Inspection on 23/05/06 for 6 Honister Gardens

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

6 Honister Gardens 04/11/09

6 Honister Gardens 14/10/08

6 Honister Gardens 14/08/07

6 Honister Gardens 28/02/06

6 Honister Gardens 04/11/05

6 Honister Gardens 17/03/05

6 Honister Gardens 07/09/04

6 Honister Gardens 26/02/04

6 Honister Gardens 06/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 6 Honister Gardens 6 Honister Gardens Stanmore Middlesex HA7 2EH Lead Inspector Clive Heidrich Key Unannounced Inspection 23rd May 2006 8:00 6 Honister Gardens DS0000017582.V296472.R01.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 6 Honister Gardens DS0000017582.V296472.R01.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. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 6 Honister Gardens Address 6 Honister Gardens Stanmore Middlesex HA7 2EH 020 8907 0709 020 8907 0709 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) Striving For Independence Group Homes Mrs Deborah Whittick Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: 6 Honister Gardens is a care home providing personal care and accommodation for up to five people who have a learning disability. There was one vacancy in the home at the time of the inspection. The home is owned and run by the Striving For Independence organisation, a local private and independent care service provider. The home has 24-hour staffing, including one waking-night staff and a sleepover staff. The home is located within a residential area on the edge of both Stanmore and Belmont, in the borough of Harrow. It is a few minutes from bus links, and around ten minutes’ walk from local shops. Parking restrictions do not apply on the road outside the home. The drive has space for two cars. The premises are a two-storey building in keeping with other homes in the street. All bedrooms are single rooms, fully furnished, and with built-in sinks, both upstairs and downstairs. One has an en-suite toilet. The home has one bathroom with adapted shower facility upstairs, and a shower room downstairs. The home has a kitchen, a lounge leading into a dining area, a spacious activities room, and a garden. Management stated that information about the fees, and a copy of the service user guide, are available in the home on request. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across three days in late May and early June. It lasted almost fourteen hours. Its focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspection process involved meeting with one service user to discuss the services provided in the home. Discussion did not take place with other service users as one service user was not present throughout, one chose not to speak with the inspector, and the inspector was unable to communicate effectively with the fourth service user. The inspector also discussed aspects of the service with a number of staff who were working during the visits, and with the deputy, the manager, and the owner. Additionally, on the first two days, care practices were observed and aspects of the environment were checked on. Records were sampled across all three days, the latter of which involved visiting another of the organisation’s homes to access certain staff records. Concurrent to the inspection, the organisation was investigating an anonymous complaint about its care services. They had reported this complaint to the CSCI. The investigation was being conducted by an external consultant. The first day of inspection finished early to facilitate this investigation. A few months prior to the inspection, the manager was requested to send out comment cards to involved people, and to complete an inspection questionnaire. Consequently information from two relatives’ and two health & social care professionals’ comment cards, have been included in this report. Feedback was almost entirely positive. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: The one service user spoken with repeatedly said that the home is a good place. Comment cards received from four involved people were almost entirely positive. Staff generally have good knowledge of service users’ needs and how to meet those needs. Training is provided to address specific needs. Service users can make choices about their lifestyles, and that they are treated individually, for instance in terms of activities and lifestyle. Service users’ rooms are spacious and nicely decorated. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 6 There are excellent standards of providing service users with support to follow individual occupations and activities. There is a good standard of acquiring health professional support where needed. The home has an experienced and capable manager. What has improved since the last inspection? What they could do better: A combination of the recent maternity leave of the manager, and the increase in dependency of one service user, has had a degree of detrimental effect on the service. A number of the requirements reflect this. For instance, there are a number of areas where written guidance on how to meet service users’ current needs is not up-to-date. This can cause inconsistent or inappropriate care, and so must be addressed. There has also been a lack of formal supervision of staff during 2006, and staff meeting minutes were not available beyond January. Management must ensure that this is improved on. Management must ensure that staff always treat service users respectfully. This refers in particular to where one service user has become increasingly dependent on staff support. The manager must ensure that the ongoing work, to enable at least half of the staff team to achieve NVQ qualifications, is fully realised. The current staff team has no-one with such a qualification, albeit a number of staff are working towards it. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 7 Two specific recruitment check issues were put to the manager as immediate requirements at the end of the inspection, as the shortfalls potentially put service users at risk of having unsuitable staff supporting them. The manager must ensure that new staff always have suitable written references and Criminal Record Bureau checks in place before they start work. 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. 6 Honister Gardens DS0000017582.V296472.R01.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 6 Honister Gardens DS0000017582.V296472.R01.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ needs are suitably assessed in advance of moving in. The home aims to meet these needs through such things as providing staff with relevant training and through liaison with community health professionals. EVIDENCE: No one has moved permanently into the home since the last inspection. The home continues to have one vacancy. The manager reported that the vacant room was used once within the last year, to accommodate someone for a short respite period, and that the placement had worked out well. Checks of the file on the above person showed that a social worker’s assessment had been obtained, and that the person’s needs had also been assessed by the home’s manager. This was a broad assessment that highlighted key care needs, and which matched the social worker’s assessment. The evidence shows therefore that suitable assessment processes were undertaken. Records and feedback showed that the previous requirement to supply dementia care training, to help meet the specific needs of one service user, has been addressed. Staff showed good awareness of general and specific needs in this respect. Records also showed how community health professional support is acquired where needed. 6 Honister Gardens DS0000017582.V296472.R01.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are with the clear guidance provided in response to service users’ needs on their care plans and risk assessments, that service users can make choices about their lifestyles, and that they are treated individually. The key improvement needed is with keeping care plans up-to-date so as to reflect changed needs, which will better enable staff to provide consistent and appropriate care. EVIDENCE: The main support guidance for each service user was in the form of risk assessments that were generally revised at the start of 2006. Each person had a care plan dating from a review meeting, although these were not up-to-date, according to feedback, on files that are easily accessible to staff. This can contribute to inconsistent or inappropriate care, and so must be promptly addressed. Management noted that the support needs of service users are discussed verbally with staff, and may also be documented within staff meeting minutes. However, there are identified shortfalls in both of these respects that are discussed under standards 37-43. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 11 There should additionally be a method of enabling each service user to hold their care plans, in a method that best enables them to understand the key points of the plan. This would work in conjunction with the reported involvement of service users in their formal review meetings and their verbal input with care plans. The standard of documenting risk-assessments is judged as good. The assessments are updated sufficiently often, they consider the key areas of risk, and they stipulate the actions necessary to reduce risks. They also consider rights issues, such as whether or not it is safe for each service user to hold a key to their room. Feedback and records showed evidence of service users continuing to be enabled to take risks. Checks of the money that the home holds on behalf of service users showed no concerns. A suitable system of recording and receipting is in place that is individualised depending on the needs of the service user. Management are involved in supporting one service user to access their money, and are funding that service user’s personal spending in the interim. Steps have also been taken to reduce risks associated with another service user’s personal banking in the community. Feedback and observations showed that service users are able to assert themselves in making decisions about their lives, and that staff will calmly challenge inappropriate decisions such as about weather-appropriate clothing. One service user stated that they choose what to do at all times of the day. Three-monthly service user meetings are held, records for which showed discussions focussing on food and activities. 6 Honister Gardens DS0000017582.V296472.R01.