Inspection on 19/01/07 for Apton Road

This inspection was carried out on 19th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apton Road 15/12/08

Apton Road 09/01/08

Apton Road 28/02/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Apton Road 34 Apton Road Bishops Stortford Hertfordshire CM23 3SN Lead Inspector Angela Dalton Unannounced Inspection 19th January 2007 11:30 Apton Road DS0000064237.V327020.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 Apton Road DS0000064237.V327020.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. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apton Road Address 34 Apton Road Bishops Stortford Hertfordshire CM23 3SN 01279 755656 01279 505939 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) Hertfordshire County Council Ms Elizabeth Jane O`Reilly Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: 34 Apton Road is a four bedroom two storey house standing within the 32-40 Apton Road supported living complex of buildings operated by Hertfordshire County Council. Number 34 has been separately registered as a care home providing respite care to a maximum of four adults with learning disabilities at any one time. The house is fully equipped with lounge, dining room, kitchen, utility room, bathroom and toilets. There are four single bedrooms for service users as well as the staff sleep-in room and the office on the first floor. There is a large angular garden to the rear, although its utility is compromised somewhat due to the sloping ground. There is no lift therefore the home cannot admit service users unable to manage stairs. The Apton Road complex is effectively in a cul-de-sac, located very close to the centre of Bishops Stortford with its shops, amenities and mainline railway station. The site offers easy access to all public transport and community facilities and there is a day centre in the same road. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted by one inspector between 11:30am and 4pm. The inspector spent time with the registered manager, service users and staff at 34 Apton Road. Only one service user was available during the inspection as it was ‘change over day’ but other service users arrived towards the end of the inspection. Care is of a high standard and staff know service users well and have good insight into their individual needs. Some requirements from the previous inspection remain in place but many have been met. Requirements have been made relating to environmental issues and record keeping. The fees range from Key standards have been inspected on this occasion and further expansion of findings is discussed in the main body of the report. Fees were unavailable on the day of inspection and the home were unable to provide evidence of charges on request. What the service does well: What has improved since the last inspection? Several requirements have been met from the previous inspection. Assessments were in place for all service users. Risk assessments were completed to evidence how identified risks are monitored, managed and met. Access to the garden has been achieved but improvements are needed to enable better use by service users and staff. The kitchen has improved with the replacement of the cooker and worktops. Fire doors were not found to be wedged open and Dorguards have been fitted to the lounge and kitchen doors which appear to get used regularly. They are now safely held back allowing easy access. A copy of the local inter- agency adult protection policy is now held at Number 34 to ensure all staff are aware with the local protocol regarding vulnerable adults. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Apton Road DS0000064237.V327020.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 Apton Road DS0000064237.V327020.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. Each service user had an assessment in place. EVIDENCE: Service users are generally assessed by Social Services prior to their stay in the home. Staff will also conduct an assessment to ensure that necessary information is in place prior to a stay or in the absence of an assessment completed by a member of the multi-disciplinary team. Apton Road DS0000064237.V327020.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 adequate. This judgement has been made using available evidence including a visit to this service. More detailed information is required in care plan documentation to better illustrate how staff assist in meeting service users’ needs. EVIDENCE: Care plans were evident for each service user that stays at 34 Apton Road. However, more information is needed to reflect how staff meet individual needs: staff clearly know service users very well and can determine how their needs are met but this high standard of care delivery was not reflected in care plans. No evidence was in place regarding how a successful transition into respite care was achieved and managed with a service user. Another care plan identified that an individual experienced anxiety and depression but did not specify how this was successfully managed. The inspector observed a member of staff skilfully work with this individual during the inspection but their methods were not recorded. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 10 Other areas that require further development were how health needs were managed e.g. epilepsy. The care plan did not identify the type of seizures experienced, how long seizures lasted or what treatment was required. A member of staff commented that they had never seen the individual have a seizure but the care plan did not reflect this. Because Apton Road provides respite care the staff would be involved in reinforcing any goals that had been determined by the service user or other care providers. Independence is encouraged at Apton Road: staff assist service users to maintain their current levels of independence and continue to access the community as they would at home. Work is also undertaken to develop independence and prepare service users for moving out of the family home or onto the next stage of supported living. Risk assessments have been completed following a requirement made at the previous inspection. Apton Road DS0000064237.V327020.