Inspection on 04/09/08 for Adeyfield Road (39)

This is the latest available inspection report for this service, carried out on 4th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Adeyfield Road (39) 28/09/06

Adeyfield Road (39) 02/11/05

Adeyfield Road (39) 19/04/05

Adeyfield Road (39) 26/08/04

Adeyfield Road (39) 10/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Adeyfield Road (39) 39 Adeyfield Road Hemel Hempstead Hertfordshire HP2 5DP Lead Inspector Unannounced Inspection 4th September 2008 01:20 Adeyfield Road (39) DS0000019260.V371020.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 Adeyfield Road (39) DS0000019260.V371020.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. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adeyfield Road (39) Address 39 Adeyfield Road Hemel Hempstead Hertfordshire HP2 5DP 01442 251840 01442 251840 adeyfieldrd@walsingham.com www.walsingham.com Walsingham 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) Mrs Christine Hewitt Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (5), Physical disability (5) of places Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 5 older people with physical disability (only when associated with a learning disability.) This home may accommodate up to 5 older people (only when service users have had residency at the home prior to that age). 5th September 2007 Date of last inspection Brief Description of the Service: 39 Adeyfield Road is a detached, chalet style bungalow located in a residential area of Hemel Hempstead. It is owned by Walsingham, which is a voluntary organisation. The home provides accommodation and support for six adults who have learning disabilities. All the bedrooms are single, and none have en-suite facilities. The home stands in its own grounds with a parking area, detached office and garden with seating area to the front and a rear garden with a greenhouse, that has views over parkland. Local shops are close by and the home is not far from the Jarman centre, which has leisure facilities, a supermarket complex and a day centre, which the residents attend. The home has the use of its own minibus. The house provides a domestic environment and it is indistinguishable from the neighbouring houses. The Statement of Purpose and Service Users’ Guide provide information about the services provided by the home for prospective residents and social workers. Information on the fees charged was not available on this occasion – please contact the acting manager for up to date information. Adeyfield Road (39) DS0000019260.V371020.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. We (The Commission for Social Care Inspection) spent one afternoon at Adeyfield Road, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We looked around the home and the garden. We met most of the people who live in the home, and we spoke to staff and to a visiting relative. We also received a letter from a relative before this inspection. We looked at some of the records kept in the home and some of the home’s policies. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. We talked to the manager about what we had seen during our visit. The acting manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. The AQAA is a self-assessment document that focuses on outcomes for service users. It also provides us with some statistical information. What the service does well: The AQAA states: “We promote individuality, empowerment and choice. There is a strong management team in place at this time. Senior management are on hand to support and advise if and when needed with constructive and productive outcomes.” There is a supportive and homely environment for the people who live at 39 Adeyfield Road. The ethos of the home is that each person’s views are valued. The information in care plans and observation of the staff and residents confirmed that everyone is encouraged and supported to make their views and wishes known, and to make decisions about their lives in the home. People are involved in a wide variety of activities, both in the home and in the community, and the staff do everything they can to enable these to take place. Some of the people in the home enjoy gardening, and have planted and looked after a variety of vegetables and herbs, including tomatoes and runner beans, which they then use in their meals. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 6 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. Adeyfield Road (39) DS0000019260.V371020.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 Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Prospective residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each person’s care needs. EVIDENCE: Five of the people who live in the home have lived there for more between twelve and seventeen years. One person, X, moved into the home in July 2008, two months before this inspection. They were placed as an emergency, due to a crisis with their family, but they had visited the home earlier in the year. The home had information from the health and social services single assessment, but as X had not received support at home little was known about their support needs and health needs before they moved in. The Walsingham assessment format is thorough, and is written in a person centred way, with questions about their needs addressed to the person concerned. This means that the person’s voice should be heard in the document, even if someone else completes it. On this occasion the assessment was carried out when X visited the home earlier in the year to meet the other people who live there. Because there was insufficient information available about X’s needs at this time, the process of assessment continued after they moved in. The daily records in X’s file show that the staff were getting to know X and recording their needs and Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 9 behaviours. A review took place when X had been in the home for six weeks, and this serves as a full assessment of X’s needs. X’s care plan has not yet been written (see Individual Needs and Choices). However the staff said that they have sufficient information and training to enable them to meet the needs of all the people in the home. There are sufficient staff in the home every day, although many of these are agency staff (see Staffing), and the care plans have appropriate information so that the staff know how to support each person effectively (see Individual Needs and Choices). Adeyfield Road (39) DS0000019260.V371020.