CARE HOME ADULTS 18-65
117A & B Hitchin Road Shefford Bedfordshire SG17 5JD Lead Inspector
Andrea James Unannounced Inspection 7th February 2006 10:00 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 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 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 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. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 117A & B Hitchin Road Address Shefford Bedfordshire SG17 5JD 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) 01462 850022 01462 850689 jeff.smith@hft.org.uk www.hft.org.uk Home Farm Trust Mr Jeffery Smith Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: 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 - 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 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 room and a large garden. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over a 4-hour period on the 7th of February 2006. A partial tour of the home took place and the staff and service users were spoken to. The focus of the inspection undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for service users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The primary method of inspection used was “case tracking” which involved selecting a sample of service users and tracking the care they received through review of their records, discussion with them, the care staff and observation of care practices. The inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection in August 2005. This was the second of the two inspections required to be undertaken by the Commission and as a result some standards that were assessed and met at the last inspection were not assessed on this occasion. What the service does well:
The home provides an environment where service users were encouraged to develop their independence and daily living skills. This was evident in the service users daily lives. In recent months one service user was able to move independently into the community and the home supported this transition in a positive manner. Service users spoken to said they enjoyed living in the home and from observation they appeared relaxed and comfortable. Service users spoke about their daily activities, which included college placements and attending the resource centre. The home was also able to cater for some service users who had high needs and needed extra staff support. This was also enhanced by the input of external professionals who had regular contact with the service users. Several policies and procedures were implemented to show that the home regularly listened to service users. One recent implemented document called “Listen to me” was observed to detail service users life histories, their likes and dislikes and goals required. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 6 The care staff spoken to had a good understanding of the service users needs and the home had invested in the care staff through implementing regular training for the current time and into the future. What has improved since the last inspection? What they could do better:
The home should ensure they maintain the safety and welfare of the service users by identifying and rectifying all hazards. On the day of the inspection some radiators were uncovered and as a result vulnerable service users could be harmed. It was also noted that some areas of the home dispelled water that was excessively hot, again this could harm service users. This resulted in the home being issued with an immediate requirement, but since the inspection the Commission received confirmation that the issues identified had been addressed. There were also other areas of the environment that needed urgent attention in order to maintain the safety of the service users. The home needed to address the lack of care plans that were unavailable for service users despite having this as a requirement in past inspection reports. The lack of satisfactory care interventions demonstrated the homes inability to identify the needs of the service users. The home failed to demonstrate how the service users wishes would be recorded in the event of terminal illness or death. The home’s quality assurance monitoring systems needs further development to ensure the service delivery is monitored and reviewed on a regular basis. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 7 There was a need for more specific training in identifying the changing needs of the service users. The Commission would like to thank the service users, care staff and manager for their co-operation in the inspection process. 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 DS0000015002.V281590.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the last inspection. EVIDENCE: 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 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 the following standard(s): 6,9 and 10 Service users were supported to take risks as apart of their independent lifestyles and were confident that their information was handled in an appropriate manner, however the assessed needs of all the service users were not achieved and as a result the care planning procedures were not in place to reflect the standards of care given to the service users. EVIDENCE: The home encouraged service users to develop and maximise their potential in appropriate ways that met with their needs and individual potentials. Service users spoken to said they were encouraged to attend college placements, day centres, leisure activities and religious establishments. A service user was also assisted in reaching his potential and was able to move into his own home. The home failed to demonstrate their ability to satisfactorily assess and implement care plans that identified how the care staff were expected to care for the service users. The care plans inspected suggested that some development was made. A new admission document showed that a full assessment was carried out but there were no care interventions implemented. The documents inspected showed that the daily notes and service users wishes
117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 11 were recorded but the intervention of care was not demonstrated. The files had a lot of information on service users, which would make it more difficult for staff wanting to know how to care for service users to dissect. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 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 the following standard(s): 12,13 The home encouraged service users to participate in age and cultural activities and were not isolated from the community as a result service users were aware of their surroundings and were able to make choices of when and where they wanted to go. EVIDENCE: Service users spoken to said they were encouraged to attend weekly clubs where they met like-minded people and were able to develop friendships. Some service users said they were enabled to attend weekly church services. The activities programme inspected suggested service users were encouraged to attend various activities within the community. Service users were also able to go on various holidays of their choice. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19,20 and 21. Service users were observed to have received good emotional and health care needs, to include satisfactory medication to assist in the betterment of their lives, however the recording and implementation of these needs were poor. The home had good policies in place to deal with the death of service users, but the wishes of the service users in the event of death or terminal illnesses were not recorded. As a result the wishes of the service users in this area was not met. EVIDENCE: Service users and staff spoken to explain the various therapist and medical practitioners they had attending to their emotional and health care needs. It was disappointing to note that these were not documented as a part of their care intervention. The home had satisfactory medication procedures and the records and stock control implemented was of good standard. The home ensured that all care staff received accredited training and those spoken to appeared confident in the knowledge of the medication the service users needed to have. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 14 The home had good death and dying policies but further development was needed to ensure the wishes of the service users are documented in the event of terminal illnesses or death. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 15 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 the following standard(s): These standards were not inspected but staff said they have had no complaints since the last inspection. They commented that they received complimentary letters. EVIDENCE: 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 24,27 and 30. The home was clean and welcoming and service users appeared comfortable, further development was needed to ensure the safety of the environment, as a result all aspects of the home did not meet with the needs of the service users. EVIDENCE: The home was clean and free from offensive odours throughout. The new furniture that had arrived since the last inspection enhanced the décor of the home. The home also had a recent audit where some aspects of safety were identified and as a result care staff explained that risk assessments were developed to safe guard the service users. The home was still awaiting new bathroom facilities for service users who were unable to use the present facilities. On the day of the inspection there were some aspects of safety in regards to excessively hot water in areas of the home and uncovered radiators that had caused concern. An immediate requirement was made to the home but since the inspection actions have been taken to resolve the identified issues. Care staff spoke about the washing machine that kept breaking down and as a 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 17 result caused the laundry room floor to become slippery and this area was accessible by service users. One fire door leading to the lounge was also broken. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, and 34. The service users were cared for by a good staff team that were trained and appeared competent and knowledgeable about their needs. They were satisfactorily recruited and as a result service users safety and welfare was maintained. EVIDENCE: The home had recruited an additional 3 care staff that further enhanced the staff team. 4 of the 10 care staff had achieved their NVQ level 2 and above in care and another 3 staff had recently embarked on the qualification. The home had a running training programme that ensured staff had mandatory training. There was a need to develop this training programme to include dementia awareness that affected some of the service users in the home. The home had satisfactory recruitment procedures and the files inspected suggested that satisfactory clearances were provided. It was recommended that a copy of the Criminal Bureau Checks be available for inspection and evidence to show that staff were not allowed to commence employment prior to satisfactory clearances being obtained. Staff spoken to appeared to have a “genuine“ caring attitude towards the service users. The service users spoke positively about the care staff and they were seen interacting effectively with each other. The atmosphere was a jovial and relaxed one where service users could express their sense of humour.
117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 and 43. The acting manager appeared competent and accountable for the service delivery, but the ability to monitor the service delivery was poor as were some aspects of health and safety within the home. This resulted in the homes inability to measure the quality of care delivered to service users and the impact some aspects of safety may have on their welfare. EVIDENCE: The acting manager appeared competent in dealing with the day-to-day management of the home. The care staff spoke positively about her leadership style. The home had not developed their quality assurance systems and as a result it was difficult to measure the service delivery and the satisfaction of the service users. The home had recently sent out questionnaires to relatives but these were not yet collated. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 20 The home had satisfactory health and safety policies and procedures and had made efforts in ensuring service users safety was maintained, however some aspects of safety were identified on the day of the inspection that could cause harm to service users. The home was issued with an immediate requirement for the safety of service users from scalding and possibly burning from hot radiators. Since the inspection the Commission received confirmation that the identified issues were resolved. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 21 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 2 X X 2 X X 2 3 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 22 Yes 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 YA6 Regulation 15 (1) Requirement Arrangements must be made to develop the service users care plans to ensure their identified needs are being met. Previous timescale: 30.01.04/30.05.05/30.09.05 All care plan must be reviewed on a regular basis and changes made where necessary. Previous timescale: 30.09.05. Arrangements must be made to ensure all service users wishes in the event of terminal illness or death are recorded. Arrangements must be made to ensure the safety of the service users are maintained which will not expose them to excessive hot water or hot surfaces that could scald. This is in particular reference to excessive hot water and uncovered radiators. (Confirmation received by the commission that these have been actioned) Arrangements must be made to ensure the washing machine is replaced or made safe to be used by service users for washing their clothes.
DS0000015002.V281590.R01.S.doc Timescale for action 30/04/06 2. YA6 15 (1) 30/04/06 3 YA21 12 (3) 30/04/06 4 YA24 12 (2) 13 (4) (a) 14/07/06 5 YA24 16 (f) 30/04/06 117A & B Hitchin Road Version 5.1 Page 23 6 A27 23 (2) (a) 7 YA39 24(1) (a) (b) 8 YA42 23 (2) (b) All toilets and bathing facilities must have sufficient floor space to ensure the safe manoeuvre of service users. Previous timescale: 30.10.05 The home must make arrangements to implement their quality assurance system to ensure they are able to monitor the service delivery to the service users. Arrangements must be made to repair or replace the broken fire door in the lounge. 30/05/06 30/05/06 30/04/06 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. 2 3 Refer to Standard YA19 YA34 YA34 Good Practice Recommendations Arrangements should be made to ensure the emotional, health and physical needs of the service users are clearly identified and accurate records kept on files. The home should ensure a copy of the Criminal Record Bureau Checks are available for inspection. Staff records should be transparent to ensure care staff does not commence employment prior to having satisfactory clearances. 117A & B Hitchin Road DS0000015002.V281590.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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