CARE HOME ADULTS 18-65
St Hughs Avenue (22/24) Micklefield High Wycombe Bucks HP13 7JD Lead Inspector
Chris Schwarz 11th Unannounced Inspection December 2005 10:00 St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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 St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Hughs Avenue (22/24) Address Micklefield High Wycombe Bucks HP13 7JD 01494 444507 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) The Fremantle Trust Mrs Pamela Wheeler Care Home 6 Category(ies) of Learning disability (6) registration, with number of places St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st February 2005 Brief Description of the Service: 22-24 St Hugh’s Avenue is located in a residential area, Micklefield, east of High Wycombe town centre. It is registered to provide accommodation for up to six adults with learning disabilities and was full at the time of this inspection. The home is close to local shops and transport into nearby towns and is owned and staffed by The Fremantle Trust. All bedrooms are single and the home has been decorated and arranged to reflect a family environment. Service users have a cat called Bunty. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was carried out on a Sunday morning, from 10.00 am until 1.00 pm. It provided opportunity to meet with service users in a relaxed atmosphere as well as examination of some of the required records and discussion with staff on duty. What the service does well:
Admission of a new service user had been effectively undertaken, with appropriate assessments and visits carried out, to ensure that needs could be met. Care plans have been produced for each person, outlining their needs. Service users are enabled to make everyday decisions so that they have fulfilled lives and exercise choice and rights. This includes risk taking. Service users have appropriate cultural, peer and age related activities to choose from, to provide variety and stimulation. Service users are part of the local community, promoting self worth. Service users are supported to maintain important family and social contacts, to maintain relationships. The rights and responsibilities of service users are promoted, supporting independence and self worth. Wholesome and varied meals are provided for service users, to meet their nutritional needs. Staff provide personal assistance to service users as required, to ensure that needs are met. Physical and emotional care needs are being met, to keep service users healthy and well. A homely, safe and comfortable environment has been created, providing pleasant surroundings for service users. Bedrooms are personalised and individual. The home has sufficient shared spaces, providing service users with suitable communal areas. The home is clean and hygienic, safeguarding against the risk of infection.
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 6 The home is appropriately staffed, to ensure that service users’ care needs are met. The home is effectively managed, promoting continuity of care for service users. Regular monitoring is undertaken by the provider, to ensure that service users’ needs are being adequately met. 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. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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 St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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 the following standard(s): 2 The home effectively assesses the needs and aspirations of prospective service users before they are admitted to the home, to ensure that needs can be met. EVIDENCE: One service user had been admitted to the home since the last inspection. She said she was feeling settled and described continuation of interests and activities from where she previously lived. Both she and staff confirmed that a series of visits had taken place prior to the admission and this sounded as though it had been arranged at the person’s pace. The care plan folder contained information regarding needs with input from relatives and previous agencies involved with her care. Risk assessments were in place to facilitate independence. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 9 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, 7 and 9 Care plans are in place for each person, to ensure that current needs are identified and can be met. Service users are enabled to make decisions in their everyday lives, to promote choice and independence. Service users are enabled to take acceptable risks, promoting independence. EVIDENCE: Care plans are in place for each person living at the home and consist of a range of details including a photograph of the person, current needs assessment, risk assessments and review notes. Documentation was signed and dated and well organised within the folders. A front sheet in each folder was in place as a reviewing tool. There was evidence of service users making decisions and taking risks, through observation of the morning routine and examination of risk assessments. Service users helped themselves to drinks in the kitchen, assisted with laying the table for lunch and, where able, got themselves showered and dressed for the day when they were ready to do so. Menus
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 10 showed service user choices for each day and a picture book was in the kitchen to facilitate selections for those service users with communication difficulties. Regular meetings are held at the home to consult with service users and seek their views and minutes are kept of these. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 11 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, 15, 16 and 17 Service users have appropriate cultural, peer and age related activities to choose from, to provide variety and stimulation. Service users are part of the local community, promoting self worth. Service users are supported to maintain important family and social contacts, to maintain relationships. The rights and responsibilities of service users are promoted, supporting independence and self worth. Wholesome and varied meals are provided for service users, to meet their nutritional needs. EVIDENCE: Service users attend day services during the week and some undertake voluntary work as part of work experience. They described busy lives; a party had been held at a local home the previous evening which three of the service users had attended. A forthcoming trip to the International Horse Show at
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 12 Olympia was planned, as was an outing to the pantomime at Wycombe Swan theatre. One person accompanied a member of staff to the local garage shop during the course of the inspection. Service users supported to relationship. A made sure she also described seeing their families and friends and being keep in touch. One person was being supported with a service user took a particular interest in the home’s cat and was fed and comfortable. Menus reflected a range of meals provided for service users, with their choices evident. The Sunday roast of beef, Yorkshire pudding, roast potatoes, gravy and vegetables was nicely presented and plentiful and staff sat with service users to share their meal. The dining table had been attractively set and reflected a typical family meal time. The morning was relaxed and calm, with service users getting up and dressed when they were ready. Some opted to spend time in their rooms, one listened to music via headphones in the lounge and there was free movement around the home. A couple of the service users were involved with doing their laundry and taking clean clothes to their rooms. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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): 18 and 19 Staff provide personal assistance to service users as required, to ensure that needs are met. Attention is needed to promoting dignity and respect to reinforce service users’ self worth. Physical and emotional care needs are being met, to keep service users healthy and well. EVIDENCE: Some of the people living at the home have good independent living skills and were able to attend to their personal care unaided. One person who required support from staff was assisted in private, but the member of staff discussed a service user’s incontinence with another service user, in the lounge. A requirement is made to ensure that staff carry out their tasks with due regard for the promotion of service users’ privacy, dignity and respect. Records of health care appointments were contained within one file for all of the service users, along with letters from day services and colleges. It is recommended that medical appointments details are contained within each service user’s care plan folder, in a separate section. Records available at the time of the inspection provided evidence of attendance at doctors’ surgeries when ill and preventative measures such as influenza vaccination.
