Inspection on 29/11/07 for Cherrymead

This inspection was carried out on 29th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherrymead 08/05/06

Cherrymead 23/11/05

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Southfields

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

CARE HOME ADULTS 18-65 Cherrymead Station Road Angmering West Sussex BN16 4HY Lead Inspector Christine Walsh Unannounced Inspection 29 November 2007 11:00 th Cherrymead DS0000064747.V356730.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 Cherrymead DS0000064747.V356730.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. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherrymead Address Station Road Angmering West Sussex BN16 4HY 01903 783791 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) Outreach 3 Way Mr Mark Daniel Peirce Care Home 7 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1), Physical disability (1) of places Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to seven (7) male and/or female service users in the category Learning disability age 18 to 65 years may be admitted/accommodated. one (1) person with Learning and Physical Disability may be admitted/Accommodated. One (1) Service user over the age of 65 years may be accommodated. The total number of service users that may be accommodated must not exceed seven (7). Date of last inspection 8th May 2006 Brief Description of the Service: Cherrymead is a care home registered to provide accommodation for up to seven adults with a learning disability. Outreach 3 Way owns the services. The registered manager responsible for the day-to-day running of the home is Mr Mark Peirce. The responsible individual on behalf of the providers is Mrs Vanessa Keen. The property is a large detached property. Accommodation is provided on ground and first floor level, a vertical lift is in situ enabling residents to access all areas of the home. There is an enclosed garden to the rear of the property and parking facilities to the front. The establishment is near to Angmering train station and local amenities. The weekly fees are £944.50 - £1244.51 per week. Extras include hairdressing, trips out and personal items. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident and relatives comment cards were recieved. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, where possible speaking with the residents and staff and observing care and support practices. The people who live at Cherrymead have little verbal communication, communicating their needs through gestures and other forms of communication. A tour of the home took place and documents pertaining to health and safety were viewed. What the service does well: Cherrymead does well to ensure it provides prospective residents and their representatives with information about the home, it assesses if it can meet their needs and supports them to become familiar with their new surroundings and others living in the home prior to moving in. This is followed up by a review of the persons stay. The home provides staff with information about the residents in the form of care plans, these provide specific detailed information on each resident and how they wish their care to be carried out. A staff member said: “Support plans are good and we are told if they change. We can make changes or suggest changes as well.” The people who use the service have access to GP’s dentist, psychologists and physiotherapists where needed. A staff member said: “If we receive or have any concerns with write it down, date it and keep it in a place and inform the manager”. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 6 Cherrymead offers a homely, safe and welcoming environment, which is spacious, tastefully decorated and furnished and offers individual bedrooms that are personalised and decorated to the residents liking. “Cherrymead is a really happy home”. What has improved since the last inspection? What they could do better: Following the last visit to the home it was issued with two requirements neither of which have been met and will be repeated as a consequence of this visit. A further eight requirements have been issued which reflects and has some bearing on insufficient staffing levels to meet the needs, choices and decisions made by the residents, and the administration practices of the manager. Care plans although very detailed and describe how the residents wishes to be supported could be hard to follow and inaccessible for the residents and for staff who are new or unaware of the needs of the residents. The home has detailed risk assessments, however risk assessments for choking, eating and drinking were not in place, which applies to more than one person. Nor were there opportunities to have professional care in put. Residents are unable to participate in community and social activities as and when they wish, as there is insufficient staffing to support this, impinging on the residents rights to make choices and decisions about their daily lives. Residents are currently not included in the day-to-day running of their home and are at times left to their own devises for long periods of time whilst staff undertake daily chores. Residents who require support to access the bath without potential risk of harm must have suitable equipment and adaptations in place to do so. Residents are placed at potential risk from medication practices that do not conform to pharmaceutical guidelines such as storage, recording and disposal of medications. Residents are placed at potential risk from the homes poor administration practices which includes: Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 7 Keeping records and knowing what training staff have received, including fire and safeguarding vulnerable adults. Keeping records and knowing if staff have been recruited correctly using robust recruitment procedures. Keeping records and knowing if staff have received supervisions. Failing to undertake appropriate checks on fire safety equipment. 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. Cherrymead DS0000064747.V356730.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 Cherrymead DS0000064747.V356730.