Inspection on 27/06/06 for 8 Haslerig Close

This inspection was carried out on 27th June 2006.

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

The inspector found 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 13 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 13/08/07

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 Gill Wooldridge Unannounced Inspection 27th June 2006 2:00 Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 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) 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.V292248.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 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 local amenities and public transport links, the home appears to be well integrated into the local community. The home provides twenty-four 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, formally the Mental Aftercare Association (MACA). There is an established staff team which is supported by bank and agency staff. The staff team liaise with health professionals to ensure that residents receive the appropriate care. The fees for this service are £792.15 per week. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 27th July 06 from 2pm until 18.20pm approximately with the second day of the inspection being on the 3rd July. During the course of the inspection the requirements and recommendations from previous inspections were discussed. The inspection consisted of a tour of parts of the building, gaining permission from residents to enter their bedrooms. Three care plans were studied and the care of these residents tracked. Medication Administration Record (MAR) sheets were also studied as were staff personnel files. Care staff were spoken to and time was spent in discussions with the deputy manager. Some issues were discussed with the manager following the inspection. Interaction between staff and residents was observed and overheard. Residents were spoken to during the course of the inspection. Feedback from one health professional was received prior to the inspection. What the service does well: The home has an established staff team with support from a small number of bank and agency staff. The staff team has a mix of skills and experience and has an understanding of the philosophy of the home encouraging independence, empowerment, respect and dignity. There was a relaxed, calm atmosphere and residents/clients and staff did not appear phased by the inspection. Interactions between residents/clients and staff were positive with humour and lots of smiles from residents/clients. Communication with other professionals supports the care of residents. This was confirmed by staff and recorded in residents records. Staff described having an approachable, supportive manager who has formalised supervision and team meetings which supports the care of residents. Staff were able to described the strengths within the team. Staff have access to a confidential help line. PRN management plans are in place. Staffs’ described practice was detailed regarding the care of residents. A particular piece of work with one resident is being supported by a cognitive behavioural therapist. Records seen supported this practice. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 6 The paper work seen regarding a recent admission to the home showed some clear detail. Staff had recorded trial visits and that the group had been consulted regarding any admission. What has improved since the last inspection? What they could do better: There was no evidence to support that the staff team had discussed an admission and an audit trail to ensure that the staff team could meet this residents needs. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 7 Some care plans need to be developed to include the residents present situation and must be a useful document for newly employed staff or agency staff providing the detail of how support is to be actioned. All identified needs must be supported by a care plan. Training for staff in care planning must be made a priority as must an audit system to ensure care plans are reviewed and updated with the resident. Staff described good practice must be included in the content of the care plans Risk assessments must be in place for newly admitted residents and the process of risk assessments reviewed to ensure that residents are encouraged to take risks with measures in place to protect them from any danger. Perceived restriction of liberty, for example, staff holding residents cigarettes, must be recorded to accurately reflect staff practice and must be reviewed in a multi disciplinary forum. Residents needs regarding health appointments must be clearly available to all staff. All information relating to residents care must be reviewed and updated. Any event that effects the well being of a resident must be reported to the Commission under Regulation 37. It is strongly recommended that the staff team develop further links for residents, if that is their wish, such as advocates, befrienders and or volunteers. The proprietor and manager must increase staffing levels and consider some redeployment to ensure residents have access to a range of recreational and social activities including the opportunity for spontaneity. All residents must have a recreational and social needs care plan or programme of activities involving their choices. This programme must support the frailty and age of some residents. Residents should be encouraged to self medicate. All medication must be stored appropriately. Staff checking residents blood sugar levels must be trained and have regular competency checks. Hand written entries should be supported by two staff signatures. Staff should not transcribe medication or change the times without consultation with the GP and records to support their practice. Medication procedures must be developed to include some more detail in one PRN management plan. A protocol for the administration of’ Movicol’ should be in place. Residents views must be recorded by staff and actions recorded to ensure residents issues have been addressed. Residents should be encouraged to manager their own money with staff support as appropriate. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 8 It is not apparent that the manager has explored adult protection training for residents. All potential adult protection issues should be reported under POVA. These issues were raised at the previous inspection. The manager must ensure that he does not use agency staff who are not trained in mandatory training including adult protection training. Agency staff must have some experience of working in a mental health setting. A number of environmental and health and safety issues are identified in the body of the report and these must be actioned. The home must have a water chlorination certificate. The home’s fire risk assessment must be developed and include a risk assessment for the hold open devices and include that these are numbered and included on the tests already taking place. Quality audit systems must be developed. 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. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 9 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.V292248.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. The information regarding a recent assessment was available and showed some clear detail. However, information from the resident’s previous home was not always available to support the assessment process. EVIDENCE: The home has had a recent admission in the last few months. The resident described liking their new home. The paper work seen showed some clear detail. Staff had recorded trial visits and that the group had been consulted regarding any admission. This is noted as good practice. Information from the resident’s previous home was not available as part of the assessment process. Gaining information from the previous placement should have supported any decision making to ensure the staff team could meet this resident’s needs. It is acknowledged that the home had a recent Community Psychiatric Assessment (CPA) and a psychiatric report to support the referral process. It is acknowledged that the CPA process supported the resident’s admission. However, there was no evidence that the staff team had discussed the admission and an audit trail to ensure that the staff team could meet this residents needs. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 11 The home’s assessment gave some clear information and was supported by information from the referrer. However, it was evident from studying the assessment information that staff should have completed a detailed risk assessment. The resident described visiting the home before their stay and described a formal review although he was unsure if he had signed a contract. Staff confirmed that the detail of the contract and the residents finances were dependent on other professionals. This is unacceptable. The resident described being settled in their new home. Some clear detail was noted in the residents assessment this included their religious preference and that visiting a parent in a care home regularly was important to them. Staff described some good practice regarding the assessment process, this should be supported by clear guidelines incorporating this good practice. Medication Administration Records sheets completed during the assessment period had been transcribed from a telephone conversation. This has the potential to place the resident at risk. Residents physical and mental health needs are supported by health professionals in the wider community and how to access these services is clearly documented. This was described in records seen with many references to the GP, District Nurse, Community Psychiatric Nurse (CPN), Chiropodist and Dentists. At the inspection on the 27th July a CPN was visiting the home. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Care plans need to contain detailed information, including all assessed needs to ensure that any newly appointed staff and/or agency/ bank staff can refer to these documents to ensure that residents needs are met. Risk assessments need to be in place to support the care of residents and ensure that any potential hazards or risks do not effect residents. EVIDENCE: It is acknowledged that work has been ongoing regarding the care plans, there is a new format in place which with some further work, should meet the Standard. There must be an audit system in place to ensure there is an overall standard in the care plans. There were care plans that indicated good practice. There are some concerns regarding the content of some of the care plans viewed, for example, one care plan would give a new member of staff contradictory information regarding the management of a residents cigarettes. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 13 This is balanced by the staff knowledge, whereby they were able to describe residents care fully. Staff had a particular approach when a resident came to ask for a cigarette, this should be recorded in the care plan. Records viewed did not always support the clear verbal information in specific detail, described by staff, which may lead to this information being lost, if staff are absent or new staff are in place, in any verbal exchange or staff’s described knowledge. It was not evident that staff had received training in care planning and it was not evident that there was an audit system in place. These were part of a requirement set at the previous inspection. However, in some care plans the deputy manager had written guidelines for staff to follow. This is noted as good practice. Residents files contained regular Care Programme Approach meetings involving the individual. Care plans included resident and key worker goals supported by quarterly/six monthly key working care plan reviews. This is noted as good practice. One care plan did not contain the resident’s presenting medical situation for example, that they had recently been diagnosed with diabetes. In a further residents file information indicated that the resident had bouts of depression, blackouts and needed specific support at night. These needs must be supported by the care plan, this is an outstanding issue from the