Inspection on 13/08/07 for 8 Haslerig Close

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Haslerig Close 16/07/09

8 Haslerig Close 16/07/08

8 Haslerig Close 27/06/06

8 Haslerig Close 27/01/06

8 Haslerig Close 25/11/04

8 Haslerig Close 17/05/04

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

CARE HOME ADULTS 18-65 Haslerig Close (8) Harvey Road Aylesbury Bucks HP21 9PH Lead Inspector Mike Murphy Unannounced Inspection 13 August 2007 10:00 Haslerig Close (8) DS0000023040.V338616.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 Haslerig Close (8) DS0000023040.V338616.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. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haslerig Close (8) Address Harvey Road Aylesbury Bucks HP21 9PH 01296 331381 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) haslerigclose-londoneast@maca.org.uk www.together-uk.org Together Working for Wellbeing Mr Emmanuel Tawiah Mensah Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Haslerig Close (8) is a detached house in a quiet cul-de-sac on the outskirts of Aylesbury with good access to local amenities and public transport. The home seems well integrated into the local community. The home provides twentyfour hour care for up to eight persons with a mental health problem. Accommodation is domestic in style and each service user has their own bedroom. The home is run by ‘Together Working for Wellbeing’ (formerly known as the Mental Aftercare Association (MACA)). There is an established staff team which is supported by relief staff. The staff team liaise with health professionals and other services in the community to ensure that residents receive appropriate care and support. At the time of this inspection the fees for this service were £800 per week. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in August 2007 and included an unannounced whole day visit to the home over the course of a Monday. The inspection included discussion with the manager, residents, visitors and staff, consideration of information supplied by the registered manager in advance of the inspection, consideration of CSCI survey forms completed by residents and relatives, a tour of the home and grounds, observation of practice, and examination of records. The process included tracking the care of four residents and consideration of how the home was addressing the equality and diversity needs of its residents. The home is located in a residential area, next to Stoke Mandeville Hospital, about one and a half miles from Aylesbury town centre. It is a detached house which provides accommodation for eight people. All bedrooms are single. None of the bedrooms have en-suite accommodation. There is a small garden to the rear of the home. The home has good arrangements for assessing the needs of prospective residents, for checking whether a newly admitted resident feels comfortable accepting a place there, and whether it can meet the needs of that person. Its arrangements for care planning are generally satisfactory and it liaises well with local health services – in particular the local community mental health team (CMHT) and residents general practitioners (GPs). It own care arrangements dovetail quite well with those agreed by the CMHT through the person’s care programme approach (CPA) care plan. The home endeavours to provide support which is consistent with a residents’ desire and ability to move forward in their lives. However, it is felt, on the basis of this inspection, that some residents might benefit from a wider programme of activities and it is recommended that the home carries out a review with residents and other stakeholders (such as relatives and the CMHT). This inspection coincided with changes in the management of the home and it is important that such a review is carefully managed in order to avoid creating uncertainty or imposing undue stress on vulnerable people. Since the last inspection the home has expanded its audit activity with a view towards achieving improvements and greater consistency in the quality of the service. However, it is felt that there are still a number of areas which may compromise the overall quality of care for residents. In particular, these include its arrangements for the storage, control and administration of medicines, some areas in the environment, some aspects of staff practice in the kitchen, and some aspects of fire safety. In drawing attention to these areas, this inspection also acknowledges the strengths of the home - in particular the quality of personal support given to residents which was highlighted by both residents and relatives. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Rigorously apply health and safety policy and practice, particularly in the kitchen and in the maintenance of fire safety equipment, to ensure that the environment is safe for residents. Improve policy and practice with regard to the storage, control and administration of medicines to minimise the risk of errors in administration and give residents the chance to manage their own medicines. Develop quality assurance procedures so that the standards being assessed when audits are carried out are clear. These should include systems for identifying items in the environment which need repair or replacement. This will improve the overall quality of the service to residents by supporting good standards of practice. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 7 Conduct a review of activities in the community so that residents, individually and collectively, have a wide and appropriate range to choose from and are supported by staff. 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. The summary of this inspection report can be made available in other formats on request. Haslerig Close (8) DS0000023040.V338616.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 Haslerig Close (8) DS0000023040.V338616.