CARE HOME ADULTS 18-65
72a Broad Street House 1 Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP Lead Inspector
Andrea James Unannounced Inspection 19th January 2006 12:06 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 72a Broad Street House 1 Address Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP 01462 814196 01462 850689 pauline.jarman@hft.org.uk www.hft.org.uk Home Farm Trust 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) Pauline Jarman Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: 72A Broad Street (Ash and Birch) was a purpose built house owned by Home Farm Trust situated in a site recessed from the main street in the village of Clifton. On the same site was a second house provided by HFT for eight people with learning disabilities and the two houses shared a common paddock in addition to their individual gardens.
The house was divided into two units namely Ash and Birch, each with a lounge, dining room and kitchen. One unit catered for people with Prader-Willie syndrome and the other for people with complex communication needs. Each service user had a single bedroom. In each unit were two bathrooms and a shower room with a total of seven toilets between the two units. Staff were provided with a room with en-suite facilities, which was also used as the main office. This room was situated between the two units and formed the link on the first floor between both units. The ground floor link was the communal laundry. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over a 4 hour period on the 19th of January 2006. A partial tour of the home took place the staff and service users were spoken to. The focus of the inspection undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for service users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that needs further development. The primary method of inspection used was “case tracking” which involved selecting a sample service users and tracking the care they received through review of their records, discussion with them, the care staff and observation of care practices. The inspection report additionally addresses specific areas where requirements and or/ recommendations were identified at the previous inspection in June 2005. This was the second of the two inspections required to be undertaken by the Commission and as a result some standards that were assessed and met at the last inspection were not assessed on this occasion. What the service does well:
The home provided very good standards of care to the service users who appeared happy and relaxed. Staff and service users spoken to said they were happy. The care staff said the home was dedicated to meeting the needs of the service users. On observation service users appeared to have a good relationship with the care staff and the management team. The home was clean and free from offensive odours and in good decorative order. The service users had a full activity programme, which included college courses, part-time jobs, attending various day care centres and they were also able to access various community activities of their choice. Service users spoken to said they had regular contact with their families and enjoyed having weekend breaks with them or having them visit the home. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The home should develop their quality assurance system to ensure the service offered is monitored and reviewed on a regular basis. A development plan should also be available to suggest regular monitoring is undertaken for all aspects of the home. Some care plans had not been developed and should therefore be addressed to ensure they meet the same standards of those that have been developed to meet the standards. Their was a need to ensure employment laws are maintained in the home by making available the correct documentation that showed staff were not employed before satisfactory clearances were obtained. The home should ensure at least 50 of the care staff obtains their NVQ level 2 in care qualification. The home had one service user who was a diabetic and his insulin was being drawn up seven days before administering. The medication inspector had addressed the issue with the medical professionals but the procedures had not
72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 7 been changed. The home was in agreement to make changes but found the district nurses reluctant to change their procedures. The Commission would like to thank the service users, care staff and the management team for their co-operation in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion but were met at the last inspection. EVIDENCE: 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9. The service users needs were set out in individual plans that identified their assessed needs, personal care needs and health care needs. There was evidence to suggest that consultation was sought from some service users and their personal goals were reflected. However some care plans still failed to be developed to the same standard and as a result not all service users records showed that they were offered the same opportunities. Service users were encouraged to take risks in order to maximise their independence. EVIDENCE: The home had changed their care plan structures, which resulted in creating individual documents for each service user. The documents consisted of assessment tools, care intervention, service users consultations, daily notes and personal goals. There were also reflective practices where reviews were carried out to ensure these goals were being met. There were however some service users whose documents were not updated to reflect the new system and as a result it was difficult to identify how the home was meeting or addressing their needs.
