Inspection on 16/07/09 for 8 Haslerig Close

This inspection was carried out on 16th July 2009.

CQC found this care home to be providing an Adequate service.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Haslerig Close 16/07/08

8 Haslerig Close 13/08/07

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 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 8 Haslerig Close Harvey Road Aylesbury Buckinghamshire HP21 9PH Lead Inspector Mike Murphy Key Unannounced Inspection 16th July 2009 9:45 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Haslerig Close Address Harvey Road Aylesbury Buckinghamshire 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 Miss Zoe Michelle Collins Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 8. Date of last inspection 16th July 2008 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. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This key inspection was carried out by one inspector in July 2009. The inspection included an unannounced visit to the home on Friday 10 July between 9:45 am and 4:30 pm. The registered manager sent us the services Annual Quality Assurance Assessment (AQAA) prior to the inspection. It was clear and gave us the information we asked for. The inspection included consideration of the information in the AQAA. It also included discussion with residents, staff, the registered manager, and area manager. Documents were examined. These included care records, staff records, the homes statement of purpose, its service users guide, medicine administration records and other relevant documents. The visit included viewing parts of the home including the shared accommodation (living room, dining room, conservatory, shared bathrooms and WC’s), the laundry, kitchen, office, and garden. What the service does well: The home provides prospective users of the service with a well produced, colourful and informative package which outlines the service offered by the home. The home provides a generally comfortable and pleasant environment for people living there. It maintains a positive and supportive environment within the home and good relations between people. It has an ambience which users’ value. Users are consulted on a range of day to day issues and are involved in the running of the home. Support plans are comprehensive and have a practical layout in which areas of support are easy to identify - providing the plan is maintained and updated in line with changing needs. People using the service report a good level of satisfaction with the food and are involved in menu planning. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 6 It is an ‘open’ organisation which has good arrangements in place for dealing with complaints and ensuring the protection of users’ interests. This is reinforced by its ongoing contact with a local advocacy service. What has improved since the last inspection? What they could do better: Update the home’s Statement of Purpose so that it is consistent with other information provided by Together and is an accurate description of what is on offer to users living in this service. Review the current format of support plans to ensure that they do not include information which is not relevant to users current needs, are up to date in respect of all needs, and are in a format which is consistent with the philosophy of the service and the needs of users. Review the homes procedure on the administration of medicines where two staff are involved. This should ensure that both staff check all aspects of the process, thus minimising the risk of error and potential adverse effects on users of the service. Take action to improve the quality of the environment – in the conservatory and other areas identified in this report – to ensure that users live in a comfortable and safe home. Assess the training needs of staff to maintain staff skills appropriate to service users needs and to support developments in the service. Seek the advice of the environmental health department where necessary on safe practice on the storage of perishable foods, on maintaining optimal 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 7 performance of fridges and freezers, and the safe storage of potentially harmful materials. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 8 Haslerig Close DS0000023040.V376487.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 8 Haslerig Close DS0000023040.V376487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service are provided with a comprehensive information pack and can be assured that the home will endeavour to ensure it can meet their needs before offering a place. EVIDENCE: The home has not had a new admission since 2007 (this inspection was carried out in July 2009). The home has a good information package for prospective users of the service. This is comprised of, a general information leaflet on Together Working for Wellbeing (‘Together’), an information leaflet on the organisation’s approach to service user involvement, a copy of its magazine ‘Time Together’, and information on the home itself. The package is very well produced, colourful and informative. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 10 The information on the home includes photographs of the exterior and interior, a description of the accommodation and the support it provides, the application process, practical information, brief information on the local area, the rights of service users, information on finance and record keeping, an outline of the complaints process, a summary of Together’s services and its promises to users, notes on staffing, and contact details for the Commission (these will require updating), for Buckinghamshire County Council, and for the advocacy service in Aylesbury. It also includes an application form. This is an informative package which would be useful to prospective users, their families and professionals. In contrast to the information pack, the document entitled Statement of Purpose made available for this inspection consists of one A4 page. It is headed ‘Draft Statement of purpose – for team discussion January 2003’. The content of the statement of purpose falls short of that required of a registered. The statement of purpose is supplemented by an extract from the home’s operational policy which outlines the aims of the service, community support, ‘project ethos’, and care and rehabilitation. Together these three documents are useful and informative. The statement of purpose is the weakest of the three and needs further development and updating by managers. The registered manager said that Together has a thorough process of assessing the needs of prospective users of the service. The admissions process includes introductory visits. 8 Haslerig Close DS0000023040.V376487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,8 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using this service will have a support plan which is designed to meet their needs and which is co-ordinated by their key worker. However, some aspects of some support plans may not be updated at a frequency which takes full account of users changing needs. EVIDENCE: A support plan is in place for each service user. Each person’s support package is co-ordinated by a key worker. The support plans for four users of the service were examined during the inspection. Support plans are comprehensive and were in good order. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 12 However, the plans examined contained much information which was not directly relevant to the person’s current support needs. A system for archiving such information would help to ensure that the information in the support plan is relevant to the person’s current needs. Conversely however, in one case, the care plan did not include information on the person’s physical care which was particularly relevant to the person’s current support needs. It is noted that in the report of the July 2008 inspection we recommended ‘….that a reduction of unnecessary information contained in care plans is completed that would make the care plans more user friendly’. The overall structure of the support plans was discussed with managers. Managers acknowledged that the present system was not perfect. Ideally, the area manager said that support plans would be constructed in such a way as to reflect a ‘Recovery’ approach to mental health problems. Briefly, the Recovery approach aims to enable people to gain more control over their lives. It emphasises a person’s strengths and potential, while, at the same time, helping the person to deal with the impact of a mental health problem on their lives. A recovery oriented support plan should be more person-centred and more accessible to the user than those currently in use. The support plans examined included a photograph and general information on the person, risk assessments (as assessed by the home and in some cases by the Community Mental Health Team (CMHT)), healthcare appointments, and correspondence. A key section of the support plan, which outlined the detail of support needs, was usefully set out as a chart. This listed a number of day to day activities (including Morning Routine, General Behaviour, Mental Health, Mental Agility, among many others), opposite each area where a support need was identified was space for the user’s goals, the key worker’s goals, and for an action plan. It is a layout which is easy to understand and which supports clear identification of support needs and facilitates joint work between key workers and other staff and with service users. Two of the four plans contained notable deficits. In one, ‘Improving goals for action on weight’ was listed as a key objective. The most recent record of the person’s weight was January 2009 (this inspection was carried out in July 2009). A brief search by a member of staff was unable to locate a more recent record of the person’s weight. In the other plan, the person had recently had hospital treatment and was still recovering. The person was also receiving treatment for a condition from the district nurses. The support plan did not include reference to either of these problems. A member of staff thought that the care plan relating to the person’s post hospitalisation care had been locked away by the key worker. The 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 13 explanation for the absence of a reference to the other condition was that it had only been diagnosed the previous day and the care plan would be updated later that afternoon. As noted elsewhere in this report we observed good interaction between users and staff. Staff and users had a good relationship and the pace of life in the home seemed appropriate to the needs of the users living there. Through house meetings users are involved in menu planning, plans for redecoration, and plans for outings. Users also help out with shopping and are involved in day to day decisions. The home’s approach to risk assessment and management is good. Risks and the actions required to manage risk are good. Risks noted included fire risk, risk of scalding, and risk of harm to self or others. Some support plans included copies of risk assessments carried out by the CMHT. 8 Haslerig Close DS0000023040.V376487.