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are thoroughly assessed by experienced managers before admission to ensure that the home can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: The statement of purpose and service user’s guide were in the process of being updated at the time of this inspection and copies were not immediately available on the day of the inspection visit. In the circumstances therefore, standard 1 of this section was not assessed on this inspection. The home has a system for processing referrals. Referrals are made via local community mental health services funded by the primary care trust (PCT) and social services. At the point of referral the home has access to the person’s care plan (for mental health services this is known as the care programme approach (CPA)) and include risk assessments carried out by professional staff working with the community mental health team (CMHT). Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 10 This information is considered by the home and if the referral is to be considered further then the relevant multi-agency panel is informed. If the person is happy with the referral to continue then he or she completes an application form for a place in the home. Arrangements are then made for the manager or deputy manager to establish contact with the person. This leads to an invitation to visit the home where an assessment, using the home’s own assessment form, is carried out. If the referral progresses further then the person is invited to visit again, stay for a night and perhaps for a weekend before a four week trial admission is arranged. At the end of the four weeks a review is held between the resident, home staff and the relevant member of the CMHT – social worker or community psychiatric nurse (CPN). Admission for as long as the person needs it is then agreed. There is no limit on how long a person may live in the home. The records of a resident admitted since the last admission confirmed that this process takes place in practice. The record included a copy of the person’s CPA care plan, risk assessments, the home’s own assessment, and a review at the four week stage. The process aims to ensure that the home is able to meet the needs of the prospective resident and that the person is happy moving in to the home. From the evidence of this inspection there is good liaison between the home and relevant statutory agencies in both sharing information and in supporting the person during the transition from their current place of residence (most often, hospital) to the home. New residents sign a copy of a licence agreement with the ‘Places for People’ housing association which is responsible for the building. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A care plan is in place for each resident. Care plans include risk assessments and evidence of good liaison with health and social care agencies in the community. The participation of residents is sought through care planning, day-to-day encounters, and regular house meetings. Together, these activities aim to ensure that peoples’ needs are met, that their independence is supported, and that the residents can influence life in the home. EVIDENCE: There was a care plan for each resident. The care of four residents was ‘case tracked’ on this inspection. Care plan files include; the personal details of the person, the licence agreement with ‘Places for People’, a record of appointments with health professionals, risk assessment forms completed by the CMHT, assessment records, and correspondence. Some care plans included a photograph of the person, others did not. Photos of all residents were said to be in a file to be used in an emergency. When this file was requested towards Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 12 the end of the inspection (around 6:15 pm, after the acting manager had finished her shift) it could not be located at that time. The care plan itself includes; the residents preferred ‘Morning Routine’, ‘Mobility/Exercise’, ‘Mental Agility/Communication’, ‘Mental Health’, ‘General Behaviour’, ‘Personal Care’, ‘Living Skills’, ‘Budgeting’, ‘Relationships’, ‘Traffic Safety’, ‘Public Transport’,’ Medication’, ‘Future Plans’, ‘Vulnerability’, ‘Life Style’, ‘Physical Health’, ‘Diet/Nutrition’ And ‘Night Time’. The content in the entry under each of these headings identifies strengths, which need to be maintained, and areas where varying degrees of support are needed. Most care plans were signed by the resident and their key worker. Some care plans were noted to include specific instructions to staff on the action to follow where behaviour may be giving cause for concern – a good practice. Care plans are reviewed monthly in the home, and about twice a year – more often where necessary – with the CMHT. Daily notes are maintained in a separate folder and consist of fairly straightforward accounts of how the resident was and what they did during the course of the staff shift. Residents are supported in making decisions and allowed to progress at a pace which suits them. One resident outlined how staff support had enabled him to attend a centre in Aylesbury. The process had helped to build up his confidence and he was now able to spend more time outside the home on his own. An advocate from Aylesbury Vale Advocates drops in to the home a couple of times month. The advocate visited during the course of the inspection and was happy to contribute to it. The advocate had recently been appointed as an Independent Mental Capacity Advocate (IMCA), a position created under the Mental Capacity Act 2005, to support a person, in certain circumstances, who ‘lacks capacity’ and does not have other arrangements in place to provide such support. In this home the IMCA felt that it would be a useful role in multidisciplinary meetings held by statutory organisation (such as the CMHT). Arrangements are in place to support residents to manage their finances – these include a bank account for the resident, facilities for keeping smaller amounts of cash, and support to residents in looking after their valuable. Details are recorded in care plans. Lockable facilities are available to every resident. Cash transactions are recorded and the balance in the safe is checked at every staff handover. A check of one box towards the end of this inspection visit showed that the balance of cash in the safe corresponded with the records. Residents’ participation in the running of the home is encouraged through day to day interactions and activities and through regular house meetings between residents and staff. Meetings have been held monthly to date but it is proposed that these now be held every two months. The notes of recent meetings were read. It was interesting to read that the subject of ‘Equality and Diversity’ was to be on the agenda for the next meeting. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 13 Risk assessments are recorded in care plans. These follow from the risk assessments carried out under the CPA and already recorded in care plans and correspondence. The process of risk assessment appeared an open one and to involve the resident. Communications between the home and CMHT support good risk management although there were indications that, out of hours, problems may be encountered with some on-call doctors. More generally, good arrangements are in place for dealing with risks associated with the control of substances harmful to health (COSHH) – although the home is performing less well in terms of risks associated with some aspects of fire safety. Through observation during this inspection, and through conversation with residents and others, the home is generally considered to provide a safe environment for residents. However, the weaknesses with regard to fire safety cannot be ignored (see standard 42 below). Arrangements for maintaining the confidentiality of information appear satisfactory. A support worker was noted to close the office door while making a telephone conversation about a resident. Systems are in place for the secure storage of records. According to information supplied to CSCI by the former manager, the organisation has policies governing ‘Access to files by staff/users’, ‘Confidentiality and disclosure of information ‘and ‘Record keeping’. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that people have experience of a range of social, leisure and other activities and are involved with the local community. There seems scope however, for the range of activities to be reviewed and increased, with potential benefits for the quality of life of residents. EVIDENCE: None of the residents was ready for employment at the time of this inspection. Many residents kept in contact with friends or acquaintances and met up with them at church, at a nearby mental health unit (the ‘Tindal Centre’) or at a social support centre (‘Wings’) in Aylesbury. On the day of the inspection visit, at varying times, two residents went to a social centre, one was out dealing with some affairs, one went out shopping, and one went to a clinic appointment. Three remained in the home on that particular day. Two were Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 15 reported not to be feeling well and the acting manager said that residents are normally more active than this. The home is located in a small close. About half of the residents go out regularly. Others prefer to stay in the home. Residents make use of local facilities such as shops, a fish and chip shop, café, and hairdressers. There is no pub in the local area but one resident occasionally visits a pub in Aylesbury town centre. The home has occasional use of a minibus (which has the facility to carry a wheelchair user if required) providing it can provide a suitably competent driver, and recently did so - visiting Whipsnade Zoo. However, when it was offered the bus a few months prior to this, it was unable to accept the offer because a driver was not available. Staff have recently introduced an entertainments evening on Friday, when the TV is turned off and residents and staff have nibbles and play board games or other activities. In terms of equality the home has male and female residents and staff, a varying age range, residents with disability, residents with religious belief, and residents and staff of different ethnic origins. At the time of this inspection the home was able to meet the potentially diverse needs of its residents. Within the home there is a TV (with ‘Freeview’ channels), DVD, music centre, and reading materials – books and magazines. Some residents do crosswords on occasions. The home has games such as Connect Four, dominoes and cards. Some residents help out with light work in the garden. It is reported that residents are not interested in holidays – preferring day trips instead. Trips out have included Whipsnade Zoo (as above), a meal at the local Holiday Inn, trips to garden centres such as that in Wendover, and a day trip to Waterperry gardens, Wheatley, near Oxford. Trips out are discussed at house meetings. Residents have variable contact with their families. One family member visiting a resident during the afternoon of the inspection visit was complimentary about the home. Visitors are free to visit at any reasonable time. Resident respondents to the CSCI survey in connection with this inspection generally indicated satisfaction with life in the home, although responses were mixed. In answer to the question ‘Can you do what you want to?’ three of four who replied said ‘Yes’, one said ‘no’. In answer to the question ‘Do the carers listen and act on what you say?’ two of four said ‘Yes’ and two of four answered ‘Sometimes’. In answer to ‘Do the staff treat you well?’ two answered ‘Always’, one answered ‘Sometimes’ and one wrote ‘Some of them’. In answer to the question ‘Do you make decisions about what you do each day?’ Two answered ‘Always’, one answered ‘Usually’ and one answered ‘Sometimes’. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 16 Life seems to proceed at a fairly relaxed pace in this home. It was said that most residents tend to get up early. Residents make their own breakfast, usually cereals, toast and hot drinks during the week, a brunch on Saturdays. Lunch is taken early - before noon on the day of the inspection visit – and usually consists of soup, sandwiches or light meal. Supper is served at around 5:30 pm, It is a two course meal which is prepared and served by staff. Residents help with the clearing up. Residents help with cooking at the weekends. Drinks and a bowl of fruit are available all day. Afternoon tea is served with biscuits on Tuesdays and with cakes on Fridays. Meals are planned on Tuesdays. A folder on healthy eating is available but is said not to be all that popular with residents. Food likes and dislikes are recorded. Advice from a dietician is obtained from Manor House Hospital when required. Menu selections from the menu during the week of