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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are with providing excellent standards of individual occupations and activities, supporting service users to uphold good family relations, and providing suitable diets. The main area to address is to ensure that a holiday is provided this year to service users as most did not receive one last year. EVIDENCE: Records and feedback showed that there are established college and day care placements for most service users. One other service user accesses the community independently, as has established routines in this respect. There are no concerns with the level of community and home-based activity provisions for service users. One service user said that they go out every day, and that they are happy about this. Each service user has their own pursuits, and the home helps them to follow these. Consequently for instance, some service users attend up to three evening clubs during the week, they access the local shops and library, and 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 13 those that wish to are supported to attend church. Staff support, for both attendance and transport, is provided as needed. The home has established a system of using Dial-a-Ride services for many transportation needs. Management stated that one service user was supported to visit relatives in Ireland last year. The other service users did not receive a holiday. Plans for a holiday earlier this year fell through, but are being aimed now for September. The manager should ensure that this holiday takes place as planned. Records and feedback, including from comment cards, showed that the home provides good support to the relationships between service users and their families. Visitors are made welcome, service users are supported to visit their families, and the service supports families to acquire equipment for the service users where needed. Some families have overall control of the service user’s finances, and records showed that established systems of providing finances for personal shopping are in place. Records, feedback and observations showed that service users’ rights and responsibilities are suitably addressed. For instance, those service users assessed as capable are provided with keys to the home and their rooms. Care is provided individually, and service users are seen to have both the freedom of the home and the privacy of their rooms. Feedback about food from the one service user spoken with was positive, including that they have choice over what is provided. There was a plentiful supply of food from the start of the unannounced visit. Menus are nutritious, and have been planned with the diabetic needs of one service user in mind, including through staff training and clinical guidance. 6 Honister Gardens DS0000017582.V296472.R01.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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a good standard of acquiring health professional support as needed for service users, and the home has established medication systems. Improvements are needed with completing the documentation around health professional input so as to help address professional advice, ensuring that guidance for short-term and PRN (as-needed) medication is clear, and with upholding the dignity of service users when their needs deteriorate. EVIDENCE: Feedback, observations, and records showed that most service users receive appropriate personal support. Service users’ appearance was reasonable, and staff supportively challenged some poor decisions in this respect. For one service user with higher dependency needs, the necessary personal support was not fully in place. Whilst it was evident that the service user was recovering from a short illness, they did not have all the necessary equipment to support them with movement in and out of the house. They were also receiving some personal care in the lounge due to this restricted mobility, and in one case the inspector was not asked to leave before the personal care began. The necessary equipment was confirmed as in place shortly before the 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 15 end of the inspection visits. The manager must ensure that personal care is provided in a respectful manner at all times. Feedback from staff and management established that service users receive good support to access appropriate health professionals, including specialists such as dieticians, occupational therapists and psychologists. This has resulted in such things as specific training for staff, and a revised menu. The home also has a good record of acquiring GP input as needed. It was found that there lacked clear written guidance on what the concerning levels are for the diabetic blood tests that one service user undertakes. The tests were also being undertaken a little less frequently than then planned for. This could put the service user at risk of not receiving the necessary treatment, which the manager must address. Checks of service users’ individual health records found that there were some shortfalls in the ongoing capturing of health appointments and outcomes. This can prevent professional advice being implemented, and can lead to inconsistent care. The manager must ensure that this is addressed. It is noted however that many of the appointment outcomes are captured in writing. The home uses the Nomad system of medication. None of the service users self-medicate. Records and feedback showed that staff have received external training in the handling of medication. Checks of two service users’ medications found suitable standards in place for one service user, but some shortfalls for the other. The improvements needed are: • For there to be clear written guidance on when to use PRN (as-needed) medications, and when to consequently refer for GP input, as there were none. This was compounded by the PRN paracetamol having been recently changed to short-term regular use by the GP, according to feedback, but again with no written record of the circumstances of this or of when to end the short-term treatment. • For prescribed medications to always be in stock. The paracetamol in the above case had run out two days previously, with no sign of it being replaced. 