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): This is what people staying in this care home experience: 12, 13, 15, 16, and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service have opportunities to participate in a range of social and leisure activities in the local community. The mix of activities needs to be kept under active review to ensure that the service is making optimal use of the opportunities available. EVIDENCE: Three users of the service regularly attend a day centre in Aylesbury and two users go to a day centre in Princes Risborough. The home is located in a residential area and users make use of local facilities such as shops and a café. Some users also regularly go to a local pub. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 15 Users have access to the swimming pool and gymnasium at Stoke Mandeville Hospital which is next door. Within the home people may read, chat with others, watch TV or a DVD, or listen to music or the radio. Friday evenings is a social occasion and, after a supper of fish and chips, staff and users play board games or other entertainment. The home now has its own transport which users and staff use for outings. Recent trips have included Whipsnade Zoo and a garden centre. Further outings are to be planned with users. It is noted in the report of the 2008 annual review that service users commented ‘…that there are lack of activities and outings…’. The registered manager undertook to address this but also, it is recorded, said ‘…that in the past when outings have been arranged service users are not keen to go on them…’. Responses to this inspection including a comment from a staff member for ‘More staffing so service users can assess the community’. Another staff member wondered if the home could do more to ‘motivate users to go out more’. Users said that they can do what they want to do during the day and in the evening. There was a difference of views on this point in relation to the weekend. One user who was in the home on the day of the inspection visit said that she would normally go to the day centre but was unable to do so on that day because of medical problems. This is not a straightforward matter to deal with in this kind of service. We found a difference of views and that may not be a bad thing. This is a matter which managers will need to keep under constant review and which needs ongoing discussion between staff and users. Staff will need to be aware of opportunities to engage users in community based activities. Service users are supported in maintaining links with family and friends as required. The amount of contact varies from person to person. Users and staff plan menus and do some of the house shopping together. Some users help in the preparation of meals. Breakfast usually consists of cereal, toast, water, and tea or coffee. Lunch is a light meal, usually a savoury snack or sandwiches. Supper is the main meal of the day and consists of a two course meal. Drinks and snacks are available at all times. The menu for the week of this inspection included Steak and Kidney or Chicken Pies with Mashed Potatoes and Peas followed by Rice Pudding and Jam. On other days people might have had Lamb Chops, Mashed Potatoes and Peas followed by Apple Pie and Custard, or, Liver, Mushroom and Onion Casserole 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 16 with Mashed Potatoes followed by Fruit and Ice Cream. Fish and Chips are always chosen on Fridays and a roast meat based dish followed by desert on Sundays. 8 Haslerig Close DS0000023040.V376487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service will receive the support they need in accordance with their wishes and can be confident that the home will liaise with health and social services in the community as required. A potential weakness in the current procedure for the administration of medicines, where two people are involved, could, in some circumstances, place users at risk. EVIDENCE: Staff respect users wishes with regard to their personal preferences – in particular each persons’ daily routine. These are outlined in individual support plans 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 18 Each user of the service is registered with a local GP. The home is in contact with two GP surgeries. All users are registered with the local CMHT and all have a CPA (Care Programme Approach – a specialist variant of Care Management) which is drawn up by the CMHT. A care manager, a health or social care professional based with the CMHT, is responsible for monitoring the implementation of the CPA care plan. This incorporates the support provided by the home. Evidence of contact with GPs, Psychiatrists, CPNs (Community Psychiatric Nurses), Podiatrists and other specialist health services was noted in care plans. A district nurse was beginning a course of treatment with one person around the time of this inspection. The registered manager said that the user’s GP carries out an annual health check. Medicines are prescribed by the user’s GP or Psychiatrist and are dispensed by Boots Pharmacy in Aylesbury. The administration of medicines in the home is governed by the