Inspection on 16/06/05 for Abacus House

This inspection was carried out on 16th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abacus House 10/03/08

Abacus House 30/04/07

Abacus House 12/05/06

Abacus House 14/12/05

Abacus House 14/03/05

Abacus House 28/09/04

Abacus House 28/04/03

Abacus House 28/04/03

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

CARE HOME ADULTS 18-65 Abacus House Abacus Street 8 Princes Street Dunstable Beds, LU6 3AX Lead Inspector Leonorah Milton Unannounced 16th June 2005 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. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Abacus House Address Abacus Street 8 Princes Street Dunstable Beds LU6 3AX 01582 478998 01582 666667 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) Category(ies) of registration, with number of places Mr Chalvanayagam Menna Delia Williams Care Home MD Mental Disorder - 6 Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14.03.05 Brief Description of the Service: Abacus House was registered to provide for six adults with a mental disorder. The home had been owned and managed by Mr Menna for a number of years. The management had subsequently passed to Mrs Delia Williams a year ago. The home was a detached property that had formerly been a private residence. It was located in a residental area of Dunstable within walking distance of the towns amenities. The premises had four storeys, the upper floor being reserved for administrative purposes. Bedrooms for single occupancy were located on the ground and first floor. A kitchen-diner was located on the ground floor as was an all weather conservatory that was used as a sitting room. There was a small front garden and a large back garden to the side of the building wher service users had been supported to grow vegetables. The basement housed the laundry and room that was occasionally used for activites and storage areas. The garage that was accessed from the side garden had been converted into a gym for the use of the service users. Parking for two cars was available at the front of the building. Whilst the service provision was mainly satisfactory, the home had been reliant on using personnel from another care home also owned by Mr Menna. This arrangement was not acceptable given the concerns about the staffing situation in that home. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 5.15 hours. The manager Mrs D Williams was present in the home to assist throughout. The inspection included a review of the records for two service users, assessment of sundry other records, talking to three service users, an agency member of staff and Mrs Williams. The evening meal was shared with service users and a partial tour of the building was carried out. There were six service users in residence at this inspection. A seventh person who had formerly resided in the home but had transferred to Mr Menna’s other home was attending the home for day care. He was still at the home when the inspection concluded at 20.00 hours. The proprietor must identify the provision of day care on the home’s statement of purpose. The inspection showed that the manager had acted on requirements that were within her control. Some of those that were the proprietor’s responsibility remained unmet. This inspection showed that service had continued to improve under Mrs William’s leadership but the staffing arrangements for her and the rest of the team had hindered the progress that might have been achieved. What the service does well: The building had retained its homely appearance. Service users had been encouraged to treat the building as home and appeared relaxed in this environment. Conversations with service users and records showed that they had been consulted about the daily routines and activities in the home. They had also been supported to take responsibility for some domestic tasks as is usual when adults live together. Service users had also been encouraged to make use of local recreational places. Visits to pubs and sporting facilities had taken place. Appropriate consultation had taken place with health care professionals to ensure that this aspect of service users’ welfare was met. One service user stated that he was happy living in the home and got on well with staff. Another also confirmed that he liked the home and was treated well by members of the team. One other was a little disgruntled, and felt that Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 6 personal spending had been restricted but also accepted that they needed guidance on money management. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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) 1,2,3,5 Whilst there was a detailed statement of purpose and service user guide to inform service users and their representatives about the service provision, the contractual arrangements did not accurately reflect the individual conditions of residency in some instances that were identified on care planning agreements. EVIDENCE: Care planning documents indicated in some instances that service users would be charged for breakages and damage to furniture. There was no evidence to show that this had been agreed contractually or discussed with funding authorities. The statement of purpose showed that alcohol was not permitted in the home. The written contractual arrangements did not reflect this restriction. One service user had lived in the home for a significant time. As yet there was no written contract between the funding authority and the home. The manager explained that there had been numerous contacts with the placing authority to request a contract. In the interim the home must ensure that the service user is fully informed about conditions of residency in line with the statement of purpose and service user guide. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 9 It was evident that the permanent members of staff in the home had or were undergoing a thorough induction to prepare them to properly support service users. However the use of staff from elsewhere in the organisation, where standards were lower called into question the ability of the whole team to meet service users’ needs. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 10 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) 6,7,8,9, Although there were improvements in the written guidance to show how service users’ needs would be met this did not apply to the records for each service user. As a result there was a risk that some assessed needs could be overlooked. EVIDENCE: Care planning arrangements had improved significantly by the introduction of a format that took account of a detailed assessment of need. Plans were in hand to introduce this format for every service user. It was explained that the care plan for one service user who had lived in the home since February 2005 would be compiled using the new format after a formal review with the placing authority. There was evidence to show that plans had been devised in consultation with appropriate health care specialists, particularly in relation to restrictions to usual liberty that were required to maintain the health and safety of service users. There was also evidence to show that service users and their families had been consulted about their plan of care. Service users had signed to agree risk assessments. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 11 The manager was advised that a risk assessment must be introduced for a service user who was reliant of the support of another service user for unsupervised trips out of the home. Records indicated that meetings with service users had involved them in decisions about every day aspects of the day-to-day lifestyle within the home. There was no evidence to show that service users had access to independent advocacy services. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 12 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) 12,13,14,15,16 Service users had been supported to use practical life skills but the staffing arrangements had hindered the necessary support to enable service users to develop these skills to their full potential. EVIDENCE: Service users had been encouraged to take part in domestic duties on an agreed rostered basis and had frequently accessed the community for shopping and leisure opportunities. Attendance at college had been arranged for one service user. Records were maintained in relation to in house activities that had included sharing in the development of the vegetable patch in the rear garden and using the gym equipment in the converted garage. On the day of this inspection the manager was on duty with an agency support worker. It was evident therefore that the manager had not spent her time exclusively on personal care related practice when she had been rostered as part of the support team because, of necessity, she had to carry out the management function of the home. This when coupled with the use of agency personnel and staff from another home meant that service users had not received the necessary support to fully utilise or develop their independent Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 13 living skills. For example, it was noted that service users were served prepared sandwiches for their evening meal when they could have been supported to prepare the food for themselves. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 14 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) 18,19 Service users had received appropriate support for their personal and healthcare needs. EVIDENCE: Records indicated that appropriate professionals had been consulted to ensure that service users’ healthcare needs had been met. There were records to demonstrate that programmes to address challenging behaviours had been introduced by specialist healthcare professionals and had been agreed with service users. Records also showed that service users had received support and appropriate counselling in relation to intimate relationships. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 standard(s) 22,23 The home’s written procedures were sufficiently robust to enable service users to voice their concerns and to protect them from harm. EVIDENCE: The service users who contributed to the inspection confirmed that they were able to talk to staff about their concerns and that they had been acted upon. The permanent staff had received guidance about the protection of service users from harm. Personnel files seen at this inspection showed that recruitment procedures had included appropriate checks about previous employment and via the Criminal Records Bureau. However this standard was somewhat negated by the use of personnel from Mr Menna’s other home where the training and recent conduct in relation to protection issues was inadequate. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 standard(s) 24,25,26,28, The home provided a homely and environment with only a few omissions to service users’ comfort. EVIDENCE: The home provided single room accommodation, a lounge for relaxation and another sitting room for those who smoked. Suitable staff accommodation was located on the upper floor. Areas of the building seen at this inspection were decorated to an acceptable standard and were clean and orderly. Carpets and linoleum had been replaced in communal areas. The condition of furniture and the décor in service users’ rooms seen at this inspection were satisfactory. Rooms were lockable and contained items of a personal nature to suit service users’ preferences. The requirement from the previous inspection to replace stained carpets in service users’ bedrooms had not been met. The manager explained that these carpets had been cleaned. Those seen were satisfactory. The requirement to replace broken and worn chairs in the conservatory had also not been met. It Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 17 was explained that quotes had been obtained. There must be no further delay to obtain replacements. It was noted that there were no ceiling blinds in the conservatory. It was confirmed that this room became uncomfortably hot in warmer weather. The manager had compiled a list of maintenance issues but as had been noted at previous inspections there had been a delay to take action on these. The proprietor must ensure that the building is adequately maintained. Outstanding issues in need of urgent attention were breaches to safety such as missing window restrictors and a broken window in a service user’s bedroom. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36 The reliance over a prolonged period on staff from another home had meant that service users’ had been cared for by some staff who did not have the relevant training and support to understand and meet service users’ needs. EVIDENCE: The home had a small team of staff who had received the necessary support and guidance to work effectively with service users. However there was no evidence to show that staff from another home, who had worked regularly in at Abacus House had been properly supervised or trained in relation to meeting the needs of service users with a mental disorder. Whilst using staff from elsewhere on a temporary basis can be acceptable in the short term, it was evident that this practice had been ongoing for a considerable time. It was also evident that the staffing compliment had been further depleted by the transfer of some of the deputy’s working time to Mr Menna’s other home. The rotas also showed that there had been a lessening of the staffing cover on some days so that the waking day shifts finished at 21.00 hours rather than the previous 22.00 hours. There was no risk assessment to qualify this change in arrangements. Personnel files seen at this inspection showed that recruitment procedures had been satisfactory. However it had been not possible at the previous inspection Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 19 or again at this inspection, to verify the recruitment of one employee because there was no file on site in relation to this member of staff who had transferred from the other home. Supervision records showed that the majority of staff had received supervision with the frequency detailed by the National Minimum Standards. However a long serving member of the night staff had not received supervision since the previous year. Given that the member of staff worked alone after shift handovers the need for supervision was apparent. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 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) 37,38,39,41,42,43 A skilled person who was focused on the best interests of service users managed the home. However, service users had not benefited fully from a consolidated team. EVIDENCE: Mrs William’s skills and commitment to the home were evident. She had continued to update her professional knowledge and was undertaking a degree in mental health. Records introduced and maintained by Mrs Williams were of a good standard. Strategies to involve service users in decisions about their care and the daily operation of the home were well documented. Mrs Williams had also been proactive in introducing thorough systems for reviewing and reporting to the proprietor about the welfare of individual Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 21 service users and environmental issues. These included a well thought out refurbishment plan for the home. Formal communication with staff was in place through regular meetings and supervision. This however did not extend to members of staff from the other home who were shown on the rota as working at Abacus House on a frequent basis. Mrs William’s efforts to operate the home along professional lines were therefore somewhat negated by the ongoing staffing situation. On call arrangements at night during the manager’s absence were concerning. These had been delegated to the person who was also on call at night at Mr Menna’s other home. There was evidence that a recent employee at that home who had not worked with service users with a mental disorder, had carried out on call duties for Abacus House. This situation had therefore placed service users and the lone waking member of staff at Abacus House at some risk. The proprietor must review the home’s recruitment strategies as a priority. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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 2 2 2 x 1 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x 3 x x Standard No 11 12 13 14 15 16 17 2 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 2 2 2 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Abacus House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x x 3 I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 23 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 23( Regulation 5(1) Requirement The registered person must ensure that each service user is supplied with a service user guide that includes the terms and conditions for their residency including information about fees and any other charges. The care plans must have a care intervention for all the needs identified in the service users assessment plans (Previous timesacle of 30.05.05 had not been met.) Arrangements must be made to replace or refurbish the broken chairs in the conservatory(Previous timescales of 30.12.04 and 30.05.05 had not been met.) The carpets in the service users bedrooms that are stained and or worn must be replaced ( Previous timescales of 30.12.04 30.05.05 had not been met). Blinds must be fitted to the ceiling of the conservatory. Missing window restrictors must be replaced throughout the home. The broken window pane in JPs room must be replaced. Timescale for action 31.08.05 2. 6 15(1) 30.09.05. 3. 23(2) 24 31.08.05 4. 23(2) 26 31.08.05 5. 6. 7. 16(2) 13((4) 13(4) 24 38 38 31.08.05. 31.07.05 31.07.05. Page 24 Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 8. 18(1)(a) 35 9. 18(1)(a) 33 10. 11. 17(2) Schedule 4 18(1)(a) 41 33 12. 18(1)(a) 33 All personnel working in the home must commence induction and training that is relevant to meeting the needs of service users with a mental disorder. The home must have sufficient peronnel to support service users so that the home is not reliant on staff from another home. Personnel files must be maintained on site. The person who carries out on call duties at night must be a member of the permanent team at Abacus House. The manager must have sufficient time to carry out the management function of the home. In this instance 3 of her 5 shifts in each week must not be included in the minimum staffing arrangements for the support of service users. 31.08.05 31.10.05 31.07.05 31.07.05 31.07.05. 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. 2. Refer to Standard 7 19 Good Practice Recommendations Service users should be supported to access advocacy services. It is recommended that a sequential record of health care consultations and treatments be introduced for each service user. Abacus House I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Clifton House 4A Goldington Road Bedford MK40 3NF 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 I51 S29303 Abacus House V233689 160605 Stage 4.doc Version 1.30 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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