6 Honister Gardens DS0000017582.V296472.R01.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure that enables people to raise issues. Policies and training help to prevent service users from being abused. EVIDENCE: The home has a suitable complaints procedure in place. It includes for staff to record complaints on designated forms that are easily available downstairs. There have been no complaints since 2004 according to the complaints file. The file contained a recent written compliment from a relative. Comment cards from relatives had no complaints but noted being aware of the home’s complaints procedure. The one service user spoken with said that they would speak with staff if they were not happy. The home’s abuse-prevention policies were seen to be generally comprehensive. A recommended improvement would be to clarify timescales for reporting allegations to the CSCI and to social workers, as this was unclear from the policies. The manager stated that the training is covered in induction and through training videos, along with attendance last year at a local council training day for some staff. The manager said that they have liaised with the local council’s learning disability team in respect of working on some service users’ challenging behaviours. This has included through staff training. Consequently positive 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 17 behaviour programs are in place for individual service users where applicable, and further staff training is planned for. Detailed records are kept of accidents and incidents. Where this involves aggression from a service user, staff responses show emphasis towards remaining calm and on separating involved people. Staff also gave appropriate responses when asked about how they would respond to challenging behaviour from service users. 6 Honister Gardens DS0000017582.V296472.R01.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, 26, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s shower room has been refurbished, and equipment to aid independence is being acquired where needed. Improvements are needed to uphold suitable standards of hygiene in the laundry area, and to address the mould build-up in a small area of one bedroom. EVIDENCE: There has been no change to the structure of the home since the last inspection, but the shower room has been refurbished and looks attractive. The owner noted that a fixed shower seat would shortly be installed. There is also now a shed in the garden, both for storage purposes and to enable anyone who smokes cigarettes to have shelter if it is raining. Some of the service user’s rooms were inspected. They were seen to be individually decorated and furnished, and were judged as attractive. One downstairs room however had an amount of black mould building up on blistered paintwork around the corner from the washbasin. The manager agreed to address this as required. She noted that the room had been redecorated recently. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 19 Records, observations, and feedback found that one service user was in need of a wheelchair to assist with their mobility. Management initially reported that one had been borrowed but had had to be returned. They reported on the final day of the inspection that a new wheelchair was now in use. This complements the handling belt that staff were seen to use in support of attempts to assist the service user to move around. There was a reasonable standard of cleanliness throughout the house, including no offensive odours. The service user spoken with reported that staff do the cleaning. Staff feedback clarified that some service users are encouraged to, and do help with, such things as hoovering. The laundry room was seen to be in use during the visits. It contained a domestic washing machine and tumble drier. The room lacked soap and a bin when inspected, which means staff have to go into the kitchen to dispose of gloves and to wash their hands. This can potentially cause poor hygiene, and so must be addressed. 6 Honister Gardens DS0000017582.V296472.R01.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 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Strengths are with providing training to help meet service users’ needs, and with upholding expected staffing levels. Improvements are needed to ensure that enough staff become qualified in NVQs, that all staff receive regular planned supervision sessions, and that appropriate recruitment practices are upheld. EVIDENCE: Feedback about staff from service users, and from all comment cards, was positive. Discussions with staff found a majority being able to explain how recent training, in such areas as dementia and diabetes, has influenced their work in the home. Observations found staff to undertake their work in a generally appropriate manner. Management stated that they provide funding in conjunction with local training support schemes, in support of staff achieving NVQs. No-one in the staff team had an NVQ qualification at the time of inspection, but one staff member has equivalent qualifications, and four were undertaking the course at the time with some almost completed. Successful completion should address the training target, of 50 of the staff team having NVQ qualifications in care, as required. Additionally, a further intake of staff on the course is planned for September. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 21 Feedback and records showed that management are addressing staff training needs. Standard refresher courses such as for manual handling and first aid have either been provided or are shortly planned for. Up-to-date individual training profiles are in place for all staff, and a general training plan is in place for the business. The general plan should however make reference to NVQs. The manager is the organisation’s training co-ordinator. She explained that she is qualified to undertake training in some areas such as for food hygiene, and she showed that the organisation has a number of training resources including videos and training packages. The induction-training package was seen to be a wide-ranging process with clear links to NVQ work. It is backed by a policy that links to the national training organisation, which is appropriate. There was insufficient evidence of staff being provided with appropriate supervision. Records, and staff feedback, found no evidence of supervision sessions in 2006, although the feedback generally also found that staff feel that they can get support if necessary. There are supervision records, using the organisation’s standard template, from 2005. The manager noted that supervision has happened, but more informally, and that the organisation is currently undertaking appraisals for all staff. Appraisal planning records were seen to be individual and improvement focussed. This is useful. There remains a need to ensure that staff receive planned time to discuss their work, to help to ensure that staff receive appropriate support and guidance, and to assist management with overseeing the home. The manager must ensure that each staff member therefore receives a planned supervision session at least every two months. Rosters for the week, and the previous week, showed that a team of ten female staff currently cover the shifts in the home with the occasional support of agency staff. There is consequently at least two staff working in the home at all times except for during the day when all or most of the service users are out. There is one waking night staff and one sleep-over staff. This is generally sufficient to meet service users needs. The specific needs of one service user has recently put pressure on the service. Following the advice of a health professional, management confirmed their intention to follow this advice and provide additional staffing to meet that service user’s needs, in advance of funding agreements being reached with the relevant local authority. This is good practice. Three staff files were checked through in terms of recruitment, including one relating to a new staff member. The files showed that reasonable checks of identification are in place, and that application forms and interviews form part of the process. For a new staff member however, one written reference was 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 22 missing. Management said that it was acquired at the time, but that they would ensure now that a reference from the most recent care employer would instead be obtained, as required. Suitable Criminal Record Bureau checks were in place for most staff checked on, but one shortfall was identified. Management stated that this was due to more information being needed on the application form, which they would address. These specific recruitment issues were put to the manager in writing as immediate requirements at the end of the inspection, as these shortfalls potentially put service users at risk of having unsuitable staff supporting them. 6 Honister Gardens DS0000017582.V296472.R01.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): 37, 38, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are reasonable standards of health and safety provision, and the home has an experienced manager who demonstrates creative management skills. Improvements are needed with ensuring that the management of the home provides sufficient guidance and monitoring of staff. EVIDENCE: The manager has managed this home since it opened about three years ago. She is finishing an appropriate NVQ level 4 qualification, and she has a degree in management in another field. She demonstrated good management ability during inspection discussions, and through some records that were viewed. The manager has been on maternity leave during the early months of 2006. She is gradually returning to work. The home has been mainly overseen during this time by the owner, who visits regularly and who was seen to be wellknown to staff and service users, and the deputy, who works two days a week and briefly visits at other stages. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 24 The inspector raised concerns with management about some aspects of how the home was found to be operating. This includes about some lack of up-todate written guidance in respect of service users’ changing needs, a lack of upto-date staff meeting records being available in the home, a diary which shows that broken equipment is sometimes not promptly replaced, and the lack of recent formal supervision sessions of staff. Additionally, such good ideas as requesting staff to sign confirmation of reading new guidance or policies was found not to have worked out well. For instance, for the updated service user risk assessments, most staff had not signed the sheet despite it being available since February. Management stated that the home is well-managed, but noted that it is not running as well as in the past, as there are a few issues to address. It was clear that a number of these issues have been identified and that actions to address them were being planned. This is encouraging. Nonetheless, the partial lack of recent monitoring of staff allows staff to work