Inspection on 23/07/08 for Aldenham Road (122)

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Adequate service.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aldenham Road (122) 23/01/08

Aldenham Road (122) 11/08/06

Aldenham Road (122) 13/01/06

Aldenham Road (122) 23/07/05

Aldenham Road (122) 22/11/04

Aldenham Road (122) 17/06/04

Aldenham Road (122) 05/05/04

Aldenham Road (122) 19/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Aldenham Road (122) 122 Aldenham Road Bushey Hertfordshire WD23 2ET Lead Inspector Claire Farrier Unannounced Inspection 23 & 25th July 2008 11:15 rd Aldenham Road (122) DS0000019263.V369049.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 Aldenham Road (122) DS0000019263.V369049.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. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldenham Road (122) Address 122 Aldenham Road Bushey Hertfordshire WD23 2ET 01923 237770 01923 237770 FP aldenhamrd122@walsingham.com www.walsingham.com Walsingham 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) Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2008 Brief Description of the Service: 122 Aldenham Road is a two-storey, detached, family style house located in a residential area of Bushey. It is operated by Walsingham, which is a voluntary organisation. The home provides accommodation and support for six adults who have learning disabilities. All the bedrooms are single, and none have en-suite facilities. There is a mature garden to the rear of the property and a small garden with additional space for four cars to park at the front. The house is situated on a main road and has easy access to Watford town centre. There are also local shops that are within walking distance. The house provides a domestic environment and it is indistinguishable from the neighbouring houses. The Statement of Purpose and Service Users’ Guide provide information about the services provided by the home for prospective residents and social workers. Information on the fees charged was not available on this occasion – please contact the manager for up to date information. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We (The Commission for Social Care Inspection) spent one afternoon at 122 Aldenham Road, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We looked around the home and the garden. We met most of the people who live in the home. Three people completed Have Your Say surveys before the inspection, two relatives also completed Have Your Say surveys and we have used the information from these in this report. We made a second visit to the home to talk to the manager about what we had seen during our visit. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. We have also looked at the reports of the visits that a representative of Walsingham makes to the home. We made an additional visit to the home on 14th May 2008 to review the requirements made following the key inspection carried out on 23rd January 2008 for which the compliance date had past. No new requirements were made as a result of this visit. We have taken the findings from that visit into consideration in this report. What the service does well: The AQAA states: “The needs presented by the client group varies from moderate learning disabilities to complicated autistic tendencies with behavioural and other health needs. The service has staff well trained, knowledgeable and skilled staff who understand service users needs are able to provide them with the required support to meet these needs.” All the people who we spoke to said that they are happy in their home. Everyone who completed Have Your Say surveys made positive responses to all the questions. The staff said that they feel well supported by the company and the management. The care plans are well written with the involvement and the views of the people who live in the home, and they show that people are involved in making decisions about their care and their lives in the home. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: As reported above, the changes made by the manager have improved the quality of life for the people in the home. Unfortunately one requirement from the last report has been repeated, that all personal information must be stored securely in order to protect the confidentiality and privacy of the people who live in the home. On this occasion we saw several examples of personal information about both residents and staff left openly available for anyone to look at. We also noticed some health and safety concerns in the house and in the garden. Most of the windows on the first floor do not have restrictors fitted to prevent them opening wide, which may be a risk for the people in the home. The window of the laundry opens outwards, and may cause injury to people passing by. The built in barbecue in the garden is very rusty and needs to be refurbished or removed. The knife drawer in the kitchen was not locked. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 7 The home has several staff vacancies, and agency staff are needed for every shift. One of the relatives who completed a survey for the inspection said, “The home could improve by less reliance on agency staff who are sometimes apparently less qualified. Because of the frequent changes of staff it is difficult for our resident to always communicate effectively with them.” The recruitment procedure followed by Walsingham is very slow. It frequently takes between three to six months following a successful interview before employment checks are completed and the person can start work. Due to this delay several suitable applicants have not taken up the post. Since the last inspection there have been four separate safeguarding investigations concerning incidents in the home. The issues are currently being addressed, and all the staff have had recent training in safeguarding vulnerable adults. Although it appears that all staff are now fully aware of the importance of following safeguarding procedures, due to the ongoing investigations we have assessed that people are not currently assured of a good outcome in this area. 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. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 8 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 Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on the needs of the people who live there, so that the staff can provide appropriate support them to meet their needs. EVIDENCE: Five people live in the home, and no one has moved into the home for several years. As no one has moved in recently, during this inspection we did not see any assessments that were carried out before people came to the home. However Walsingham has a process for assessment before anyone moves into a home, and care plans are written with information and procedures drawn from these assessments. During this inspection the staff said that they have sufficient information and training to enable them to meet the residents’ needs. There are sufficient staff in the home, and the care plans have appropriate information so that the staff know how to support each person effectively (see Individual Needs and Choices). We saw service agreements for each person in their files. The service agreements are produced in a pictorial format, with photographs and clip art pictures of the person, the staff, the home, what they like to do, the support they get, and how their finances are managed. We looked at one service agreement with the person concerned. They recognised the pictures and Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 10 agreed with the things that the agreement said that they like to do. Both the service agreements that we saw were written and signed in 2005, and have not been reviewed since then. In the mean time the manager of the home has changed, and there may also be other changes in finances and what each person likes to do. In order to be meaningful documents for the people concerned, the service agreements should be regularly reviewed and updated. There is a Service Users’ Guide that is also in pictorial format. The only copy that was seen in the home was on the wall of the office in the house. It was amended by hand with details of the new manager, but it has out of date contact details for CSCI. The Service Users’ Guide should be a live and changing document that gives information on the home from the viewpoint of the people who live there. It should be available for everyone in the home. The home’s Statement of Purpose is maintained on computer and it has been reviewed and amended to provide accurate and current information on the services that are provided in the home. The manager recognises that further improvements are needed. In the Annual Quality Assurance Assessment (AQAA) she wrote, “We need to gain a complete staff team and maintain them to ensure high quality staff with good training and values. Compile more user accessible information in a suitable format.” Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 11 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, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are actively involved in their own care planning; the care plans are person centred and provide the staff with appropriate information to enable them to meet people’s individual needs. EVIDENCE: We looked at the files of two people, which show what care is provided for them and how it is recorded. The care plans are written in a person centred format, which shows that people are involved in making decisions about their care and their lives in the home. Entries are written in the first person and describe the person’s personal preferences, how they make decisions, and the support that they need (see personal and Healthcare Support). The staff who we spoke to said that the care plans provide them with good information on each person’s needs, so that they are able to provide a good quality of care in the way that each person wishes. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 12 The care plans are reviewed regularly, and the information that we saw about each person was accurate and up to date. Each person has risk assessments for some activities where a decision has been made concerning their safety. The purpose of risk assessments is to ensure that the people who live in the home can take part in the activities that they wish to. The risk assessments that we saw covered all aspects of the person’s life in the home and in the community. For example, leaving the home unsupported, smoking, cooking, and the risks of epilepsy while in the community and at the swimming pool. The risk assessments are reviewed regularly to ensure that they are still required. There is a comprehensive ‘Need to Know’ file so that the staff have all the information they need about the people in the home easily available. It contains up to date care plans and guidelines for each person in the home. However this file was on the table in the conservatory for the duration of our visit, easily accessible for anyone visiting the home to read. This is a breach of confidentiality (see Conduct and Management of the Home). Other personal information was also stored openly on the computer table in the conservatory, such as the daily record books for the people in the home, handover sheets with details of what each person is doing each day, and a file with contact numbers for each member of staff. The residents are supported to be involved in the management of the home. One person has taken on the responsibility for taking the rubbish out, and another likes to tidy up and put cups away when they have been washed up. One person has had training in health and safety, and with support from a member of staff they carry out all the weekly health and safety monitoring, such as testing the fire alarms and checking water temperatures. The Annual Qality Assurance Assessment (AQAA) states that during the last year person centred planning meetings have taken place, with each person choosing who to invite and establishing their own individual goals and aspirations. The manager plans to continue with these meetings and plans and to support service users to achieve their chosen goals and aspirations. One of these took place while we were visiting the home. The person concerned was involved as much as possible, and attended the meeting, although for some of the time they were asleep. But it was held in the lounge of the home, so that they felt comfortable and at home and their family were invited as well as professionals. Advocacy is available when needed from the advocacy group PowHer. During the last inspection in February 2008 it was reported that there were plans to involve an independent advocate, to support people to understand and make decisions about plans for the future of the home. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported to live full and active lifestyles, and to develop their skills for independence. EVIDENCE: The Annual Qality Assurance Assessment (AQAA) states, “We promote lifesyles that portray individuals as valued citizens, and allow individual to take reasonable risks. In the last 12 months we have encouraged a service user to take ownership of their cigarettes and given them the skills to check their items of washing to see if they need ironing. We have promoted community presence and community participation and have also encouraged service users to develop and maintain daily living skills, e.g. recycling household waste within the service.” When we visited the home in February this year, there were too few staff on duty to enable people to take part in activities in the home and in the Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 14 community. The action plan from the home after the February inspection stated, “We have changed sleep-in times to ensure there is enough cover to enable all service users can access the community. At present service users do access the community but there are times that due to situation in the service activities are cancelled or suspended to a later time. We are going to put a monitoring form in place so at the end of each month we can assess how many activities have taken place and how many have been cancelled and for what reason.” We visited the home again in April to check on the changes that were promised. More staff were employed in the home. On the day of our visit there were three staff on duty, plus one for 1:1 with one person. Monthly activity sheets for each person were completed every day. We saw three of these, which showed a variety of activities. However while one person had activities listed every day, one had recorded activities only twice a week. It was reported that this was their choice, as they preferred to stay in their room most of the time. The activities listed included shopping for clothes, DVDs, painting, film evening, swimming, hairdresser, pub, games, and park. One person had bowling scheduled for 1st May, but the activity sheet stated, “Not enough staff as staff on duty not confident.” The assistant manger said that there were agency staff on duty that day, who didn’t know the person well enough to go bowling with them. Recording on the daily monitoring sheets has now improved, and the staff are encouraged to record all positive choices that people make, and all interactions with staff and other residents. This now shows more clearly that everyone is able to take part in the things that they want to do. It is recorded when the person mentioned above chooses to stay in their room, and when they decide to do, or not to do, the things that other people are doing, such as a meal out or watching a DVD. Everyone attends day care or college on one or more days a week. The proprietor’s report for May 2008 noted the improvement. “There have been positive developments in support and levels of interaction for two service users based on good observation and positive interventions.” One of the relatives who completed a survey for the inspection said, “Good family atmosphere - good catering and cleanliness. They try hard to encourage normality in the home and the outside environment, e.g. taking residents shopping and for outside meals and activities.” All the permanent staff have now had training on managing epilepsy, and all agency staff must show evidence that they have also had this training. This means that no one should have to cancel an activity that they want to do because the staff do not have the skills to support them. Everyone has families or friends who visit them or who they visit regularly. They are supported to contact their families by phone. The menus looked varied and nutritious, and they reflect each person’s individual choices. The menu is drawn up each week with the involvement of the people in the home using pictures of meals to help them to choose, and there is a choice of meals each mealtime. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff support people to maintain their health needs and to consult other medical professionals to ensure residents continued well being. EVIDENCE: The care plans contain good details of each person’s care needs. They describe the person’s personal preferences for the support that they need. The healthcare records that we saw included references to hospital visits, and contact with GPs and other health professionals. The Annual Quality Assurance Assessment (AQAA) stated, “We support all service users in personal and health care needs presented and we do this consistently with guidelines and personal plans developed with the community multidisciplinary team. In the last 12 months we have actively worked with the external professionals and staff from the community multidisciplinary team to meet service users needs.” At the last inspection in February 2008 we were concerned that changes in people’s weights were not acted on to make sure that each person’s health was monitored effectively. The improvement plan from the home following the last inspection stated that the staff have been advised to report any abnormal Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 16 weight loss to management. When we visited the home in May we saw the weights charts for three people, and all had weights recorded monthly and comments where needed. We saw no examples of weight loss seen from this sample, but the staff who we spoke to confirmed that action would be taken if a weight loss was noted. On this occasion we noticed increases in weight for two people. We were told that the staff has discussed the need for healthy eating options for these people. At the last inspection we said that some of the support workers have not had epilepsy training, including administering diazepam in case of seizures, which means that they are not able to go out with individual residents. When we visited the home in May we were told that epilepsy training was in progress, but staff had not yet completed it. However an incident happened after this, when an agency worker administered diazepam for a seizure inappropriately. This resulted in a safeguarding investigation by Hertfordshire Adult Care Services, and it was apparent that there was no evidence of epilepsy training taking place. All staff have now had appropriate training so that they know what to do if anyone has a seizure. The manager has informed the agencies that supply locum staff to the home that they must provide evidence that all agency staff have been trained in the administration of rectal diazepam. The local authority was concerned about one person who was had 1:1 support due to risks of falling and behaviours that challenge. This person had a fall and broke their foot. There was also another safeguarding investigation due to unexplained bruises, and the person made an allegation against a member of staff (see Concerns, Complaints and Protection). New procedures have been put in place to make sure that all bruises are noticed and recorded. We did not look at the medication records on this occasion. At the last inspection in February 2008 we found that there were sound systems in place to manage people’s medication safely. Medication records are audited as part of the proprietor’s monthly monitoring visits, and the reports of these note if there are any discrepancies. Medication is stored securely in a locked cupboard on the landing. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Although it appears that all staff are now fully aware of the importance of following safeguarding procedures, due to the ongoing safeguarding investigations people can not currently be assured of a good outcome in this area. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “We have a user accessible concerns and complaints format in place and we actively promote and empower service users in the use of this procedure.” The home has a satisfactory complaints procedure in place that is available to all residents and their relatives. The complaints procedure is in an easy read pictorial format for the people in the home. No complaints have been recorded since the last inspection. The staff encourage people to make any concerns known, and these are recorded. One person had concerns about going on holiday, and the staff listened to their concerns and discussed it with them. The manager and staff are aware that further improvements could be made in dealing with concerns effectively. The AQAA states, “We could more effectively record all aspects of bullying within the service and use evidence to better support service users who may feel bullied by other service users.” The home has up to date policies concerning adult protection that follow the Hertfordshire County Council Adult Care Services inter-agency guidelines and a copy of the guidelines is kept in the office. At the last inspection in February 2008 we reported that not all staff have received training on safeguarding Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 18 vulnerable people, but staff spoken with were aware of procedures. When we visited the home again in May, we were told that all staff were booked for this training. The training finally took place for all the staff on 3rd July, and it covered the Hertfordshire procedures as well as how to recognise abuse, and the staff’s responsibility for whistle blowing. However since the last inspection, and before the safeguarding training took place, there were four separate safeguarding investigations concerning incidents in the home. One of these was due to an allegation by one of the people who live in the home. One was as a result of injuries and unexplained bruising to one of the people in the home. One was due to rectal diazepam being administered inappropriately. The fourth was a as a result of a complaint made by Hertfordshire County Council Adult Care Services about the behaviour of a member of staff. As a result two members of staff have been suspended, and the investigations have not yet been completed. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 19 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): 24 & 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 comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene for the benefit of the residents. EVIDENCE: The building is an ordinary detached house, furnished and decorated in domestic styles that produce a homely, comfortable environment, which allows the people who live there to relax and feel at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. The lounge and kitchen are domestic in style and are comfortably furnished and well equipped. The home appeared to be clean and generally well maintained. The home has appropriate procedures to maintain hygiene and prevent the risk of infection within the home. When we visited the home in May 2008 we reported that the door between the kitchen and hallway was no longer locked. A new handle had Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 20 been fitted to door, and the lock had been removed. Only one bedroom was locked. This is the choice of the resident, and they carry a key to their room on them. The staff who we spoke to confirmed that red bags are used for soiled laundry, and it is washed on the maximum temperature. On this occasion we noticed some health and safety concerns in the house and in the garden. Most of the windows on the first floor do not have restrictors fitted to prevent them opening wide, which may be a risk for the people in the home. The window of the laundry opens outwards, and may cause injury to people passing by. The built in barbecue in the garden is very rusty and needs to be refurbished or removed. The knife drawer in the kitchen was not locked. See Control and Management of the Home for further details. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 21 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 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A stable staff team who have the experience and training to understand and meet the needs of the residents supports the people who live in the home. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states that the main barrier to improvement in the service is the lack of permanent staff and the use of casual staff. To counteract this, “We have employed one new staff and have three in the recruitment process and try to stick with a small amount of regular agency staff.” The number of staff in the home has increased since the last inspection. The staff rota shows that there are two support staff in the home throughout the day, and one at night. An additional member of staff provides one to one support for one person, due to their physical and behavioural needs. This person moved to another service a few days after this inspection, and we were assured that the staffing levels of two support workers would remain for the remaining four people in the home. This level of staffing means that the people who live in the home can have individual support to do the things they want to do, in the home and in the community. The staff on sleepover works 1.00pm to 11.00pm, followed by the sleepover, then 7.00am Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 22 to 12 noon the following day. This shift exceeds the guidance of the Working Time Directive. However staff work only one sleepover shift a week, and total hours, including sleepover, are below the WTD maximum of 48 hours per week. The home has several vacancies, and agency staff are needed for every shift. It was reported that occasionally, usually at weekends, there may be a shift when there are no permanent staff. The waking night staff are all agency staff, but a permanent member of staff sleeps over in the home. One of the relatives who completed a survey for the inspection said, “The frequent changes and reliance on agency staff make it difficult for both staff and/or resident to communicate properly. There is also the matter of familiarity (or not) with the English language! The home could improve by less reliance on agency staff who are sometimes apparently less qualified. Because of the frequent changes of staff it is difficult for our resident to always communicate effectively with them.” This situation should improve when the new staff who have been recruited are able to start work. However the recruitment procedure followed by Walsingham is very slow. It frequently takes between three to six months following a successful interview before employment