CARE HOME ADULTS 18-65
117A & B Hitchin Road Shefford Beds SG17 5JD Lead Inspector
Andrea James Unannounced 16 August 2005 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 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 Stationary 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. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 117A & B Hitchin Road Address Shefford Beds SG17 5JD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01462 850022 01462 850689 Home Farm Trust Mr Jeffery Smith Care Home 12 Category(ies) of LD Learning Disability - 12 registration, with number of places 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7/03/05 Brief Description of the Service: 117 A B Hitchin Road is one of five registered care homes within Bedfordshire that are managed by Home Farm Trust. HFT are a nationwide provider for people with learning disabilities. The home is situated on the outskirts of Shefford, which has a number of facilities including shops, pubs, restaurants and a library. The home provides it’s own transport in the form of two domestic scale vehicles. There is ample parking space, shared with the organisations headquarters/day care facility, which is adjacent to the home.The building has been divided into two units – Oncemore House and Applewood House, and provides accommodation for 12 adults with learning disabilities. Each unit has been designed to accommodate six adults, with separate and independent sleeping and communal facilities. Each has it’s own lounge, dining room, kitchen, bathing and toilet facilities, and individual bedrooms for all service users. There are separate external doors to access each unit, and they are also linked internally, through the upstairs office/staff sleeping in area. Outside, there is a shared laundry room and a large garden. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was carried out on the 16th of August 2005. The inspection process lasted for 5 hours. The home had 12 service users who were separated into two units namely Applewood and Oncemore house. The registered manager had been seconded to manage the resource centre and the home had a new acting manager who had taken up the post two days before the inspection. A case tracking methodology was used to gather the information used in this report. Samples of the service users were chosen to case track and as a result their records were inspected in detail. The views of the service users care staff and manager are reflected in the body of the report. What the service does well:
The home provided satisfactory standards of care to the service users and enabled them in various ways to maximise their independence and live a fulfilled lifestyle. The service users spoken to said they were happy with the services they received and appeared relaxed in the environment. One service user described the home, as “it’s a nice place”. Others said the care was good and the staff were caring. The care staff felt the home was effective in meeting the needs of the service users and felt adequately equipped to meet the needs of the service users with the various training offered by the organisation. The home encouraged service users to attend various educational establishments, resource centres and other community resources. Service users were also enabled to find jobs that were appropriate to their needs and in one case a service user was being assessed for supported living. The home was able to identify the health care needs of the service users, and was proactive in meeting the identified needs. The home created an open environment where service users views were sought in order to enable them to make choices. Care staff and service users
117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 6 explained how choices were offered to service users, even to those that had limited communication skills. 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. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 and 5. Sufficient information was provided to the service users to enable them to make an informed choice about moving into the home. Potential service users received satisfactory pre- admission assessments as a result service users needs were identified from the onset of the care to be offered. All service users were given the opportunity to choose if they wanted to live at the home before permanent residency was offered. EVIDENCE: The home had a new service user who was case tracked. There was evidence to suggest he received a full pre- admission assessment that identified his needs. The service user spoken to said he was able to have various tea stays and weekend stays before he moved in. The home had a 6-week review period where service users placements were reviewed before permanent residency was agreed. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 9 The service users had evidence of contractual agreements that were presented in a pictorial as well as written format and was signed by both the service users and the home’s representative. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 The assessment and care planning procedures in the home were poor, as a result satisfactory care interventions were not carried out. Service users ability to make decisions in the home was admirable and the home ensured full assistance was offered in this area. This helped to maximise service users independence. There was evidence to suggest that service users were consulted about the decisions in the home and were encouraged to take risks. This resulted in improved skills and confidence development. EVIDENCE: The care plans inspected had various in-depth details of service users likes and dislikes, which were repeated throughout the documentation. The care plans however, failed to identify the assessed needs of the service users and as a result the care needs of the service users and the care intervention were not recorded in any of the care plans inspected. The service users spoken to said that they were able to make decisions about the lives in the home. There was evidence that service users were able to
117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 11 participate in communal activities attend educational establishments and go on holidays. Service users were also given the opportunity to assist in the preparation of meals. Service users spoken to said they attended college and enjoyed the various activities they were given. On the day of the inspection care workers were seen organising a trip for service users to engage in a community activity. Service users said they had regular residents meetings and were able to say what they wanted to happen in the home. One service user was being supported to move into supported living accommodation and to find part time employment. Another service user was encouraged to develop his skills in various aspects of the home, which subjected the service users to taking risks. A service user spoken to said she was looking forward to going to a nightclub with staff, for her birthday. She said she enjoyed living at the house. One service user was carrying out the cleaning jobs in the nearby resource centre and said he enjoyed it. The opportunity was presented to him as a form of part-time employment. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,14,15,16 and 17. The home was good at offering activities to service users that helped them to develop and gain experience. Service users were treated with respect and as individuals, which encouraged confidence and personal development. The service users’ dietary needs were satisfactorily met and as a result they were able to take control of their dietary needs. EVIDENCE: The home had various activities rota that suggested service users had a varied amount of activities. These were both structured and unstructured. Service users spoken to said they enjoyed going to the cinema, nearby pubs and a favourite was the weekly visit to the gateway club. Service users spoken to all appeared confident and happy in their environment. Care staff were seen to treat service users with respect and selfworth.