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure people who wish to use the service are provided with information about it prior to moving in. The home has good systems in place for assessing the needs of the people who wish to use the service. Those who are currently using the service have their needs regularly reviewed. EVIDENCE: The AQAA informed us that the home has an accessible Service User Guide, which has been updated in the last 12 months and that have a clear admissions policy inviting people for tea visits to observe the impact of new people on the group of people already living in the home. This was tested by speaking with the manager and viewing the records of three residents. The home has recently updated its Statement of Purpose and Service User Guide and provided the Commission for Social Care Inspection with a revised Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 10 copy. The Statement of Purpose and Service User Guide are displayed within the home for all to access if they so wish. At the time of the visit a review of a resident newly admitted to the home was taking place, this involved the resident, their keyworker, care manager and the homes manager. The manager stated that the review had gone well and the resident and been heard to say that they like living at Cherrymead. Cherrymead DS0000064747.V356730.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there are care plans in place stating the people who use the services needs, they are so detailed and in such a style that does not make for easy ready and therefore they are in danger of not being followed staff who currently do not have time to read and absorb the information. The home supports the people who use the service to make day-to-day decisions and choices in a limited way about their daily lives. The development of person centred plans and communication passports will assist in this process, however limited numbers of staff restrict impromptu and unplanned activities. The home supports the people who use the service to take risks as part of an individual lifestyle, however the home must ensure risks identified as detrimental to the health of the residents involve the support and guidance of health care professionals. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 12 EVIDENCE: The AQAA informs us that they do well to implement social services care plans with their own support plans and risk assessments and tells us that they plan to improve information included in support guidelines give practical ways of offering choice and empowering people using a person centred approach. People are supported to take risks whilst ensuring their safety. This was tested by viewing the personal plans of three residents, speaking with the manager, observing interactions between staff and residents and viewing comment cards. Each resident has a personal plan of their own which provides information on social interaction and engagement, health and welfare, personal care, communication, behaviours, independence and includes daily notes. The plans provide comprehensive detail on how to support the residents and discussion took place with the manager on how accessibility could be improved upon. There is evidence that the home is in the process of adopting a personcentered approach and developing communication passports for each resident, these are currently in their early stages of development and need further work on them. Discussion took place in respect of developing pen pictures and life plans to assist staff to have a better understanding of the residents and enable the residents to have more of a say about their lives. Staff commented on what they do well to support the residents with their individual needs and choices: “Support guidelines I think area good and they are regularly reviewed and updated” “With a higher level of staffing the care and support given could be even better.” “We provide good personal care, tailored to the service users individual needs and preferences” A relative said: “I feel the home does well to provide a high standard of care in a small family environment which suits the needs of my relative”. Through observation it was established that residents are treated kindly and supported to make decisions and choices about their daily lives, this was Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 13 evidenced by a resident deciding to stay at home rather than go to the day services and residents being given a choice of what they would like to eat. Care plans provide detail on residents’ individual likes and dislikes and enforce the message of promoting the residents to be involved in making choices. The staff said limited numbers of staff restrict opportunities for the residents to socially engage, access the community and undertake activities of their choosing unless they are planned events and extra staff have been called upon. Care plans are linked to risk assessments and provide detail of the risk and action required by staff to minimise them. However it was established for one resident that an important identified area of risk regarding their eating habits and subsequent weight loss had not been risked assessed. Through further discussion with the manager it was established that this area of need was not currently being fully addressed nor were health care professionals involved and regular monitoring of the resident’s weight was not undertaken Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is support for people who use the service to be involved in peer, age and culturally appropriate activities, the limited numbers of staff prevent the people accessing their local community and socially engaging when they wish which means they are socially isolated and not having a full lives as is their right. It is detrimental to the residents to be ignored or left for long periods of time without stimulation. The home does well in ensuring the people who use the service maintain links with family and friends. The complex eating and feeding requirements must be addressed and supported by the appropriate health care professional as people are at risk of poor healthcare outcomes. EVIDENCE: Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 15 The AQAA informed us that the home is good at promoting individual lifestyles through support planning and the risk assessment process, that they ensure people are treated with dignity and in a respectful manner and are provided with planned menus that meet their dietary needs and preferences. However the home recognises it could do better to support people to have time away