concerning the person’s care and support plans. At the time of this inspection, a follow up meeting was due to be held to conclude the investigation. Any findings will be included in the next inspection report. Most people living in the home need support with their finances. We saw that accurate records are kept of all financial transactions and daily checks are made at each shift handover to ensure that these are correct. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 19 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, 27 and 30 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. The house provides comfortable and homely surroundings for people to live. Some improvements around the home have meant that people live in a safer environment. The home is clean and hygienic. EVIDENCE: Since the last key inspection, the following areas that needed attention have now been dealt with. At the additional visit in August 2007, we saw that some of the concerns had been addressed. I.e. There was an up to date electrical safety check for the premises and the manager had consulted the Environmental Health Department who advised that the home does not require an inspection until 2010. The downstairs toilet had been predominantly designated for staff use. Records showed that this issue was discussed at a meeting on 7th May 2007 and all people living in the home wanted the option of using the downstairs toilet. One person also confirmed that they were now able to freely use this facility. A more suitable lock had also been fitted to the toilet door so that it can be overridden in the event of an emergency. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 20 During the additional visit in August 2007, we found that the front driveway remained unsafe and the required work had not been completed. The home’s accident records showed that two staff members had tripped due to the driveway’s uneven surfaces. One person living in the home commented that the pathway leading up to the drive was unlit at night. In addition rainfall collecting in the large potholes had resulted in the driveway becoming flooded on more than one occasion. We therefore issued an immediate requirement as the unsafe driveway may have put people who live and work in the home at risk of injury as well as other visitors. The organisation then complied within the given timescale. Suitable lighting was installed and the potholes filled in with gravel. Staff and people spoken to reported that the drive continues to flood after heavy rainfall. The manager also identified in the AQAA, “The flooded car park/drive needs to be sorted and sufficient drainage system implemented.” We therefore anticipate that the registered provider will take further steps to resolve the drainage problems. People choose how they want their home to look and are very involved with arranging the décor in the home. There are many “homely” touches around including photographs of social events such as holidays and special occasions. The furniture and fittings are of a good standard and people have the benefit of two comfortable lounge areas. There is a varied choice of indoor entertainment for people to use including widescreen TV, DVD player, computer games console and various board games /art and craft activities. Bedrooms were not viewed on this occasion but people spoken to said they were happy with their rooms. The home was clean and tidy with good hygiene practices in place. One person wrote “ Arrive home every day to a clean home.” A maintenance book is completed to identify any areas within the premises that need attention and Consensus has now employed a handyman to carry out essential repairs. Despite this, both the manager and staff expressed some frustration in waiting for work to be completed. For what the home could do better, staff feedback told us “ The head office carrying out maintenance when requested as normally we have to wait a while.” The AQAA also identified a barrier to improvement as, “Constant struggle with getting maintenance issues agreed.” Previous inspections have also told us that the owner’s deal with some maintenance issues in a reactive rather than a proactive manner. The manager advised that the home does not have a planned maintenance and redecoration programme. This must now be put in place so that people can be further assured that the organisation keeps the home in a good state of repair and makes any necessary improvements to the upkeep of the building. The AQAA identified some planned home improvements over the next 12 months. “Redecorate and purchase new furniture for some of the SU (service users) and the lounge area.” “Carpet in one of the bedrooms to be changed” Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 21 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, 33, 34 and 35 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. Overall people are supported by a stable staff team who have a range of skills and experience to meet their needs. Although there is an effective staff team, organisational procedures need improvement to further safeguard people’s welfare in the event of an emergency. Good recruitment practices are in place to ensure that people are cared for and protected. Some improvements with staff training have meant that people’s needs are more fully met by an appropriately trained team. Record keeping needs to improve however as a further safeguard. EVIDENCE: The manager and majority of the staff team have worked in the home for many years. This enables consistency and familiarity for the people who live there. Feedback from people spoken to showed that they have confidence in their key staff who support them. We looked at staff rotas which on the whole, show that the home is staffed efficiently. There are always between one and three staff each day and staff allocation is planned around people’s routines, lifestyles and assessed needs. Staff spoken to demonstrated a thorough understanding of the particular needs of individuals and how to support them. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 22 We looked at records and had discussions with staff concerning the home’s on call arrangements at night. Some improvements are still needed to further safeguard the welfare of people living and working in the home. At the random inspection in August 2007, the manager reported that there had been no change to the home’s on call system at night with only one senior manager/ company director on call since April. The registered provider wrote to the Commission and advised us that in the absence of the senior on call person, staff must notify a manager from one of the organisation’s other homes. During this visit, we looked at the home’s on call procedure that was issued by Consensus. Written as an organisational policy, it was not specific to this home however and did not include details of these arrangements. The procedure must therefore be revised so that staff have clear guidance on who to contact in the event of a night time emergency and how to summon assistance from a second member of staff when needed. We saw detailed records of staff meetings which are held every 1-2 months. Staff therefore have regular opportunities to share their views, develop teamwork and improve upon outcomes for the people who live there. There are good recruitment procedures which ensure that staff are vetted correctly before they begin work. This means that people using the service are protected from unsuitable workers. We looked at two staff files which contained all the required checks and recruitment documentation. Discussions with staff and written comment cards confirmed that appropriate pre-employment checks were undertaken. Both staff and relatives commented that the home could improve if there were more staff. There were three staff vacancies at the time of this visit and the manager was in the process of recruitment. Rotas showed that regular and familiar agency staff were being used to cover the vacancies. We saw an organisational training programme that provides a variety of courses for staff to update their skills and knowledge along with recognition of mandatory training that they must attend. The AQAA identified that “Four members of staff are currently undertaking level 2 and 3 NVQ in Care awards and two have completed level 2 in Care award.” In addition, “The deputy manager is currently completing her NVQ level 3 in care.” As previously required, training in first aid, safeguarding vulnerable adults and infection control was completed during 2007. Staff had also updated their training in “crisis prevention” to enable them to support people who may show anxiety or behaviours that can challenge the service. Training certificates for one staff were not available and the manager advised that the organisation had yet to provide copies. Although there was a general record of staff team training, certificates of training need to be kept on staff personal files. Overall, staff gave feedback that they are provided with the necessary training to meet people’s needs. However feedback identified that some improvements were needed. A relative, carer or advocate commented “I just feel sometimes, some of the staff does not have the training in autism.” We saw records that not all staff had received training on autism and this should therefore be arranged. In the AQAA, the manager identified planned improvements “I hope to offer all staff the opportunity to complete LDAF induction training regardless of how long they have worked here so that everyone has the same basic level of Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 23 training and understanding.” LDAF represents Learning Disability Awards Framework which is training that is specific to learning disability services. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 24 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, 41 and 42 Quality in this outcome area is good We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run by a competent and established manager. Although people’s opinions are central to how the home develops and reviews its practice, some improvements are still needed for monitoring the quality and delivery of the services provided. Health and safety practices have improved meaning that people live in a safer environment. EVIDENCE: The manager Dana Thompson has worked in the home for many years and continues to demonstrate good management practice. Staff feedback was positive about the way the home is run and also that they felt well supported. Written feedback included “manager very supportive”. Discussion with the manager showed that both she and the staff team work well to improve the Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 25 services for people living in the home. The manager advised that she was still in the process of completing her Registered Manager’s Award. We saw that there have been some improvements with the home’s quality assurance systems. At the random inspection we saw some satisfaction questionnaires that were completed by people living in the home. They included very positive comments about the staff and the lifestyle that people lead. An annual quality assurance plan was not available however and the manager advised that Consensus had taken the surveys away for analysis. We have required this to be put in place on several