organisation’s policy which was last reviewed in February 2007. The policy states that it is to be read in conjunction with a health & safety policy which was last reviewed in 2002. Staff training is in the use of the Boots MDS (Monitored Dosage System) system. The registered manager expects to make use of a foundation course in medicines in the coming year. Text reference resources available to staff include a 2006 British National Formularly (BNF) and a 2001 edition of the BMA Guide to Medicines and Drugs. The current edition of the latter was published in 2007 (reprinted 2008). Copies of our guidelines on medicines administration or of those of the Royal Pharmaceutical Society of Great Britain on Medicines in Social Care services were not available at the time of the inspection visit (both published in 2007 and both downloadable from the respective websites (the latter also available in bound form)). Arrangements for the storage of medicines were satisfactory. Most medicines are dispensed in the Boots MDS system. Liquid medicines are stored in a separate shelf in the medicines trolley. One person was administering their own medicines – still at a very early stage in the process. The home has a ‘programme/guidelines’ to guide practice. This is a five stage process which is overseen by the deputy manager and user’s key worker. The programme starts with a discussion with the user and a risk assessment, and then, over time, progresses from administration under staff supervision to self administration. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 19 It is noted that the home’s medicines policy states that two members of staff should administer medicines – one person to read and one person to administer. This practice was observed during the inspection visit. While the practice involves two people in the process it does not require either to check the actions of the other. The procedure should be revised and it would be advisable to establish a procedure in which both persons check all stages of the process. 8 Haslerig Close DS0000023040.V376487.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service can be assured that good arrangements are in place to safeguard their interests, protect their rights, and deal appropriately with any complaints. EVIDENCE: The complaints process is on display on the notice board in the dining room. The process advises a user who is dissatisfied with any aspect of the service to raise the matter with their key worker or the manager in the first instance. If they remain dissatisfied then they may refer their complaint to the Area Manager. The Area Manager is a regular visitor to the home and knows the users living there. The information notice on complaints also gives contact details for the advocacy organisation (Aylesbury Vale Advocates), local social services, the housing association (who is mainly responsible for the building), and the Commission. The process is also outlined in section 10 of the information pack. This includes the information that a person who is unhappy may, in addition to raising the 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 21 matter in the home, also complain to their local community mental health team (CMHT) and to the Commission. Within the organisation there are four stages: (i) firstly, with staff in the home; (ii) then, if dissatisfied, with the Area Manager; (iii) then, if unresolved, with the Operations Director (at which point it is deemed to be ‘..a formal complaint’); and, (iv) finally, if still dissatisfied, by requesting a review with the Chief Executive of Together. It is noted that the information in the pack includes reference to ‘…a formal complaint.. .’. We do not make a distinction between ‘formal’ and informal complaints. The home has not received any complaints since the last inspection in July 2008. We have not received any complaints about this service during this period. A house meeting is usually held once a month. Users may raise concerns there if they wish. Notes are taken. The notes of meetings held in January, March and April were examined during the inspection visit. Staff were planning to hold a meeting for July 2009. Together has a clear policy on safeguarding. This is summarised under the heading of ‘Abuse’ in section 7 of the information pack. This is very well written and includes a list of people and agencies to whom a user could report or discuss their concerns. Staff training on Safeguarding is provided by Buckinghamshire County Council through its care sector cluster group training and on line ‘E-learning’ module for care workers (‘log-on-to-care’) resource. The home had dates of forthcoming training events and the manager was planning for all staff to have an update this autumn. The home had a copy of the current Buckinghamshire Safeguarding policy. The manager undertook to obtain copies of the reporting concerns leaflet from the relevant office in the local authority. Together provides training for staff on ‘Complex Needs and Challenging Behaviour’. All new staff receive introductory level training on responding to aggression during their induction. The manager was planning to assess how many staff were due for update training on the subject through an audit of training needs. Training would be arranged accordingly. Systems are in place for supporting service users with money. These include liaison with Buckinghamshire County Council, secure keeping of cash in the home, individual risk assessment, and lockable facilities in users own rooms. Records of all transactions are maintained. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 22 The arrangements are checked on monthly (Regulation 26) visits by senior managers. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users experience an uneven quality of environment due to variable standards in housekeeping and maintenance. EVIDENCE: The home is a detached house in a small close in a residential area. It is just over two miles from Aylesbury town centre. The nearest rail stations are Aylesbury and Stoke Mandeville. The home has its own transport but users have also used the ‘Dial-a-Ride’ bus service. The ground floor accommodation comprises the entrance hall, lounge, dining area, walk-in shower, WC, bedrooms, office, staff sleep-in room (with shower 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 24 and wc), kitchen, laundry, and conservatory. Stairs lead to the first floor. The first floor accommodation is comprised of bath and WC, six bedrooms, storage, and a separate WC. None of the bedrooms have en-suite facilities, all have a hand basin. There is a small area of green to the front of the house and a pleasant enclosed garden to the rear. The standard of the accommodation is variable. Some areas are due for refurbishment. Standards of housekeeping are also variable. The lounge and dining area is sufficient in size for present needs. This was the centre of activity on the day of the inspection visit. The layout seemed to promote interaction between people and those living in the home were able to observe people coming and going throughout the day. The lounge is comfortable and has a TV, dvd/video, books and magazines. There is an informative notice board in the dining room. The conservatory is the smoking area. This area needs thorough refurbishment. Even making allowances for the additional wear and tear in this area it is difficult to justify the present state of this room. It was dull, untidy, and furnished with old, tatty and damaged furniture. This area was the subject of a requirement at the last inspection in July 2008. There was little evidence on this inspection of action having been taken by Together as a result. Standards of cleanliness were noticeably inferior to the rest of the home. The people living in this home should not have to accept such conditions. Both the registered manager and the area manager acknowledged that conditions were below standard and said that the room was due for refurbishment. The kitchen is a busy area. It is fitted with domestic standard storage units which staff feel are not robust enough for current use. Other equipment includes a gas cooker, refrigerator, freezer, and a water dispenser (which is very popular, dispensing chilled still and sparkling water). Standards of cleanliness in the kitchen were satisfactory but it was noted that the freezer was severely frosted which could impair performance. It was also noted that some perishable foodstuffs in the fridge had not been labelled when opened. The registered manager is advised to seek the advice of the environment health office with regard to good practice in such matters. Light fittings in the kitchen appeared in need of cleaning one looked a little unstable. Carpets in some areas of the home were in need of cleaning – and in some cases replacement. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 25 The laundry is equipped to a standard which meets current needs. It was tidy and clean on the day of the inspection visit. Bathrooms and WCs were clean and were considered suitable for current needs. The garden is a pleasant area. It has an area of lawn, some flower borders and mature shrubs. There is a rabbit hutch which is occupied by the house rabbit. Garden furniture provides seating and dining areas for day to day use and social functions. A gazebo provides a pleasant shaded seating area. However, on the other hand, the garden shed was open and included storage of substances such as paint, which should either be stored in safer conditions or be thoroughly risk assessed in the context of the risk posed to users of the service. It was also noted that numerous cigarette ends had accumulated in some areas of the patio and lawn. Users of the service seemed very happy living in the home and in the area. There is clearly scope however, for improvement in standards of housekeeping in the kitchen, conservatory and garden. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a home in which they are well supported by trained and experienced staff. This could be compromised however, if weaknesses in some records of recruitment are not addressed. EVIDENCE: The current staffing of the home provides for a minimum of two staff in the morning, two in the afternoon and evening, and one waking and one ‘sleepover’ at night. Staffing is adjusted to take account of activity. These figures exclude the registered manager. The staff mix includes a deputy manager, senior social care workers, and social care workers. There are four relief support staff who have good knowledge of the home and of those living there. The staffing includes male and female staff and individuals from a mix of ethnic backgrounds. Some restructuring of 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 27 management arrangements is to be implemented in the autumn of 2009. This will not affect the number of staff available to support to service users. Staff turnover is low. Since