Care Home: The New Bungalow

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What the care home does well Residents are supported by competent staff. The home are committed to good practice, and in developing a service lead by individual residents needs and choices. Residents spoke enthusiastically about the home and their lifestyles. It was clear that residents experience good outcomes and lead valued and fulfilling lives. What has improved since the last inspection? A new manager has been appointed. This has had a positive effect on the service, and plans for improvement are underway. New procedures for administering medication are in place. This has improved practice and ensures residents are safeguarded. CARE HOME ADULTS 18-65 The New Bungalow Forge Hill Aldington Ashford Kent TN25 7DT Lead Inspector Sarah Montgomery Unannounced Inspection 15th July 2008 10:30 The New Bungalow DS0000023568.V363146.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 The New Bungalow DS0000023568.V363146.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. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The New Bungalow Address Forge Hill Aldington Ashford Kent TN25 7DT 01233 721222 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) Canterbury Oast Trust Care Home 6 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Physical disability (PD). The maximum number of service users to be accommodated is 6. Date of last inspection 15th May 2007 Brief Description of the Service: The New Bungalow is registered to provide accommodation, personal care, and support to a maximum of six people with learning disabilities who may also have a physical disability. The premises is in a rural location and is a purpose built, single story bungalow which is approximately 15 minutes walk from the village shop and 10 minutes from the local pub. It is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Susan Trevett. Staffing is provided based on the assessed dependency support requirements of each service user. Two ‘sleep in’ staff provide cover at night. Communal areas have been extended to include a conservatory. All bedrooms are registered for single occupancy. The home provides transport for all service users. There is a wheelchair accessible decked area to the rear of the premises and access to paved woodland walks nearby. Fees currently start from £1167.31 per week with additional costs being met by the service user for hairdressing, toiletries and chiropody. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 5 The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place between the hours of 10.30am – 2.30pm. The manager was present throughout the inspection. Discussions were held with staff and residents. Evidence was gathered through inspection of documents and records, observation of working practice, and discussion with residents and staff. All key standards were inspected. Evidence gathered throughout the inspected evidenced that this home has achieved a rating of ‘good’, and is a two star service. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be confident their needs will be assessed, and that they will be offered opportunities to ‘test drive’ the home prior to making a decision to move there. EVIDENCE: Assessment documentation inspected evidenced the home ensures a robust and full assessment of needs is conducted prior to admission. Prospective residents and their representatives are involved in a thorough process, which ensures that all needs and risks are identified, thus making the decision of whether the placement is suitable an informed one. At present, individual aspirations of prospective residents are not assessed during the pre assessment process. However, further assessment continues once a resident has moved into the home, and this concentrates on individual’s aspirations. It is suggested that the home includes this in the pre assessment to ensure that individual aspirations identified by the prospective resident can be met by the home. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 9 Prospective residents are encouraged and supported to visit and have trial stays at the home. it was clear from inspection of individual records that the home are lead by the resident in this area, and provide gentle support during the trial visits and transition period, ensuring the resident feels comfortable and positive about making the decision to move in. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is adequate. Residents benefit from having their assessed needs recorded in care plans, but would benefit further if care plans and risk assessments contained more detail. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three individual files were inspected. While it is clear that the home have been working on improving care plans and risk assessments, it was evident that further work is needed, and that both care plans and risk assessments lack sufficient detail to be considered effective documents. An example of this is that where it was identified that an individual needed more support with personal care, this further support was not identified or documented. Risk assessments were confusing and did not contain enough information. This can lead to the resident not receiving adequate support, and remaining at unnecessary risk. The home must develop care plans and risk assessments, The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 11 which fully identify the needs and identified risks, with clear support guidelines to enable the staff team to support people effectively. It was noted that current care plans describe the ‘need’ as ‘identifying problem’. This is both a negative use of language, and incorrect. The home was asked to consider this title, and to develop care plans and risk assessments using positive and supportive language regarding supporting residents in meeting their assessed needs. Records inspected and discussions with residents and staff indicated that residents are encouraged and supported to make decisions about their daily lives, and also to plan and make long-term decisions. Throughout the inspection staff were observed communication effectively with residents, asking their opinions and giving options and choices. For residents with communication difficulties the home is developing communication passports and communication boards with a speech and language specialist. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Residents can be confident they will be supported to make positive lifestyle choices and decisions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents have opportunities to participate in activities of their choice. Discussion with the manager and with residents evidenced a varied programme of weekly activities designed around individual needs and aspirations. Activities range from art and craft, swimming, reflexology, music, computer skills and reflexology. Some of these activities take place at the headquarters of Canterbury Oast Trust – Woodland Farm, while others are home based and community based. All residents are supported to maintain relationships with friends and family. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 13 Throughout the inspection staff were observed being sensitive to the needs of the residents, and supporting and enabling residents to be involved in the domestic routines of the home, for example meal preparation, laundry and cleaning their rooms. Residents eat their main meal at lunchtime. The meal prepared on the day of inspection was healthy and nutritious. It was served in a relaxed environment, and residents were given support if they required it. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. Residents can be confident their personal and healthcare support needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with the staff team evidenced they have in depth knowledge of the needs of residents with regard to individual wishes and preferences concerning support with personal care. However, care plans do not currently support this knowledge, and require detail to be recorded with regard to assessed need, personal wishes, and support guidance. All residents have a medical file. This document records all individual’s health care needs, and includes records of healthcare appointments, including outcomes, and any correspondence with healthcare professionals. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 15 Medication storage and procedures were inspected. The home have new administering procedures in place, which are robust and safeguard residents. All medication is stored appropriately. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. Residents are protected from harm by the home’s robust policies and procedures, and can be confident their views are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are supported and encouraged to express their views and wishes in individual discussions with staff and within meetings. For residents with communication difficulties, the home is developing communication passports and communication boards. The staff team are knowledgeable regarding individual residents changing moods and their likes and dislikes. Residents spoken with demonstrated an awareness of who to talk to if they were unhappy or had a problem or complaint. Staff and residents were observed to be communicating well, and it was clear that residents have confidence in the staff that support them. Recruitment procedures are robust, and serve to protect residents. Staff training in safeguarding is good, but the home must ensure that all the staff team receive training in this area. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is adequate. Residents live in a homely and safe environment, but would benefit from some areas of the home being redecorated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Bungalow is spacious and homely. Residents spoken with are proud of their home and particularly their bedrooms. Some shortfalls were noted. The main entrance and hallway is very dark, and the flooring is unsuitable for a home environment. Consideration needs to be given to the use of the conservatory. At present it has a staff sleep in bed in it. This is not acceptable. Bedrooms presented as comfortable, homely and personalised. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is good. Residents benefit from being supported by competent and qualified staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff training matrix demonstrates that the majority of the staff have received, or are booked onto training which is necessary to carry out their roles and responsibilities. Over 50 of the staff have NVQ certification. It was noted that not all staff have received or are due to attend safeguarding training. The manager must ensure that all staff receive this training. Three staff files were inspected. All files contained appropriate information as specified in schedule 2. Files also evidenced a robust recruitment procedures and practices, and demonstrated the home’s commitment to safeguarding residents. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 19 The inspector spoke individually with two members of staff, as well as observing staff practice and competence throughout the day. It was clear through these discussions and observations that staff are knowledgeable and competent within their roles, and support people living at the home effectively. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 and 38. Quality in this outcome area is good. Residents can be confident they live in a well run home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion, observation and inspection of records all indicated strong foundations of a well run home. Lack of a manager at the home for a considerable time has led to shortfalls. The current manager has been in post for four weeks, and is currently applying for registration. Discussion with the manager demonstrated she is aware of The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 21 shortfalls at the home, particularly in the areas of care planning, risk assessment, staff training and environment, and is in the process of addressing this in a timely fashion, in consultation with residents, and with the staff team. The manager has several years management experience in social care, and presented as knowledgeable and competent. The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 3 3 X X X X X The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The New Bungalow DS0000023568.V363146.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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