from Cherrymead. This was tested by observation, speaking with the manager, viewing three personal plans and comment cards recieved from relatives, residents, health care professional and staff. On the day of the visit there were four residents at home, whilst others were accessing day service arranged activities and there was three staff on duty, this included the manager and deputy manager. Both the manager and deputy manager were involved in a review with a resident and their care manager and another member of staff was undertaking household tasks in the morning. Two of the four residents were observed for approximately 25 minutes to roam aimlessly around the home and garden with little supervision or engagement from the remaining member of staff. These residents were seen to be rubbing their hands and picking at leaves outside and not supported by staff. A resident who tried to engage with the member of staff did not receive a response and was left unsupervised in the kitchen. Care plans and the development of communication passports lists the residents likes and dislikes and preferred activities such as colouring, listening to music and watching films and doing jigsaws. Residents were observed in the evening engaged in these activities and appeared to enjoy them; residents undertook a joint music session which they also appeared to enjoy, supported by additional staff who had stayed on to assist with a party tea. . Through observation and later speaking with the manager it was established that the residents are not involved in day to day activities such as helping to clean their home or involved in the process of planning, buying and preparation of mealtimes. Discussion took place on how this can be improved upon. Reflected in all surveys returned from care staff and a relative raised concerns of the lack of opportunity for the residents to go out, access the community and go on holiday. A relative said: “My relative has difficulty accessing the home mini bus and therefore loses out in going out”, “I have spoken to the home about this but nothing appears to have happened about it”. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 16 In response to the question what the home could do better s0taff said: “Give more hours to service users so that we can get out more with them”. “Access the community more during the weekend shifts. “Sometimes more hours are needed to provide support for leisure and social activities”. The manager confirmed that the current staffing levels does not allow for impromptu and unplanned visits to the community, leisure and social activities. Viewing the activity sheets for three residents over a months period identified that only one had accessed the community on two occasions in this period. Access to leisure, community based activities and social events are provided by the day service for those residents who wish to attend. The spiritual needs of residents are supported for those wishing to exercise their faith, arrangements are made for residents to access church and church groups. The manager stated that arrangements are made for the residents to visit relatives and relatives are always made welcome when the visit the home. One of the residents has a calendar that tells her when she is due to visit her family and all residents have a telephone communication log that details all contact with family and friends. A staff member said: “Communication with families is very good”. In the surveys received from staff there was evidence that the staff are aware of the importance of respecting the residents rights, needs and choices. Staff said: “During my induction I was informed of person centred planning, this made me understand the whole concept of caring, supporting and maintaining the independence of the residents”. “The staff support one another to gain knowledge, which supports us to meet the different needs of our service users.” On the day of the visit a resident had chosen to stay home from day services and the manager said they had respected this decision. The manager was asked to describe what work had been done to establish residents dreams and desires, the manager confirmed that the home is in its early stages of developing life plans but was optimistic and keen to encourage the residents to participate in the development of their plans. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 17 Detailed in the resident’s personal files are their likes and dislikes and the support they require to eat their meals. For the majority of the residents soft meals are provided. For two of the three personal plans viewed concerns and risks were identified in respect of their eating function and behaviours towards mealtimes. One raises the concern regarding the resident’s refusal to eat meals and subsequent weight loss and another refers to the hazard of choking especially when eating foods such as pastries. A weight chart is available in the resident’s personal plan but there was no evidence of this being filled in or a record of weight loss being monitored. The home has not undertaken a nutritional assessment and has not referred the residents to the specialist health care team for advice and support in maintaining a healthy weight for the resident concerned. The other resident was identified at risk of choking especially when eating pastries and it was reflected in her plan that she receive a soft diet, however in the evening the same resident as observed eating a pastry dish. The advice of health care professionals such as speech and language therapists regarding the changing needs of resident’s diets and the way in which food could be presented has not been sought. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst physical care needs of the people who use the service seem to be met for most people the emotional needs are not fully met due to staffing levels, also the accessibility to the bath dose not meet everyone’s needs. The dietary needs of the people who use the service requires greater attention and professional advice sought. The management and administration of medications needs improvement such as storage and returns of medication to protect the people who use the service. EVIDENCE: The AQAA informed us that the home provides sensitive support to each persons personal and health care needs and respond to those needs. it informs us that the home has developed good working relationships with health care professionals and the local pharmacist and they administer medication appropriately. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 19 This was tested by viewing resident’s personal plans, viewing comment cards from relatives, staff and a health care professional and speaking with the manager. Personal plans describe how the residents require support to undertake everyday activites from getting up to going to bed and in some instances describe what the preferred time these take place. As mentioned in standard six the plans are comprehensive and this information is lost within all the information held on the residents, discussion took place on how this could be improved upon to assist with continuity of care and limit potential anxieties caused by unfamiliar approaches. The home keeps records on the visits made to or by health care professionals, these include accessing the dentist, GP, chiropodist and specialist health care teams such as occupational therapists and psychologists. The records provide information on the nature of the visit, the outcome and any treatment required. As identified in standard seventeen the home does not access a dietician and/or speech and language specialist to in respect of the residents eating habits and support requirements. In addition a bath remains inaccessible for a resident despite occupational therapist input and this has not been followed up. A health care professional said: “I find the atmosphere and openness of the staff makes this an excellent home setting for the clients, however perhaps with the aid of local voluntary organisations they could promote a little more exercise such as swimming, and walking”. Currently all the residents living in the home are supported to take their medications, a record of medication held and administered on behalf of the resident is kept and support guidelines are in place to support staff when they are to give “As required “ medications. Staff signature gaps were found on the medication administration record with no evidence to demonstrate if the residents had received their medication or not. The manager stated that the home has developed a good relationship with the local pharmacist, who has assisted with the training and support of staff. The manager also confirmed that all staff had received medication training and this was reflected in one of the staff comment cards, but their was no written evidence at the time of the visit to support this. The homes storage and returns procedures needs improving upon, evidence of items other than medications were found to be stored in the cupboard, liquid medications were sticky, the cupboard untidy and medications were not separated for each resident but mixed together. A record is kept of returned Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 20 medications, which is signed by the returning member of staff and pharmacist, but there was a bagful not yet returned. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 21 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does well to provide the people who use the service with information on how to express concerns and complaints. The home does well to protect the people who use the service from abuse, self harm and neglect, however the home must provide evidence that staff have received training in abuse awareness and have been correctly recruited. EVIDENCE: The AQAA informed us that the home has complaints, concerns and compliments policies in place and the behaviour of the residents is monitored. It went on to tell us that it has safeguarding policies and procedures in place and plans in the future to embrace the local authorities safeguarding procedures. This was tested by viewing the homes complaint procedure, viewing comment cards received from staff and relatives, observing practice in the home and speaking with the manager. The home has developed an accessible complaints procedure to support the residents to understand the process of making a complaint, however the manager confirmed that the majority of the residents would struggle to understand the concept of making a complaint and therefore their behaviours and interactions are monitored to establish when the residents is unhappy. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 22 All comment cards received from relatives confirmed that they knew how to make a complaint. A relative said; “I have not had any concerns over the care provided”. Residents were supported to complete their comment cards and details were provided by the manager on how they assess the needs of the residents. A resident commented that she would speak to a member of staff if she were unhappy. All staff commented that they knew what to do if a concern or complaint was made in respect of the care and management of the home. some detailing the process of recording the details and informing a senior member of staff as soon as possible. The home keeps a complaints and compliments log book which details the nature of the complaint, what action was taken and the outcome of the action. The manager confirmed that all staff had received training in abuse awareness and this was evidenced by certificates held on file for some staff, but this could not be fully evidenced for all staff. The manager had not kept training. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 23 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, 26, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure the people who use the service live in a welcoming, comfortable and clean environment. However people who require specific mobility aids to access areas of the home must have these needs assessed. EVIDENCE: The home is spacious, and is decorated and furnished in keeping with the needs of the residents. There is warm suttle colours on the walls, and easy clean furniture and floorings. Residents with mobility difficulties are located on the ground floor, however the home has a lift to the first floor if required, hand rails positioned in places where required such as bathrooms and an en suit accessible facilities. The manager is advised to seek support from the appropriate health care professional in respect of supporting a resident discussed at the time of the visit who requires a moving aid to access the bathroom. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 24 The garden is enclosed and is easily accessible for the residents. The kitchen is spacious and provides amble work space to support the residents to participate if the opportunity arises. The manager stated that the residents are supported to choose the colours, fabrics and furnishing of their bedrooms. A Resident kindly showed the inspector her room, it had been personalised to reflect the resident’s personality and individuality. Comments received from relatives and a health care professional compliment its comfort, homeliness and cleanliness. A comment received from a residents said she liked her bedroom and the house is nice. A relative said: “The home is very pleasing and is always clean and tidy”. “It is warm and welcoming” A health care professional said: “It is a warm and welcoming home for the residents to live”. The home is clean and follows recognised practices in maintaining a clean hygienic environment. The AQAA informed us that the home has an infection control policy, however it could not be evidenced that staff have received infection control training as stated by the manager. Staff have access to equipment to minimise the risk of cross infection such as disposable gloves and the home has a clinical waste contract. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 25 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 poor. This judgement has been made using available evidence including a visit to this service. The home provides the people who use the service with competent staff, however it must ensure the staff undertake all mandatory training and refreshers at the times scales stipulated and required by law. I.e. fire safety training. The home has insufficient staffing levels to meet the current needs of the people who use the service denying them access and participation in community and social activities. The home fails to demonstrate that it has undertaken robust recruitment procedures in order to safeguard the people who use the service from potential risk of harm. The home fails to demonstrate that it undertakes regular support and supervision with its staff. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 26 EVIDENCE: The AQAA informed us that the home has six permanent staff and four relief staff and that it will be putting pressure on purchasers in order to provide appropriate staffing levels. The AQAA also informed us that it does well to follow appropriate recruitment checks and every staff member has a criminal bureau check (CRB) and references are taken up prior to commencing working the home and the home is committed to staff training as funding will allow. This was tested by viewing the staff duty rota, recruitment records, observing practice, speaking with the manager and viewing comments cards completed by staff and relatives. Following the last visit to the home in May 2006 it was issued with a requirement to provide suffient numbers of staff to meet the needs of the residents. There is evidence that the service is approaching funding authorities to provide additional funding in order to recruitment more staff, however the duty rota and practices observed at the time of the visit demonstrates that the home continues to lack sufficient numbers of staff to meet the holistic needs of the residents. A twenty-five minute observation provided evidence that residents are not involved with daily activities within the home and wandered the home and the gardens aimlessly. A discussion with the manager confirmed that residents are not involved with daily activities. A resident was observed trying to engage a member of staff but this was not reciprocated. The member of staff was carrying out domestic chores. The homes domestic chores such cleaning, cooking washing, shopping are carried out by staff. Comment cards received from staff provided information that they feel they provide a good standard of care but would like more staff in order to take residents out more. A staff member commented: “As the client group has got older their needs have changed, they do not always access day services for various reasons, not wanting to go, dementia, refusing to go out. This increases the workload in the home, and sometimes there are not enough staff to undertake the more social activities”. Another said: “With a higher level of staffing the care and support given could be even better, clients would be able to go out, go on holiday and days out”. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 27 The home does not hold staff recruitment details, these are held with the services human resources department, and however the home uses annex 4 forms to demonstrate that it has taken appropriate steps to employ its staff. All staff annex 4 forms were viewed as the first few did not provided sufficient evidence that robust recruitment procedures had been undertaken. Start dates, CRB and POVA checks (Protection of vulnerable adult) when recieved, and evidence of two references were inconsistently completed. The forms had not been checked and signed off by the manager or the member of staff. The manager confirmed that staff receive regular mandatory training, such as moving and handling and food hygiene, supports its staff to undertake a national vocational qualification (NVQ) and provides specific training such as dementia to meet specific needs. Staff commented that good training was provided and a relative stated they felt the staff were competent to meet the needs of their relative. A staff member said: “At Outreach 3Ways they give us any training we need to provide with the experience, knowledge we need to meet the residents needs”. A relative said: “As far as I am aware all the regular staff have the right skills and experience to look after the people properly”. Some staff files had certificates to evidence that staff had undertaken training, however the manager could not confirm what training staff had received or when as he had not kept the training record up to date. This included fire training for staff, which he stated he thought they had received September 2006 and not twice in the last year. Staff indicated in their comment cards that they feel well supported by the manager and deputy manager, one commented that she received regular support and supervision sessions. The manager stated that supervisions were taking place but not as frequently as the minimum of six times a year. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 28 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, and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home fails to ensure the people who use the service benefit from a well run home, however the poor administration duties of the manager places residents at potential risk of harm and not having their needs met. There is some quality monitoring however this is not resulted in a plan that would benefit the people who use the service and staff. The home does not fully promote and protect the health, safety and welfare of the people who use the service. EVIDENCE: Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 29 The AQAA informed us that the manager has achieved his level 4 NVQ and registered managers award, and that the homes has risk assessments in place for the health safety and welfare of the people using the service and working in the service. This was tested by speaking with the manager, observing practice, viewing fire records, quality audits and viewing comment made by staff. The manager confirmed he has been the registered manager since the home opened transferring with the residents from their previous home. The manager verbally demonstrated that he is aware of his roles and responsibilities and the needs of the residents. A the time of the visit the manager was holding a review meeting and in the process of agreeing additional funding for extra support in respect of the changing needs of a resident. Staff comments demonstrate that they are respectful of the manager, finding him approachable and caring. This was established through discussion with the manager and observation of interactions with both residents and staff. As indicated through the body of the report certain records have not been maintained by the manager such as ensuring his staff have been appropriately recruited, trained and supervised and the health and safety of the residents maintained. The manager provided evidence that the service undertakes regular quality audits and is visited monthly by a senior manager to assess the quality of the care to the residents. Questionnaires have recently been sent to families, health care professionals and funding authorities to seek their views on the service provided to the residents and the manager is in the process of collating the information recieved. The residents views are monitored through their behaviours as their limited communication, cognitive and sensory abilities prevents them from completing written documentation. Views and comments received from relatives and staff prior to the visit included: “It is a nice comfortable caring home where we are all meeting our residents needs as and when possible” “it is a happy home”. “The home has a friendly atmosphere and staff seem to enjoy working here and the people who live here seem to be very happy”. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 30 Following the last visit to the service it was required to ensure all staff have regular fire safety training, this requirement has been repeated as the manager could only guess that staff had received training in September 2006 as there were no records available to confirm this. The manager was able to state how often staff must receive this training. Fire record also provided evidence that regular checks were not taking place on fire alarms and fire safety equipment. Other areas of health and safety such as service checks on utilities and the shaft lift appeared in good order. Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 31 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 x 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 2 X X 1 X Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 32 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 YA9 Regulation 13(4)(c) 12(1)(a)(b) Requirement The home must ensure the people who use the service have detailed risk assessments for residents that effect their individual health and safety such as risks associated with eating and drinking. The home must ensure the people who use the service are consulted about their social interests and make arrangements for them to engage in local, social and community activities and this must be recorded. The home must ensure the people who use the service who have specific health care needs have detailed risk assessments in place and where needed referral for consultancy with the appropriate health care professional such as speech and language therapist. The home must ensure that it DS0000064747.V356730.R01.S.doc Timescale for action 31/01/08 2 YA12 16(2)(m) 28/02/08 3 YA19 13(1)(b) 31/01/08 4 YA20 13(2) 31/01/08 Page 33 Cherrymead Version 5.2 5 YA23 13(6) medication administration practices meet the Royal Pharmaceutical Guidance. Such as the storage, recording and returns of medications. The home must ensure the people who use the service are safeguarded from harm of abuse, therefore it must provide evidence that all staff have received training. 28/02/08 6 YA29 23(2)(a) 23(2)(n) The home must ensure that 28/02/08 all the people who use the service have safe and appropriate access to all areas of the home including baths. The home must ensure that it has sufficient numbers of staff on duty at all times to ensure it can meet the people who use the services needs. This is a repeated requirement first issued on the 8th May 2006. 31/01/08 7 YA33 18(1)(a) 8 YA34 19(1)(a)(b)(c) The home must ensure that it 31/01/08 can demonstrate that all staff 17(2) have undergone robust Schedule 4 recruitment procedures before commencing working in the home, including CRB’s & POVA checks and have two authentic references. Full details must be held in the home. 23(4)(d) To ensure the safety of the people using the service all staff must receive fire safety instruction at the recommended by the fire safety service. This is a repeated 31/01/08 9 YA42 Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 34 requirement first issued on the 8th May 2006. 10 YA42 23(4)(c) The home must ensure the people who use the service are protected from risk of fire and ensure all fire safety equipment is checked as per the fire safety service instructions. 29/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Cherrymead DS0000064747.V356730.R01.S.doc Version 5.2 Page 36 - 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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