the last inspection one person has left and one new person has been appointed. The home had 30 hours of staff time vacant on the day of the inspection. The registered manager was not under pressure to make an appointment to those hours, planning instead to hold them until the outcome of the autumn restructuring was clear. The home is supported in the recruitment of new staff by Together’s Human Resources department in London. Applicants are required to complete an application form, supply two references, provide evidence of fitness for the post, and have an enhanced CRB check. Examination of one record highlighted a weakness in exploring gaps in a candidate’s employment history and in the detail of educational background. These were discussed with the registered manager and area manager at the time. There are good arrangements in place for the induction of new staff. The detail of this is contained in an induction folder. During the course of their induction new staff are familiarised with the home and the organisation and then pursue the common induction standards through a Skills for Care workbook. Staff have access to an excellent and comprehensive training programme which is planned and coordinated by the organisation’s training department. The current programme includes training on the Mental Capacity Act 2005, Cognitive (therapeutic) approaches, Self-Directed budgets, Medication, and Drug & alcohol Awareness. Arrangements are in place for staff to attend basic and update training in key subjects – including those relating to health and safety and the administration of medicines. One problem with this centrally organised programme however was releasing staff to attend events in London. Managers were also utilising other training options including those offered locally by the local authority. At the time of this inspection the home had four staff who had achieved an NVQ qualification at level 3 and three more staff who were pursuing such training with the aim of qualifying in 2010. Two staff were training as NVQ assessors. Staff supervision is firmly established in the home. The process includes discussion on matters relating to service users, staff issues, and training and development. All staff have an annual appraisal. Staff were positive in their accounts of the home. The staff seen were experienced and had a good focus on the needs of service users. They reported good teamwork and gave positive accounts of the training opportunities offered 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 28 by Together. The registered manager was said to be approachable and supportive. Some anxiety was expressed about the forthcoming restructuring and its potential impact on the focus and ethos of the home – in particular on the need to continue to maintain appropriate support to users with complex and long standing problems. One person expressed a wish for more time providing one to one support to users. The local ‘crisis team’ was considered by another person as not being very supportive. One staff respondent said the home did well by having a ‘Good staff team. Normally a happy environment. Happy service users’. In response to a question on what the home could do better the respondent wrote ‘More staffing so service users can assess the community, (and), Buy new hall carpet. Also update kitchen area’. Another wrote that the staff ‘Work well as a team – this reflects on the welfare and happiness of the residents’. The person also wrote that the home should ‘Employ more staff – so residents can go on outings i.e. Zoo, Parks etc and short seaside holidays’. Another wrote that (among others) ‘The home provides adequate support for the residents to enable them to live a near normal life.’ And that ‘staffing levels are good to enable residents to receive the care they needed. Staff could arrange their shifts in a way to enable residents to go out on day trips or holidays in the future’. Another staff respondent said that the home ‘Care for the residents as individuals with a lot of understanding’. However, the same person thought it could do with more staff. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service live in a home which is generally well managed, in particular in terms of maintaining a positive and supportive environment. However, this report includes a number of matters in relation to health and safety, communication in care plans, medicines administration, and the quality of some aspects of the material environment, in which improvement is required if the positive aspects of this service and the benefits for users are not to be undermined. EVIDENCE: 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 30 The registered manager has worked in the home for 10 years and has been manager for two years. The manager is supported by a deputy manager and is accountable to the area manager. The manager was described as approachable and supportive. The inspection visit coincided with a visit from the area manger. This provided an opportunity to discuss the forthcoming management restructuring and others matters with both the area manager and registered manager. The ethos of the home seemed appropriate for supporting people with serious mental health problems. Managers were approachable and knew the users well, staff were seen to be responsive and supportive to users, and there was a pleasant and positive atmosphere in the home throughout the day of inspection. Users said that it was “a very good