this inspection included: Shepherds Pie served with carrots and cauliflower followed by Strawberry Angel Delight; Fish & chips served with peas or beans followed by snacks; Lamb roast, potatoes, parsnips, carrots and Yorkshire pudding followed by Yoghurt; and, Spaghetti Bolognaise with pasta shells followed by Jelly and Fruit. The home follows tradition by serving fish on Fridays and a roast meat joint on Sundays. Residents’ privacy is respected. Staff knock on doors before entering rooms. Confidentiality is respected. Residents mail is not opened by staff. Residents are free to pursue their own interests. Over the course of the eight and a half hours or so of this inspection visit residents were observed to sit in groups, be on their own, sit in the garden, sit in the lounge, go out, or be in their room for a while. The home meets a range of needs. Some residents clearly benefit from its relatively low demand ethos. One resident was gaining benefit and felt ready to take on more independence, confident that support from staff, and from other residents, was there when needed. Other residents appeared to be at a point where they needed a moderate level of staff support and the company of fellow residents, but were not yet ready for more independence. It is possible that there are some who would benefit from a higher level of structure and a wider range of community based activities. The challenge for managers and staff is to get the right balance without causing undue stress to vulnerable people, or, of being so directive that residents are not provided with opportunities to develop greater independence in their own way and at their own pace. However, it is felt that there is scope for development here. It was suggested there is a need for more activities, more shared events, more things to look forward to with anticipation - and to look back on. It is felt that a shift in favour of activity may be needed and that a review of this aspect of the home’s life should be carried out when the management position is more settled. It goes without saying that such a review must involve the residents as well as staff and other stakeholders. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 17 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. 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 this service. Staff provide support to residents as required. Arrangements for liaising with health and social care services in the community are satisfactory. These aim to ensure that people’s healthcare needs are met. However, weaknesses in the home’s arrangements for the control and administration of medicines could pose a risk to residents. EVIDENCE: Staff provide support and guidance to residents as required, the process being a matter of discussion between the key worker and the resident when reviewing care and through consultation on a day to day basis. The home routine is flexible and accommodates a range of needs. Staff are not always able to provide as much support to residents outside of the home because of staffing levels – although it was said that the duty rota can be adjusted for planned events. The residents were generally physically able and did not routinely require physical aids. However, one resident needed a frame to provide support when walking. Such aids are acquired from local NHS services as needed. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 18 All residents were registered with a local GP practice. All but one were in contact with the local CMHT and each had a community psychiatric nurse (CPN). One resident was in contact with the local mental health services team for older people. An optician can visit residents in the home if required, although this may not be desirable in all cases. Podiatry and dentistry services were accessed through the local health centre. Other NHS services, including specialist nurses, were accessed through the resident’s GP. Dietetic advice can be obtained through Manor House hospital in Aylesbury. Residents have an annual health check – ‘a health MOT’ – carried out by the GP practice. Reviews under the CPA could take place quarterly. CPNs visit once a moth. The acting manager said that care managers were in regular contact with the home. Residents are not routinely weighed – only where there is reason to do so i.e. unexpected weight gain or weight loss. Medicines are prescribed by the resident’s GP, or, in the case of Clozapine, their psychiatrist. Medicines are dispensed, most in monitored dosage system (MDS) form, by Boots Chemists in Aylesbury. Staff practice is governed by the organisation’s policy. The policy, which is categorised under health and safety policies, was last reviewed in 2002. There is a supplementary policy statement on medication records which was issued in 2005. Medicines are stored in a metal cabinet which is firmly fixed to the wall and in a small fridge (not a special medicines fridge) – both in the staff office. Clozapine is stored in a lockable metal box in the metal cabinet. The temperature of the fridge is not monitored. Information references for staff include the organisation’s policy, a British National Formulary (BNF) of September 2006, a copy of the guidelines for the control and administration of medicines in care homes which were published by the Royal Pharmaceutical Society in 2003, and an informative text on medicines published by the British Medical Association (BMA) 2001. It is noted that the organisation’s policy was last revised in 2002 and that the BMA book is a 2001 edition. Staff training consists of the Boots one day course. The home does not currently have arrangements in place for assessing competence after training or for periodic update training. No member of staff had attended an advanced course and this would be advisable. Potential providers of such courses were discussed during the visit. The home has arrangements for the manager to check staff practice and records were seen. While this is a good practice it could be improved if the precise aspects of practice that are being checked were explicit and the results quite clear (such as (aspect met?) a ‘yes’ or ‘no’). Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 19 An example from the inspection process was discussed with the acting manager during the course of the visit. No residents were administering their own medicines at the time of this visit. The acting manager said that this is to be addressed by the home in the near future. A procedure has been drawn up. It was noted that there are clear guidelines for the administration of ‘as necessary’ (‘PRN’) medicines – a good practice. However, it was also noted that the home appeared to be accumulating a stock of surplus ‘PRN’ medicines – Diazepam in particular. This is a result of the dispensing system, where the pharmacy dispenses such medicines where prescribed, whether they have been used or not. It would be helpful to discuss this matter with the pharmacy concerned. Examination of medicines administration records (‘MAR charts’) revealed no errors – although it would be advisable for staff to obtain a counter signature on the MAR chart where a medicine is discontinued and to include a reference to the authority for discontinuing the medicine. More significantly, it was noted that the colour of some MDS containers did not correspond with the time the medicine was due. Staff in the home had to write this on the container. This should not be necessary. The dispensing pharmacy should dispense the drug in the correct colour container and it should not be necessary for staff to make amendments. It was reported that this was not an exceptional occurrence. The matter should be taken up as a matter of urgency with the head pharmacist of the pharmacy concerned. The pharmacy carries out occasional audit of the home’s arrangements. The most recent audit was carried out in February 2007 and included recommendations which the acting manager said had been acted on. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home has a good policy and procedure for reporting and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the protection of vulnerable adults (POVA). Together, these aim to protect people from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home has a good and clear complaints procedure which is set out in text and picture and flow chart form on the notice board. A copy is included in care plans. However, it was noted that the version of the flow chart on the wall was out of date – listing an office of the organisation which is no longer operational. The version in care plans was the current one. This was immediately corrected. The text and picture version includes contact details for CSCI in Oxford and those of the local authority. The official complaints policy appears to allow four weeks for the informal stage of the process, four weeks for a second level formal stage, and a further unspecified time for consideration by the chief executive. It does not include mention of CSCI. For the purposes of this inspection, it is the policy made available to residents in the home that is assessed and rated. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 21 The home has received no complaints since the last inspection, nor has the CSCI. There is a policy governing the protection of vulnerable adults (POVA) dated November 2005. This subject may also be referred to as safeguarding vulnerable adults. The home has a copy of the Buckinghamshire joint agency policy on this matter. The home also had a copy of a summary on POVA from Kensington and Chelsea. It was unclear what purpose this might serve given that it already had copies of the two key documents - the organisation’s own policy and the joint agency policy - on file. Staff training on POVA is provided locally by an independent training agency. The subject of POVA has been discussed in staff meetings. No POVA allegations have arisen in this home since the last inspection. Staff were aware of POVA issues and did not believe that such an event was likely in the home. If it did occur however, staff were clear on reporting arrangements within the organisation and were confident that such allegations would be thoroughly investigated by managers. Arrangements are in place for assisting residents in managing money. These include secure facilities for cash and valuable in their rooms, secure facilities in the staff office for storing cash, arrangements for bank accounts for residents, recording of all transactions, and checking balances at each staff handover meeting. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is quite well located for the amenities of the area and it generally provides a safe, comfortable and pleasant place to live. However, standards in some areas fall short of those required in a care service and there is a need for greater attention to detail in order to maintain an acceptable standard of environment for residents. EVIDENCE: The home is a detached house, situated in a residential area near to Stoke Mandeville Hospital, about one and half miles from the centre of Aylesbury. There is limited parking to the front of the home but sufficient alternative parking in nearby streets. Buses serve the hospital and nearby roads. The nearest rail stations are Aylesbury (about 1.5 miles away) or Stoke Mandeville (over 2.0 miles away). Residents also use the local ‘Dial-a-Ride’ bus. There are shops, a café, and hairdressers within walking distance. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 23 The accommodation is over two floors. The ground floor is reported to be accessible to a wheelchair user although no resident required a wheelchair within the home at the time of this inspection. There are eight bedrooms. All bedrooms are single. None have en-suite facilities. Two of the bedrooms are on the ground floor. Entry for visitors is controlled by staff. Residents have keys to the front door and to their bedrooms. The ground floor accommodation comprises the entrance hall, two bedrooms, shower room, WC, laundry, open plan living and dining area, kitchen, staff office, staff sleep-in suite, conservatory (now the only area where smoking is allowed), and garden. Stairs lead to the first floor. The first floor accommodation comprises six bedrooms, two bathrooms, WC’s, and store cupboard. The quality of the accommodation varies. A bedroom, which was seen with the permission and in the presence of the resident, was a pleasant fair sized room. It was well decorated and furnished. It provided a comfortable and safe room and the resident expressed