checks are completed and the person can start work. Due to this delay several suitable applicants have not taken up the post. The acting manager confirmed that the recruitment procedures followed by the company are robust and that she sees all the information on each applicant during the recruitment process. The references, CRB (Criminal Record Bureau) disclosures, evidence of identity and full employment history are stored at Walsingham headquarters by agreement with us through the Provider Relationship Manager. Walsingham provides comprehensive training for staff that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training to meet special needs the residents have such as epilepsy and challenging behaviour. The staff spoken to said that the training and support provided for them is very good. Since the last inspection everyone has had training in safeguarding vulnerable people (see Concerns, Complaints and Protection), and in epilepsy, including administering diazepam in case of seizures, which means that they are able to go out with individual residents (See Lifestyle). The AQAA states that all the full time support workers have a qualification at NVQ2 or above. All the staff have regular one to one supervision with either the manager or deputy manager, so that they can discuss their work and training. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 23 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, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. However regular checks should be made ensure that there are no avoidable environmental hazards which may cause a risk to the people living in the home. EVIDENCE: Since the last inspection the acting manger has been appointed as manager of both 120 and 122 Aldenham Road, and following this inspection the process of registration with CSCI has been competed. A deputy manager in each of the homes supports her. The Annual Quality Assurance Assessment (AQAA) states, “The change in management has enabled fresh eyes and the development of the service to improve service users’ lives.” The manager has implemented changes and improvements in the care plans and record keeping in the home, Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 24 and in staffing levels, supervision and training. In the AQAA she says, “The service provides good quality all round care for service users, staff demonstrate a good understanding of service users needs and are competent and confident to meet these needs. In the past 12 months we have actively worked with the extenal professionals and staff from the community multidisciplinary team to meet service users needs.” Walsingham has a comprehensive system for quality assurance in its homes, which includes annual surveys of residents and their families. The company carries out regular service audits of the home and monthly Regulation 26 monitoring visits. These visits include discussions with staff and with the people who live in the home, and auditing of records and medication. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. One of the people who live in the home has had training in health and safety, and with support from a member of staff he carries out all the weekly health and safety monitoring, such as testing the fire alarms and checking water temperatures. We found four health and safety concerns in the house and garden during our visit to the home. The windows of most of the rooms on the first floor have no restrictors to prevent them from opening to an unsafe distance. We were informed that only one person may be at risk from windows that open wide, and there is a window restrictor in their room. However the windows in the bathroom that this person uses, and in the staff sleep-in room and other bedrooms that this person could access, do not have restrictors fitted. There are no risk assessments in place to show that these windows do not present a risk for anyone in the home. The laundry is in an outhouse outside the home. It has a window that opens outwards, with sharp edges at face height towards anyone coming into the garden through the side door. There is a built in barbecue in the garden. The racking and trays are very rusty, and need to be refurbished or removed. In the kitchen there is a drawer that holds sharp kitchen knives. There is a lock on the drawer, but it was not locked. We were told that access to knives is a risk for one person in the home, so it is necessary that this drawer is kept locked. At the last inspection we made a requirement that all personal information must be stored securely. Following this, the residents’ weight records were moved to their personal files, kept in the office in the home. However during Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 25 this inspection we found that the Need to Know file, which contains up to date care plans and guidelines for each person in the home, is kept on the table in the conservatory for easily accessible for anyone visiting the home to read. Other personal information was also stored openly on the computer table in the conservatory, such as the daily record books for the people in the home, handover sheets with details of what each person is doing each day, and a file with contact numbers for each member of staff. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 2 X Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA33 Regulation 18(1)(b) Requirement Timescale for action 31/10/08 1. YA41 17(1)(b) 2. YA42 13(4)(a) The Responsible Individual must take steps to ensure that the recruitment process supports the employment of suitable staff to the home without undue delay. This will support the home in reducing the numbers of temporary and agency staff, so that the people who live in the home can benefit from a stable team of permanent staff. All personal information must be 30/09/08 stored securely in order to protect the confidentiality and privacy of the people who live in the home. Previous timescale of 31/03/08 not met. Measures must be put in place to 30/09/08 ensure that the all areas of the home are safe for the people who live there. This includes, but is not specific to, the wide opening windows on the first floor, the window of the laundry room, the barbecue in the garden, and the storage of knives in the kitchen. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 28 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 YA1 Good Practice Recommendations The service users’ guide should be a live and changing document that gives information on the home from the viewpoint of the people who live there. It should be available for everyone in the home. Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 Aldenham Road (122) DS0000019263.V369049.R01.S.doc Version 5.2 Page 30 - 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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