Inspection on 30/09/05 for 94 Chatsworth Road

This inspection was carried out on 30th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

94 Chatsworth Road 25/10/06

94 Chatsworth Road 18/04/05

94 Chatsworth Road 18/11/04

94 Chatsworth Road 21/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Chatsworth Road 94 Westfields Hereford Herefordshire HR4 9HZ Lead Inspector Jean Littler Unannounced Inspection 30th September 2005 11:00 Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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 Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Chatsworth Road 94 Address Westfields Hereford Herefordshire HR4 9HZ 01432 340560 01432 340560 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) Aspire Living Ceridwen Jones Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users who have a physical disability in addition to their learning disability can be accommodated in the Home. As some aspects of the layout of the Home fall below those recommended in the National Minimum Standards for wheelchair users any new service user who has a physical disability must not be admitted without an Occupational Therapy assessment being completed, and written agreement with the Commission regarding the suitability of the placement. 18th April 2005 Date of last inspection Brief Description of the Service: 94 Chatsworth Road is a service run by Aspire Living and Choices Ltd. which is a Voluntary Organisation. The head office is based at the Fred Bulmer Centre, Wall Street, Hereford, HR4 9HP. The Care Home provides personal care, social support and accommodation for four adults with learning disabilities, some of whom also have physical disabilities. The accommodation is provided in a purpose built bungalow within a modern housing development in Hereford. There are pubs, local shops, a supermarket and post office all within a distance that residents can access. Transport for longer distances is provided in the Home’s unmarked minibus. The four single bedrooms have sinks fitted and there is a communal assisted bathroom, assisted shower room and a separate toilet. The bedrooms are smaller then the standards recommend for wheelchair users. The total average living space provided exceeds the size set in the National Minimum Standards. The design of the building takes account of the access needs of wheelchair users, with wide corridors and door openings of 950mm. Opened in 1996 the premises met relevant building regulations at that time. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on a week day morning. The main focus of the inspection was to investigate a complaint made to the Commission by a relative of one of the residents. Staffing arrangements and some health and safety areas were also assessed. All four residents were at Home during some part of the 3hr inspection. The manager was working on a care shift as a worker had called in sick that morning. Two other staff were on duty but were out for the most part assisting with a swimming trip. The manager therefore assisted with the inspection process and staff were not formally interviewed on this occasion. Information already known about the service, correspondence between the service and the Commission since the last inspection, and the content of the monthly provider visit reports were all considered as part of the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Records need to be completed with more detail to provide a clear account of specific events. Risks associated with changes in resident’s care needs must be fully assessed to ensure appropriate care arrangements are put in place. Some health and safety areas need to be addressed and the manager must ensure fire doors are not obstructed. Staff should be provided with more in depth training in the management of medication. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 6 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. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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 Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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): EVIDENCE: These standards were not fully assessed, however information is available about the Home and the service provided in a suitable format. Only one resident’s representative has signed a copy of the Organisations Terms and Conditions document on their behalf. Efforts should be made to arrange for a representative or advocate to sign this document for the other residents. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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): - EVIDENCE: These standards were not fully assessed, however the residents were well presented, and appeared comfortable and relaxed. Staff were interacting with them in a calm and friendly manner. Care plans are in place but these were not seen on this occasion. It is positive that Person Centred Planning training has been arranged for November. Daily care records were being maintained, however those seen as part of the investigation into one resident’s accident were not detailed enough to establish the order of events. A risk assessment had not been completed to establish how the resident’s additional needs could best be met whilst he recovered from sedation, and no specific instructions had been given to the staff on duty. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 10 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): 14 The residents were being supported to follow personalised activity plans. EVIDENCE: Two of the residents had been out to the swimming pool on the morning of the inspection. At the start of the inspection one resident was enjoying the garden and the other was relaxing and smiling in his room during a relaxation session. All four residents had personalised activity plans and good efforts had been made to ensure these had not been adversely affected during the recent staffing shortages. The Home has been liaising with the manager of the public swimming pool about some difficulties with the new disabled access equipment that they had campaigned for. Due to the staffing difficulties work on developing personalised communication methods to assist residents in expressing their needs and choices has been delayed. Once the team is stabilised this should be given more priority. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 11 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): 20 Arrangements for the management of emergency medication need to be further developed to fully safeguard the residents who are prescribed this. EVIDENCE: The manager reported that the keys to the medication cabinet are now being held securely and only staff authorised to give medication have access to them. Accredited training has not yet been provided for all staff who administer medication. Staff usually only attend training in the Monitored Dose system, although three staff have attended a more in depth training course. Local training providers are now able to gain ‘accredited’ status through the Skills For Care Council, so the manager should now arrange this training for those who need to attend. Protocols for the administration of emergency life saving medication for residents with epilepsy still need to be authorised by a health professional involved in their care. The manager reported that this would be actioned in the near future when a nurse was due to visit the Home. The manager was advised to arrange annual refresher training for staff who administer intrusive medication. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 12 One resident had had to miss out on an outing on the day of the inspection as a worker had gone off sick and the replacement worker was not trained in administering the medication for the resident’s epilepsy. This training has been booked for the new staff so this situation should not reoccur. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 13 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. A suitable procedure is in place for dealing with formal complaints. The arrangements for dealing with concerns presented informally had not been effective and should be reviewed. The manager was fully co-operative with the investigation and was willing to acknowledge the shortfalls identified. EVIDENCE: A complaint was made to the Commission by a resident’s relative on September 28th 2005. The issues were investigated during the inspection. The complainant raised concerns that the resident concerned had not been suitably safeguarded and monitored whilst recovering from sedation given during routine dental treatment, and that staff had failed to report an accident in a timely manner. The manager and staff co-operated fully in the investigation. There was evidence that the resident had been monitored and cared for whilst recovering, however a risk assessment had not been completed by senior staff to highlight that additional measures may be needed for the 24 hrs following the treatment e.g. additional staff support or a protective mat on the floor next to the bed. This part of the complaint was therefore partially upheld. The resident’s relative had been informed the following day of the accident. As at the time of the fall the staff had not realised that there had been any injury. No specific agreement was in place about contact that would cover this type of circumstance therefore this timeframe seemed reasonable. This part of the complaint was not upheld. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 14 The complainant had not felt able to make a complaint directly to the manager or providers. Every effort should be made to facilitate residents’ representatives to raise concerns directly so the Organisation can demonstrate that complaints will be fully investigated in a transparent manner. The manager reported that some concerns had been mentioned informally in the past but she had not recorded these, addressed them formally herself or arranged for someone in the Organisation to respond. A review of how informal complaints is recommended. During the course of the investigation shortfalls were noted in some areas. These have been covered under the relevant sections in this report. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 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 the following standard(s): - EVIDENCE: These standards were not fully assessed, however the Home was clean, comfortable and homely. The garden was attractive with the new raised flowerbeds in tyres full of flowers and the wind chimes moving. The bedrooms had been nicely personalised and these, and the communal rooms, were furnished with good quality items. Further improvements to mobility aides have been recommended by an occupational therapist. Funding for the fitting of two sections of ceiling tracking hoist are being explored. A toilet is also due to be changed to better suit one resident’s posture. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 16 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, 33. Suitable staffing levels were being maintained. Staff had been flexible and provided cover whilst new staff were being recruited. Staff training arrangements reflect the needs of the residents. These will be further improved with the additional medication and first aid training this is planned. EVIDENCE: The Home has been through a period of staff shortages since three staff left in the summer. During this time one worker had an injury and was off for several weeks and another worker moved to another location whilst pregnant. Staff have been working additional hours to provide cover and the manager has been working on more care shifts than usual. Good efforts have been made to keep staffing levels up to ensure the residents’ planned activities and overall quality of life has not been affected. There are usually three staff in the morning and two in the evening. Additional staffing is provided for specific outings and activities. The manager reported that staff morale is good despite the recent difficulties. Two new staff have now been recruited and a worker from another Aspire Home has transferred to the Home. The manager reported that the new staff have been working with experienced staff and have attended appropriate training as part of their induction e.g. epilepsy and food hygiene. Other Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 17 courses are booked e.g. moving and handling. Supervision and guidance about safe handling techniques has been provided in the interim. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 18 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): 40,42. Records relating to accidents and care were not of a sufficient standard to safeguard the residents’ best interests. Suitable arrangements were not made to protect a resident whilst he was drowsy from sedation. Arrangements for managing health and safety had been further improved in some areas, and other issues were being addressed. EVIDENCE: Quality assurance arrangements were not fully assessed, however the providers have recently informed the Commission that a formal system has been developed to monitor the outcomes of the service for residents. The content of the providers monthly visit reports, which are copied to the Commission, have been greatly improved and show that the service is being closely monitored. The accident report and care records viewed as part of the complaint investigation were not sufficiently detailed to provide accurate and useful Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 19 information. The manager had not investigated the accident to established the facts, and had not reported the incident to the Commission. The requirement to carry out a risk assessment about the control of Legionella has been actioned. The manager reported that there is currently some negotiation taking place between the providers and the landlords about who is responsible for carrying out annual water system cleansing. The manager must follow this up and ensure some agreement is reached in a timely manner. Staff had recently been provided with fire awareness training by a professional trainer and the fire extinguishers had been serviced. At the time of the inspection two fire doors were obstructed by furniture. The mechanism that holds the door open but releases it when the fire alarm goes off was broken on the lounge door so furniture was propping it open. The kitchen door mechanism was working by a stool had been placed against the door. The manager must ensure fire safety procedures are followed so the residents and staff are not put at risk. Hot pipe work had been covered since the last inspection to help prevent burns. The bath water was being tested before each bath to help reduce the risk of scalding. It is positive that a risk assessment has been completed about the level of First Aid cover provided in the Home. As a result of this the decision has been taken to provide all staff with a full First Aid at Work qualification. Currently the manager and deputy are fully trained, but other staff have only received one days basic first aid training. Two staff have been booked on to a course in November 05 and another two in January 06. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chatsworth Road 94 Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X 2 X 1 X DS0000024688.V255624.R01.S.doc Version 5.0 Page 21 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 YA20 Regulation 13 Requirement The manager and staff must receive accredited medication training. (brought forward, previous time scale 30/09/05). Protocols for the administration of emergency medication need to be approved by the health specialists involved. (brought forward, previous time scales 31/01/05 and 30/06/05). Known risks to residents must be formally assessed and appropriate action taken to safeguard their well-being. Clear and accurate records must be maintained of any accidents and incidents that occur that affect a resident’s wellbeing. Incidents that affect the wellbeing of a resident must be fully investigated as soon as possible, and reported to the Commission. Fire doors must be kept free from obstruction at all times. Timescale for action 30/11/05 2 YA19, 42. 13 31/10/05 3 YA40 13, 17 31/10/05 4 YA40 13, 17 31/10/05 5 YA42 13, 16 30/09/05 Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 22 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 YA6 Good Practice Recommendations 2 3 4 5 6 7 Clarify with a resident’s relative the arrangements for informing him about incidents that affect the well-being of the resident. Ensure all staff are appropriately informed of the arrangements. YA6 and 42 Complete a new risk assessment to ensure there are no unnecessary hazards in one resident’s bedroom, and provide a mat to put next to his bed at night. YA6 Review one resident’s care plan to ensure this contains clear instructions to staff about how they can help to prevent falls and deal with any that do occur. YA5 A representative or advocate for each resident should be asked to agree to the Terms and Conditions of Residence. YA7 Continue to develop communication systems appropriate to each resident. YA20, 35. Arrange annual refresher training for staff who administer intrusive medication. YA22 Review how informal complaints and concerns are managed. Chatsworth Road 94 DS0000024688.V255624.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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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