CARE HOME ADULTS 18-65
Apton Road 34 Apton Road Bishops Stortford Hertfordshire CM23 3SN Lead Inspector
Mr Tom Cooper Unannounced Inspection 28th February 2006 1:30 Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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.V282877.R01.S.doc Version 5.1 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.V282877.R01.S.doc Version 5.1 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.V282877.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection N/A 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.V282877.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection following the separate registration of the respite unit as a care home within the Apton Road complex in August 2005. The inspection took place on a weekday in the afternoon and early evening. A tour of the premises was conducted, discussions were held with members of staff on duty and the service users present and the interaction between staff and service users was observed. Documentation examined included a sample of care plans, some equipment servicing records, complaints records, medication records and a personnel file. The inspection indicated that the service was basically well run, with highly motivated and well trained staff who related well to the service users. However the respite unit still appears to be regarded as part of the wider Apton Road complex and further work must be done to provide number 34 with complete documentation that reflects its separate registered status and complies with the Care Homes Regulations 2001. In addition, the various premises problems identified below must be rectified to ensure the safety and welfare of service users. What the service does well:
The service users present all said they liked staying at the home and got on well with the staff. They also liked the accommodation and the food provided. Observations of the members of staff on duty working with the service users indicated that they enjoyed positive relationships based on mutual respect and trust. One service user was feeling low and staff were being very supportive, offering reassurance and companionship in a sensitive way that was clearly appreciated. Staff were able to demonstrate good knowledge of the individual needs of the different service users. There was a calm and positive atmosphere in the house during the inspection, with three of the service users happily following their own pursuits upon return from their day care activities. Care plans were in place and held at number 34 for each service user who stays at the respite unit, except for one individual who had been placed on an emergency basis several weeks earlier (see below for further comment). Care plans sampled contained wide-ranging information about the needs of each person coupled with guidelines for staff on how to proceed to achieve positive outcomes. Specific medical conditions or behaviours presented requiring a consistent care management response were noted, providing useful working documents for staff. Staff have good access to relevant training opportunities and said they felt well supported and supervised. The newest member of staff had received a thorough induction and all staff rated communications systems and teamwork
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 6 in the home as good. Hertfordshire County Council has rigorous recruitment, induction and ongoing training policies that are designed to ensure the staff employed are suitable and competent. However no evidence of identity or Criminal Records Bureau vetting was available for inspection. The house is homely and well appointed, providing a comfortable living environment for the residents, including pleasant single bedrooms and adequate domestic bathing and toilet facilities. Communal areas are nicely presented and maintained to a reasonable standard. The garden provides a potentially very useful amenity for use in fair weather, although its accessibility needs to be improved. See below for further comment. The home is currently used by approximately one hundred service users living in the community and represents an invaluable local resource. However the placement of two service users over a long period has blocked half the beds and caused the cancellation of several other clients’ allocated stays. This clearly undermines the home’s status as a respite care unit and should be resolved as soon as possible. What has improved since the last inspection? What they could do better:
No up to date assessment information, risk assessment or current care plan were held in the respite unit in respect of one service user placed in the unit on an emergency basis. This meant that staff were not fully conversant with his status and the agreed care management strategy. This was particularly worrying bearing in mind anecdotal information supplied about this service user’s behaviour and a complaint made by another service user in this regard. An immediate requirement was made to put these elements in place. One personnel file examined contained no evidence of identity or CRB disclosure. Evidently such records are held centrally by Hertfordshire County Council. It was therefore impossible to verify that the home had followed the compulsory rigorous recruitment procedures before appointing members of staff. The Care Homes Regulations 2001 require identity evidence and records of Criminal Records Bureau (CRB) disclosures to be kept in the home available for inspection at all times. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 7 The unit manager, who reports to the registered manager, felt she was expected to assume greater responsibilities than her HCC grade 4 status merited. An appropriate job description should be devised which clearly defines the limits of the unit manager’s role and the appropriate level of authority. A separate complaints book must be kept at number 34 Apton Road and all complaints received and the action taken in respect of them must be recorded in it. During the inspection the lounge and kitchen doors were being held open, one by a wedge, the other by a magazine rack. Fire doors must not be wedged open as this compromises the fire safety of the building. The lounge should be redecorated as there was obvious heat grime on the wall above the radiator. The laminate on the kitchen worktops is worn out in places, creating a hygiene hazard. The cooker has an electric hotplate hob that represents a burn hazard to service users with learning disabilities. These must be replaced. Access to the garden is poor, with no handrail fitted and a steep slope to negotiate. This presents a fall hazard to both service users and staff and must be rectified. 