Inspection on 18/04/05 for 86 Harvey Road

This inspection was carried out on 18th April 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

86 Harvey Road 14/08/06

86 Harvey Road 12/12/05

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 Gill Wooldridge Unannounced 18th April 2005 8.45 a.m. 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 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 Stationary 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) Version 1.10 Page 3 SERVICE INFORMATION Name of service Harvey Road (86) Address Aylesbury, Bucks, HP21 9PL Telephone number Fax number Email 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) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09 August 2004 Brief Description of the Service: 86 Harvey Road is a registered care home for three adults and provides personal care and accommodation for residents /clients. The home is a satelite 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 have been in post for some time. The home is run by the Brain Injuries Rehabilitation Trust. The home has three bedrooms and comfortable commmunal areas and is situated in a reisdential street close to local shops and a hospital. Public transport is easily accessible. Harvey Road (86) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place on 18th April 2005. The inspection took 6 hrs. The inspection was carried out by Gill Wooldridge. During the course of the inspection the requirements and recommendations from the last inspection were discussed and some evidence was found to ensure that these shortfalls were met. The inspection also included a tour of the building, gaining permission from all the residents/clients to enter their bedrooms. Two care plans were studied and the care of these residents/clients tracked. Staff personnel files, staff training records and Medication Administration Record (MAR) sheets were also studied. Two care staff were spoken to and time was spent with the team leader. Breakfast was observed and time spent in conversations with residents/clients and observing interactions between staff and residents/clients. What the service does well: The team leader was able to describe a large number of areas in which he feels the home does well these include:The home has an established staff team with support from a regular group of bank 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. The staff team give residents/clients flexibility and involve them in choices and decisions in many aspects of their lives, within the limitations of their illness. The environment has improved in many areas with just some finishing touches needed. There is a homely relaxed feel to the home. Management support is given to the home by the registered manager who visits twice weekly. A daily meeting with staff and residents/clients promotes independence and involves residents/clients in decision making. Staff positively reinforce residents/clients involvement. The home promotes advocacy. The home has purchased new equipment to support residents/clients needs. 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. Harvey Road (86) Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harvey Road (86) Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Harvey Road (86) Version 1.10 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 standard(s) 2 An assessment process is in place which aims to ensure that the individual aspirations and needs of prospective residents/clients are assessed and acknowledged. EVIDENCE: Details of resident /clients needs assessment were seen on residents/clients files. These needs were on the whole converted into care plans. Residents/clients described being involved in the process of care planning. Harvey Road (86) Version 1.10 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 standard(s) 6,7 & 9 There has been some overall improvement regarding the quality and content of care plans which along with action of some good practice recommendations will ensure that residents/clients care is documented fully to ensure continuity of care is maintained. Residents/clients participate in a daily orientation meeting which encourages them to participate in meaningful decisions which effect their lives. Risk assessments need further development and documentation to ensure resident /clients independence and safety is maintained. Perceived restriction of liberty care plans need to be documented fully as detailed in the evidence this will ensue residents independence is maintained and documented. EVIDENCE: Resident files randomly sampled were found to contain individual plans of care. At the last inspection the manager was required to audit care plans to ensure they met the standard. There was evidence to show that the team leader had Harvey Road (86) Version 1.10 Page 10 carried out a recent audit. The audit system needs to be developed further as discussed during the inspection. After studying two care plans, and tracking residents/clients care from previous inspections, records more fully reflected residents/clients needs. Involvement of the residents/clients was described by them and included comments such as ‘anything different is included in my care plan’. Residents /clients care plans are held in their bedrooms. Records viewed showed that in key sessions care plans are discussed regularly. This could be developed further to describe more fully these discussions and staff’s good practice. The detail of staff’s daily recording has improved considerably. Staff described clearly how they meet residents/clients need. It is recommended that staff’s approach and level of support is described more fully in care plans. Recent initiatives relating to individual cooking programmes with support from the Occupational Therapist will need to be documented. The morning orientation meeting between residents/clients and staff happens on a weekday which encourages residents/clients choices and selfdetermination. The morning meeting focused on positive reinforcement, participation and encouragement of each individual. Staff described some of the planned activities and appointments during the week. Staff promoted residents/clients choice during the meeting and then worked alongside residents/clients to complete some household tasks before going out for the morning. Generic and individual risk assessments need to be developed. Some risk assessments were not signed or dated. Risk assessments did not contain enough information relating to the residents/clients independence. All perceived restriction of liberty care plans, for example staff holding residents/clients cigarettes, must be documented fully, dated and formally discussed with residents/clients, their relatives or representatives and professionals outside the organisation. Records of these discussions and outcomes must be maintained for inspection purposes. One risk assessment referred to an epilepsy management plan, this was not available as supporting documentation but held in another section of a file. Harvey Road (86) Version 1.10 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 standard(s) 12 & 17 Social activities and work opportunities are encouraged within the wider community enabling wider interaction and opportunities for socialisation for residents/clients. Breakfast was determined by residents/clients choice providing a relaxed and supportive atmosphere. EVIDENCE: Residents/clients described a number of activities including Thrift Farm, shopping in town, walks, visiting a pub, going for a coffee, bowling, visiting garden centres and trips to the cinema. Residents/clients had been for a walk to Coombe Hill during the inspection and commented favourably when they returned. Observation of breakfast indicated that residents/clients were encouraged to be self-managing. Staff were seen to offer residents/clients choice and there was a relaxed atmosphere with the radio playing. Cereal and toast were offered and juice, tea or coffee