Inspection on 15/12/05 for Abacus House

This inspection was carried out on 15th December 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abacus House 22/01/08

Abacus House 16/01/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Abacus House Abacus House 55 Victoria Road Swindon Wiltshire Lead Inspector Mrs Jacqui Burvill Unannounced Inspection 15th December 2005 11:30 Abacus House DS0000064394.V269709.R02.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 Abacus House DS0000064394.V269709.R02.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. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Abacus House Address Abacus House 55 Victoria Road Swindon Wiltshire 01793 511181 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) Holmleigh Care Homes Ltd Suzanne Hanratty Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the two bedrooms on the second floor and the single bedroom leading from a single staircase off the rear lounge are not to be used by service use r or staff until a fire safety sprinkler system has been installed. N/a Date of last inspection Brief Description of the Service: Abacus House is one of a number of homes owned by Holmleigh Care, based in Gloucestershire. There are two homes in Wiltshire as well as two supported living projects. This home offers care and accommodation to adults aged between 18 and 65 years who have a learning disability. The home was registered in August 2005 for 7 service users. At this time, only one service user is resident. Each of the 7 bedrooms has an ensuite shower room with a toilet and hand washbasin. The accommodation is on three floors, but the third floor cannot be used until a sprinkler system has been installed. On the ground floor, there is a dining room, a kitchen with a separate utility room that leads to a sitting room and a staircase for another bedroom. There is a small garden and patio to the rear of the home and parking. The home is close to Swindon Old Town centre. The home is staffed twenty four hours a day. As yet staffing levels have not been agreed, because the home is not full. On the day of inspection, two staff were on duty as well as the manager. One staff member sleeps in every night. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place at short notice on 15th December 2005 and lasted from 11.30am – 4.30 pm. The manager was present during the inspection. The inspector spoke to two staff who were on duty and one service user. The service user was not able to comment directly on the care received, so observations were made of the interaction between the staff and service user. The following areas were looked at: Staff recruitment and training, admission and assessment processes, care plans and risk assessments, medication and medication records, a tour of the premises and some of the policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: When the manager assesses new service users, the accompanying assessment documents must be kept and held in the home, rather than in the head office. The manager must ensure that the full range of records required to be held in the home are in place. This includes evidence of CRB certificates having been obtained and training and recruitment records for all staff employed in the home. This is especially important where staff may be working in more than one Holmleigh service. The vulnerable adult procedure contains some guidance that does not fit with the procedure as it is expected to be used. It must be updated as guidance Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 6 contained within the document may lead staff not to make referrals in certain cases. The complaints procedure is in place, but contains contact details of another CSCI office. The procedure must contain the details of how to contact the correct CSCI local office. 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. Abacus House DS0000064394.V269709.R02.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 Abacus House DS0000064394.V269709.R02.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): 2 Service users may be at risk from a lack of evidence of an assessment of their needs before they are admitted to the home. EVIDENCE: There is insufficient evidence to assess how the service user was assessed and admitted. The admission policy and procedure has a series of stages, and can be variable dependent on the needs of the service user. On this occasion, it was not deemed appropriate for the service user to chose the home. Other appropriate adults made this decision. The manager visited the service user on a number of occasions, but there is no evidence of an assessment, other than a ‘pen picture’. No assessment was in place or had been provided to the home, by the placing authority. There is a three month trial period, which is for the home and the service user to say whether they feel the home is right for them. It is unclear if an assessment of the service user’s needs had been made formally. The manager stated that this documentation may be at the head office. Abacus House DS0000064394.V269709.R02.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): 6, 7, 9 The service user benefits from a care plan that describes how needs will be met. The service user is encouraged and supported to make decisions and manage risks in some aspects of his life. EVIDENCE: An interim care plan was in place, that described how the service user’s needs would be met, through setting aims and objectives and action to be taken after describing the ‘current situation’. This was written on the day of admission and will last for the three month trial period. The care plan includes sections on how to provide personal care, behaviour management, daily living skills, activities, family contact, medication and eating and drinking. The care plan is not in a format suitable for the service user to read. Parts of the care plan have been explained to the service user. The manager aims to find ways to enable to make the care plan accessible to the service user. The service user is supported in making some decisions over parts of his daily life, from choosing what clothes to wear and some of the meals and the mealtimes. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 10 The care plan does not include the responsibilities over household duties, but does include the choices made over weekly activities. This describes the choices available to the service user. Risk assessments are clearly defined. This includes support provided by staff for some of the risks that may be posed when supporting the service user in the community. Daily notes are recorded to show other additional choices that have been made, or offered. The person completing them did not always sign daily notes. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 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 The service user is supported by staff to take part in activities and events in the local community, family and friends and within Holmleigh Care. The service user’s privacy and dignity needs to be considered when continuing to assess personal care needs. The service user benefits from meals that he enjoys and that he has chosen. EVIDENCE: The service user takes part in activities in the community. These had been arranged prior to his admission and have continued. This means that the service user is able to meet friends that he has known for some time. Some of the places the service user visits are part of the local community. The service user is getting to know the area and developing interests. Other service users from within the Holmleigh care homes have been invited to Abacus House, so that service users can meet one another and develop friendships. Part of the care plan contains details of how the service user will maintain family contacts. The service user was looking forward to visits to his family over the Christmas period. Some of the entries in the daily notes were discussed with the manager, as it is possible that in trying to support a service user with their personal care, Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 12 their dignity and privacy may have been affected. This was clearly not intended, but the issue could have been addressed in a less intrusive way. The service user is able to choose meals. The menu record shows meals provided. Not all of the dishes made have been recorded; for example, the vegetables or side dishes had not been included in a number of meals. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 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 The way in which the service user likes to receive personal support is still being developed. The service user’s physical and emotional needs are being met. The service user would benefit from a medication review and some clearer guidance about the way some medication is administered. EVIDENCE: As part of the ‘getting to know you’ phase, staff are working closely with the service user to find out how the service user likes to be supported with personal care. There are detailed sections in the care plan describing how the staff are to support the service user with personal care. There are records to show when the service user went to visit the dentist, chiropodist and optician. An appointment had been made to visit the GP as a new GP had been found. The service user was unable to choose a new GP, but a request was made to the nearest surgery. The care plan also details when a homely remedy needs to be given, following previous directions. This was queried, as this medication may not be effective when taken in the way the service user is used to. The instructions, if to be followed, need to be very clear, so that staff can administer the medication consistently, during possible periods of anxiety. Unclear instructions also applied to some other medication, and included the use of inhalers, both of which were administered on a daily basis, when one is Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 14 as and when required only. There were other medication issues that need to be addressed with the new GP. This was followed up with the CSCI pharmacy inspector, who advised that the service user’s GP should approve homely remedies and other medication and how they are administered. Staff have recorded medication on the medication administration sheet. Where there are handwritten entries, these have not been checked by two staff. There is a medication policy and procedure which states that the service users’ consent has to be obtained, and that records of medication received, administered, and disposed of needs to be recorded. The manager plans to obtain a book to record medication that has been returned to the pharmacy. The policy contains a procedure for service users to self administer if assessed as able to do so. Staff completed safe handling of medication training in August 2005. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 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 Service users are not fully protected from adult abuse by the organisation’s policies and procedures. Service users do not benefit from a complaints procedure, which is up to date with all the relevant contact details. EVIDENCE: There is an adult protection poster on display in the staff office. There are policies and procedures regarding adult protection held in the home. On close examination, these policies do not relate to the local Wiltshire and Swindon ‘No Secrets’ guidance. One policy states that ‘where no referral is made in line with the service users wishes then appropriate action should be considered’. This contravenes guidance which ensures that all referrals made are subject to multi disciplinary reviews. This is in order to avoid situations where abuse may be swept under the carpet, or the rights of the individual may not be fully considered by all relevant parties. This is especially important when service users may not fully comprehend the circumstances that surround allegations. The policies in place do not have the correct CSCI details, referring to the CSCI Gloucestershire office, rather than Chippenham in Wiltshire. This policy also states that the CSCI is the lead office for adult protection and this is incorrect. There are policies about whistle blowing, bullying and aggression towards staff. The complaints policy and procedure has the contact details for the CSCI Gloucestershire office. Staff have signed to say they have read and understood the above policies and procedures. Staff spoken with said they had received copies of the General Social Care Council code of conduct. Staff were aware of adult protection reporting procedures and had received their own copy of the adult protection booklet. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 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 The home is suitable for the needs of the service user who lives there and is clean and tidy. EVIDENCE: Abacus House was previously a Guest House, and all rooms have ensuite shower rooms, with a hand washbasin and a toilet. It is situated on a busy street in Swindon old town. There is level access to the front of the home There is a condition to the registration that certain rooms and staircases must not be used until a sprinkler system has been installed. This has not been met yet as there is only one service user in the home. All parts of the home were clean and tidy on the day of inspection. There is a ground floor dining room to the front of the home, with a kitchen in the centre of the ground floor accommodation. A utility room and then a further sitting room lead off from the kitchen. There is a single staircase to a bedroom from the rear sitting room. There is one bedroom on the ground floor, with all of the remaining bedrooms on the first and second floors on the home. There is a staff office and sleeping in room and a communal bathroom. Service users will be invited to choose the colours to decorate their room, once they have completed the three month trial period. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 17 There is a small patio area and a garden laid to lawn, which is enclosed. There are a few parking spaces to rear of the home. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 18 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 Service users benefit from the knowledge staff have to meet their needs. This would be enhanced by further training in NVQs. Recruitment practices protect service users, but there is a lack of documentation to evidence all aspects of this held in the home. EVIDENCE: Five staff including the manager are currently employed in the home. This number will increase as new service users are admitted. At this time, there may be one or two staff on duty with one service user. The manager is also working care shifts due to the small number of staff. The staff team received training before service users were admitted, although for a short time in August they provided care for a service user who moved to more suitable accommodation within Holmleigh services. This was with the approval of the CSCI. All staff have received training in challenging behaviour, positive behaviour management, basic food hygiene, safe handling of medication, infection control, diabetes awareness, epilepsy, adult protection, health and safety at work, and first aid. Staff spoken to on the day of inspection commented that this had helped to give them more confidence when starting work, as all of this training had been done before they met service users. Staff also commented that because of the training, they felt valued by the organisation. NVQ training has not been arranged for staff at this time. One member of the staff team did not have training records held in Abacus House. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 19 All of the staff recruitment records were seen. The manager has been provided with a letter stating that staff have a CRB certificate and in most cases, this gives the CRB certificate number and the date of disclosure, but does not hold the employers copy of the CRB certificate in the home. One application form was noted not to have a section for prospective staff to detail any convictions they may have, or to sign to say whether they had any. One member of staff did not appear to have a CRB certificate and the inspector discussed POVA First checks with the manager, who was unaware of this process. This member of staff is working under staff supervision only. All staff have provided two references, including one from the last employer. The manager was not in post when all of staff were recruited, so other managers within Holmleigh Care interviewed staff. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 20 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 The service user benefits from a well run home. The quality assurance system has not been fully implemented in the home yet. The service user benefits from safety checks that take place in the home. EVIDENCE: The manager has been in post since July and was registered during this time. She has two years experience of managerial work in other care homes. She has NVQ level 3. She is currently completing her NVQ level 4 and registered manager’s award. It has been difficult to do any work on this during the period of time when there have been no service users and a small staff team. The manager has completed supervision and appraisal training and plans to do training in total communication. Regulation 26 visits are due to start in January 2006. The quality assurance system has not been set up in the home yet and the quality assurance policy and procedure was not in the file with other policies and procedures. The manager needs to investigate how this will be implemented in the home. The organisation is seeking the Investors in People Award and was due a visit the Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 21 week following inspection. This can be seen as part of the quality review process, but the views of stakeholders, service users and family are not measured as part of this process. There are risk assessments in place for radiators, as not all radiators have been covered. There are safety data records for cleaning products in use in the home, but the COSSH cupboard was not locked. Water temperatures are regulated and checked. There is a fire risk assessment dated 20.7.05, but it does not include details that electrical items will have been PAT tested. The fire risk assessment has not been completed room by room. This will need to be done as more service users are admitted. The manager has obtained the distance learning pack from Wiltshire Fire Brigade and one staff member is currently completing this. Two staff need to complete fire safety training and three staff need to take part in a fire drill before the end of 2005. Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 22 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 2 X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Abacus House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000064394.V269709.R02.S.doc Version 5.0 Page 23 N/a 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. 2. Standard YA2 YA20 Regulation Requirement Timescale for action 31/01/06 31/01/06 3. YA22 4. YA23 5. YA34 14(1)a b c Details of assessments of service d users made before admission must be held in the home. 13(2) Guidance for administering medication for one service user for as and when required must be clearly described. 22 (2) (6) The complaints procedure must (7) be accessible to the service users and contain details of how to contact the local CSCI office. 13 (6) The adult protection policy and procedure must be revised to reflect local policy guidance with regard to multi disciplinary meetings about referrals. 19(4) b There must be evidence that Sch 2.7 staff have a current CRB certificate. 31/01/06 27/02/06 31/01/06 Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 24 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. Refer to Standard YA6 YA16 Good Practice Recommendations The manager should find ways of making the care plan accessible to service users. Staff should be supported by the manager to find alternative ways of ensuring the personal needs of service users are identified that do not infringe the service users’ privacy. All side dishes and vegetables should be described on the menu record. The service user should receive a medication review. The adult protection policy and procedure should be amended so that it does not refer to the CSCI as the lead office for adult protection. The application form should be amended to include a section for staff to declare any previous convictions. The COSHH cupboard should be locked at all times. The fire risk assessment should be completed room by room, as new service users are admitted. 3. 4. 5. 6. 7. 8. YA17 YA20 YA23 YA34 YA42 YA42 Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Abacus House DS0000064394.V269709.R02.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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