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): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are actively involved in their own care planning and are consulted on every aspect of community life in the home so that their needs and expectations are met. EVIDENCE: We looked at the files of two people, which show what care is provided for them and how it is recorded. One of these was for Y, who has lived in the home for many years, and the other for X, who moved into the home two months before this inspection. As described in Choice of Home, X was admitted as an emergency, and the staff have assessed the needs as they have got to know them. The file includes records of these observations and contact with health services for concerns that have come to light. A six-week review was carried out, which provides a full assessment of X’s current needs. No care plan has yet been completed due to this extended period of assessment. This must now be completed without further delay, so that any staff who work in Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 11 the home have appropriate information on how to meet X’s needs in the way that X wishes. Y’s care plan has recently been completed in the Walsingham format, so that all the information on their needs and wishes is easily available. The care plan is written in a person centred format, which shows that Y is involved in making decisions about their care and their life in the home. Entries are written in the first person and describe the Y’s personal preferences, how they make decisions, and the support that they need (see Personal and Healthcare Support). The care plan includes detailed guidelines for understanding Y’s behaviours and how they communicate their wishes. There are clearly written risk assessments for some activities where a decision has been made concerning Y’s safety. The purpose of risk assessments is to ensure that the people who live in the home can take part in the activities that they wish to. The risk assessments that we saw covered all aspects of the Y’s life in the home and in the community. For example, day trips, swimming, the risk of self-harm and the risks of epilepsy while in the community. The risk assessments have been reviewed regularly to ensure that they are still required. The staff who we spoke to said that the care plans provide them with good information on each person’s needs, so that they are able to provide a good quality of care in the way that each person wishes. In the last inspection report we commented, “Although many care plans had been reviewed information has not been dated and therefore it is difficult to establish if this is still relevant. As care plans and risk assessments for residents are stored in separate places, it was also difficult to find current information whilst case tracking residents during the inspection.” It was reported that Y’s care plan is the only one that has been completed in the new format, and therefore the others remain disparate and confused. The Annual Quality Assurance Assessment (AQAA) stated, “As a result of listening to people who use our services our service user meetings are now individual and an activity planner has also been put in place. We will be developing communication cards and menus in pictorial form.” Adeyfield Road has been selected to be involved in the Kings Home project, which involves the people who use the service in saying what they want for their home. The AQAA stated that this project will give them the opportunity to discuss, change and develop all aspects of their care. The deputy manager is responsible for this, and will co-ordinate the input of the people in the home, feed it into the project and feed back the findings. People are involved in decisions and choices about their lives in the home on a daily basis. During the inspection we observed the staff supporting people to choose what they want to do, and what they want to eat for supper, giving them appropriate choices so that they could express their wishes. The staff encouraged and supported people to take part in cooking the meal, and one person took responsibility for putting new hand towels in the towel holders in the kitchen and bathrooms. Adeyfield Road (39) DS0000019260.V371020.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): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported to live full and active lifestyles, and to develop their skills for independence. EVIDENCE: Everyone attends day care during the week. Each person has one day at home where they can relax or go out on a one to one basis with staff. On the day of the inspection two people were at home. One had chosen to have a hair cut in the morning, and to have an “all day breakfast” at a local cafe. Their sister visited them during the afternoon. We spoke to most of the people who live in the home about the things that they like to do. Every Sunday evening they choose what they want to do on their day off from day care, and this is displayed in pictorial format on the activities board in the kitchen, so that they can recognise what they have chosen and look forward to it. During this the activities that