Care Home: Newlands Cottages (8)

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What the care home does well The home provides good support for one person to live as independently as possible. Support is often given on a one to one basis, offering them quality time with their key staff. The person is encouraged to take responsibility for running their home and learn, or further develop their daily living skills in cooking, budgetary and household management. The home is furnished and personalised with their chosen possessions and belongings. When support needs change, the home is good at making sure that the appropriate action is taken. This includes consultation with other relevant healthcare professionals and any changes are acted upon and adjustments to their care and support are put in place. The person has been fully involved in the planning of their lifestyle and the home is commended for exceeding some of these standards, specifically in relation to activities. The person is offered many social activities in a variety of ways that are based upon their needs and preferences. "Treating clients individually" and "encourages clients to be independent where possible and to make their own choices" said a staff. The manager is knowledgeable, experienced and provides good support and leadership. On the whole, the person benefits from a stable staff team who have worked in the home for a number of years. Staff practices promote individual rights and choice, but also consider the person`s protection in supporting them to make informed choices. The person gave positive responses to the questionnaire that we sent out. For what the home does well, a relative said , "There is a low turnover of staff at Newlands that leads to stability, understanding and very good personal care. Clearly the staff enjoy their jobs which produces a happy environment." What has improved since the last inspection? The faulty shower facility has been attended to meaning that the person lives in a safer environment. 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. 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. . 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 time 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. Some redecoration work in the person`s bedroom remains outstanding from our last visit. 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. The lounge carpet needs replacing with more suitable flooring that meets the needs of the person and the layout of the building. This is because main entry to the cottage is through the lounge. A planned maintenance and redecoration programme is therefore needed to show 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. Staff need training in mental health awareness. This will further ensure that they can understand and meet the person`s specific needs. Also, that they refresh their knowledge and skills in this specialist area. 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. 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 the person living in the home. All staff should complete refresher training on person centred planning so that they are familiar with current good practice and developments. CARE HOME ADULTS 18-65 Newlands Cottages (8) 8 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS Lead Inspector Claire Taylor Key Unannounced Inspection 30th January 2008 10:40 Newlands Cottages (8) DS0000025817.V357692.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 (8) DS0000025817.V357692.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 (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Cottages (8) 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) 8 Newlands Cottages Fox Lane Coulsdon Common Coulsdon Surrey CR3 5QS 01883 349 507 01883 349 507 thfcare@newlandscottages.fsnet.co.uk THF Care Estates Limited Dana Thompson Care Home 1 Category(ies) of Learning disability (1) registration, with number of places Newlands Cottages (8) DS0000025817.V357692.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: 8 Newlands Cottage is registered with the CSCI to provide personal support and accommodation for one younger adult with a moderate learning disability. The registered manager, Dana Thompson, continues to be responsible for the day to day running of this home in conjunction with no.10 Newlands cottages. Both the cottages share the same staff team and laundry facilities, which are located in the garage at the rear of the property. This older style semidetached bungalow 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, a popular country pub, and is on a main line bus route, which has good links to Caterham and Croydon. The property comprises of a single occupancy bedroom with its own communal lounge, a small spare room, kitchen, and bathroom/WC. The rear garden has a vegetable patch and herb garden. Fees range from £1,200 to £1,500 per week and were correct at the time of this inspection. Newlands Cottages (8) DS0000025817.V357692.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 stars. This means the people who use this service experience good quality outcomes. The home is managed in conjunction with no.10 Newlands cottages for which a separate report is available and the reader may also wish to refer to this report. 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. There are therefore similarities in this inspection report as there are for the adjoining cottage and some areas where the home could improve also apply to this service. 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. The person who lives in this home completed a questionnaire and also gave their views about Newlands during the visit. One relative also returned a questionnaire. There was a walk around the house and records were checked in relation to care planning, staffing and the way the home is run. The manager assisted with the inspection. What the service does well: The home provides good support for one person to live as independently as possible. Support is often given on a one to one basis, offering them quality time with their key staff. The person is encouraged to take responsibility for running their home and learn, or further develop their daily living skills in cooking, budgetary and household management. The home is furnished and personalised with their chosen possessions and belongings. When support needs change, the home is good at making sure that the appropriate action is taken. This includes consultation with other relevant healthcare professionals and any changes are acted upon and adjustments to their care and support are put in place. The person has been fully involved in the planning of their lifestyle and the home is commended for exceeding some of these standards, specifically in relation to activities. The person is offered many social activities in a variety of ways that are based upon their needs and preferences. “Treating clients individually” and “encourages clients to be independent where possible and to make their own choices” said a staff. The manager is knowledgeable, experienced and provides good support and leadership. On the whole, the person benefits from a stable staff team who have worked in the home for a number of years. Staff practices promote individual rights and choice, but also consider the person’s protection in supporting them to make informed choices. The person gave positive responses to the questionnaire that Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 6 we sent out. For what the home does well, a relative said , “There is a low turnover of staff at Newlands that leads to stability, understanding and very good personal care. Clearly the staff enjoy their jobs which produces a happy environment.” 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 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. Some redecoration work in the person’s bedroom remains outstanding from our last visit. 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. The lounge carpet needs replacing with more suitable flooring that meets the needs of the person and the layout of the building. This is because main entry to the cottage is through the lounge. A planned maintenance and redecoration programme is therefore needed to show 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. Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 7 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. Staff need training in mental health awareness. This will further ensure that they can understand and meet the person’s specific needs. Also, that they refresh their knowledge and skills in this specialist area. 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. 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 the person living in the home. All staff should complete refresher training on person centred planning so that they are familiar with current good practice and developments. 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 (8) DS0000025817.V357692.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 (8) DS0000025817.V357692.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 person has lived at the home for a number of years and the home is currently only registered for one. 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 person and had been updated each year. A specialist assessment known as a “Care Programme Approach” had also been completed in January of this year as the person has some additional mental health needs. This ensures that staff have accurate information to support their full range of needs. We looked at the person’s care records; 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 Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 10 and conditions. People who use the service are expected to make additional payments for some services and individuals must be given accurate 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 (8) DS0000025817.V357692.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. The person has an individual plan of care that clearly show how they are supported to achieve their personal goals. They are consulted and given opportunities to influence how the home is run. The person is supported to take risks that promote their independence as well as their safety, as far as possible. EVIDENCE: We looked at the person’s plan of care which contained lots of up to date information about their support needs and individual life. Personal goals are developed with the individual which focus on how they will develop their skills, as well as outlining their future aspirations. The person spoke about wanting to live with a friend in the cottage one day. They also plan to go on a holiday to Poland and make a visit to Auschwitz. Records reflected this person’s wishes. 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 Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 12 and identifies action points. There had been some changes to this person’s needs and staff had taken action to review the care plan and refer to other professionals where appropriate. The manager advised that person centred plans were due to be developed with each person. 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 the person to make choices about how to live their life. Where there are limitations, the decisions have been made with the agreement of the person or their representative and were accurately recorded. Regular house meetings are held at the next-door cottage and the person is always asked to join in. People are asked about the things that they like, what they want and how they want things to happen. We sampled some records of meetings. Recent discussions centred on the person’s choice 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. A risk assessment tells the staff how to make sure that each person is kept safe from anything that might harm them. Individual assessments covered the full range of assessed risks and matched the needs of the person. Examples included using public transport, smoking and using kitchen equipment. Following a serious incident staff had promptly reviewed the risk plans and support guidelines. Records were detailed and informed staff on how to minimise a potential incident of aggression. Newlands Cottages (8) DS0000025817.V357692.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. The person leads their chosen lifestyle and has the opportunity to make the most of their abilities. Planned around their needs and preferences, they 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 their dignity and rights are respected in their daily life. People who use the service are offered a healthy diet and enjoy their meals at times that suit them. EVIDENCE: We looked at records related to the person’s lifestyle. The service is committed to ensure that people are enabled to make choices and are able to live fulfilling and active lives. Personal preferences with regard to daily routine and how they spend their leisure time is respected. The home keeps a social diary of all activities undertaken which includes going out on a monthly social event that is Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 14 chosen by the individual. Recent events included a visit to Dickens World, Thorpe Park, music concerts and festivals, Chislehurst Caves and a football competition. Individually, the person goes to the cinema, church and a weekly social club. The person said they had enjoyed a holiday to Prague last year. They also spoke about meeting up regularly with a friend who lives in another home owned by Consensus. During the visit, they went out to buy some food provisions for their home. The person is supported to follow their interest for rock and roll music and the 1950’s era. Records confirmed that good efforts were being made to find alternative employment and educational opportunities as the person had chosen to give up working at the farm. Care records include details about the person’s social network and who is important in their life. Staff support the person to visit and to keep contact with those that are close to them. The individual plans their own weekly menu chart and can eat their meals at flexible times that fit in with their routines and social lives. However, feedback from staff highlighted that there was not always enough money to buy the required food items for someone who is diabetic. Records showed that the person’s diabetic condition is controlled by diet. The registered provider should therefore consider a review of the home’s food budget, so that it reflects the person’s changed dietary needs. The budget has remained at the same amount for over five years and a suitable increase should also allow for general inflation costs. Newlands Cottages (8) DS0000025817.V357692.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. The physical and emotional health needs of the person 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: The person lives on their own and staff support them to take on responsibilities for leading an independent lifestyle as far as possible. They are very independent and require little or no assistance with personal care. Any support required was clearly documented within the individual care plan. The plan gave a comprehensive overview of the person’s health and emotional care needs. Records seen showed there had been some significant changes in their mental health needs. We were also told about two serious incidents where the person’s behaviour had challenged the service. The manager and staff were in close consultation with other relevant professionals to address these changed needs. Ongoing review meetings were being held to ensure that agreed outcomes were followed and risks reassessed. There were also emergency support plans for staff to recognise any signs and triggers for deterioration in Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 16 the person’s mental health condition. Staff were given refresher training in “Crisis Prevention Intervention”. Staff confirmed that they found this training beneficial as it taught them techniques and strategies for diffusing a potential aggressive incident. The home keeps a record of all healthcare appointments, outcomes and any follow up action required. Examples seen highlighted that the person had been recently diagnosed with “type 2 Diabetes”; a condition that is controlled by diet. A suitable support plan was in place to meet this person’s changed needs. The dietician had also provided menu guidelines and advice for both the individual and the staff team. This shows that healthcare needs are monitored closely and the home acts promptly 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 the person receives the correct medication regime or treatment where necessary. Newlands Cottages (8) DS0000025817.V357692.