CARE HOME ADULTS 18-65
Horsebrook (45) Calne Wiltshire SN11 8HG Lead Inspector
Tim Goadby Key Unannounced Inspection 4th & 19th October 2006 17:25 Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Horsebrook (45) Address Calne Wiltshire SN11 8HG 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) 01249 811222 www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Mrs Jean Caroline Foley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: 45 Horsebrook is a purpose built care home that provides accommodation for up to six service users with a learning disability. Cottage and Rural Enterprises Ltd (CARE) is registered as the care provider and the property is owned by the Westlea Housing Association. The service was first registered in 2003. It is a semi-detached building on two floors. Each service user has a single room with an en-suite shower and toilet. There is also a bathroom on the first floor. The communal space includes an open plan lounge and dining room. Service users take an active role in the household routines. There is a domestic type kitchen with a separate laundry area. The home has its own ‘people carrier’ for trips out. 45 Horsebrook has close connections with ‘CARE Wiltshire’, another CARE establishment in the nearby village of Rowde, which provides various social, therapeutic and work based day activities. Some administrative and personnel support is also provided through the CARE Wiltshire service. Fees charged for care and accommodation are £600 per week. Information about the service is on display within the home, including a copy of the most recent CSCI inspection report. Service users have their own copies of documents such as the complaints procedure and service user guide. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was completed in October 2006. The evidence gathered included information relating to the CARE organisation which was obtained at the inspection of the larger local service in July 2006; pre-inspection information supplied by the service; five survey forms completed by service users, with support where necessary; and three survey forms completed by staff of the home. An unannounced visit to Horsebrook was carried out one evening, at a time best suited to meet with service users. The home’s assistant manager was on duty during this visit. This fieldwork section of the inspection included the following: observation of care practices; sampling of records, with case tracking; sampling a meal; discussions with service users and staff; and a tour of the premises. The inspection process concluded a couple of weeks later with a visit to the main CARE Wiltshire site at Rowde, to view records, discuss management issues and give feedback. What the service does well:
The admission of new service users is managed effectively, ensuring that the person thinking about moving in gets the opportunity to make an informed choice. Prospective service users can undertake trial visits to the home, and make their own contribution to their assessment. Once they have moved in, an initial review takes place after a few weeks to check that they are happy with the home. Choice and independence is promoted for service users in all aspects of their daily lives. They can decide how they wish to spend their time at home, and what activities they would like to undertake elsewhere. Risk assessments are used to support service users in having new opportunities, such as accessing local employment, or spending time at home alone. The accommodation offered to service users is of a good standard and meets their individual and collective needs. All service users have their own bedroom with en-suite facilities. These are of a good size, and the examples seen during the inspection were all attractively furnished and decorated, in line with the preferences of their occupants. Communal areas are homely in scale, and service users were all seen to be comfortable in using them. Service users benefit from the support of well trained staff. CARE has its own training co-ordinator, based in Rowde, who oversees this area. All employees undertake a range of courses relevant to their job roles. This includes achieving nationally recognised qualifications in care.
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 6 The service has access to various organisational supports via administrative and senior staff who are based at Rowde. This helps to ensure that some of the systems for areas such as health and safety are overseen regularly. It also means that issues which cannot be resolved within Horsebrook can speedily be taken to another level within CARE. CARE has an effective organisational system for quality assurance. The range of measures used includes obtaining feedback from service users and staff. Service users can be confident that their views contribute to an overall philosophy of continuous service development. What has improved since the last inspection? What they could do better:
Care plans for service users need to include all relevant details about the key issues for their support. They need to show any progress being made in particular areas, and to provide up-to-date information and guidance on significant issues. This will help to demonstrate that service users are receiving effective support for all their needs and wishes. Suitable procedures need to be put in place for each service user to ensure that they receive effective support with personal care. A balance needs to be struck between proper respect for the wishes of individual service users, and the need to uphold minimum standards and the duty of care. Similarly, the same balance is needed in supporting service users to maintain their environment to suitable standards of hygiene. In particular, staff need to ensure that all practices are appropriate to control the risk of infection, so that service users are not placed at risk of harm. Practices for medication need to include keeping a record for all stages in the administration of the drugs prescribed for service users. This helps to promote the safe and effective management of medication, and to protect service users. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 7 Procedures for responding to complaints need to include notification of the CSCI, where these include concerns relating to the welfare of service users or the conduct of staff. Records about complaints need to be made with due regard for confidentiality, and to ensuring that a complete record can be followed through from receipt of the complaint to investigation and outcomes. This would provide clearer evidence that service users and others can be confident that any complaints will be handled appropriately. Processes for the recruitment of staff need to include all required checks before new employees take up post, to ensure the protection of service users. Criminal records disclosures from previous employments must not be relied upon. If staff are to begin restricted working before a new disclosure is completed, they must have had satisfactory clearance to establish that their name is not on the national list of those deemed unsuitable to work with vulnerable adults. Record keeping systems need to be improved so that all required documentation is maintained, and is available for inspection. Records relating to key issues for service users cannot always be located, and it is not clear whether they have not been completed, or are being held elsewhere. Systems need to ensure that records are in place, are kept up to date, and that there is effective cross referencing if material is held in more than one place. Care also needs to be taken to keep detailed individual records about any service user separate from information relating to the others. These improvements will help the more effective operation of the service, to the benefit of its users. Arrangements for fire safety need to be reviewed to ensure that they are providing effective protection for service users, staff and other visitors to the home. Following recent changes in fire safety regulation, Horsebrook must have a fire risk assessment for its premises. Actions to uphold fire safety must then be taken in line with the findings of this. Review of staff cover for the service is proposed, and should take place without delay. The home often has only one staff member on duty at times when all service users are present, and there have been examples when this has hampered the ability to support service users’ wishes and needs. 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. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 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 Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 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): 2 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users have their needs assessed and make a positive choice about moving into the service. EVIDENCE: Horsebrook has admitted one new service user since its last inspection. Records were seen for this individual, who was previously living with their family. The new service user already knew Horsebrook’s existing group, as they were at school with one of them, and also had some short term stays at CARE’s facility in Rowde. Clear information is on file about the pre-admission process. The assessment included the service user’s own input alongside that of the registered manager. An initial review meeting took place several weeks after the service user moved in, which concluded that they were settling in well. This was attended by the service user as well as their family and care manager. The service user’s own contribution to this inspection included a comment that they are happy at Horsebrook and like living there. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are placed at risk by failure to have up-to-date information clearly available about how all their needs and wishes are to be supported. Service users can make choices and decisions in their daily lives, and about the conduct of the service. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Two sets of service user records were sampled during this inspection. Staff reported that all care plans are being reviewed and that not all relevant information is on file yet. The records seen did not contain all the current detail that should be in place to reflect each service users’ needs and the support given to these.
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 11 There was also a lack of satisfactory evidence of monitoring and review of care. When goals had been set for service users, the record did not always contain any information about progress on these. Updates about service users’ general welfare are made in diary entries. These do not necessarily need to be recorded every day, but it is sensible to maintain a minimum frequency, as evidence of monitoring. However, in one case the most recent entry for a service user was on 21st July, almost eleven weeks before the inspection visit. Records for another service user could not be located within the home. Staff thought they may have gone over to CARE’s establishment at Rowde. Where care plans are in place, they are focused on the service user’s own perspective. They are written in the first person. Strengths and abilities are set out, as well as needs. The service user’s wishes and preferences are made clear. Sections include ‘Good things about me’ and ‘Things important to me’. Service users were observed exercising choice and independence. For instance, they made their own drinks, and decided where to spend time within the home. Risk assessments are used to support judgements about the activities undertaken by service users. For instance, a decision has been reached by all relevant persons about one service user being safe to spend periods of time at the home unsupported by staff. Another service user has a part-time job in a local shop and is not supported by staff of Horsebrook whilst there. This arrangement was reached after a period of training with the service user, and there is informal monitoring to check that it remains suitable. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 13 CARE has its own day service facilities at its nearby project in Rowde. This offers a range of opportunities, including arts and crafts, gardening and information technology. Most of the service users at Horsebrook attend this facility. One service user who has expressed a wish not to do so is provided with an alternative programme. This includes attendance at other day centres and participation in college courses. The service user’s response for this inspection confirmed that they enjoy having this different support. Service users access a range of local community amenities, such as shops and the leisure centre. On the evening of the inspection visit to the home three service users attended a club. Another was visited by a relative and went out with them. Service users are able to maintain contact with their families and friends. Some have regular visits from relatives, or go and stay with them. Contact is also maintained through telephone calls. One service user had just returned from a family holiday in Spain. Menus for the home are chosen by the service users at the beginning of each week. The evening meal on the day of the inspection visit was a vegetable and bean bake. An alternative was prepared for one service user who had expressed a wish to have something else. The home ensures that there are always options in case someone does not like the main meal. Some service users have particular dietary needs, linked to the genetic cause of their learning disability. Work is being done in the service to develop knowledge about these conditions and how best to support the individuals concerned. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Some service users are placed at risk by failure to address their personal care needs effectively. Service users’ health needs are met. Service users are protected by most of the home’s policies and procedures for dealing with medicines, but practice needs to improve in one specific area of recording. EVIDENCE: A recent complaint from the relative of a service user about arrangements for this individual’s personal care was upheld by CARE’s own investigation. Various deficits in practice were identified, and the service has agreed a number of actions to address these. A suitable balance needs to be struck between the service users’ own preferences and the need to uphold minimum standards and the duty of care. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 15 Some service users need to be observed or monitored whilst carrying out personal care, for reasons of safety. This is set out in their individual risk assessments. Information about service users’ health care needs is included within their records. This includes any contacts they have with other health care professionals. None of the current service users at Horsebrook are responsible for their own medication. Staff therefore take on the tasks of storing, administering and recording all drugs prescribed for service users. Arrangements for storage were seen to be appropriate and secure. Recording was mostly satisfactory, with one exception. Once a week the home’s staff take one service user’s drugs out of the containers they were dispensed in, and put the following week’s supply into a dosette box, which has marked compartments for when each dose is due. As this is an extra stage in the administration of the drugs, it needs to be recorded. The home has put a form in place, but it has not been signed every week. Some non-prescription drugs are also approved for use in the service. A GP has signed relevant permission to confirm that these may be given. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are placed at risk by failure to take all required actions in response to complaints and significant incidents. EVIDENCE: The service has a complaints procedure. Information about this is given to service users and their representatives. It includes contact details for the CSCI. Service users are given the information in an accessible version, with the use of pictures to support the text. Records are kept of any issues raised, and of the actions taken in response. Examples of these were seen during the inspection, but not all details were available in each case, and staff on duty were unable to give additional information. One record had been entered inappropriately in the general handover book used to communicate information between staff. Placing details of a complaint here compromised confidentiality. It also made it more difficult to keep all the records regarding this complaint together. The recent complaints received by the service covered various issues, including the care of service users and the conduct of staff. More details were established through conversations with senior representatives of CARE and the care manager for one of the service users involved. The organisation appeared to have taken many of the appropriate steps in investigating and responding to
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 17 these concerns. However, the complaints were not notified to the CSCI, as required under care homes legislation. CARE has suitable procedures for adult protection, and also works within the local multi-agency arrangements. Issues have been referred to this process when necessary. This has helped to identify agreed strategies for managing known risks for some individuals. All staff receive training about abuse and protection. Again, records were unclear about the current situation in relation to a recent concern. An issue between two service users was referred to vulnerable adults procedures a few weeks before this inspection. The staff member on duty was unsure about the actual outcome. Records could not be located within the home, and there was no certainty about where these might be. At the follow-up visit to Rowde, it was confirmed that more sensitive and confidential information may be filed in offices there. However, if this is to happen, the service user’s care record at Horsebrook must have some effective means of cross-referencing, so that there is a clear audit trail about matters which are of particular importance. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area was mostly good. But quality in the specific area of infection control was only adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in an environment which is suitable to their needs. Service users are placed at risk by the failure to ensure effective measures for hygiene and infection control. EVIDENCE: Horsebrook is a new property in a development of similar buildings. It was registered as a care home in 2003. The service is a short walk from the centre of Calne, which offers a number of local amenities. The town is on the main A4 trunk road, providing access via public transport to larger nearby centres, such as Chippenham and Bath. All six service users have single bedrooms, with en-suite shower and toilet. One of these is on the ground floor. Three of these rooms were viewed during the inspection visit, at the invitation of their occupants. All were clean, tidy
