CARE HOME ADULTS 18-65
72a Broad Street House 2 Cedar And Douglas Units 72a Broad Street Clifton Shefford Bedfordshire SG17 5RP Lead Inspector
Andrea James Unannounced Inspection 19th January 2006 12:08 72a Broad Street House 2 DS0000014885.V279798.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 2 DS0000014885.V279798.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 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 72a Broad Street House 2 Address 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) Cedar And Douglas Units 72a Broad Street Clifton Shefford Bedfordshire SG17 5RP 01462 813824 01462 813824 diane.humberstone@hft.org.uk www.hft.org.uk Home Farm Trust Mr John Masterson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 72a Broad Street House 2 DS0000014885.V279798.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: Cedar and Douglas was one of two homes run by the Home Farm Trust in the small town of Clifton. The building was divided into two units to support 8 adults with learning disabilities; the units catered for 8 service users with complex needs and autism. The units were designed to accommodate four service users independently from the other unit. As a result of this, each unit had its own kitchen, lounge and bathing facilities and was linked by the laundry room on the ground floor and the staff room on the top floor. There were separate entrances to each unit and service users communally shared the garden facilities. The home was situated close to local amenities including shops and pubs. The service users were able to access other towns such as Bedford, Biggleswade and Shefford with the use of their local transport or route cars and the homes own transport facilities. 72a Broad Street House 2 DS0000014885.V279798.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 and the staff and service users were spoken to. The focus of the inspection undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for service users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The primary method of inspection used was “case tracking” which involved selecting a sample 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: What has improved since the last inspection?
Since the last inspection a new manager has been in post and had worked hard in improving some care practices and their procedures. She had developed new care planning systems although this was not yet implemented for 6 of the
72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 6 8 service users. Risk assessments had improved to ensure the safety of the service users. The staff team had received various training to ensure they were aware of the needs of the service users. The home had recruited more care staff and as a result less agency cover was required in the home, thus ensuring service users receive continuity of care. The menus were improved to offer service users a choice at meal times. What they could do better:
The home had failed to meet several requirements of the last inspection. The home needs to ensure all service users receive a full and comprehensive assessment of need and that the needs identified are recorded in individual care plans that details the care interventions intended in order to meet these needs. It is also of importance that the care plans are reviewed and service users are consulted about the contents. Arrangements must be made to improve the handling of service users finances within the home to prevent service users being open to abuse. The quality assurance systems in the home needed further development to ensure the care practices within the home are reviewed to reflect good standards of care that are continuously monitored. The faulty call point system in the home should be addressed to ensure service users could be assisted if needed. At least 50 of the care staff should obtain their NVQ level 2 or equivalent to ensure they are aware of good care practice procedures when delivering care to the service users. Better management practices should be in place to ensure effective management of staffing and other performance issues are carried out satisfactorily. The wishes of service users must be recorded to include what to do in the event of terminal illness or death. A review of the medication procedures should be carried out to ensure correct records are kept for receipt of medication and guidelines are written for PRN medication stock control and returns. There was a need to review the staffing levels for units where the needs of the service users are high to ensure adequate staffing levels are available equally throughout both units. 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 7 The Commission would like to thank the service users, care staff and manager for their co-operation in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 72a Broad Street House 2 DS0000014885.V279798.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 2 DS0000014885.V279798.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 2 DS0000014885.V279798.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 and 9 The homes ability to assess and develop service users personal goals was poor and as a result several service users needs were not satisfactorily addressed. The home was good at supporting service users to take risks in order to maximise their independence both in house and in the community. EVIDENCE: The home had developed a new system that would improve their ability to assess service users needs and improve their care planning process but this was only partially completed for 2 of the 8 service users and as a result the majority of the service users need were not recorded and could not be assessed as met. The staff explained that some service users had high needs but these could not be measured because adequate care plans were not available. There was no evidence that the service users were consulted about aspects of their care, and more importantly where service users had developed or were able to take risks, these were not adequately recorded to reflect good care practice procedures.
72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 11 Care staff and service users spoken to said the home helped to promote their independence and the service users were able to take risks in order to develop and maximise their potential. It was also noted that where one service user was aging he had his college placement reduced to reflect his changing needs. 72a Broad Street House 2 DS0000014885.V279798.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): 11,12 and 16. Service users were provided with satisfactory opportunities for personal development and were able to participate in age and cultural appropriate activities and were also respected and recognised in their daily lives, as a result they lived a balanced lifestyle that met with their needs. EVIDENCE: Service users and care staff both spoke about the various opportunities available for personal developments. One service user had recently embarked on part-time employment in a pub, supported by the staff team. Others received college placements and were pursuing other areas of selfdevelopment. Service users had weekly club visits where they were able to meet with likeminded people and share in age and cultural activities. Service users were respected and their rights as individuals observed. Service users living in the home were able to decorate their rooms to their choice, have a choice of music, choice of meals and how to spend their spare time.