72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 11 There was evidence to suggest service users were encouraged to take risks as one service user was enabled to have a part- time job while other received training in using public transport and managing their own finances. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14. Service users were encouraged to take part in community activities and appropriate leisure activities, as a result they were living a good quality of life, which ensured they were able to maximise their independence. EVIDENCE: Service users spoken to said they were able to have access to community resources. On the day of the inspection staff were observed taking service users to various places of interest. A service user had staffing input while he pursued part time employment. Service users were also encouraged to take part in the weekly shopping trips. Records showed that they attended various community activities on a regular basis. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20. Service users daily lives suggested that they were supported in the way they preferred and their medication needs were met satisfactorily. This resulted in service users having good standards of care. EVIDENCE: Service users spoken to said they enjoyed living at the home, and although restrictions were place on some service users they appeared to understand the reasons. Records viewed suggested service users received personal support in the way they preferred and most were encouraged to maximise their independence. The home had recently ensured all care staff were trained in medication and the procedures implemented suggested that service users safety was not compromised. There were still some discrepancies in regards to district nurses drawing up insulin 7 days in advance, but the procedure for the service user taking insulin home had changed to reflect safer usage. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 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): 23. The home had satisfactory procedures in place to ensure any suspected abuse would be adequately addressed thus ensuring the safety of the service users. EVIDENCE: The home had a Protection of Vulnerable Adults policy in place, which included whistle blowing and staff spoken to said they were aware of the procedure. Some staff had also embarked on abuse awareness training. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 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): 25,26 and 30 The environmental standards of the home met with the needs of the service users and as a result service users bedrooms met their needs and promoted their independence. The home was also clean and had no offensive odours. EVIDENCE: The home ensured that all service users had individual bedrooms, which were decorated to their tastes and requirements. Service users had free access to their bedrooms and were encouraged to take responsibility to maintain cleanliness. Service users spoken to said they liked their bedrooms. The home was clean and free from offensive odours throughout. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 16 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): 34 and 35 The home had a stable and effective staff team who had received improved training and supervision since the last inspection, which resulted in a more effective work force that would reflect on good care practices for the service users. Better procedures needed to be in place to ensure new staff members clearances are obtained in the home prior to them commencing employment. This would ensure the safety of the service users at all times. EVIDENCE: The home had a good and stable staff team that appeared dedicated to meeting the needs of the service users. The staff spoken to said they were happy and felt that they received better supervision and their training needs were being met. The home had a structures programme in place to ensure all staff received supervision and the training records suggested that staff needs were being met in regards to training. Some staff files inspected suggested that satisfactorily clearances were not obtained in the home prior to new staff commencing employment. The manager explained that paper work often went to the head office before being filtered to the home. This resulted in references and Criminal record Bureau checks not being available to view on the day of the inspection. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 17 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, 40 and 42 The home was under good leadership and was in the process of reviewing and updating their policies and procedures and all health and safety procedures were satisfactorily maintained. However the home’s ability to monitor their service delivery through quality monitoring processes was poor. EVIDENCE: The management structure within the home was praised by the staff team who appeared more confident and relaxed. The homes policies and procedures were being reviewed to reflect good care practices and some had already been updated. The home continued to maintain good health and safety procedures and the records checked including fire safety were satisfactorily maintained. The home needed to further develop their quality assurance systems to reflect the good practices offered to service users through regular monitoring. 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 x 25 3 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x x x 2 3 x 3 x 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 19 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 (1b) (c) 13 (2) Requirement Timescale for action 30/03/06 2. YA20 3 YA34 19 4. YA39 24 91)(a) Arrangements must be made to ensure all service users care plans are updated to meet the requirements of the standard. Arrangements must be made for 30/04/06 insulin syringes to be drawn up on a daily basis and not weekly. Previous timescales: 30/08/06.30/01/06.30/08/05 Arrangements must be made to 30/03/06 ensure satisfactory clearances are obtained within the home prior to new staff commencing their employment. Arrangements must be made for 30/04/06 the quality assurance system to be implemented in the home to review quality monitoring. Previous timescale 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000014884.V279797.R01.S.doc Version 5.1 Page 20 72a Broad Street House 1 1. Standard None None 72a Broad Street House 1 DS0000014884.V279797.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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