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 19 and attractively personalised. Each service user had their own furniture, pictures, ornaments and home entertainment equipment. There is a bathroom for general use on the first floor. Another separate toilet is also available downstairs. Communal areas are all on the ground floor. The kitchen is domestic in scale, and has a separate utility room containing a washing machine and tumble drier. There is also a dining room and a lounge. A sleep-in room and office for staff is also on the ground floor. Some improvements have been made to the accommodation since the previous inspection. Levels of lighting have been improved in a number of areas. Fire doors have been adjusted so that the closure mechanisms operate without the doors slamming. Some redecoration has taken place, and more is planned. Each service user has an allocated day when they do their own laundry. Staff support is offered as required. A recent complaint to the service included concerns about levels of cleanliness and hygiene in parts of the home. CARE’s own investigation upheld these, and found evidence of deficits in hygiene practices, including a failure to uphold some basic infection control principles. Issues related to striking an appropriate balance between encouraging a service user to maintain their own personal hygiene and that of their environment, and the staff’s duty of care to uphold basic minimum standards. The service is now working on developing suitable agreements on boundaries for this. The home was seen to be clean and hygienic in all the areas viewed during this unannounced inspection. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Further review of staff levels is needed to ensure that all service users’ needs and wishes can be supported effectively. Service users are placed at risk by failure to carry out all required recruitment checks prior to new staff taking up post. Service users benefit from the support of suitably trained staff. EVIDENCE: At the time of the inspection visit to Horsebrook, the service’s staff team included the manager and assistant manager, both working full-time; two support staff working slightly fewer hours per week; and another part-time employee on their induction period. More recruitment was planned. The rota for the service ensures that one staff member is on duty at all times when service users are at home. This includes sleep-in cover overnight. Two staff may be on duty at certain times to support particular activities, such as service users attending college or clubs.
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 21 One service user is funded for a number of hours of one-to-one support each week, in addition to the main rota cover. This was being provided by agency workers, until the home recruited its own staff to cover these hours. Regular agency employees were used to promote consistency. The provision of these separately funded hours was clearly shown on the home’s rotas. Concern has arisen about the suitability of the home’s current staff levels. Having only one staff member on duty can limit access to activities for service users, leading to frustration, and tensions between some individuals. A significant incident between two service users in August 2006 was directly linked to this difficulty. It can also affect the service’s ability to meet its users’ needs and preferences. For instance, one service user has a goal of going swimming, but if only one staff member is on duty the service user can only do so if all the others agree to go as well. CARE has acknowledged the need to address this. Horsebrook is in the process of reviewing its staff levels, and it is planned to have a second person on duty more regularly. It is also hoped that more service users may become assessed as safe to spend periods of time at the home unsupported by staff, which will be another means of creating greater flexibility. There is an extensive range of training available to all staff. This is overseen by a training co-ordinator, based at Rowde. New staff have a six week induction programme. The first two weeks of this is spent being introduced to key policies and guidelines, and shadowing other staff members on shifts to observe care tasks. New starters also receive a handbook of relevant information, including the national codes of conduct for social care staff. Induction is carried out in accordance with the national framework for staff working in learning disability services. CARE participates in a scheme within Wiltshire where different organisations act as markers for each other’s staff. This leads into staff undertaking National Vocational Qualifications (NVQs) in care. Senior staff have the opportunity to go on to take the qualification at a management level. Over 50 of the present care staff team at Horsebrook have achieved an NVQ. There is a range of mandatory courses that all staff undertake, with more training required for more senior roles. Individual training records are maintained for all staff. There is also an overall database, which helps to keep the service plan updated. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 22 Training records for staff at Horsebrook could not be located in full at the initial visit to the service. They were provided at the follow-up visit to Rowde, where they were seen to be satisfactory. CARE has its own training staff who can deliver many of the courses which are needed. Other sources of training are accessed as necessary. There is a training room on site at Rowde. CARE has a central human resources department, which generates all recruitment and selection policies. The actual process is managed locally. Service users are involved wherever possible. This has included some of them participating on interview panels, after receiving suitable training. Recruitment records for Horsebrook staff were also checked at the visit to Rowde. One important deficit was noted for the most recent appointment. The employee had begun working eleven days before completing a criminal records check. They had not had the minimum verification that their name is not on the national list of those deemed unsuitable to work with vulnerable adults – the POVA list. A recent criminal records check, from a previous employment, was relied upon in the first instance. This is not permissible, as the form alone may not contain all relevant information that an employer needs before making an appointment decision. A new check must always be carried out, and a new employee can only begin working, within certain prescribed restrictions, if it has first been established that they are not on the POVA list. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 23 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, 41 & 42 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Key Standard 37 was not assessed at this inspection, owing to the absence of the manager during the process. Quality assurance measures underpin service developments, and include actions based on the views of service users. Record keeping systems are not functioning effectively, and fail to provide the necessary evidence that the home is being conducted appropriately in all areas, placing service users at risk of not receiving all the support they need. Service users’ health and safety are protected by the systems in place in most cases. Service users and others are placed at risk of harm by some deficits in fire safety practices. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager for Horsebrook is Mrs Jean Foley. She was absent due to ill health over the period of this inspection, and therefore not able to contribute to the process. The home also has a recently appointed assistant manager. CARE has a number of senior management and administrative staff based at Rowde, who oversee various areas of service delivery. These include staff training, health and safety, quality assurance, financial issues and day services. There are regular management meetings covering all aspects of service delivery. There is a locality manager for CARE’s Wiltshire services, including Horsebrook, and clear systems for reporting to the senior levels of the company. CARE has an organisational quality assurance system. One staff member, based at Rowde, is responsible for overseeing the implementation of this locally. The process involves auditing all areas of service delivery, with checks at various frequencies. This includes obtaining feedback from service users and staff. Any actions identified from the quality assurance process are planned in order of priority. Records specify what action is to be taken and who is responsible for this. There are regular meetings to oversee progress. As mentioned throughout this report, deficits in record keeping were identified in a number of areas during this inspection. These included records relating to service users, staff, complaints and adult protection issues. Not all statutorily required records were being kept. Others were not complete or up to date. Where information was available elsewhere, this was not made clear by effective cross-referencing, and staff were not necessarily aware of it. Care should also be taken to keep individual service user records in separate files. In examples seen at this inspection, detailed entries about important elements of service user care, and about a complaint from a service user’s relative, were contained in a general handover book. This is not appropriate, as it means that the information is alongside other material that is not part of the service user’s care record. Although records were not being maintained satisfactorily, all the staff who contributed comments highlighted the amount of paperwork required within their jobs as a negative aspect. Health and safety arrangements are overseen from Rowde. CARE has a wide range of standard policies and manuals covering all aspects of this topic. The organisation has also entered into a consultancy agreement with another
Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 25 company specialising in health and safety, which will advise on various aspects of practice. Risk assessments are carried out on various safety topics. These may be to do with specific service users, or for general issues. Fire safety records were checked during the inspection. Checks and practices were recorded as being carried out and up to date. But no current records of staff instruction could be found. The service’s fire procedure was available, but a current fire risk assessment for the property was not. Following recent changes to fire safety regulation, care homes must ensure that they have a suitable current risk assessment, and that all their fire safety measures are suitable to address any actions identified by this. Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X X X 3 X 2 2 X Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 27 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 17-1a Sch3-1b Requirement All service users must have upto-date individual plans which set out how all their needs in respect of health and welfare are to be met. Timescale for action 31/12/06 2 YA18 12-1,2,3 15 All service users must have 31/12/06 suitable guidelines to ensure that they are supported to maintain appropriate standards of personal hygiene within the framework of their own preferences. These Regulations also relate to the above Requirement. From now on, a record must be maintained for all stages in the administration of medication on behalf of service users. 31/12/06 19/10/06 2 3 YA18 YA20 17-1a Sch31b,3q 13-2 17-1a Sch3-3i 37-1e,g 4 YA22 From now on, the persons 19/10/06 registered must notify the Commission without delay of any complaint concerning the welfare of service users or the conduct of staff. From now on, suitable hygiene
DS0000033510.V302655.R02.S.doc 5 YA30 13-3 19/10/06
Page 28 Horsebrook (45) Version 5.2 16-2j 23-2d 6 YA34 19-9,10 Sch2-7 practices must be maintained in all parts of the home to control risk of infection. From now on, new employees 19/10/06 must not commence work in care positions until a satisfactory result has been received from a POVA First check. From now on, all required records must be maintained, and must be available for inspection in the home at all times. The persons registered must have a suitable fire risk assessment for the premises and ensure that all fire safety arrangements are in accordance with this. 19/10/06 7 YA41 17 Sch3&4 8 YA42 23-4A 31/12/06 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 Refer to Standard YA23 Good Practice Recommendations If sensitive confidential information is to be held separately from the main care record, there should be clear cross referencing between the two. Review of staff cover should take place, in line with the proposed changes already identified. A suitable minimum frequency of entries should be maintained in ongoing records of care. Detailed records relating to individual service users should be entered in that person’s care record and not be made in the handover book. 2 3 4 YA33 YA41 YA41 Horsebrook (45) DS0000033510.V302655.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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