previous inspection. These care plans must be complete within 7 days of receipt of this report. Care plans were not all dated, or signed and some records had no manager or key workers, signature and did not always indicate that the resident refused to sign. Staff need to evidence residents involvement in the process by obtaining their signatures or to record that they have refused. The use of ‘tippex’ was seen on one risk assessment, this practice must cease. Some scribbling over entries and crossing out was noted in one care plan. Staff must be reminded of clear recording guidelines. following the inspection the manager confirmed that staff had been reminded of good recording practice. The care plan for a newly admitted resident indicated some contradictory information, staff described concerns relating to the residents road safety, there was contradictory information in the care plan. There was no evident risk assessment to support this potential risk. This was apparently a recent discovery and must be supported by an updated care plan and risk assessment within 7 days of receipt of this report. Staff described a verbal altercation between two residents a week ago. This has not been reported to the Commission under Regulation 37, nor was it detailed in either residents care plan or supported in a risk management plan. It is acknowledged that one resident had a reviewed money management plan. Detailed daily records indicated that staff had gained support from a Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 14 Community Psychiatric Nurse. This information should also relate to the care plan. As both residents are vulnerable this should have been reported under POVA. One residents PRN management plan which supports their care needs should be more detailed and incorporate staff’s described reluctance to administer PRN medication and the residents level of anxiety. This information should also relate to the care plan. One resident had some potentially risky behaviours these were not detailed and supported by a clear risk assessment or care plan. This must be completed within 7 days of receipt of this report. One residents care plan was incomplete and this included areas such as vulnerability the document was not dated and signed. This care plan must be completed and contain more detail within 7 days of receipt of this report. Some scribbling over entries and crossing out was noted in one care plan. A particular piece of work with one resident is being supported by a cognitive behavioural therapist. The detail of the support for this resident is indicated on a separate information sheet, this should be recorded in a care plan and documentation needs to interrelate. After the session the therapist feeds back to the staff to continue the work. the residents key worker is working positively with the resident and promotion of positive reinforcement clearly supports the residents care. Some risk assessments seen had been updated since the last inspection. However, other risk assessments regarding scalding /bathing and fire were still dated ‘01 & ’02. Staff must ensure that risk assessments and care plans interrelate. Risk assessments relating to residents activities have been drawn up but need further development as discussed during the inspection. Risk assessment documentation needs to ensure resident independence and safety are maintained and define residents and staff roles in supporting this. One resident did not have easily assessable information that would aid their care for example there were no triggers highlighted. Staff were not fully aware of all the triggers, regarding the residents mental health deteriation, regarding the residents health and this has the potential to place residents at risk. It is acknowledged that this information was available but not prominent and easily accessible to staff. Any perceived restriction of liberty, for example, the holding of residents cigarettes, must be supported by a discussion within a multi disciplinarily process with records maintained. Encouraging the resident to be part of the process. This is an outstanding requirement from the previous inspection. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Residents are not able to choose fully a range of appropriate activities and staffing levels do not encourage any spontaneity for residents to choose to go out socially. EVIDENCE: Residents described social activities and trips out for coffee and into the town for a coffee on a weekly basis. Some residents attend local groups and clubs. Residents and staff described residents attending day centres and accessing the local community. The world cup was an interest and residents described supporting England and Italy with flags and a program on view. Residents self determination is given a high priority by staff and residents often choose to spend time in their rooms or communal areas, smoking and watching the television. Points of motivation are often difficult for some residents. Although ongoing support for residents is low key it is supported by Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 16 working at the residents pace on achievable goals indicated in care plans. Staff described encouraging residents to socialise and integrate within the local community. Staff described a programme of activities discussed with one resident to support their recreational and social needs. One resident was going out for a coffee on the second day of the inspection. Residents meetings need to continue on a regular basis. A recent meeting indicated that residents had been consulted about buying bedding plants for the garden, trips out and the open agenda encourages staff and residents contributions although there appeared to be a focus on housekeeping related problems. These issues should be discussed in individual key sessions. As an alternative to an annual holiday residents described wanting trips to the seaside and a zoo. It is not evident that the present staffing levels can facilitate these trips. Staff re deployment should support residents requests to go to the pub. Staff described that normally there are not enough staff on