inconsistently and without sufficient guidance, which can have a detrimental effect on service users. Management must ensure that this is fully addressed. Management must also ensure that standard records are kept up-to-date and available for use as needed. For instance, the menu was six days out-of-date at the time of the initial visit, and the staff meeting minutes on display for staff were from January. The home’s quality assurance policy was seen to aim to meet standard 39. The manager noted that quality issues are discussed informally with service users and their families on a regular basis, as befits a home of this size. She plans to review the service’s development plan this year, and provided a copy of the sample questionnaire with which to ask all involved people on their views of the home. Health and safety considerations were generally up-to-date. There were suitable checks of the fire systems and equipment by staff, backed by a fire safety risk assessment dating from January 2006. Up-to-date professional checks were in place for the fire system and equipment, the gas system, electrical wiring, and portable electrical appliances. On both of the visits to the home, there was a screw protruding from a drawer under the sink in the kitchen. Its purpose would have been to fasten a knob onto the drawer, however without the knob it is judged to potentially cause an injury. The manager must ensure that it is made safe, and that staff address similar safety concerns promptly. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 25 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 2 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 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 2 3 X 2 2 X 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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(2) Requirement The manager must ensure that each service user’s care plan is updated whenever their needs change significantly. The manager must ensure that personal care is provided in a respectful manner at all times. The manager must ensure that, for one service user who undertakes diabetic blood tests: • the tests take place according to the planned frequency; and • there is written guidance as to what would be a concerning test result and what actions to then take. The manager must ensure that records are kept of all health appointments, including all professional advice from these, within each service user’s care file, as this was not always the case. The manager must ensure that there is clear written guidance on when to use PRN (as-needed) medications, and when to consequently refer for GP input, for each applicable service user. DS0000017582.V296472.R01.S.doc Timescale for action 15/07/06 2 3 YA18 YA19 12(4), 23(2)(n) 13(1), 15, 18(1)(a) 15/06/06 15/06/06 4 YA19 17(1)(a) sch3 pt3(m) 01/07/06 5 YA20 13(2) 01/08/06 6 Honister Gardens Version 5.2 Page 27 6 YA20 13(2) 7 YA24 8 YA30 9 YA32 10 YA34 11 YA34 12 YA36 13 YA38 14 YA41 The manager must ensure that prescribed medications are in stock, or else are promptly restocked, as there was a shortfall in this respect. 23(2)(d) The manager must ensure that the black mould building up on blistered paintwork around the corner from the washbasin, in one bedroom downstairs, is removed of, and that the area is then redecorated. 13(3) The manager must ensure that soap and a bin are available for use at all times in the laundry area. 10(1)(a), The manager must ensure that 18(1)(c) the ongoing process of NVQ training for staff results in 50 of staff achieving the training in due course. Misc Amnd The registered people must Regs 2(6) ensure, with immediate effect, that all new staff have two written references, including one from their last employer in which they worked with children or vulnerable adults for a period of three months or more, before they are employed with SFI. 17(2) s4 The registered people must pt 6(f) ensure that, for a named staff member, a suitable CRB and POVA-First check is promptly acquired, and that the CSCI is kept notified of this. 10(1), The manager must ensure that 18(2) each staff member receives a planned supervision session at least every two months. 10(1), Management must ensure that 18(2) the partial lack of recent monitoring of staff is fully addressed. 17(3)(a) Management must ensure that standard records are kept up-todate and available for use as needed. DS0000017582.V296472.R01.S.doc 15/06/06 01/08/06 15/06/06 01/12/06 15/06/06 15/07/06 01/09/06 01/08/06 01/07/06 6 Honister Gardens Version 5.2 Page 28 15 YA42 10(1), 13(4) The manager must ensure that the loose screw, protruding from a drawer under the sink in the kitchen, is made safe, and that staff address similar safety concerns promptly. 01/07/06 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 4 Refer to Standard YA6 YA14 YA23 YA32 Good Practice Recommendations There should be a method of enabling each service user to hold their care plans, in a method that best enables them to understand the key points of the plan. The manager should ensure that the holiday, provisionally planned for September 2006, takes place as planned, as recently-planned holidays have not happened. It is recommended to clarify timescales for reporting abuse allegations to the CSCI and to social workers, as this was unclear from the abuse-prevention policies. The general training plan should make reference to NVQs. 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 6 Honister Gardens DS0000017582.V296472.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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