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): 12,13,14,15,16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users fully participate in the running of the house during their stay at 34 Apton Road. Every effort is made to ensure that a seamless service is provided. TV Reception was poor on the day of inspection. EVIDENCE: Activities at 34 Apton Road are very service user led. Individuals can request to go out or take part in activities and staff readily honour this. Because most of the service users are local, the unit is able to provide a seamless service with regard to continuation of daycare and activities. Many activities are local to the home and the town centre is a short walk away. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 12 Service users continue to maintain contact with families whilst receiving respite care unless a prior arrangement has been made and agreed as a multi disciplinary decision. Service users confirmed that they were asked for their input into their stay and this was observed during the inspection. They participate in menu planning and shopping and are encouraged to be involved with the running of the house during their stay. On the day of inspection the television was poor and service users reported that this was often the case. This should be addressed. Apton Road DS0000064237.V327020.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ individual needs are well met by staff. The medication system requires review to ensure the safety of service users and staff is assured. EVIDENCE: As stated previously staff are well equipped to meet service users’ needs but this needs to be more reflected in the care plans. Service users confirmed that they were treated in a respectful manner and that there were individual staff that they could share any concerns with. The medication system in place requires a review as secondary dispensing is taking place: when medication is received into the home staff take it from its original containers and place it into dossett boxes. Not only does this put staff at risk, it also potentially contaminates the medicine. The guidance on administration of medication in care homes issued by the Royal Pharmaceutical Society states ‘But a further safeguard is that care workers only give medicines to residents from the container that the pharmacist or dispensing GP has provided. This container must have the name of the resident on the label and the full instructions for the care worker to refer to. Re-packaging medicines Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 14 into another container with the intention that a different care worker will give it to the resident at a later time is called secondary dispensing. Both the Royal Pharmaceutical Society and the Nursing & Midwifery Council state that this is unsafe practice that can potentially cause drug errors.’ One service user was resident with medication that had been placed in a dossett box at home but the tablets were unidentifiable due to lack of accompanying information. Staff were signing to say medication had been administered but did not adequately reflect what had been given due to the lack of available information. Some service users are self administering medication but the assessments in place contain inadequate information to demonstrate how competence has been assessed and reviewed. Storage temperatures are not recorded and this must be addressed to demonstrate that medication is kept at the correct temperature. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 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. 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. There was no record of a clear and effective complaints procedure on the day of inspection. The financial system would benefit from tighter measures being introduced. EVIDENCE: Following a recommendation made at the previous inspection a copy of the Hertfordshire inter-agency adult protection guide has been obtained and is kept on site at 34 Apton Road. Staff are aware of the Whistleblowing policy to raise any concerns that they may have regarding poor practice or the safety of service users. As stated earlier service users confirmed that their views were listened to. Records of complaints made and action taken are not kept on site at 34 Apton Road and the binder attributed to keeping records of complaints was empty. No evidence was available to demonstrate how complaints were investigated or resolved. A user friendly complaints policy is given to each service user which explains how they can raise concerns. The financial system in place requires improvement. Receipts are not always acquired when transactions take place and financial records reflect that one member of staff is responsible for conducting balance checks. The senior member of staff checks this at irregular intervals. Tighter financial controls would minimise the opportunity to abuse service users’ finances. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some further environmental improvements are needed to better meet the needs of service users. EVIDENCE: There have been some improvements since the previous inspection: Handrails and paved pathways have been fitted. Unfortunately, one pathway leads to the ‘top’ of the garden and leads to a dead end with no patio area or bench. The only option once reaching the end of the path is to return to the house. This does not meet the needs of the service users or observe their dignity. The kitchen has been fitted with a new oven, worktops and dishwasher but would benefit from refurbishment as the fixtures are worn. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 17 Heat grime marks the wall of the lounge and this room is in need of redecoration. A requirement has been made to ensure that this occurs. Cracks were evident in the bathroom and paint was peeling from the boxed in pipe unit. New lounge furniture is on order for the lounge and this will better facilitate service users and staff sitting together. With exception of the stained stair carpet the home was clean and odour free. The carpet must be cleaned or replaced if necessary. Number 34 continues to lack identity as part of the complex: Staff suggested that if the front garden was fitted with a low fence it would enable service users to sit outside and wait for their transport to day centres or for their families or friends. The addition of a low fence would also differentiate Number 34 as a separate provision. Service users commented that their doors closed noisily and that this disturbed their sleep when others came to bed or night checks were conducted. A recommendation has been made. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff adequately meet service users’ needs. No evidence is available to demonstrate how the home ensures that vulnerable adults are safeguarded by robust recruitment checks. EVIDENCE: Staffing levels are adjusted accordingly to meet the needs of service users. There have been no staff changes since the previous inspection. Criminal Record Bureau (CRB) checks are conducted centrally and not held on site. Proof must be available that thorough recruitment checks are conducted and that evidence reflects that a ‘clear’ CRB has been received. An ongoing training programme is available to ensure that staff are competent and equipped to meet the needs of service users. Apton Road DS0000064237.V327020.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 adequate. This judgement has been made using available evidence including a visit to this service. The home manager is familiar with the requirements of Apton Road. Some improvements are required to ensure the health and safety requirements of service users and staff are fully met. EVIDENCE: 34 Apton Road forms part of a complex of car services but is the only one registered with the Commission for Social Care Inspection. The registered manager is responsible for all Apton Road Services and has been in post for several years. Staff and service users confirmed their approachability and availability. Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 20 Service users are given regular opportunities to comment on the service that they receive and satisfaction with the respite care they receive is discussed in formal reviews. Some improvements are needed to fully ensure that the health and safety of service users and staff is assured. Fire checks did not reflect when fire drills were conducted or who was involved. Hot water checks are not recorded and staff reported that the hot water temperature fluctuated. Apton Road DS0000064237.V327020.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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 2 X Apton Road DS0000064237.V327020.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 YA7 Regulation 12 Requirement Care plans must reflect how identified needs are monitored, managed and met e.g. epilepsy, depression, transition to respite care. A safe medication system must be implemented. The home must adhere to guidance issued by the Royal Pharmaceutical Society. Medication must be stored at the correct temperature and records kept to reflect that this occurs. Medication Administration Record sheets must accurately reflect the type of medication and dose prescribed. Self administration assessments must reflect how service users’ competence is assessed Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 23 Timescale for action 30/04/07 2. YA20 13(2) 16/02/07 and reviewed. 3. YA22 22 A complaints procedure reflecting complaints received and action taken must be kept and available to staff at all times. The complaints procedure must accompany this documentation. The finance system must adequately protect vulnerable service users. The lounge must be in an acceptable state of décor: Heat grime is currently defacing a wall in the lounge. Paintwork is cracked and peeling in the bathroom. A newly fitted handrail and pathway lead to nowhere and this must be addressed. The stained stair carpet must be cleaned or replaced. Confirmation must be available that CRB (Criminal Record Bureau) checks have been completed and are held centrally. Records of fire drills, the time of occurrence and who participated must be kept. Hot water temperature checks must be conducted. 28/02/07 4. 5. YA23 YA24 13(6) 12(4) 23 28/02/07 31/03/07 5. YA30 12(4) 23 31/03/07 6. YA34 Schedule 2 31/03/07 7. YA42 13(4) 16/02/07 Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA14 YA24 Good Practice Recommendations The television reception in the lounge should be improved. Door closers should be fitted to bedroom doors to minimise the disturbance to service users at night. The front garden of 34 Apton Road should have a low level fence fitted to better meet the needs of service users. The kitchen should be refurbished. 3. YA24 Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office 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 Apton Road DS0000064237.V327020.R01.S.doc Version 5.2 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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