people chose for themselves included shopping, a meal out, Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 13 going to the hairdresser, a walk in the woods, going to the pub and swimming. They choose if they would like anyone else to join them in their chosen activities, and as far as possible they also choose which member of staff they would like to support them. This individual approach also extends to their holidays and days out. One person spoke about a trip to Brighton that they have planned for the following week, and said who they are going with and which member of staff they would like to go with them. The staff encouraged and supported people to do what they wanted to do when they returned from day care. Some of the people in the home enjoy gardening, and have planted and looked after a variety of vegetables and herbs, including tomatoes and runner beans, which they then use in their meals. The staff encouraged and supported people to take part in cooking the evening meal, and one person took responsibility for putting new hand towels in the towel holders in the kitchen and bathrooms. We have been contacted by a relative of one of the people in the home, who said, “I am appalled this is still happening, all agency staff on duty and not a permanent member of staff in sight, this means that my adult son/ daughter does not get taken out when they are on duty and I don’t think this is right.” The staff told us that due to the low number of permanent staff who are able to drive the home’s vehicle, people are sometimes not able to do everything that they would like to. This needs to be addressed through the Walsingham recruitment procedures. But the evidence that we saw on this occasion showed that people are involved in a wide variety of activities, both in the home and in the community, and the staff do everything they can to enable these to take place. Everyone is supported to maintain contact with their families. We spoke to one visiting relative during the inspection, who said that she is made very welcome when she visits, and the staff keep her informed about her relative, and include her in the annual reviews of their care. Other relatives have had meals at the home, and joined their relatives on outings. The menus looked varied and nutritious, and they reflect each person’s individual choices. The meals that are cooked in the home are mainly healthy choices, to enable people to maintain a healthy weight. The menu is drawn up each week with the involvement of the people in the home using pictures of meals to help them to choose, and there is a choice of meals each mealtime. We heard the staff asking people what they wanted for supper, giving them a choice of main meal, pasta or potatoes, and choice of vegetables. One person said they would like baked beans and cheese, and the staff discussed this with her, explaining that there was none of these left as the person had chosen to eat them the previous day. The weekly shopping trip was due for the following day. On the previous day one person had asked for fish cake and chips from the chip shop, which they were able to have, and other people sometimes choose a take away Chinese meal. Adeyfield Road (39) DS0000019260.V371020.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): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an experienced team of staff, who have the training and skills to provide a good quality of care for the people who live in the home, and to ensure that individual needs, choices and preferences are met at all times. EVIDENCE: The care plans contain good details of each person’s care needs. They describe the person’s personal preferences for the support that they need. The acting manager has worked with the staff to make sure that they pay more attention to detail regarding the delivery of personal care, so that they treat everyone with the respect due to people living in their own home. The healthcare records that we saw included references to hospital visits, and contact with GPs and other health professionals. The Annual Quality Assurance Assessment (AQAA) stated, “We identify and address any health issues promptly, facilitate access to external health providers, maintain health requirements as discussed. Our evidence to show that we do this well is the low level of health issues of service users.” One person, Z, has been seen at hospital for a health condition, and will need an operation. The acting manager Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 15 was shocked by the attitude of the hospital staff, including the consultant, when Z visited the hospital for their out patient appointment. The staff did not talk directly to Z, and they asked the support worker from the home to hold Z down so that they could be examined. This was very distressing for both Z and the home’s staff who supported them, and the acting manager has made an official complaint to the hospital. Before Z returns to the hospital for the day surgery, the staff will arrange to take them to see where they will be and what will happen so that they are well prepared for the procedures. The care plans show that the staff support people to choose healthy food and to take regular exercise, with work in the garden, swimming and local walks. The weight records that we looked at show that on the whole people maintain a steady weight. It was reported that in some cases the healthy life style that people follow in the home is jeopardised by generous family members at weekends! The staff are working sensitively with some of the relatives to try to improve this for the benefit of the residents’ good health. The people who live in the home are aged between 36 and 62, and their needs are changing as they get older. The acting manager is aware of this, and stated in the AQAA, “What we could do better is to be more aware of health issues that service users may suffer from in the long term and identify areas of possible training” The home has sound systems in place to manage people’s medication safely. We checked a sample of medication records, which were free of errors, with no signature gaps found on the MAR (medication administration record) charts. Two members of staff sign the MAR chart, and the medicines that are not in blister packs are counted each time to make sure that the medicines have been administered properly. There are guidelines for each person for when any PRN (when required) medicines should be given. Adeyfield Road (39) DS0000019260.V371020.