satisfaction with it. A curtain on the first floor landing was partly hanging loose, having separated from some hooks. Two lampshades had broken off and had not been replaced. The two bathrooms on the first floor did not have hand towels. Overall standards of cleanliness were good. The store cupboard, where COSHH substances are stored, was appropriately locked. The open plan living and dining area on the ground floor was satisfactory. The conservatory, now the only communal area where smoking is allowed, is a small room which seemed adequate for its purpose. Ventilation was achieved by the door being open throughout the day. It was said that it can become very warm on hot days. Use of the room on cool days has yet to be tested because the new laws restricting smoking only came in to force in the summer of 2007. The ventilation of the room may have to be reviewed later in the year. The new kitchen is a disappointment for residents and staff. A new kitchen has been installed since the last inspection but the quality is not up to the standard required in this type of service. Drawers and cupboard doors are damaged, the laminate was separating in a number of areas, but particularly on work surfaces. This is not just unsightly and unsatisfactory but will in time pose a health hazard in an area where food is prepared. The laundry is adequate for current use. There are two washing machines, one tumble dryer, ironing facilities and a sink. The garden is a small but accessible area to the rear of the house. It is mainly lawn with shrubs and fencing on the border. There is a seating area just outside the conservatory. The garden is maintained by staff and residents. This arrangement can lead to variable standards since it depends upon there being Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 24 people who have some enthusiasm for gardening. In this home the lawn to the rear of the house was maintained but there was an overgrown area developing to the side of the house. It was noted that a fair number of cigarette ends had been left on the lawn. A suitable ashtray, designed for external use, would help to avoid the unsightly appearance of this. The home has a TV, DVD, music centre and bookshelves. There are a number of health and safety related matters which need to be addressed by managers, some of which are out of the control of the managers in this home (see standard 42 below). Improvements will require action from senior managers in both the care organisation and the housing association. There were a number of notices around the home – one or two which were noted to be out of date – and it was suggested that a member of staff be nominated to take responsibility for making sure that notice boards are up to date. The number, location, presentation, and subject matter of notices can have an effect on the overall ambience of a home. That said, however, residents were comfortable in the home. Throughout the day residents made use of the lounge, conservatory and kitchen. Residents watched TV, read, chatted or just observed daily life. Visitors were welcomed and made to feel comfortable. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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 this service. Staffing levels and procedures for the recruitment of new staff are considered satisfactory. Procedures for the recruitment of new staff are thorough and staff have access to a range of appropriate training opportunities. This aims to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet people needs. Some aspects of the homes arrangements for staff supervision may benefit from review to ensure that it is being carried out in the interests of residents. EVIDENCE: The present staffing provides for two care support workers in the morning, two care support workers in the afternoon and evening, and one waking care support worker and one sleep-in support worker at night. These numbers are supplemented by the manager who is usually available during office hours, Monday to Friday. A domestic assistant works on five mornings a week. The home does not employ volunteers. The report of the inspection carried out in June 2006 included the following requirement ‘The proprietor must review staffing levels to ensure residents social and recreational needs are met’. The acting manager reporting to this inspection said that the home had managed Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 26 to acquire an extra care worker as a consequence of changes in the hours worked by some staff. These had allowed an increase in relief staff and supported adjustments in staffing which enable residents to go out more with staff support. This change is reported to have been achieved at no additional cost. Two of nine permanent staff have acquired NVQ 3 ‘Promoting Independence’ and one is currently pursuing it. One of four relief staff has acquired NVQ 3 ‘Promoting Independence’. The organisation has its own NVQ assessment centre. Staff turnover was described as low. The staff group is mixed in terms of age, gender and ethnicity. Staff meetings are held every two weeks and notes are taken and filed. The recruitment of new staff is supported by the organisation’s human resources department in London. All applicants are required to complete an application form and a health declaration. Health declaration forms are checked by an external occupational health service. Applicants are required to provide two referees and an enhanced CRB certificate – and a POVA First check if appointed before the CRB is received. The manager and deputy manager interview all applicants for positions in the home. One new member of staff had started work since the last inspection. However, the person concerned was already employed as a relief care worker and had regularly worked shifts in the home. Examination of the personnel file showed that appropriate preemployment checks had been carried out in connection with the relief worker post. The person was required to complete and application form for the permanent position. A reference had been provided by the then registered manager. A recent photograph was not on file. It was felt that a new CRB was not required because the person was already employed by the organisation and was already working in the home. A