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 14 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): EVIDENCE: None of the standards in this section were assessed on this occasion. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 15 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, 26, 28 and 30 A homely, safe and comfortable environment has been created, providing pleasant surroundings for service users. Bedrooms are personalised and individual but work is needed to ensure they have all required facilities, to promote independence. The home has sufficient shared spaces, providing service users with suitable communal areas. The home is clean and hygienic, safeguarding against the risk of infection. EVIDENCE: The home was clean, comfortable and sufficiently heated with lights on where necessary. The building seemed well maintained and communal areas were homely and nicely furnished, and Christmas decorations had been put up. The premises were accessible to all of the service users and there was free movement around the building. There is a large enclosed rear garden to complement indoor facilities. Each person has a single bedroom and those seen were individually arranged, personalised and lived in. The only concern was that some of the bedrooms do
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 16 not have wash hand basins (four of the six) and this needs to be rectified to meet the standard; a requirement is made to attend to this. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 17 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): 33 and 35 The home is appropriately staffed, to ensure that service users’ care needs are met. Training needs to be brought up-to-date, to ensure that service users are cared for by appropriately skilled staff. EVIDENCE: Two staff were on duty at the time of this visit. Rotas reflected that this is a typical level of cover during the waking day which seems sufficient for current care needs. Recommendations are made for the surnames of staff to be added to the rota and for the precise hours to be used rather the word “mid” to describe some of the shifts. The training log showed that updates are needed to moving and handling for some staff, food handling and hygiene input was not listed for two workers, two people had not undertaken fire safety awareness training, infection control training was needed for two people and POVA updates or first time training was needed for most of the team. Additionally, some first aid training needs refreshing. Neither of the staff on duty were entered on the training matrix, therefore it was not possible to check whether they were suitably qualified. A requirement is made for all mandatory training to be brought up-to-date, where necessary, and for the training records to be maintained accurately, including courses attended by any relief staff working at the home.
St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 18 St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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): 37, 39 and 42 The home is effectively managed, promoting continuity of care for service users. Regular monitoring is undertaken by the provider, to ensure that service users’ needs are being adequately met. A range of health and safety checks is undertaken to safeguard against the risk of harm. Attention is needed to ensuring that fire dills are conducted at routine intervals. EVIDENCE: The manager has the appropriate experience of working with the service user group. She is registered with the Commission and has achieved the Registered Manager’s Award. The provider carries out regular monitoring at the home and reports of these visits were available on the premises, reflecting ten visits so far this calendar St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 Page 20 year. Quality assurance audits are also undertaken by the provider, with one booked for the week after this unannounced visit. Various health and safety checks are undertaken at St Hugh’s, for example, fridge and freezer temperature checks, core food cooked temperatures, weekly testing of the fire alarm, regular emergency lighting checks and regular checks of the means of escape from the building. Extinguishers had been serviced in August this year and the fire system serviced in October. A fire based risk assessment was in place, most recently reviewed in August this year. A fire drill had been conducted in November this year with the previous one undertaken in August 2004. A requirement is made for drills to be conducted at least every six months, to ensure that staff and service users are sufficiently rehearsed in evacuation procedures. St Hughs Avenue (22/24) DS0000023046.V270504.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 2 x 3 x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Hughs Avenue (22/24) Score 2 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x DS0000023046.V270504.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 YA18 Regulation 12(4)a Timescale for action Staff are to carry out their tasks 11/12/05 with due regard for service users’ privacy and dignity and convey respect. Service users’ bedrooms are to 01/03/06 have wash hand basins installed. All mandatory training is to be 01/06/06 brought up-to-date, where necessary, and for the training records to be maintained accurately, including courses attended by any relief staff working at the home. Fire drills are to be conducted at 11/12/05 least every six months. Requirement 2 3 YA26 YA35 23(j) 18(1)c(1) 4 YA42 23(4) 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 Refer to Standard YA19 YA33 Good Practice Recommendations Records of medical appointments are to be added to each person’s individual care plan folder. Staff rotas are to include surnames and precise hours worked.
DS0000023046.V270504.R01.S.doc Version 5.0 Page 23 St Hughs Avenue (22/24) Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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