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 feel listened to and safe. EVIDENCE: 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. 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. The person needs some 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 (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 18 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, 26, 27 and 30 Quality in this outcome area is adequate We have made this judgement using a range of evidence, including a visit to this service. Overall, the cottage is clean, homely and meets the needs and lifestyle of the person currently living there. Some redecoration is still needed however so that the occupant is provided with more comfortable surroundings. EVIDENCE: The person lives on their own with minimal support from staff. They are thanked for taking the time to show us around their home. As previously required the damp spot and peeling wallpaper in the bedroom areas had not been attended to. We have highlighted the need for the organisation to improve their routine maintenance programme at our last key inspection in March 2007. Previous inspections have also told us that the owners’ deal with some maintenance issues in a reactive rather than a proactive manner. 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 Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 19 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.” A planned maintenance and redecoration programme 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 manager advised that the bathroom shower facility had still not been repaired and that the hot water sometimes exceeded the safe limit of 43 degrees centigrade. The person living in the home confirmed that they preferred a bath and did not use the shower. The manager then arranged for the handyman to disconnect the faulty shower during our visit. We saw that the lounge carpet was stained in places and had several cigarette burns. It is therefore in need of replacement. The manager also highlighted in the AQAA, “Flooring in the lounge needs to be changed from carpet to hard floor as the lounge is also entrance into the house.” Aside from these issues, the communal areas in the cottage are reasonably well furnished and personalised with the individual’s chosen possessions and belongings. They have their own TV, music system and lots of memorabilia form the 1950’s. The person spoke about wanting a friend to come and live in the cottage with him. We advised that the spare bedroom was not currently registered and that it may be too small to suit another person’s needs. The owners would have to make an application to the Commission if they wanted to use a second bedroom. Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 20 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 adequate 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. Although some improvements with staff training have meant that people’s needs are more fully met, further training is needed that is specific to the assessed needs of individuals. Record keeping also needs to improve as a further safeguard. EVIDENCE: The home is managed in conjunction with the neighbouring no 10 Newlands cottages and shares the same manager and staff group. 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 the person showed that they have confidence in their key staff who support them. They confirmed that staff treated them well and respected their point of view. We looked at staff rotas which on the whole, show that the home Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 21 is staffed efficiently. The person benefits from a supported living type environment with one to one support and supervision from staff when needed. Staff spoken to demonstrated a thorough understanding of their particular needs and how to support them. 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. Although there was a general record of staff team training, certificates of training need to be kept on staff personal files. Overall, staff said that they are provided with the necessary training to meet people’s needs. However feedback identified that some improvements were needed. “Newlands has a client with mental health issues and I don’t have the relevant training” Another said “ no mental health training and need it”. All the staff must therefore attend suitable training in mental health awareness. This will further ensure that the person’s specific Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 22 needs are understood and met. Also, that staff can update their knowledge and skills in this specialist area. Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 23 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. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The manager Dana Thompson has managed both cottages 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 (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 24 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 the person living in the home. They included positive comments about the staff and the lifestyle that they 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. 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. A regular check and walk round the premises is carried out monthly to ensure that it remains safe for the person living there, the staff and any visitors. Risk assessments covering safe working practices have also been completed to safeguard their welfare. Accurate records are kept for accident and incidents and the Commission is kept promptly informed of any reportable events. Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 25 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 2 27 X 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 X 3 X Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 26 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 the person living in the home. 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 (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 27 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. 31/03/08 4 YA26 23(d) A time specific rolling 30/04/08 programme to redecorate the cottage interior, including the bedroom and spare room, must be established and a copy forwarded to the commission. Repeated requirement. Timescale of 1/07/07 not met The lounge carpet is in need of replacement with a more suitable flooring that meets the needs of the person and the layout of the building. This is because main entry to the cottage is through the lounge. 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 30/06/08 5 YA24 23(2)(b) 6 YA33 13(4) & 18(1)(a) 31/03/08 Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 28 living and working in the home. 7 YA35 18(1)(c i) 19(5)(b) Staff must receive training on mental health awareness as it is specific to the needs of people living in the home. This will ensure that individual needs are more fully met and that staff have updated their knowledge and skills in this specialist area. 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. 31/05/08 8 YA35 18(1)(c) 19(5d) 30/04/08 9 YA39 26(5a & b) The responsible individual must 31/03/08 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. 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. 10 YA39 24(2)(3)(4) Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 29 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 the person and general inflation costs. The budget has remained the same for five years. For the home manager to complete her Registered Managers Award by June 2008. 2 YA17 3 YA37 Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI Newlands Cottages (8) DS0000025817.V357692.R01.S.doc Version 5.2 Page 31 - 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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