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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are encouraged and enabled to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “We carry out procedures as outlined in the policies and access additional information to carry out investigations/complaints. What we could do better is to ensure that there are impartial persons available so that service users are able to discuss their concerns or fears. Due to one to one meetings, service users appear to be more confident in airing their concerns. We have had productive outcomes from actions carried out.” The home has a satisfactory complaints procedure in place that is available to all residents and their relatives. The complaints procedure is in an easy read pictorial format for the people in the home. No complaints have been recorded since the last inspection. In the last year a member of staff was observed to treat one of the people in the home badly, and there was a safeguarding investigation led by the Local Authority. The member of staff concerned has since left the home, and no further action has been taken on the advice of the Local Authority. The acting manager is fully aware of the measures that should be taken to make sure that the people who live in the home are protected from harm, and the correct Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 17 procedures were followed in this case. The investigation identified a need for further training for the staff on the procedures for safeguarding people, and on their responsibilities for whistle blowing, and this is currently in progress. Adeyfield Road (39) DS0000019260.V371020.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the people who live there, and the staff maintain the home to a good standard of cleanliness and hygiene. EVIDENCE: 39 Adeyfield Road is a detached chalet bungalow. The home stands in its own grounds with a parking area, detached office and garden with seating area to the front and a rear garden with a greenhouse, that has views over parkland. The house is furnished and decorated in domestic styles that produce a homely, comfortable environment, which allows the people who live there to relax and feel very much at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. Since the last inspection the stained area of carpet in the hallway has been replaced with carpet tiles, and much of the home has been redecorated. The people who live there were very involved in choosing the decorations and new furniture for Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 19 their home. The person who had recently moved into the home showed us their room, and was very pleased with the newly painted lilac coloured walls. The Annual Quality Assurance Assessment (AQAA) stated, “Service users are involved in maintaining the grounds and their home. In the last 12 months the external area has become a centre of activity and gardening projects. Service users grow herbs, vegetables that are then used for their dinner. What we could do better is to ensure that all areas of the home have easy access, and are utilised for the benefit of the service users. In the next 12 months we plan to ensure that the internal décor of the house is brought up to a better standard.” The home appeared to be clean, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. The home is generally well maintained, but broken toilet seats need to be replaced so that there is no risk that the people who live in the home may slip or fall when using the toilets. Adeyfield Road (39) DS0000019260.V371020.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, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A stable staff team who have the experience and training to understand and meet the needs of the residents supports the people who live in the home. However the high number of agency staff has some effect on the quality of life for the people in the home. EVIDENCE: The home has an experienced and stable staff team, most of whom have worked at the home for several years. However there are only seven permanent staff in the home, and agency staff are employed on every shift. The staff rota shows that there are three support workers in the home throughout the day, and one person at night. It was reported that on some night shifts there are no permanent staff on duty, and the agency support worker is in the home alone, and so in charge of the home. On one occasion the police were called to the home because the agency worker was not sufficiently experienced to understand how to deal with the behaviour of one of the residents effectively. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 21 The shortage of permanent staff in the home has been noted in the reports of inspections over the last two years. In the last inspection report we said, “Agency usage remains at a high level and evidence was found to suggest that this adversely affects the lives of the residents. Activity logs showed that some outings had to be cancelled, as the agency staff cannot drive the bus.” Since the last inspection a relative of one of the people who live in the home has contacted the Commission in two occasions, stating, “I am appalled this is still happening, all agency staff on duty and not a permanent member of staff in sight, this means that my adult son/ daughter does not get taken out when they are on duty and I don’t think this is right.” And, “On my last visits there are more agency staff than permanent they are in charge of shifts by the looks of it…. I am somewhat concerned for my family member who resides there.” On this occasion the staff told us that due to the low number of permanent staff who are able to drive the home’s vehicle, people are sometimes not able to do everything that they would like to (see Lifestyle). In the Annual Quality Assurance Assessment (AQAA) the acting manager stated, “We need to retain staff and employ others that are aware of the requirements of the role as well as the demands. We have two new starters this year. In the next 12 months we plan to bring our employment up to the required levels.” However the recruitment procedure followed by Walsingham is very slow. It frequently takes between three to six months following a successful interview before employment checks are completed and the person can start work. Due to this delay several suitable applicants have not taken up the post. A pilot scheme is about to start, with an agency taking over the recruitment procedures for 39 Adeyfield Road and another Walsingham home, in an attempt to improve the situation and appoint people to the homes more speedily. The acting manager confirmed that the recruitment procedures followed by the company are robust and that she sees all the information on each applicant during the recruitment process. The references, CRB (Criminal Record Bureau) disclosures, evidence of identity and full employment history are stored at Walsingham headquarters by agreement with the Commission. Walsingham provides a comprehensive training programme that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training is available to meet special needs the residents may have. The acting manager has identified that training is needed to meet the changing needs of the people in the home as they grow older. Individual training needs and wishes are identified in the staff appraisals. All the staff have monthly one to one supervision so that they can discuss their work and their development needs. The agency staff are formally supervised by their agency, but they can also talk to the manager about the needs of the people in the home. Four of the permanent support workers (57 of the total number of staff) have a qualification at NVQ2 or above. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 22 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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. EVIDENCE: The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. The registered manager is on long-term sick leave, and a temporary acting manager was appointed in December 2007. She has a NVQ level 3 qualification, and she has completed the Registered Managers Award. The acting manager has implemented changes and improvements in the care plans, and in staffing levels in the home and supervision. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 23 In the AQAA she says, “There is a strong management team in place at this time. Senior management are on hand to support and advise if and when needed with constructive and productive outcomes. The home has run well under pressure regarding staff shortages. In the next 12 months we plan to develop our staff and bring recruitment level up to reduce agency input.” Walsingham has a comprehensive system for quality assurance in its homes, which includes annual surveys of residents and their families. The company carries out regular service audits of the home and monthly Regulation 26 monitoring visits. In the home the residents meetings have been replaced with individual meetings with the key workers. For the residents of 39 Adeyfield Road this has been found to be a more effective way to enable people to make their views known, as they feel less restrained than in a larger more formal meeting. The décor of the home has been the biggest issue of concern for the people in the home, and they have been involved in choosing colours for the redecoration and going to auctions and furniture stores to choose the items that they would like in their home. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. All the staff have regular training in moving and handling, fire safety, and food hygiene. The record of fridge temperatures shows that the fridge is constantly at 8°C, which is at the top of the recommended range for safe food storage. It was reported that the fridge is due to be replaced. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 24 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 3 4 X 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 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement Timescale for action 30/11/08 2. YA24 13(4)(c) 3. YA33 18(1)(b) All people who live in the home must have a care plan that is up to date. This will ensure that they receive the support that meets their current needs. The broken toilet seats must be 04/10/08 replaced so that there is no risk that the people who live in the home may slip or fall when using the toilets. The Responsible Individual must 30/11/08 take steps to ensure that the recruitment process supports the employment of suitable staff to the home without undue delay. This will support the home in reducing the numbers of temporary and agency staff, so that the people who live in the home can benefit from a stable team of permanent staff. Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 26 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 Adeyfield Road (39) DS0000019260.V371020.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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