duty to facilitate a regular programme of evening activities or any spontaneity for example, going to the pub, or cinema which is the residents choice. Staffing levels must be reviewed to ensure residents social and recreational needs are met. All residents must have an activity or recreational needs care plan to support their care. It was strongly recommended at the previous inspection that the staff team facilitate befrienders, volunteers, and/or advocates to increase residents’ social contacts if they choose. Some work has been done in this area. However, it is strongly recommended that the staff team invite an advocate to meet with the residents to ensure that there is regular communication and information is displayed for residents to access as they wish. Staff described clearly the importance of upholding residents’ rights. The teatime meal was cottage pie and cauliflower this was presented attractively. Residents had been encouraged to serve the meal and lay the table. The overall ambience was slightly spoilt by the use of some plastic beakers. The deputy manager stated she would dispose of the plastic beakers. Meal times are planned through a weekly residents meetings and residents help themselves to breakfast and tea. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Residents physical health needs may not be fully met and this has the potential to place residents at risk. There are some adequate medication systems, which need to be supported by further training, this should ensure residents are protected from any risk. An emphasis on self-medication should ensure residents have more control over their lives. EVIDENCE: Staff described that they were sensitive to specific gender care. However, this is not detailed in all the care plans. No clear care plan for a resident suffering with diabetes was in place. Dates for a resident to have an Electro Cardio Gram annually were described in their assessed needs, the date for this check was omitted from the care plan. There was no frequency recorded for one resident needing a regular blood test for lithium levels. Theses omissions have the potential to place residents at risk. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 18 The deputy manager stated she would personally address and rectify the situation. Medication Administration Records sheets showed no gaps or scribbled over entries. Entries regarding the times of medications had been altered without written confirmation from the prescriber to indicate that medication times could be changed. This has the potential to place residents at risk. It was also noted that hand written entries on the Medication Administration Records sheets were not supported by two staff signatures. This was also evident on a Medication Administration Records sheet where medication had been transcribed from a telephone call. This should have been supported by a fax. One residents self-medication assessment was dated 19/8/04 this is unacceptable. Three staff spoken with appeared keen to develop the process of residents self-medication. It is apparent that residents could sign for their medication and are aware of the times of medication; this should form the basis of a detailed regularly reviewed risk assessment. Any self-medication programme should be done in consultation with the residents psychiatrist and GP and involve the resident and/or their representative. This process needs clear leadership as some staff may consider the risk too great and may not be willing to change their practice. Any self medication programme must be supported by a risk management framework. Training to check staffs competencies have been developed using a series to test knowledge. Staff need to be very clear regarding any error and should be supported by clear guidelines and policy. The deputy manager stated that she had not gone through the scenarios completed by staff yet. It is important that the issues regarding the scenarios and staff practice are discussed in individual supervision. It became apparent that staff do residents blood sugar monitoring, this must be supported by specific training and regular competency checks carried out by the district nurse. The deputy manager stated that she had started work on an audit systems to support medication and other practice issues. Individual PRN management plans were in place, some further advice was given regarding one management plan. Other PRN management plans documents were clear and contained some useful information. Staff confirmed that the residents GP reviewed medication regularly. Medication perceived as controlled drugs for example Diazepam were described by staff as counted when administered. There was no counter available and so Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 19 this brings into question their practice. This medication should be counted daily as good practice and records maintained. Other controlled drugs were in sealable packaging and so could be counted easily. Some medication was not safely stored for example ‘Movicol’ was left on the side this practice must cease. This has the potential to place residents at risk and does not ensure that staff are following the homes medication policy. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. A clear awareness of adult protection protocol should ensure residents safety. Residents views about the service should be recorded to ensure staff are acting on the residents views appropriately. EVIDENCE: All potential adult protection issues should be reported under POVA. An historic adult protection issues had been reported by letter to the care manager. There was no apparent follow up. The manager stated that he would ensure that this matter is followed through. It was not evident that adult protection was discussed regularly in staff meeting minutes and that staff new the outcome of the historic event. It was not apparent that all agency staff have completed adult protection training. The manager must confirm that all staff including agency are aware of their responsibility under the interagency protocol. Two residents money and records were checked and these tallied. The deputy manager stated that there are sometimes discrepancies but staff always checked back on the records to see if there was any subtraction error. One staff member discussed a resident holding some of their own money, this is to be encouraged and supported by a risk assessment which is being worked on. Residents must be encouraged to be self-managing in a risk management framework. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 21 Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Some shortfalls in the environment and health and safety issues have the potential to effect resident’s safety. An odour in one bedroom distracts from the overall pleasant environment for residents. There is a planned programme of repairs and refurbishment and this should add to the overall ambience of the home. EVIDENCE: There is a programme of repairs and refurbishment of many aspects of the home. A new kitchen is recently installed. Decoration of the hallway, stairs and landings, which indicates work in progress and the other stairs and lounge are part of the overall plan. Some bedrooms have been decorated and at least two vanity units have been replaced. New furniture will add to the ambience once the decoration is completed. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 23 The bathrooms upstairs and downstairs need to be made a priority along with the call bell being linked to the mains electricity. The deputy manager stated that she and the manager would prioritise this work in consultation with the housing provider. It is acknowledged that the timescale for completion has not been exceeded. During a tour of the home which included viewing all the residents bedrooms (with their permission) a number of issues were identified. These included. • One residents bedroom had a number of cobwebs this needs to be addressed. However, it is acknowledged that the condition and general upkeep of this room has considerably improved. Credit should be given to the resident and staff for their work in this area. A lock must be fitted to the shed and in the interim a risk assessment must be in place. the manger stated that this has been actioned. A lock must be fitted to the laundry door in consultation with the fire officer and in the interim a risk assessment must be in place to protect residents. Changes to the residents house rules and statement of purpose and contract will need to take place to support this. Privacy in the garden must be increased. A risk assessment must be in place regarding the exit near the laundry door. A risk assessment must be in place for the use of 3 way adapters. New furniture for the lounge and conservatory must be purchased The blinds in the conservatory must be cleaned or replaced. The front garden requires attention. • • • • • • • • Although much work has been done with more planned for the coming year, there is no regular tour of the home taking place by the manager and responsible individual to identify any issues regarding health and safety or repairs and refurbishment. The manger confirmed that this was in hand. It was noted that some information regarding residents care was on their wardrobes and doors this should be supported by written conformation from the resident that this is their choice. Hot water temperatures must be recorded regularly to ensure residents are not scalded. This must be supported by updated risk assessments. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. The use of agency staff who are not adequately trained has the potential to impact on the residents care. Staff training for the established team has been given a high priority which should benefit the care of residents. Staffing levels must be increased to support residents recreational and social needs. Recruitment procedures appear robust which should protect residents. EVIDENCE: Through discussions it was evident that the established staff team have a good understanding of residents needs and have a clear understanding of their roles and responsibilities. Staff were knowledgeable regarding working alone and management of the home in the absence of the manager. There is a rolling programme of training and staff have generally completed all mandatory training. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 25 A training matrix supported staffs information. Staff stated that they had not had any recent training in mental health issues or challenging behaviour and that there is difficulty in securing places on a ‘hearing voices course.’ The manger stated that the training matrix is supported by a planned programme of training. Staff stated that they had difficulty in accessing NVQ training this must be available for all staff. Information held on agency staff was more detailed than at the last inspection. It is evident from studying this file that agency staff are either not undertaking training in adult protection and/or some mandatory training. This must be rectified. The manager must ensure that all staff including agency staff are competent and qualified to support the residents living in the home. Two staff files were studied. Staff had CRB and 2 or 3 references however the manager is reminded that the authenticity of all references must be supported by a compliment slip official stamp and or letter head. If this is not available the manager must follow up the references with a telephone call and record this. Staff did not have a copy of their contract on file nor was their medical form. These documents are apparently held centrally. One staff file had a job description. The deputy manager confirmed that new staff are in the process of being recruited this will support the care of residents. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Residents generally benefit from a well run home and an open and receptive staff team. Shortfalls in health and safety procedures may place residents at risk. Quality audit systems must be in place to support the residents’ care. EVIDENCE: The deputy manager appears open and responsive to the inspection process and the staff team appeared un phased by the process. Some health and safety records were seen and others were confirmed as being in place by the pre inspection questionnaire. A water chlorination certificate Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 27 must be obtained. The emergency lighting is now being tested monthly this must be recorded regularly. The call bells fitted must be audible to staff when downstairs, in the interim a risk assessment was seen to be in place. Risk assessments for radiator not covered were also seen. Other health and safety issues have been discussed under standards 19 and 26. Regulation 26 visits take place and reports are sent to the Commission. The proprietors representative must ensure that these visits are unannounced. The manager is reminded that under Regulation 37, ‘any event that effects the well-being of a resident’ is to be reported to the Commission. There is a new accident reporting system in place. It is strongly recommended that the manager develops an audit system for all accidents and incidents. The system of recording accidents must be supported by a clear procedure. It is not clear that there is a distinction between accident and incident recording. The manager must re affirm the homes policy and procedure to all staff. Accidents and incidents should be supported by a risk management plan. Quality audit systems were discussed and the manager, the organisation need to involve residents in any quality audit system ensuring that there are clear outcomes to improve the service delivery. The manager must develop audit systems to identify and solve areas of practice where the standard has not been met, this includes care plans, risk assessments and medication practices. Staff had removed residents names from the office wall to protect residents anonymity. Guidelines for data protection regarding the use of the message book should be put in place. Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 28 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 2 32 1 33 X 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 2 X X 2 X Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 2. Standard YA6 Regulation 15 Requirement Care plans must reflect all assessed needs and reflect the residents present situation ensuring staff approach is described fully. The process of care planning must be supported by training and ongoing support for all staff. A quality audit system will support the process to ensure an overall standard for the home. Previous timescale 31/11/05 not fully met and this timescale is not exceeded at this inspection. Any perceived restriction of liberty must be supported by discussions held and reviewed in a multi disciplinary forum. Previous timescale 31/05/06 not fully met. Risk assessments must be in place, reviewed regularly and focus on residents independence whilst supporting them if any danger. Previous timescale 31/05/06 not fully met. The proprietor and manager must address the shortfalls in the environment detailed in the DS0000023040.V292248.R01.S.doc Timescale for action 30/09/06 3. YA9 13 (4) 30/09/06 4. YA9 13 (4) 30/09/06 6. YA24 23 (2) (b) 31/08/06 Haslerig Close (8) Version 5.1 Page 30 7. YA24 23 (2) (b) 10. YA39 24 11. YA42 13 (4) 1 YA20 13 (2) 2 YA20 13 (2) 3 YA33 18 (1) 4 5 YA35 YA42 18 (1) 13 (4) (c) 6 YA42 13 (4) previous inspection. Timescale not exceeded at this inspection. The proprietor and manager must ensure that they maintain the property to ensure that residents live in a homely comfortable and safe environment. Previous timescale 31/9/05 not fully met. Timescale has not been exceeded at this inspection. Quality audit systems must be developed and supported by resident involvement. Previous timescale exceeded 30/06/06. The manager must obtain a water chlorination certificate. Previous timescale exceeded 30/04/06. The manager must ensure that the storage of medication must be appropriate and in line with the homes medication policy. Staff must not transcribe medication on to Medication Administration Records sheets or change the times of medication without authorisation from the prescriber. The proprietor must review staffing levels to ensure residents social and recreational needs are met. Staff must be trained to ensure that they can carry out blood sugar monitoring. The manager must develop an audit system for residents who have had an accident or incident ensuring that risk management plans are in place. The call bell fitted must be wired into the mains electricity supply to ensure staff can hear the system. DS0000023040.V292248.R01.S.doc 31/08/06 30/11/06 30/09/06 31/07/06 31/07/06 30/11/06 30/08/06 31/10/06 30/11/06 Haslerig Close (8) Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA2 YA2 Good Practice Recommendations Staff described some good practice regarding the assessment process, this should be supported by clear guidelines. It is strongly recommended that the staff team gain information from the residents previous home. It is strongly recommended that the staff team discuss any future residents admission in staff meetings and there is an audit trail to ensure that the staff team could meet any prospective residents needs. It is strongly recommended that the staff team ensure that care documentation interrelates. It is strongly recommended that the two staff sign all hand written entries. It is strongly recommended that the staff team consider developing a self medication system. It is strongly recommended that the manager reviews the storage and recording of Diazepam. It is strongly recommended that the manager develop the PRN management plans and ensure they relate to the residents care. It is strongly recommended that the manager purchase a medication counter. It is strongly recommended that the manager has a regular agenda item in staff meetings to discuss adult protection. It is strongly recommended that the manager records residents concerns and records these ensuring they are actioned. 4 5 6 7 8 9 10 11 YA6 YA20 YA20 YA20 YA20 YA20 YA23 YA22 Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haslerig Close (8) DS0000023040.V292248.R01.S.doc Version 5.1 Page 33 - 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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