Inspection on 05/09/07 for Adeyfield Road (39)

This inspection was carried out on 5th September 2007.

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. 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

Adeyfield Road (39) 28/09/06

Adeyfield Road (39) 02/11/05

Adeyfield Road (39) 19/04/05

Adeyfield Road (39) 26/08/04

Adeyfield Road (39) 10/05/04

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Paradise Lodge

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

CARE HOME ADULTS 18-65 Adeyfield Road (39) 39 Adeyfield Road Hemel Hempstead Hertfordshire HP2 5DP Lead Inspector Alison Jessop Unannounced Inspection 5th September 2007 10:00 Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adeyfield Road (39) Address 39 Adeyfield Road Hemel Hempstead Hertfordshire HP2 5DP 01442 251840 01442 251840 adeyfieldrd@walsingham.com 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) Walsingham Mrs Christine Hewitt Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (5), Physical disability (5) of places Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 5 older people with physical disability (only when associated with a learning disability.) This home may accommodate up to 5 older people (only when service users have had residency at the home prior to that age). 2nd May 2007 Date of last inspection Brief Description of the Service: 39 Adeyfield Road is a care home registered to provide care and accommodation for up to six people with learning disabilities. (And see above additional conditions). 39 Adeyfield Road is currently home to five adults with a learning disability, five of whom came into the home together as part of the resettlement from Cell Barnes. The home is run and maintained by Walsingham, of 1331-1337 High Road Whetstone, London N20 9HR and consists of a large, detached, chalet style bungalow, with additional facilities on the first floor. The home stands in its own grounds with a parking area, detached office and garden with seating area to the front and a rear garden, including a greenhouse enjoying views over parkland. Local shops are close by and the home is not far from the Jarman centre, which has leisure facilities, a supermarket complex and a day centre, which the residents attend. The home has the use of its own minibus. The current accommodation fees are £1704.00 per week. A copy of the most recent inspection report can be obtained from the office. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried this unannounced inspection out over six hours. The inspector visited the home on the 5th September 2007 and spent the morning talking to one resident. The other residents were out attending day care services and arrived home just as the inspector was leaving. The resident at home agreed to be link resident for the inspection. Her role was to hand out service user questionnaires and assist people to give their views about what it is like to live at the home and then send these back to the inspector. Time was spent gaining feedback from staff and key records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Although some work has been done to review care plans, it is difficult to establish which information is relevant as care plans have not been dated. Residents or their representatives have not agreed the care plan. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 6 Although some new staff have been recruited, there remains a high use of agency staff. This adversely affects the lives of the residents as they limit activities and outings. A complaint had been received by a visitor who found an agency worker sleeping in the lounge whilst on duty. The recruitment process appears to be taking along time and therefore applicants are finding employment elsewhere. The carpet in the hallway is heavily stained and needs to be replaced so that the residents can enjoy a homely atmosphere. 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. The summary of this inspection report can be made available in other formats on request. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken, ensuring that so far as possible service users needs can be met. EVIDENCE: A comprehensive needs assessment is carried out and once an agreement has been made that the home is suitable, regular introductory visits are arranged so that the prospective service user can get to spend time with staff and other residents and get to know the home before moving in. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are encouraged to make their own decisions and choices and this is documented in each care plan, ensuring that staff are aware. Residents are supported to take risks as part of an independent lifestyle within a risk management framework. EVIDENCE: Residents care plans offer detailed information about their needs and choices. Although many of these had been reviewed information has not been dated and therefore it is difficult to establish if this is still relevant. As care plans and risk assessments for residents are stored in separate places, it was also difficult to find current information whilst case tracking residents during the inspection. The residents or their representative has not signed care plans. Several good examples of how residents make choices were observed. One resident said that she is able to choose a female carer to carry out personal care. Feedback from a survey said ‘yes’ when asked are you involved in Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 10 making decisions in your home. When residents are going on holiday there is a planning form, which is written in accessible format. Residents are asked where they would like to go, when, who with and how would they like to get there. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. The service enables residents to develop their skills, including social, emotional, communication, and independent living skills. EVIDENCE: All service users attend day care during the week. However, they each have one day at home where they can relax or go out shopping on a one to one basis with staff. On the day of the inspection all but one service user was attending day care services. This person was out shopping and having lunch with a member of staff. They appeared to be very happy when they returned and stated that they had a nice time. Each resident has a record of outings that they have attended. These included swimming, bowling, shopping in town, visit to the pub, outing to the woods Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 12 and a day out at the seaside. Residents also had planned a day out in London at the theatre to see Mamma Mia! One survey returned said that there are sometimes good activities. It was also noted that some activities couldn’t be undertaken due to the lack of permanent staff available at times. One resident has chosen to make their own packed lunches for the day when they goes out and also enjoys growing strawberries and tomatoes in the garden. Residents are able to choose their meals and are offered a healthy balanced diet. Feedback about the food was good and care plans contain information about dietary requirements. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention is given to ensuring privacy and dignity when delivering personal care and staff are sensitive to changing needs of residents. EVIDENCE: It was evident that service users are involved in planning their personal health care and support. One resident said ‘I like the girls to help with my care.’ All residents who offered feedback said they are well cared for. Care plans contain information about health care needs and since the last inspection foot care is now included. There are also clear guidelines for staff about epilepsy and other medical conditions. Procedures relating to medication are generally satisfactory, however two people had not signed handwritten instructions on medication administration records. This must be done in order to reduce any medication errors. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others associated with the home understand how to make a complaint and they are very clear of what can be expected to happen if a complaint is made. EVIDENCE: Residents who offered feedback said that they know who to speak to if they are unhappy about the service and also said that they feel safe here. Two complaints have been received since the last inspection. One was from a visitor who complained that the house was too cold for the residents. Another was from a visitor who arrived at the home to find an agency worker asleep on the sofa and who did not wake up for up to 10 minutes. The manager investigated and notified the supplying agency that they will not use this person to cover shifts again. Both complaints were responded to within the timescales given on the complaints procedure. Staff spoken to have received training on Safeguarding Adults and a copy of the local authority procedure is available to all staff. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 23 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The lay out and design of the home allows for small clusters of residents to live together in a non-institutional environment. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers. EVIDENCE: The home is attractively decorated and offers a clean, homely environment to the people who live there. Bedrooms are decorated to reflect the individual taste of the residents. Adaptations in the home such as automatic door mechanisms promote service users independence. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 16 Since the last inspection a new window has been fitted in the lounge and the floor has been levelled, as it was previously sloped. The lounge area is due to be decorated and new furniture has been purchased. It was noted that the carpet in the hallway is very stained by the kitchen door. Staff are aware of universal infection procedures and the home looked very clean throughout. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There remains a high use of agency staff, which adversely affects the lives of the service users. EVIDENCE: Since the previous random inspection, some new permanent staff have been recruited and the agency usage has reduced from 205 hours to 150 hours per week. This remains at a high level and evidence was found to suggest that this adversely affects the lives of the residents. Activity logs showed that some outings had to be cancelled, as the agency staff cannot drive the bus. A complaint had been received that a visitor found an agency worker asleep and other feedback gained during the inspection was ‘agency staff do the minimal, they watch the TV a lot.’ The requirement made at the previous random inspection will be carried forward. Staff spoken to confirmed that they are receiving regular training from induction/foundation to NVQ levels 2 & 3. The manager has completed her registered managers award. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 18 Records relating to recruitment were unavailable on the day of the inspection. An arrangement has been made for the organisations recruitment records to be inspected centrally by the Commission and no concerns have been reported. It was however pointed out to the inspector that the recruitment process is taking months and suitable applicants have found employment elsewhere as they are no longer prepared to wait. Although permanent staff confirmed that they receive supervision, agency staff are not closely supervised during shifts. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. The home has a good record of meeting relevant health and safety requirements and legislation. EVIDENCE: The manager has recently returned from a secondment where she worked at another home for several months. She has completed her Registered Managers Award. The service has changed the way they consult with residents. Residents meetings were held monthly however attendance was low, individual meetings are now held with residents to find out their views. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 20 Health and safety procedures in the home are adequately maintained and accident records are completed comprehensively in the event of an incident or accident. Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 X Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 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 YA6 Regulation Requirement Timescale for action 31/10/07 2. 3. 4. YA20 YA24 YA33 5. YA36 15(2)(a)(b) The service user plan must be regularly reviewed, dated on review and where possible the service user or their representative must sign to show their agreement with the plan. 13(2) & 13 Two people must sign (4)(c) handwritten instructions on MAR sheets. 23(2)(c) To enhance the environment the heavily stained hallway carpet must be replaced. 18(1)(a) Appropriate numbers of staff to meet service users needs are on duty at all times. This has been carried forward from inspection report 02/05/07. 18(2) Temporary staff must be adequately supervised to ensure that the needs of the service users are met. 31/10/07 30/04/08 31/12/07 31/10/07 Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 23 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 It is recommended that the care plan contains all information in relation to the service user including risk assessments and any out of date information should be archived, allowing easy access to current information. It is recommended that the company reviews it recruitment procedures so that recruitment of staff is completed within appropriate timescales. 2. YA34 Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Adeyfield Road (39) DS0000019260.V349224.R01.S.doc Version 5.2 Page 25 - 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. 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