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. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Appropriate information about the philosophy, aims and operation of the respite unit is available to prospective service users. The needs of individuals using the service are normally fully assessed and documented prior to admission. However this documentation must be available in the registered care home i.e. number 34. Each service user has an individual licence agreement with Hertfordshire county council outlining the terms and conditions of staying in the home. This ensures that service users and their representatives know what to expect from the service. EVIDENCE: The home has a statement of purpose and service user’s guide that detail the aims of the service and the way it is proposed to operate. These documents enable prospective service users and their representatives to make an informed choice about whether to use the respite care service. New service users are normally accepted following a careful referral process and are subject to thorough assessments of individual needs. These form the basis of the care plan drawn up detailing how the needs will be met (however see the comments below in relation to one service user placed on an emergency basis). In the absence of assessment information it was hard to judge whether this placement was suitable or that the respite unit could meet his needs.
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 10 Personal files examined contained licence agreements that set out the terms and conditions of staying in the home. Where possible the service user is asked to sign the agreement, otherwise a relative or other representative may be asked. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 In general, for each service user a care plan is in place containing comprehensive details of his or her needs, preferences and routines. However, up to date care plans and risk assessments must be kept in the respite unit for every service user. Staff consult service users about their preferred lifestyles and help them to make decisions and choices for themselves. Staff assess and document perceived risks and support service users to lead reasonably independent lives during their stays. However no risk assessment was in place for one service user. Staff follow the home’s policy and maintain confidential information appropriately. Documentation about service users is kept safely and staff respect confidentiality. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 12 EVIDENCE: Seven care plans were examined. These contained varied information about individual needs and personal preferences, coupled with clear instructions to staff on how to proceed, including useful behaviour management guidelines as well as tips on personal care, preferred daily routines and social/cultural issues. There was no indication of unduly restrictive rules applied in the home. Relevant risk assessments were on file covering a range of service users’ activities such as going out, The care plans seen conveyed a good overview of the individuals concerned and were generally reviewed shortly before each short stay. However no up to date care plan and risk assessment was in place at number 34 in respect of one service user who had been placed in the unit on an emergency basis several weeks before the inspection. Given the anecdotal evidence presented of his behaviour and discussion with this individual, it was of concern that no clear plan had been drawn up in consultation with him for staff to follow in order to meet his needs and manage the risk to himself and other service users whilst living at number 34. In addition, the staff on duty were unfamiliar with all the details of this service user’s case. An immediate requirement was made to produce the necessary documentation. Staff recognise the importance of helping the service users to lead independent lifestyles and encourage them to make decisions for themselves, offering guidance as appropriate. Any restrictions on individuals’ freedom of action are justified by reference to assessment information in their personal files and are only imposed in the person’s best interests. Many examples of legitimate risk assessments with suitable control measures were found in the files examined, covering healthcare issues and activities. However this was obviously not the case in respect of the service user referred to above. The home has a procedure for responding to a service user going absent without authority. Service user’s files are kept securely in the office. Hertfordshire County Council has a policy on confidentiality that staff are aware of and follow. Information is shared with partner agencies and others on a need to know basis. The topic is covered during the induction of new staff. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Staff encourage and assist service users to make choices with respect to activities in and out of the home, using community facilities in the ordinary way. Service users are able to maintain family and personal relationships. Service users’ rights to make decisions for themselves and undertake appropriate activities are upheld and individual responsibilities are recognised and supported. Service users have healthy diets that correspond to their particular preferences and they enjoy their meals and mealtimes. EVIDENCE: The service users spoken with said that they enjoyed staying at the home and were happy with the lifestyle available during their stays. On the day of the inspection one resident had decided not to attend his usual day care activities.