home” although one user to our survey selected ‘Never’ in response to the question ‘Do the care staff and managers listen and act on what you say?’ and ‘Sometimes’ to the question ‘Do the care staff and managers treat you well’. Another user selected ‘Always’ to both questions and wrote ‘I am looked after very well. The food is good’ and (in answer to ‘What could the home do better?’) ‘Like it as it is’. Another wrote that the staff ‘Look after us well. Good Food’ and (in answer to what the home could do better) ‘They are doing everything possible for us’. Another also praised the food and said that in their opinion no improvements (to the home) were required. The registered manager is required to complete a monthly internal management report which compares practice against a standard statement. This is submitted to the area manager. The area manager carries out a monthly monitoring visit (to comply with Regulation 26) of the home and completes a report. This includes talking to users and staff. The service conducts an annual service review in which the views of a range of stakeholders are sought through questionnaires. The review for 2009 was under way around the time of this inspection. A summary report of the 2008 review (although undated) was made available to this inspection. It is noted that a good level of satisfaction was expressed by a number of stakeholders. One area for action included ‘….a lack of activities and outings’. The manager undertook to ‘…look at staffing levels at the weekends to try and accommodate more outings’. It is noted that this need is echoed to some extent in some of the responses to this inspection. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 31 Arrangements for ensuring the health and safety of people in the home are variable. There is a comprehensive Health and Safety policy. Systems are in place for recording accidents and incidents. The home has not had a visit from the local environmental health department since the last inspection. Contracts are in place for the maintenance of such equipment as fire safety equipment and gas appliances. Portable electrical appliances were checked in May 2009. Records appeared to indicate that the electrical wiring was last checked in 2002. The manager undertook to follow this matter up with the owners of property ‘Places for People’, a housing organisation. Staff have access to training in first aid, food hygiene, manual handling, infection control, fire safety, administration of medicines, challenging behaviour, and safeguarding vulnerable adults. However, records of training show variable take up since the last inspection (although all staff had attended basic training). An audit of the position, combined perhaps with a training needs analysis, would enable the manager to identify gaps and take action accordingly. As noted elsewhere in this report there are a number of matters in the environment which require attention: labelling perishable foods in the fridge, defrosting the freezer, improving the environment in the conservatory, safe practice in storing potentially hazardous substances, and cleaning or replacement of some carpets. Arrangements for fire safety are satisfactory. The home had a visit from the fire safety officer in June 2009. According to the manager all was found to be satisfactory. A fire risk assessment was completed in July 2009. Weekly fire safety checks are carried out. Staff training on fire safety is conducted through ‘E’ learning. 8 Haslerig Close DS0000023040.V376487.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 3 33 3 34 2 35 3 36 3 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 2 X Version 5.2 Page 33 8 Haslerig Close DS0000023040.V376487.R01.S.doc 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 registered person is required to ensure the repairs are made to the homes as identified in the main body of t he report. This must include the replacement of the hall and stairs carpet and the furniture in the conservatory is replaced. The registered persons are required to ensure that all areas of the home to which users of the service have access are kept in a good state of repair. The registered persons are required to ensure that care plans are kept up to date in line with service users changing needs Timescale for action 30/10/09 2 YA24 23(2)(b) 31/12/09 3 YA6 15(2) 31/08/09 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 DS0000023040.V376487.R01.S.doc Version 5.2 Page 34 8 Haslerig Close 1. Standard YA6 2 YA20 3 YA42 It is recommended that the registered persons consider removing unnecessary information in care plans, making appropriate arrangements for the storage and retrieval of such information as necessary, with the aim of ensuring that care plans are relevant to current needs. It is recommended that the registered persons review and modify the home’s present procedure for the administration of medicines to ensure that where two staff are involved, both jointly check all aspects of the process. It is recommended that the registered persons review staff practice in the kitchen in order to maintain good standards of housekeeping and safe practice in relation to the storage of perishable foodstuffs. The registered persons should seek the advice of the local environmental health department as necessary. 8 Haslerig Close DS0000023040.V376487.R01.S.doc Version 5.2 Page 35 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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