were part of the choices. Takeaways are a weekly feature of the menu. Harvey Road (86) Version 1.10 Page 12 Harvey Road (86) Version 1.10 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 standard(s) 20 Medication procedures and staff training are in place however, these procedures are not always followed. This may put residents/clients at risk. EVIDENCE: Following a requirement made at the last inspection there was evidence seen that the points raised had been actioned by staff and the manager. Staff confirmed that training in medication administration had taken place. Medication Administration Record (MAR) sheets were completed showing no gaps. However, hand written entries on the (MAR) sheets need to be signed and dated by staff and ideally the manager will need to obtain computer generated charts or printed labels from the pharmacist. Further to this the manager will need to ensure that staff return all out of date or discontinued medication to the pharmacist and not to Kent House as described by staff in the stock control records. It is recommended that the manager obtain a copy of the Royal Pharmaceutical Society Guidelines and review the storage of medication in the home. Harvey Road (86) Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Complaints are handled objectively which should ensure that residents/clients views are listened to and acted on. Both the staff and the manager demonstrated awareness of abuse issues which alongside the organisation’s policies and procedures should ensure that residents/clients are protected from abuse. EVIDENCE: The home advertises its complaints procedure on the notice board and it appears that residents/clients are able to comment about the service freely. The Commission has not received any complaints since the last inspection. The complaints book showed in recent months one complaint which was handled appropriately. The team leader described recent Adult Protection training which is supported by the organisation’s policy and procedure. Staff were able to describe the different types of abuse and how they would action any alleged, potential or actual abuse and reporting process. Harvey Road (86) Version 1.10 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 There have been marked improvements in the décor in the communal areas and residents/clients bedrooms which have undoubtedly had a positive effect on how residents/clients feel about their home. The home lacks pedal bins which if provided would aid infection control and protect residents/clients. EVIDENCE: There is a marked improvement in the overall condition of the communal areas and residents/clients bedrooms. There are new carpets, curtains, lighting and finishing touches which have created a homely feel for residents/clients. Residents/clients described being involved in choosing the lights and colour schemes. The manager has purchased a new bath which meets one resident’s/client’s needs. On the whole the home is cleaner than at previous inspections which has added to the overall good impression of the home. The manager is strongly recommended to obtain pedal bins to aid infection control. . Harvey Road (86) Version 1.10 Page 16 Harvey Road (86) Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 & 36. The procedures for the recruitment of staff appear robust and should provide the safeguards to offer protection to residents/clients living in the home. Training records showed that not all staff have completed mandatory training which has the potential of failure to meet residents/clients needs. EVIDENCE: Three staff files were studied, all contained a CRB disclosure and references Staff recently employed also had a POVA check in place. Training records showed on the day of inspection that not all established/permanent staff and particularly bank staff have received mandatory training. The team leader confirmed that not all staff had received all mandatory training. However, following the inspection the manager was sent records which confirmed that all staff have received mandatory training. These records indicated a rolling programme of training. Records of training and certificates must be maintained for inspection purposes in the home. In the interim, the manager must ensure that all bank or relief staff can respond to a first aid and/or fire emergency by assessing their competence. Records must be maintained for inspection purposes. All newly appointed staff, including bank staff, should have completed mandatory training within six months of the commencement of their employment. Harvey Road (86) Version 1.10 Page 18 Harvey Road (86) Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Clear systems are in place to record fire alarm tests however, these are not supported by accurate recording to demonstrate compliance with the duty of care. Improvements in recording will provide supporting evidence that the health, safety and welfare of residents/clients are promoted and protected. Improvements in fire safety procedures will contribute to a safe environment for residents/clients. EVIDENCE: Fire records seen showed regular checking of systems to support residents/clients safety. However, records seen need to describe more fully staff responsibilities when a fire alarm is not responded to. This will indicate compliance with their duty of care. It is concerning that all fire drills lead residents/clients to exit the building via the back door. It is recommended that the manager review the fire procedure to include a scenario relating to a fire in Harvey Road (86) Version 1.10 Page 20 the kitchen, hence an alternative exit. These scenarios and procedures will need to be explained to residents/clients frequently. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No Standard No 31 32 Score x x Page 21 Harvey Road (86) Version 1.10 11 12 13 14 15 16 17 3 x x x x x 3 33 34 35 36 x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 1 x Harvey Road (86) Version 1.10 Page 22 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. 1. Standard 9, 24 & 43 Regulation ,13 (4) Requirement The manager must ensure that generic, individual risk assessments and any percieved restriction of liberty care plan are developed further as detailed in the evidence. The manager must obtain pedal bins to aid infection control measures. All bank staff must be trained in mandatory training within six months. Fire procedures must be developed to include advice given in the Standard. S staff must explain to residents regularly the fire procedure for given scenarios and record this fully. Timescale for action 31/7/05 2. 30 16 (2) (j) 30/6/05 3. 4. 35 42 18(1)(a) 13 (4) 31/12/05 31/8/05 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 6 Good Practice Recommendations It is recommended that staff record fully the detail of Version 1.10 Page 23 Harvey Road (86) 2. 3. 4. 5. 6. 6 6 20 20 20 7. 8. 20 their key sessions with residents. It is recommneded that staff more fully record, in resident care plans, and describe their approach and support given to residents. It is recommneded that staff record in detail the recent initiative relating to residents cooking and support from the Ocupational Therapist. It is strongly recommended that the manager reintroduces the medication returns book and ensures all staff are aware of this procedure. It is strongly recommmended that the manager purshase a specific cabinet for the storage of the residents medication. It is strongly recommended that the manger ensures that all staff sign and date hand written enteries on MAR sheets and where possible obtains computerised MAR sheets to reduce this practice. It is strongly recommended that the manger obtain a copy of the Royal Pharmacutical Societys Guidelines for the Administration of Medication. Harvey Road (86) Version 1.10 Page 24 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, 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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