occasions. The registered provider must therefore send a copy of the home’s annual development plan to the Commission. This will further show the expected aims and outcomes for improving the services for the people in the home. Records showed that the service was in the process of seeking accreditation with an external quality auditor, namely the Investors in People Award. Records of operational visits showed that they had not been happening at the required frequency. The manager confirmed that the responsible individual visits the home each month but we saw that the last available report was dated 27/04/07. It was therefore not clear how the organisation was monitoring the conduct of the home. Consensus must therefore address this and ensure that the monthly report is completed and made available in the home. In addition, copies of the reports for this service made under regulation 26 must be sent to the Commission on a monthly basis until further notice. As previously required, Consensus have now provided the home with a policies and procedures manual. This will ensure that both current and new staff have access to relevant information and legislation applicable to their work. The completed AQAA stated that all relevant safety checks were up-to-date. We looked at a selection of servicing and maintenance records for the home. As previously required, an electrical safety check on the premises had been completed. Fire drills are organised at regular intervals and fire alarms and equipment checks were up to date. Checks on hot water temperatures are carried out regularly to ensure that they are maintained at a safe limit. Risk assessments covering safe working practices have also been completed to safeguard the welfare of people living in the home, staff and visitors. Accurate records are kept for accident and incidents and the Commission is kept promptly informed of any reportable events. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 X 5 1 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 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 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 3 3 X Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 5(1)(2) Requirement An up to date Service Users Guide must be produced and given to each person. This will ensure that current and prospective people have full information about the home and the services they can expect to receive. A copy must also be sent to the Commission. Timescale for action 30/04/08 2 YA5 5(1)(2) Each service user must be 5(1)(bc) (c) supplied with a contract that includes more detailed 17(2) information about the Sch 4 (8) providers arrangements for charging and paying for so called ‘extra’ services (specifically holidays and community based activities), which are not covered by the basic price of their placement. Repeated. Timescales of 01/07/07 and 31/10/07 not met- Failure to address this on going issue within the new timescale for action, which has been extended for a final time, 31/03/08 Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 28 will result in the Commission considering taking enforcement action to ensure future compliance. 3 YA5 5(3) 17(2) Sch 4 (8) Contracts between the service user and their placing authority must be made available to them in the home so that they have access to full information about the costs of living in the home. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. The homes night time on call arrangements must be reviewed as a matter of urgency and the Commission notified about the outcome. Partially met. Timescale extended with additional requirement. The on call procedure must accurately reflect the arrangements for staff to summon assistance when needed. This will further safeguard the welfare of people living and working in the home. 6 YA35 18(1)(c) 19(5d) Training certificates for all staff must be held in the home to show that they are adequately trained to meet the needs of the people using the service. 30/04/08 31/03/08 4 YA24 23(2)(b) (d) 30/04/08 5 YA33 13(4) & 18(1)(a) 31/03/08 7 YA39 26(5a & b) The responsible individual must 31/03/08 DS0000025818.V357689.R01.S.doc Version 5.2 Page 29 Newlands Cottages (10) ensure that visits are carried out monthly and reports are made available. This is to show how the organisation monitors the conduct of the home and identifies areas for improvement. Copies of the regulation 26 visit reports for this service must be sent to the Commission on a monthly basis until further notice. 8 YA39 24(2)(3)(4) The responsible individual must 30/04/08 send a copy of the home’s annual quality assurance plan to the Commission. Based upon the home’s quality management systems and findings, it needs to show what action has been taken to improve the quality and delivery of services for people. 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 Good Practice Recommendations All staff complete refresher training on person centred planning so that they are familiar with current good practice and developments. That the food budget for the home is increased to reflect the changed dietary needs for some people and general inflation costs. The budget has remained the same for five years. Both regular and agency staff should receive refresher training on Autism so that they are up to date with current ways of working with people who have such specific needs. For the home manager to complete her Registered DS0000025818.V357689.R01.S.doc Version 5.2 Page 30 2 YA17 3 YA35 4 YA37 Newlands Cottages (10) Managers Award by June 2008. Newlands Cottages (10) DS0000025818.V357689.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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