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 14 Another was feeling unwell and was spending the afternoon quietly in the company of staff. Another returned at around 4pm from the day centre and said that he had had a good day and now wished to relax by watching television. The fourth was planning to go out to a party in the evening and spent some time preparing himself. Staff said that they attempted to strike a sensible balance between encouraging personal development and independence skills and allowing service users to relax and enjoy the break away from their normal home routines. There are various entertainment facilities in the lounge. References to preferred activities were noted in the care plans sampled. The central location of the home in Bishops Stortford allows easy access to community facilities and shops. Staff frequently take service users out for shopping or recreational activities. The home has a welcoming atmosphere and service users may have visitors at any reasonable time. Staff assist and encourage the service users to enjoy positive relationships with each other during their stays. If any disputes or conflicts arise staff may act as mediators and if necessary negotiate with the parties to resolve any problems. Such a situation had arisen on the day of the inspection and staff were considering an appropriate response. Staff strive to balance the rights and responsibilities of the service users and promote an understanding of the need to act considerately in a group living setting. Staff are aware of the importance of promoting service users’ privacy and act accordingly. For example, they were observed knocking and waiting at residents’ bedroom doors, and two of the residents spent lengthy periods alone in their rooms during the inspection. References to particular behaviour patterns were noted in care plans. Three of the four service users present said that they liked the food provided. The fourth declined to comment. Staff reported that menus were planned by asking the residents what they wanted in advance and then make small shopping trips with a service user to buy the necessary items. Adequate food stocks were noted in the kitchen cupboards and freezer. Particular food preferences and dietary needs are noted in care plans. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Staff treat residents with sensitivity and respect, following guidance in the care plans. Service users’ healthcare needs, emotional needs and personal preferences are detailed in their care plans and staff act accordingly. The home operates sound procedures for handling, storage and recording of medication that protect service users’ interests. EVIDENCE: Care plans seen detailed individual personal and healthcare needs. For example, files seen referred to a service user’s heart condition, mobility and medication issues, with up to date information on the level of support required. In more general terms, staff provide appropriate guidance to service users regarding health matters, personal hygiene, suitable presentation and dress and so on. All the service users said they found staff friendly and helpful. Staff demonstrated good knowledge of individual needs and evidently were able to address them sensitively. Service users were physically well presented and dressed in appropriate, clean clothing.
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 16 Medication is securely stored in a locked cabinet in the office. Good procedures are in place to record all movements of medication in and out of the home and good recording was found on MAR sheets. Staff are aware of the need to follow the GP’s prescription and continued to do so despite pressure from one service user who said that the prescription for one item had been changed, although there was no evidence to support this. Staff attempted to find out from the GP whether the prescription had in fact been changed. Staff double-check the medication records and note any mistakes. All staff have been trained to administer medication. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home has a clear complaints procedure that should protect service users’ interests. However the home must keep its own record of complaints separate from the main Apton Road office. Appropriate policies and procedure are in place to protect service users from abuse. Staff are trained in abuse awareness and have a good understanding of adult protection principles. EVIDENCE: The Hertfordshire County Council complaints procedure is used that contains all the elements to meet the standard. Staff stated that no formal complaints had been made since the home was registered in August 2005. There was no complaint record book or file on the premises of number 34 and this must be introduced immediately. One of the service users currently staying had complained about the behaviour of another resident and this was being treated purely as an untoward incident rather than a complaint and staff seemed unaware that it was actually a complaint about the operation of the home and should therefore be recorded as such. All complaints must be formally investigated by the registered manager and a timely response sent to the complainant. See requirements. The service users spoken with had only limited understanding of the complaints procedure but said they trusted the staff. The impression gained was that they felt they would be listened to sympathetically. The home has clear policies on how to respond to suspicion or allegations of abuse. The issue is covered both in-house and in the formal induction training
