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Inspection on 17/02/09 for 117A & B Hitchin Road

Also see our care home review for 117A & B Hitchin Road for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 117A & B Hitchin Road 117A & B Hitchin Road Shefford Bedfordshire SG17 5JD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Dalton     Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 117A & B Hitchin Road 117A & B Hitchin Road Shefford Bedfordshire SG17 5JD 01462850022 01462850689 hftbedfordshire@hft.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Farm Trust Name of registered manager (if applicable) Mr Jeffery Smith Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 117 A B Hitchin Road is one of five registered care homes within Bedfordshire 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 its 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 - Once more House and Apple wood 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 its 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 Care Homes for Adults (18-65 years) Page 4 of 27 care home 12 Over 65 0 12 Brief description of the care home room and a large garden. Information relating to the homes range of monthly fees is available. It is included within information provided about the home and individual service users contracts. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector conducted this unannounced site visit on 17th February 2009 between 10.15am and 5.00pm. Three people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service, their relatives, members of the staff team and the manager. We received some surveys from people who use the service and their comments have been included in the report. We were present for lunch and observed interaction between staff and people who use the service. We toured the building and examined Care Homes for Adults (18-65 years) Page 6 of 27 documentation to check that what was happening in the service was being recorded. The services weekly fees are under review but currently range from 715.85 pounds to 884.09 pounds. This does not include toiletries and private chiropody and other personal expenses. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The necessary information is in place to enable people who use the service to make an informed choice about moving in. Evidence: We looked at 3 peoples personal files and each of them had a service users guide. This contained information about the home and local area and facilities and had photographs to illustrate the information. It also made it simple to understand for people who use the service who have difficulty reading. Some people who use the service had moved into the area and found the service users guide helpful in providing information about their new home and local facilities. There has been one new admission since the previous inspection. The person who moved in last summer told us that they had lots of information about their new home to help them live away from their family. There was evidence to support that the moving process had been at the individuals pace and supported by family and professionals. Each person had a copy of the contract in their personal folder detailing what the home offered and what costs would need to be paid for by the people who lived there. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The statement of purpose is equally as informative and this is reviewed each year to ensure that all the information is current and correct. It contained up to date details of staff and facilities. A new computer system has been introduced and Hitchin Road was one of the services to pilot the software. There are plans to review all documentation to ensure that it is as user friendly as it can be. A reassessment is completed each year so that the person using the service can be assured that their needs are being met and any new developments are included in information given to staff. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service enables people who use the service to take control of their lives and make their own decisions and choices. Evidence: A new computer system introduced: SPARS - Support Planning Assessment and Recording System. This aims to streamline the recording of information. Staff are continuing to duplicate some recording until they are familiar with the new system. Hitchin Road was involved in piloting the new system and staff appear to be coping well with the change in documentation. We looked at care plans for 3 people. They contained detailed information on how to meet each persons needs. The care plan is divided into separate headings and each heading contains some information about goals and risks. Risk assessments are held in a separate folder and explain how identified risks are monitored, managed and met should they occur. There are plans to introduce a person centred plan for each individual, which identifies hopes, dreams and aspirations and how staff can help them Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: to be realised. This will expand upon how goals are met. Identified staff have received training on how to facilitate the plans once the new care plan format has settled in. Care plans were signed by people or there was a record of when the content had been explained to them. There are annual reviews and they are attended by the funding authority to ensure that they are happy with the service that is being delivered. Each person has a dedicated Health Action Plan which details their individual health needs and how they are met. Care plans clearly explain how people make their needs known. One person uses an object of reflection in the form of a cup to signify that they want a drink. They keep the cup in their bedroom and all staff understand their request. This is documented in the care plan. The acting manager is investigating the availability of Makaton training for staff. There is a session planned for staff to attend but a longer period of training will be beneficial to new staff and will enable them to communicate more effectively to people who use Makaton and do not communicate verbally. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and how they spend their leisure time. Evidence: Each person has an activity plan which reflects their daily schedule. As an example one person spends their week at music, snoezelen (relaxing in a therapeutic environment) and swimming. Any changes to this are recorded in their care plan. The house is situated next to the companys resource centre which is attended by the people who live at Hitchin Road. A variety of sessions is available from arts and crafts to singing. Some people were attending a course on their personal safety and human rights on the day of the inspection. As part of a college course some people are attending a work placement at a local superstore. 2 people attend church and the home benefits from support from church volunteers. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: A menu was on display in both houses and they were different in the options available to reflect peoples choices. We observed lunch being prepared and staff offering people choices. Menus have a picture of the evening meal printed in colour to assist people to make a choice and be aware of what is to be served. There are also menu cards with larger pictures available. One person was making shepherds pie with some staff support and supervision. Holidays are being planned - the options include a canal holiday, staying at a cottage and going to a holiday camp. Most people have contact with their families and will visit regularly. Many also visit Hitchin Road. Staff are working with a family to devise a memory box for a person who has some sensory needs. There are plans to include smells of perfume and items that will trigger memories. One person has a talking photo album and there are plans to purchase more. The manager also plans to purchase photo phones to assist in using the telephone more easily and recognise who they want to call. There are 2 vehicles to enable people to go out individually or in a group. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medication system safeguards people who use the service and care plans reflect individual health and social care needs. Evidence: Care plans reflected peoples likes and dislikes regarding their personal support. It was evident that people receive the professional support that they need and a record of appointments is kept. Each person has a detailed Health Action Plan which is reviewed to ensure that the identified needs are current and being met. One person is supported in managing their diabetes by the district nurse. The manager plans to ensure all staff have evidence of receiving relevant blood sugar check training. We checked the medication records of 3 people and found them to be in good order. This reflects that the system ensures the safety of people. The manager had recently received current guidance regarding medication administration and storage and plans to circulate this among the staff team. A training matrix reflected that all staff had received up to date training to enable them to meet peoples needs. Staff had attended a variety of training including moving and handling, autism, dementia, first aid and medication. Care Homes for Adults (18-65 years) Page 16 of 27 Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are enabled to express their concerns. Staff have a clear understanding of the safeguarding procedure. Evidence: The complaints policy reflected that people who use the service were able to make a complaint. Each person has a copy of the policy in a user friendly easy to read pictorial format. A record of the complaint and any action taken is recorded which means if regular complaints are recorded an overall picture can be gained. This also monitors concerns that people who use the service may raise. Most issues are resolved at house meetings or one to one meetings. Advocacy Alliance hold monthly meetings to enable people to talk to someone independent and support if required. We received 2 completed surveys from people who use the service and all reflected that they knew who to speak to if they were unhappy. All staff have received training on safeguarding vulnerable people information is on display to prompt people who use the service or staff if they have any concerns. We checked three financial records and found them to be in good order. The service uses a specialised system (Versapak) which has a separate number for a lockable tag. Each time finances are checked a new tag is issued with a corresponding number. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean, tidy and homely. Evidence: There are plans for the house to be extended in the coming months. This will provide a larger office, an additional sleep in room and additional ensuite bathroom facilities for the sleep in rooms. A larger lounge will be built downstairs. Because of the expansion an additional patio area will need to be built and this is planned as part of the expansion. The manager was showing round a kitchen designer during our visit. There are plans to refurbish both kitchens and ensure that they can meet the specific needs of the people who live at Hitchin Road. This work is scheduled to begin before the major building work. An occupational therapist has advised the company to ensure that peoples specific sensory and additional needs associated with dementia are able to be met. Both houses are personalised by the people who live there. There are computers available for use in communal areas and some have their own computers in their bedroom. People are able to have private space and access to the telephone as it is cordless. Bedrooms reflected individuals personalities and one person had fresh flowers as they liked to brighten their room. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The manager plans to replace dining tables and chairs as part of the kitchen refurbishment and aims to replace the fooring in the dining rooms to better meet peoples needs. They are investigating a suitable alternative to hand towel and toilet roll dispensers as the current facilities do not meet peoples needs. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support from competent and trained staff. Evidence: As discussed earlier, a training matrix reflected that staff undertake regular and relevant training to enable peoples needs to be met. The manager confirmed that staffing levels will be increased once building work begins. This is to ensure that people will be supported as they may be disorientated due to the layout changes and increases in noise and building staff. An additional sleep in member of staff will be employed during this time and will remain in place once additional sleep in provisions are in place. The manager has completed risk assessments and sent them to funding authorities to secure additional staff during the expansion. We checked 3 recruitment records and found them to be in good order. All original documents are held at head office but the manager has copies to refer to. All staff complete the Learning Disability Qualification, which equips them with specialist induction training and enables them to progress to completing NVQ qualifications. A number of staff are working towards achieving their NVQ qualifications. All staff receive supervision to ensure that they are competent to do their job and request any specific training that they may require. The manager is researching Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: training on bi-polar disorder to assist the staff to meet individual needs. There is a full staff complement. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an effective quality assurance system in place but the manager must register with the Commission for Social Care Inspection. Evidence: The manager has a good rapport with people who use the service and they clearly feel comfortable accessing the office as this was evident during the inspection. The manager has yet to submit their application form to register with the Commission for Social Care Inspection. They plan to do this by the end of the month to ensure observance of the Care Homes Regulations. The AQAA (Annual Quality Assurance Assessment) was completed prior to the inspection by the manager to demonstrate how the service had reviewed the care they delivered and identified any improvements required. We inspected fire records and found them to be in good order and the manager plans to update the fire plan in line with guidance provided by the local fire service. Health and safety records are maintained and reflected that necessary safety checks were being conducted e.g. hot water checks to ensure the safety of people who use the Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: service. Fire drills were taking place and the manager has plans to conduct a late night drill to ensure sleep in staff know how to respond. The service sends out a quality assurance questionnaire to families, people who use the service and to professionals. A report is published and sent out to all participants and reflects what action will be taken. The manager plans to incorporate the findings into the statement of purpose as this is reviewed annually. This will ensure that the statement of purpose illustrates how the service is responding to comments that are made by people who use the service and their relatives. The company meets with the Family and Friends Association quarterly, which enables the management team to address any concerns and provide an update of any developments within the service. We spoke to several people who live at Hitchin Road and they were very positive about the care they received. I love here, I just love it. Staff are lovely. I can tell my keyworker my problems. Surveys were equally as positive My social worker told me about this home and I liked it. I make my own choices and decisions. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 The manager must register with the Commission for Social Care Inspection. This will ensure that people who use the service benefit from a well run home. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!