Inspection on 14/08/06 for 86 Harvey Road

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

86 Harvey Road 12/12/05

86 Harvey Road 18/04/05

86 Harvey Road 09/08/04

86 Harvey Road 13/04/04

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

CARE HOME ADULTS 18-65 Harvey Road (86) Aylesbury Bucks HP21 9PL Lead Inspector Joan Browne Unannounced Inspection 14th August 2006 09:00 Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harvey Road (86) Address Aylesbury Bucks HP21 9PL 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) 01296 399341 The Disabilities Trust Mrs Christine Wood Care Home 3 Category(ies) of Physical disability (3) registration, with number of places Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 Adults with brain injury Date of last inspection 12th December 2005 Brief Description of the Service: 86 Harvey Road is a registered care home for three adults providing personal care and accommodation. The home is a satellite of Kent House but has its own registration. Harvey Road maintains some administrative support and the registered manager spends, on average two days a week at the home. The home is supported by a staff team of whom the core has been in post for some time. It is run by The Brain Injuries Rehabilitation Trust. The home has three bedrooms and comfortable communal areas and is situated in a residential street close to local shops and a hospital. Public transport is easily accessible. The current scale of weekly charge is £1250.00. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 14 August 2006. Prior to the fieldwork visit previous information about the home was reviewed and the outcome of the previous inspection noted. Comment cards were received from three clients, one relative, two health and social care professionals and one general practitioner. Overall they were satisfied with the care that was being provided. A tour of the premises was undertaken and care documentation and records were examined. Clients and staff were spoken to. The care of three clients was ‘case tracked’. Care practices and the home’s approach to quality and diversity issues were observed. What the service does well: What has improved since the last inspection? What they could do better: The risk assessment relating to the client that suffers from epilepsy should be reviewed to include more detail of the process in the event of a seizure occurring during the night. The protocol in place relating to convene treatment should be reviewed as discussed during the inspection. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 6 A recent photograph must be obtained for staff as part of the process to confirm proof of identity. The home’s application form must be amended in line with current regulations to include a section requiring applicants who previously worked in a position, which involved contact with children or vulnerable adults to give their reasons for leaving their employment. 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. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 7 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 Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 8 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 good. This judgement has been made using available evidence including a visit to the service. The home aims to assess prospective clients prior to admission to be sure that they could meet their needs. EVIDENCE: There has not been any new admission to the home for sometime. The home’s admission procedure was discussed with staff. They confirmed that a prospective client would not be admitted to the home until the individual’s needs had been fully assessed to be sure that the placement would be appropriate. It is the practice in the home to invite the prospective client to the home to spend sometime and meet with other clients. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 9 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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Information recorded in care plans were detailed to ensure that clients’ personal, social and health care needs would be met. Clients are supported by staff to maintain their independence and appropriate risk assessments are put in place to minimize any identified hazards. EVIDENCE: The three clients’ care plans were examined. Plans contained detailed information relating to the individuals’ assessment of needs and covered all aspects of their personal, social and health care needs. The plans were signed by clients to indicate their involvement in the process. It was noted that some individuals’ assessed needs were reviewed daily, weekly or three weekly. Evidence was in place to indicate that six monthly reviews of the management of the care plans were taking place and the clients’ relatives and care managers were involved in the process. Each client had been risk assessed for the prevention of tissue damage. Waterlow assessments were in place and they were reviewed three monthly. Those clients who needed to be supervised when having a cigarette signed Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 10 agreement forms to allow staff members to supervise the activity. Staff were observed carrying out this task in a sensitive and discreet manner. Clients confirmed that they were involved and consulted about decisions that affected their lives. Staff were observed discussing with individuals how they wished to spend their day. Some clients were quite clear in how they wished to spend their time. Others needed support from staff. Clients were not managing their finances. However, one particular client was being supported by the staff team as part of the individual’s rehabilitation programme to have a small amount of money daily for personal use. The individual was encouraged to keep a written record on how the money was spent. It was noted that arrangements were in place for individuals to have access to their personal allowances when required. Social Services and personal solicitors were responsible for investing clients’ savings. As part of the home’s ethos clients are expected to take risks to promote an independent lifestyle. Risk assessments seen were relevant to activities undertaken by clients. One particular client who is very fond of horses was visiting the local stables once a week to groom the horses. A risk assessment detailing the action to minimize the identified risks and hazards had been developed. Risk assessments were reviewed six monthly or as and when required. It is recommended that the risk assessment for a particular resident that suffers with epilepsy should be reviewed to include more detail of the process in the event of a seizure occurring during the night. The home has a missing person’s procedure. Staff spoken to said that they were familiar with it and would implement it if there were any unexplained absences. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to the service. Clients are encouraged to be independent, choose their own lifestyle and to take part in social activities and work opportunities within the wider community. Thus enabling them to feel part of the community. EVIDENCE: Clients said that they were attending college twice a week and were studying numeracy, literacy, pottery, painting and information technology. Two clients were doing voluntary work placements. One was working in a dog kennel and a second was working in a horse stable grooming horses. They both said that they were enjoying their jobs. Clients are seen as part of the local community. They visit the local pubs, leisure centre and shops. They are also members of the local social club, which they attend weekly. On the day of the site visit they requested to go out to the local coffee shop. As part of their rehabilitation programme some clients were able to visit the coffee shop unescorted but with some covert shadowing from staff. Clients are given the opportunity to be politically active Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 12 if they wished to. It was noted that staff were making arrangements to take clients on holiday. Clients are encouraged and supported by staff to maintain links with family and friends. One particular client said that staff regularly arrange transport for him to visit his family. The home’s daily routine promotes clients to be independent. One client was observed hoovering the sitting room. Some clients were prompted to wash their cups and tidy the kitchen. All clients have been issued with keys for their bedroom doors however, some choose not to use them. Clients’ preferred form of address was recorded in their individual care plans. Staff were observed interacting with clients in a positive manner. Breakfast was observed and seemed to be a relaxed and flexible activity. It was noted that clients were encouraged to choose their breakfast cereal and make their own toast. Clients are encouraged by staff to plan, prepare and serve their own meals. Some clients were on a rehabilitation programme and had been assessed by the occupational therapist to prepare microwave meals. Staff were observed implementing the programme and supporting clients when necessary. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Arrangements are in place to ensure that clients’ personal and health care needs are adequately met. EVIDENCE: Information was recorded in care plans to indicate how individuals’ preference in personal care should be provided. It was noted that some clients preferred to have daily showers instead of baths. All clients needed encouragement and prompting by staff with personal care. Clients said that staff respected their privacy when providing personal care and they were able to choose their own clothes. It was noted that a particular client was in receipt of conveen treatment to promote continence. It is acknowledged that the care records indicated that the continence advisor had visited the home on two occasions to advise staff on its use. Because of the sensitivity of the procedure and staff could be perceived as providing invasive treatment it is recommended that the protocol in place should be reviewed as discussed during the inspection. It was noted that clients’ toiletries, toothbrushes and holders were labelled with their names and stored on the windowsill in the bathroom. This has the Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 14 potential to compromise clients’ privacy and dignity. This was discussed with staff and it is acknowledged that staff agreed to purchase a bathroom cabinet to store these items. All clients are registered with a general practitioner who would treat them at home or at the surgery. Clients are able to access national health service specialist treatment via the general practitioner. Dental, audiology, chiropody and optical treatments can be accessed when needed. The medication administration record (MAR) sheets were examined and no gaps were noted. Two staff signatures were noted on handwritten entries on MAR sheets to verify that information had been doubly checked. Medication returned to the pharmacy was appropriately recorded in the returns book and signed by a staff member and the chemist. A requirement was made at the previous inspection that staff’s competencies in the administration of medication should be regularly assessed to ensure that they are following the home’s medication procedure. The requirement had been complied with and staff confirmed that they had received updated training in the administration of medication. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to the service. Clients feel safe and listened to. Staff have been trained in adult protection and understand how to apply the home’s procedures. EVIDENCE: The pre-inspection questionnaire indicated that the home had not received any complaints since the last inspection. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. Clients said that they felt safe living in the home and they were able to speak to the staff and manager if they were not happy about anything to do with their care. The Commission has not been informed of any allegation of abuse made to the service since the last inspection. The home’s training records indicated that all staff had undertaken training in the protection of vulnerable adults. Staff spoken to were aware of the action that should be taken if an allegation of abuse was made. Arrangements are in place to ensure that clients have access to their personal allowance when required. Written records of all transactions are maintained and records corresponded with money in safe. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to the service. The home’s environment is well maintained to ensure that clients live in a place that is safe and homely. EVIDENCE: The home was generally clean and tidy. Clients said that they liked their bedrooms, which were personalised, clean and well presented. Since the last inspection new dining room and garden furniture had been purchased also a computer table. The garden was well maintained with pot plants and a new garden fence had been erected. The home was free from offensive odours. Hand washing procedures were in place to prevent the spread of cross infection. The area where the washing machine and drier were placed was adequately maintained. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to the service. The home has systems in place to ensure that staff are appropriately vetted and trained to care for clients. However, the systems could be improved further, which would result in better outcomes for the clients. EVIDENCE: Staff were working towards achieving the national vocational qualification (NVQ) level 2 in direct care. The file for the most recently recruited staff member was examined. A completed application form was in place and evidence that a criminal record bureau (CRB) clearance had been obtained. Two references were obtained and there was a note recorded on one of the references to indicate that the manager had clarified a concern with one of the referees. This is deemed as a good practice. A copy of the individual’s terms and conditions of employment along with a signed declaration of fitness of health were seen. There was not a recent photograph of the individual on file. However, two black and white photocopies of passport pictures were seen. It is recommended that a recent photograph should be obtained as part of the process to confirm proof of the individual’s identity. The home’s application form does not provide a section for applicants to give their reasons for leaving previous employment. From 26 July 2004 the Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 18 regulations require that where a person had previously worked in a position, which involved contact with children or vulnerable adults, written verification (so far as reasonably practicable) of the reason why he ceased to work in that position should be obtained. It is acknowledged that the manager discusses with prospective employees at the interview any gaps in employment details and tracks their employment history. However, the process needs to be developed further to ensure that the information is recorded on the application form. The home has training programmes in place to ensure that mandatory training for staff is kept updated. Non-statutory and specialist care needs training is also provided. It is recommended that the process for recording and updating staff training records be reviewed to ensure that information is current and accurate. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to the service. There are systems in place to ensure that the home is run in the best interests of clients. Health and safety records are well maintained to ensure that clients’ health and safety are promoted and protected. EVIDENCE: The manager is registered with the Commission and has completed the registered manager’s award. She is supportive of the staff team and visits the home on a weekly basis leaving the day- to- day management of the service to the team leader. Comment cards received from relatives, clients, the general practitioner and care managers expressed overall satisfaction with the care that was being provided. Specific comments included: “Excellent home since current team leader has been in post. Good communication. I am sent care plans and risk assessments to sign off. I wish BIRT would open more units like this one.” Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 20 “I feel that the successful running of this home is down to a particularly good house leader currently insitu.” Clients are issued with a written contract and statement of terms and conditions of occupancy. Key workers are expected to discuss contracts and the service user’s guide with clients regularly at key sessions. The home has systems in place to ensure that clients and stakeholders views are obtained. Monthly audits relating to health and safety and staff’s practice are undertaken. There is an annual and development plan, which is based on a systematic cycle of planning, reviewing and reflecting outcomes for clients. The home is accredited with investors in people and is working towards obtaining a further accreditation with another recognised body. The manager and the staff team were committed to promoting equality and diversity in the service and meeting clients’ individual needs. The fire records indicated that the fire panel is checked weekly. Clients participate in weekly fire drills. On the day of the site visit a fire drill was undertaken and clients responded appropriately to the procedure. The pre-inspection questionnaire indicated that the fire equipment was serviced in May 2006. The health and safety officer carried out a visit on 3 May 2006 and the recommendation made had been acted on. The central heating system was serviced on 10 May 2006. The water temperature check for compliance with legionella is carried out weekly. There was a valid electrical wiring certificate for the building in place that was issued on 12 December 2003. Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 21 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 3 X 3 X 3 X X 3 X Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations It is recommended that the registered manager should review the risk assessment relating to the client that suffers from epilepsy to include more detail of the process in the event of a seizure occurring during the night. It is recommended that the registered manager should review the protocol for conveen treatment. The registered manager should ensure that a recent photograph is obtained for staff as part of the process to confirm proof of identity. The registered manager should amend the home’s application form to include a section requiring applicants who previously worked in a position, which involved contact with children or vulnerable adults to give their reasons for leaving their employment. 2 3 4 YA19 YA34 YA34 Harvey Road (86) DS0000023066.V301932.R01.S.doc Version 5.2 Page 23 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. 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