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 18 for new staff. Staff spoken with had a good understanding of the basic principles and procedures involved in adult protection. The Hertfordshire interagency adult protection guide should be obtained and kept in the office. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 , 29, 30 The building is basically suitable for meeting the aims of the home, with comfortable, living spaces, good quality furnishings and effective heating, lighting and ventilation. However work must be done to improve the safety of the premises in a number of areas. Service users’ bedrooms are comfortable and private and the communal areas provide a homely domestic environment. Bathroom and toilet facilities are adequate. Staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The service users present all said they liked the accommodation provided and were happy with their bedrooms. The house is well appointed and nicely decorated, and sufficiently spacious for four residents. The communal areas are domestic in style and attractive. Residents’ single bedrooms are comfortable and safe, with restrictors fitted to windows and smoke detectors in each. Carpeting and floor coverings throughout the home are safe and in good condition. The kitchen is functional and sensibly laid out although it is fairly
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 20 worn and should be refurbished. Laundry facilities are adequate. Bathing and toilet facilities are adequate and have lockable doors that can be overridden by staff in an emergency. Hot water temperatures are regulated within safe limits by thermostatic mixer valves. The central heating is effective, with individually controllable low surface temperature radiators. There is a hard-wired fire detection and alarm system. The angular rear garden is spacious and would provide a useful extra amenity were the access improved. The premises are in good condition, were clean and tidy throughout and basically provide a suitable environment for service users. However several health and safety issues were identified that must be resolved to achieve the proper standards of safety and amenity. These are listed below. During the inspection the lounge and kitchen doors were being held open, one by a wedge, the other by a magazine rack. Fire doors must not be wedged open as this compromises the fire safety of the building. It is clearly desirable to be able to keep these doors open during the daytime but this must be done safely therefore suitable holding devices must be fitted such as magnetic clasps or ‘Dorgards’ that release upon activation of the fire alarm. The lounge should be redecorated as there was obvious heat grime on the wall above the radiator. The laminate on the kitchen worktops was worn out in places, creating a potential bacteria trap that is a hygiene hazard. The cooker has an electric hotplate hob that represents a burn hazard to service users with learning disabilities because the hotplates remain hot for up to half an hour after switching off with no visible indication of the danger. Also the control markings on the cooker had worn away making it hard to tell which hotplate was being turned on. These must be replaced. Access to the garden is poor, with no handrail fitted and a steep slope to negotiate. This presents a fall hazard to both service users, some of whom are unstable on their feet and to members of staff who have to assist them. This must be rectified, preferably by creating a level access path and fitting a handrail. See requirements. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 36 Staff understand and support the home’s aims and their roles in delivering the service promised in the statement of purpose. However the role of the unit manager should be more clearly defined. Adequate staffing levels are provided that ensure service users are well supported and the aims of the home can be met. Hertfordshire County Council has rigorous recruitment policies and procedures that ensure all staff are suitable to work at the home and protect service users’ interests. However not all the required records were available to verify the procedures were being followed. Staff are well supported by senior colleagues and receive regular supervision. This ensures they perform consistently well and improves their ability to care for service users. EVIDENCE: Staff spoken with had a clear understanding of the aims of the respite service and their individual and collective responsibilities in achieving them. The unit manager expressed some dissatisfaction that in her opinion she was being expected to take greater responsibility in the home than was appropriate for someone at her current grade (scale 4). The registered manager should raise
Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 22 this matter with Hertfordshire County Council Adult Care Services and produce a clear definition of the unit manager’s role. Staff indicated that teamwork and communications in the unit were good and said that they felt well supported by senior colleagues, with shift handovers, regular team meetings, individual supervision and annual appraisals. The registered manager was said to be approachable and constructive. The staff rota available for inspection indicated that one or two staff were on duty when service users were present, depending on the needs of the individuals staying at any particular time. The home has its own discrete staff team, with an establishment of three full time members and three part timers. Agency staff are rarely used. Hertfordshire County Council has comprehensive and up to date recruitment and employment policies that include a commitment to equal opportunities. The personnel file of the most recently recruited member of staff was checked. This was held in the main office rather than at number 34 and contained some of the information and documents required by regulation, including an application form, two references and evidence of a thorough induction. However there was no identity evidence or CRB disclosures to demonstrate that the person had been properly vetted. A requirement has been made. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41, 42 The registered manager is very experienced and qualified. The home is well run, with a committed staff team and an open and inclusive atmosphere. However, the long term placements of two service users are rather compromising the aims of the respite service. The records present in number 34 are well maintained. However the home does not keep all the records required by the Care Homes Regulations. In general, the home is a safe place in which to live and work. However several health and safety matters must be addressed to ensure the well being of service users and staff. EVIDENCE: Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 24 The registered manager has over 25 years management experience and is multiply qualified in social care and management including CQSW and NVQ5 amongst others. Staff reported that she was able to provide very positive leadership and promoted an inclusive atmosphere where staff were encouraged to contribute ideas and innovations to improve the service delivered. Staff understand the philosophy of the service as laid out in the unit’s statement of purpose. The records inspected that were available in the home had been well maintained. However as indicated elsewhere in this report not all the required records were present and the impression was gained that number 34 was still regarded as part of the main Apton Road complex rather than as a separate establishment registered in its own right. See requirements. The premises are mostly safe and suitable for service users with learning disabilities. Nevertheless the health and safety matters listed in the environment section of this report must be addressed to ensure satisfactory safety in the home. The home’s policies and procedures cover compliance with relevant legislation and this is reinforced through appropriate training. Appliances checked such as fire extinguishers and electrical equipment had been serviced/PAT tested within the last year. Cleaning substances were safely locked away in accordance with the COSHH regulations. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 25 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 3 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 X 33 3 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 X 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 3 X X 2 2 x Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 YA2 Regulation 14(1) & 17(1)(a) 15(1)&(2) 17(1)(a) Requirement Pre-admission assessments of needs in respect of every service user must be kept in the care home. An up to date care plan detailing how the person’s needs are to be met must be devised in respect of every service user and kept in the care home. Risk assessments must be made in respect of all potentially hazardous activities engaged in by service users and appropriate action to minimise or eliminate any risks identified. Safe access must be provided to the garden for service users and staff assisting them. A handrail and level pathway should be installed. The electric cooker hob must be replaced or made safe from the risk of burns to service users. The worn out kitchen worktops must be replaced to maintain good hygiene and prevent infection. Timescale for action 03/03/06 2. YA6 03/03/06 3. YA9 13(4)&(6) 03/03/06 4. YA24YA29YA42 13(4) 23(2)(a) 31/07/06 5. YA24 YA29YA42 YA24YA30 13(4) 23(2)(a) 13(3)&(4) 23(2)(a) 31/07/06 6. 31/07/06 Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 27 7. 8. YA24 YA22YA41 9. YA34YA41 28/02/06 23(4)(c)(i) Fire doors must not be wedged open at any time. 17(2) Sch A record of all complaints 03/03/06 4(11) made by service users or representatives or relatives of service users or members of staff must be kept in the care home. All complaints must be formally investigated by the registered manager and a timely response sent to the complainant. 17(2) Evidence of identity and 01/05/06 Criminal Records Bureau 19 enhanced disclosures in respect of every member of staff must be kept in the care home at all times available for inspection. 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. 3. 4. 5. Refer to Standard YA23 YA24 YA24 YA24 YA31 Good Practice Recommendations The manager should obtain a copy of the Hertfordshire inter-agency adult protection guide and keep it in the office of number 34. The lounge walls should be redecorated. The kitchen should be refurbished. Holding devices such as magnetic door clasps should be fitted to the lounge and kitchen doors. An appropriate job description should be devised which clearly defines the limits of the unit manager’s role and the appropriate level of authority. Apton Road DS0000064237.V282877.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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