72a Broad Street House 2 DS0000014885.V279798.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): 20 and 21. The home needed to improve some procedures used in the receiving and administering of medication, to ensure the safety of the service users at all times. The recorded wishes of service users in the event of terminal illnesses or death was poor and as a result it could not be assessed that service users wishes would be handled with respect or carried out satisfactorily. EVIDENCE: The home had made improvements to their medication procedures but further development was needed. In some cases inspected there was no evidence that medications received were recorded. Some PRN medications were in stock for more than a year and not administered, the staff had not reviewed these medications. The manager said all staff were due to receive accredited training and as a result the areas of concern would be addressed satisfactorily. The home had a death and dying policy but the procedures for individual service users in the event of terminal illnesses or death was not recorded and as a result service users wishes could not be respected. 72a Broad Street House 2 DS0000014885.V279798.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): 22 and 23. The home had satisfactory complaints policies and procedures in place and service users were safe guarded from abuse by their protection policies, as a result service users views would be addressed if they were to complain or suffer abuse. EVIDENCE: The manager spoke about their complaints procedure and service users spoken to said they knew how to complain. The service users were provided with easy to read materials that explained how to complain. The manager said they had received one complaint since the last inspection from the neighbours and the organisation was investigating. This was in relation to the excessive noise a service user made when listening to his music. The home also had a Protection of Vulnerable Adults (POVA) issue where a member of staff had been suspended. The manager said staff had received POVA training but on speaking to the staff team on shift they had very little understanding of the procedures to follow. The home still needed to ensure satisfactory procedures are in place to record the transactions when using service users finances. The records showed that only one signature was used for transactions and when service users are given personal pocket money sometimes these are not recorded. 72a Broad Street House 2 DS0000014885.V279798.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): These standards were not assessed on this occasion. EVIDENCE: 72a Broad Street House 2 DS0000014885.V279798.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): 31,32,33,35 and 36. The staffing structures within the home were poor and as a result staff roles and responsibilities were disjointed and did not always meet the needs of the service users. Staff were effectively supervised and received adequate training in order to carry out their duties to the service users. EVIDENCE: The manager had identified recent problems in the staffing structure where a culture had developed that impacted negatively on the service users. The care staff spoken to said some care staff had refused to work with the more difficult service users and thus on some shifts the service users were not adequately supported. The manager said that the needs of the service users had also exceeded the ratio of staff available and this prevented the more able service users to embark on social development. The home used an average of 54 hours per week agency cover but said they were consistent in the staff they had each time. The home had ensured that several aspects of training were undertaken by the staff team to include dementia, dealing with challenging behaviour, autism
72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 17 and risk assessment. Future training was also scheduled that would ensure the staff will be effectively trained. The home had 14 care staff and, although 3 staff had embarked on their NVQ level 2 in care, no staff had yet achieved the qualification. Staff spoken to said they received regular supervision and staff meetings and they felt supported to do their jobs. 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 18 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 and 42. The home benefited from a manager who created a welcoming and homely atmosphere where service users could feel safe, but some aspects of the management practices needed further development. The health and safety aspects of the home were satisfactory but the quality monitoring systems needed further development to ensure service users are receiving satisfactory standards of care. EVIDENCE: The manager showed tremendous strengths in her attitude towards the running of the home. She had recently submitted her application for registration and was due to complete her NVQ level 4 in the near future. The inspection identified that there was a lack of understanding on some management aspects of the home and until recently had not received satisfactory induction, supervision or appraisal in her new post. 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 19 The home still needed to improve their quality assurance systems to ensure effective monitoring is carried out on service delivery for the service users. The home had satisfactory health and safety procedures in place and the records checked were satisfactorily maintained. 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 20 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 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 1 3 3 2 X X 3 X 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 21 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. Standard Regulation 1. YA2 14 (1) (a) Requirement Arrangements must be made for all service users to receive a full assessment that identifies their needs to be provided by the home. Previous timescales: 30/03/05.30/08/05. Arrangements must be made to implement and improve all care plans in the home. These must demonstrate the identified needs of the service users and the intended plan of care. Previous timescales:03/11/03.30/10/04.08/03/05 and 30/08/05. Consultation must be sought where possible for all plan of care recorded for the service users. Previous timescale: 30/08/05. Arrangements must be made to ensure satisfactory stock control measures are in place for all medications used in the home. Arrangements must be made to improve the medication procedures in the home to ensure all medications received are recorded and correctly audited before storing. The wishes of all service users must be recorded in respect of terminal illness and death. Arrangements must be made to improve the handling of service users finances within the home. Previous timescale: 30/07/05 Sufficient staff must be employed in the home in such numbers as to meet the needs of the
DS0000014885.V279798.R01.S.doc Version 5.1 Page 22 Timescale for action 30/04/06 2. YA6 15 (1) (2)(a,b,c) 30/04/06 3. 4 5 YA6 YA20 YA20 15 (2) 13 (2) 13 (2) 30/04/06 30/03/06 30/03/06 6 7. 8. YA21 YA23 YA33 12 (2) 13 (6) 18 (1) (a) 30/04/06 30/03/06 30/06/06 72a Broad Street House 2 9. YA39 10. YA42 service users. Previous timescales: 30/03/05.30/08/05. 24(1) Quality assurance system must be implemented in the home in order to monitor the service being provided. Previous timescales:01/12/04.30/03/05 and 30/08/05. 13 (4) ( c) The call point system in the disabled toilet must be improved in order that it can be heard in other parts of the building. Previous timescales; 30/01/04. 30/03/05 and 30/08/05. 30/04/06 30/05/06 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 Refer to Standard YA3 YA20 Good Practice Recommendations Arrangements should be made to review the needs of all service users to ensure the home is able to meet their needs. The home should ensure all service users medications are reviewed on a regular basis especially in the cases where service users no longer need to take prescribed medications. The home should ensure the staff are aware of the procedures to follow in the event that they observed or know of abuse occurring to service users. The home should provide evidence of how 50 of the care staff will obtain their NVQ level 2 in care. The providers should consider offering the manager further training in management development. Better arrangements should be made to ensure sufficient support is available to the manager. 3 4 5 6 YA23 YA32 YA37 YA37 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 23 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
© 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 72a Broad Street House 2 DS0000014885.V279798.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