117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 13 One service user spoke of how the staff helped her to loose weight, another spoke about his ability to attend college and develop more skills to enhance his life. The home encouraged service users to follow a healthy eating routine when preparing meals. Service users were seen to consume meals that appeared nutritious and wholesome. Service users were also encouraged to take part in the food shopping and menu planning. One service user stated that the food here is “ nice”. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Service users received satisfactory support in order to develop their independence. Procedures were in place to ensure service users physical, emotional and health needs were addressed but further development was needed in this area. The medication procedures were good and as a result service users welfare was being maintained. EVIDENCE: The home ensured service users received sufficient information to enable them to develop their personal skills and become more independent. One service user was due to move into supported living in the near future. Six of the service users attended college and the home had recently installed broadband to enable service users of have access to the Internet. The service users physical, emotional and health care needs were being addressed. One service user was given a walking aid after being in a wheelchair. The home also bought in additional staff through enhancements to cater for service users health care needs. One service user had a waking night carer to ensure his needs were being met. Records showed that various external professionals were consulted about service users health needs. The
117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 15 home however, needed to develop their procedures to ensure the need of the service users were identified in their care plans. The medication procedures were satisfactorily maintained but service users did not self medicate. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The service users were able to express their views confidently in the home. This resulted in confidence being developed in the service users. Satisfactory policies and procedures were implemented to safe guard the welfare of the service users. EVIDENCE: Service users spoken to said they had regular residents meetings and felt confident in expressing their views. The care staff and manager were observed communicating effectively with the service users. The service users said they felt able to complain should they have concerns. Two service users had used the complaints procedure and these were recorded in the home but the outcome was not recorded. The manager said they were resolved. The home ensured care staff were trained in abuse awareness and this was also covered in their induction process. Care staff said they knew how to report abuse should they occur. The home was in the process of investigating a recent complaint of a care staff that was alleged to have shouted at a service user. The home followed correct procedures. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25.27,28, 29 and 30. The environmental standards of the home were good and it created a comfortable and safe environment for the service users. All bedrooms were individually decorated to meet the needs of the service users. The spaces occupied by the service users were satisfactory in ensuring sufficient communal areas were available in complementing their bedroom spaces. The bathroom and toileting facilities did not meet all the needs of the service users and as a result some service users dignity was being compromised. Service users had specialist equipment needed to meet their needs and develop their independence. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 18 EVIDENCE: The home was welcoming and all areas were decorated to a satisfactory standard. Service users spoken to said they were able to chose the colour scheme in their rooms. One service user was excited about the fact that her bedroom was due to be decorated in the near future and she was able to choose what she wanted to have. The home had separate dining and lounging facilities that ensured sufficient communal space was available for the service users. The home had sufficient bathing and toileting facilities that met the needs of most of the service users but care staff stated that the toileting facilities were too small to manoeuvre a service user safely. The home had also identified the need to have a better shower room to facilitate service users with changing needs. One service user had to have strip washes in his bedroom because the shower facilities could no longer meet his needs. Specialist equipments such as wheelchairs and walking aids were provided to enhance service users independence. The home was clean and no offensive odours were identified. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35 and 36. The supervision and training ensured that the skills and knowledge of staff was good and ensured that service users were supported. The numbers of staff and the recruitment processes needed improvement to ensure continuity of care and to safeguard the service users. EVIDENCE: The home had a steady core of staff that had worked in the home for a number of years. They spoke knowledgeably about the service users and demonstrated a good understanding of the service users care needs. The home had 3 full time vacancies and as a result used an average of 70 hours of agency cover per week. The acting manager said they were in the process of recruiting. The home had developed a training programme that identified future training but this was on a corporate level and as a result the records were not available for inspection. Care staff spoken to said they received various training in addition to this 4 care staff had achieved their NVQ level 2 in care. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 20 Care staff spoken to said they received regular supervisions and records seen suggested that these occurred on a regular basis. There was no evidence that satisfactory clearance was obtained for a new staff member who had recently been employed in the home. The manager said the copy of the files had not yet arrived from the head office 6 weeks into the care staff’s employment. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,42 and 43. The manager created a friendly and open atmosphere where service users and care staff could feel confident to express their feelings and opinions. The health and safety aspects of the home were maintained to ensure the safety of the service users. EVIDENCE: The manager created a warm and welcoming environment where the service users were able to speak to the manager at any time. There was evidence that an open door policy was in operation and service users were observed going to the manager just to tell him about their days activities or seek reassurance. Care staff also shared the same working station and as a result a united team was evident. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 22 Care staff said they were not aware of the manager’s secondment until the day it happened and felt that better communication was needed in such instances. The home had satisfactory health and safety procedures and the records inspected appeared to be satisfactorily maintained. There was a need for further risk assessments to be carried out on some equipment used by the service users in the home. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x 2 3 3 3 Standard No 11 12 13 14 15 16 17 3 x x 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
117A & B Hitchin Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x 3 3 I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 24 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. 1. Standard 6 Regulation 15 (1) Requirement Arrangements must be made to develop the service users care plans to ensure their identified needs are being met. Timescale for action original dates:30/1 1/04.30/05 /05. new date:30.9. 05 30.09.05 Original date: 30.11.04/ 30.05.05. new date: 30.09.05 30.10.05 2. 3. 6 6 all care plan must must be reviewed on a regular basis and changes made where necessary. 13 (4) (c ) All areas that poses a potential risk to service users must be risk assessed. 15 (1) 4. 27 23 (2) (a) All toilets and bathing facilities must have sufficient floor space to ensure the safe manouvre of service users. 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 19 Good Practice Recommendations Arrangements should be made to ensure the emotional,
I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 25 117A & B Hitchin Road 2. 32 health and physical needs of the service users are clearly identified and accurate records kept on files. Arrangements should be made to ensure the service users have a consisitent group of staff by reducing the number of agency carers where possible. 117A & B Hitchin Road I51 S15002 Hitchin Road V241025 160805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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