contract and letter of appointment in relation to the new post was not yet on file. Staff have access to a comprehensive training programme run by the organisation. The organisation’s website states: ‘We are committed to developing our staff. Project-based staff receive at least eight days training in their first six months. We are approved by City and Guilds as an NVQ assessment centre and are able to offer staff the opportunity to work towards Promoting Independence at Levels 3 and 4 in the Care and Registered Managers Award, and the Assessor and Internal Verifier awards’. The training programme for 2007/08 was on display in the office. The home also had a copy of a very good booklet which outlined the programme in more detail. Training organised by the head office is supplemented by local training on the ‘mandatory’ subjects of fire safety, food hygiene, infection control, first aid, moving & handling and in POVA, and medicines administration. The acting manager reported that all care staff will be attending a training course on dealing with aggression and violence. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 27 There is a policy on supervision and all care staff have supervision on a monthly basis. The organisation offers training on a supervision skills course. The supervision policy and supervision records were not examined on this inspection. Managers do not check supervision records, other than of those staff they directly supervise. It is not known whether this is the policy of the organisation. The impression gained is that these records are considered to require a greater level of confidentiality because of the subject matter recorded therein. This is a matter for the organisation. Supervision is normally a delegated task but the manager who is delegating remains accountable for standards of practice. It is difficulty to see how the home’s current practice enables the manager to be assured that practice is in line with policy, that it fully meets this standard, and is being carried out in the interests of residents, unless he or she is able to periodically check supervision files. Staff confirmed that supervision takes place monthly but appeared to communicate mixed views on its value. All staff have an annual appraisal. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home carries out a number of quality assurance activities aimed at providing a good quality service to residents. However, the potential benefits of these are undermined by health and safety matters which require management attention to ensure that the safety and welfare of residents is not compromised. EVIDENCE: This inspection coincided with a change in the management of the home. The deputy manager had been the acting manager for one week. However, the inspector did have the opportunity to meet the former manager who contributed to the inspection. The changes under way did not appear to be having any adverse effect on residents. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 29 The acting manager has acted up for the manager in the past. She has worked in the home for nine years and prior to this had experience in other care settings. The deputy manager is therefore, appropriately experienced for her current position. A number of activities make up the home’s approach to quality assurance. The area manager does a monthly management report which covers the information required under Regulation 26 of the Care Home Regulations 2001. Copies are retained in the home and were seen during the course of this inspection. The acting manager reports that there is a business plan for the current year (2006/07) which is to be reviewed in October 2007. The former manager has conducted an audit of a number of aspects of activity each month – of medication, care plans or health and safety for example. However, the process does not involve the use of any particular audit tool. While this does not detract from the value of the work it does mean that the standards against which the activity is being assessed are not explicit and that different auditors may be using different standards or different benchmarks to assess performance. This was discussed during the course of the inspection in the context of the control and administration of medicines. The organisation requires the home to carry out a stakeholder audit each year. This includes a survey of residents, staff, relatives and professionals involved with the service. The acting manager said that the results are reported on by the area manager. It is expected that the next survey will take place in October 2007. Residents are supported by staff in completing survey forms. The potential for this to unintentionally influence the outcome of the process was discussed. It is acknowledged that this is an issue for many care services, not just this home, when conducting such work. The ideal would be support from an independent source – such as an independent advocacy organisation. Residents’ views are sought in the course of day to day interactions and during house meetings. The meetings used to be held monthly but are now held every two months. Notes are taken by staff and retained on file in the office. The file was examined during this inspection. Relative respondents to the CSCI survey were satisfied with the care provided. In answer to the question ‘What do you feel the care home or agency does well?’ one wrote ‘Look after my son very well. Encourage him to be independent, encourage him to take part in the local community. Provide me with support and advice. Staff are friendly and approachable’. Another answered ‘Good Care’. Under ‘anything else that you would like to tell us?’ one resident wrote ‘I praise the staff for all they do’. Another wrote ‘Not really, it is all right’. Arrangements for maintaining the health and safety of residents are generally good but there are significant weaknesses which managers must attend to. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 30 New staff are introduced to the key aspects of health and safety during the course of their induction (which takes place at the organisation’s head office in London). This is followed up by attendance at local training events. This includes training in Moving and Handling, Food Hygiene, Medicines Administration, POVA, Infection Control and Fire Safety. Training providers include the Buckinghamshire Fire Authority, Boots Chemists, St John’s Ambulance, and private training organisations. There is a policy governing COSHH (Control of Substances Harmful to Health) and procedures for ensuring that COSHH materials are safely managed in the home. The home is dependent on the housing association ‘Places for People’ for maintenance of the property. Of particular concern to the safety of residents is the fact that the association is reported to have changed its arrangements for the maintenance of fire equipment in the spring of 2006. Since then no checks have been carried out in the home by specialist maintenance personnel. It would appear from records that the association has not responded to requests from the home with regard to this. The most recent communication to the housing association from the former registered manager was in June 2007. This matter needs to be urgently addressed by senior managers in both organisations. The home carries out regular tests on fire alarms and emergency lighting weekly. A fire risk assessment is in place for the current year. Fire training, involving the local fire service, was carried out in December 2007. A fire drill was last held in April 2007. Rentokil have checked the home’s hot water storage for Legionella, the results of which were satisfactory, but which were communicated in hand written form. A Health and Safety inspection was carried out in May 2007 and according to the report no requirements were made by the inspector. The temperature of the hot water in areas to which service users have access is regulated. Records are maintained. The home has an arrangement with Aylesbury Vale Council for the collection of clinical waste. The council have not provided a lockable bin and the material is put into a yellow plastic bag and left out overnight for collection early next morning. This seems an unusual arrangement for a care service and managers would be advised to obtain an opinion on its safety from the local environmental health department. The acting manager said that staff have received training in food hygiene in 2005. Examination of the kitchen after supper on the day of the inspection visit suggested variable conformance to safe practice in the storage of some food products. A large jar of mayonnaise in the fridge had not been labelled when opened and did not have a ‘use by’ date (such products should be used within four to six weeks of opening – as advised on the label). The same applied to two bottles of salad cream and a jar of mint sauce. A half-empty packet of commercially sliced chicken had not been labelled. A jar of marmalade which stated that it should be stored in a refrigerator after opening and used within Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 31 six weeks was stored in a cupboard and had not been labelled when opened. A pedal bin failed to operate properly requiring staff and residents to open the lid with their hands – an action which could lead to cross contamination of food. It also needs to be recorded that a fitted kitchen which had been installed since the last inspection is of such questionable quality that it could pose a risk to the health of residents in this home. The laminate was noted to be cracked and separating in a number of areas including surfaces on which food is prepared, and on drawer and door fronts. A door to one unit was missing. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 32 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 3 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 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 2 X X 2 X Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes 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 YA24 Regulation 23 (2) (b) Requirement The proprietor and manager must ensure that they maintain the property to ensure that residents live in a homely comfortable and safe environment. Previous timescales of 31/9/05 and 31/08/06 not fully met. The manager must ensure that the storage of medication must be appropriate and in line with the homes medication policy. Previous timescale of 31/07/06 not fully met. Timescale for action 30/11/07 2. YA20 13 (2) 30/09/07 3. YA34 Sch. 2 4. YA42 13 (4) The registered persons must 30/09/07 ensure that staff files contain all of the information required under Schedule 2 31/10/07 The registered persons must ensure that health and safety polices and practices are rigorously applied, to ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA14 Good Practice Recommendations It is recommended that the registered persons conduct a review of activities so that residents, individually and collectively, have a wide and appropriate range to choose from and receive support from staff in accessing these. It is recommended that the registered persons establish a process which supports residents in the storage and administration of their own medicines where desired. It is recommended that the registered persons monitor and record the temperature of the small refrigerator used for the storage of medicines. It is recommended that the registered persons seek the advice of a pharmacist on the control of stocks of ‘as required’ medicines in order to avoid building up excess stock levels in the home It is recommended that the registered persons seek the advice of a pharmacist on ensuring that the colour of medicine packs conforms to the supplying pharmacies policy with regard to the time of administration It is recommended that the registered persons devise a system for the prompt repair or replacement of damaged or missing items in the environment It is recommended that the registered persons review the practice of supervision, including access to supervision records by managers It is recommended that audit of activity carried out under the home’s quality assurance processes include methods which enable more precise identification of the standards being assessed. 2. YA20 3. YA20 4. YA20 5. YA20 6. 7. 8. YA24 YA36 YA39 Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Haslerig Close (8) DS0000023040.V338616.R01.S.doc Version 5.2 Page 36 - 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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