Inspection on 29/04/05 for Cheshire Drive

This inspection was carried out on 29th April 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Cheshire Drive 15/06/07

Cheshire Drive 29/01/07

Cheshire Drive 03/05/06

Cheshire Drive 17/11/05

Cheshire Drive 02/12/04

Cheshire Drive 17/05/04

Cheshire Drive 18/03/04

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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 Cheshire Drive 51-53 Cheshire Drive Leavesden Watford, Herts WD25 0GF Lead Inspector Marian Byrne Unannounced 29th April 2005 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 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 Stationary 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. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cheshire Drive Address 51-53 Cheshire Drive, Leavesden, Watford, Hertfordshire, WD25 0GF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 682671 Pentahact Trevor Hopkins Care Home, PC Care Home only 6 Category(ies) of LD Learning Disability (6) registration, with number of places Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 02/12/2004 Brief Description of the Service: Cheshire Drive is a detached, purpose-built, two storey home that can accommodate up to six young adults who have a learning disability. It is located on a newly constructed estate and blends in well with surrounding properties. One of the bedrooms is on the ground floor and has been designed to accommodate a wheelchair user. It has a full assisted bathroom adjacent. The other five bedrooms are upstairs and can only accommodate ambulent people as there is no lift installed. There is a lounge on the ground floor that opens onto a secure garden. There is a dining room, a utility room and a kitchen. Off road parking is available at the front of the building and the home is located a short drive away from the M25 and from Watford town centre. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two evenings - on 29 April 2005 and on 7 June 2005. It was conducted by one inspector, all the service users were seen and where possible spoken with. Meal time was observed on the first visit. The main purpose of this inspection was to follow through the requirements left at the last inspection. As this is a home for young people with learning difficulties the inspection was carried out over two visits at the busiest times in the home. There was very little difference in visits. On both occasions the home had a very stressful atmosphere. It was marginally better on the second visit as one of the service users was visiting his father. On the first visit the administration of medication contained gaps in recording that could indicate that the staff involved showed little understanding of the homes’ medication policy. There was a noted improvement on the second visit. Cheshire Drive continues operate in what could be described as a ‘chaotic’ manner. There appeared to be little planned interaction between staff and service users all the interaction observed was reactive. The result of this is that service users live and staff work in a very stressful environment. Since the last inspection an additional member of staff has been appointed on each shift to ensure that the needs of one service user who is totally dependant on two carers has her needs fully met. This is working. The service user in question was calmer on both visits. There are six service users in the home. All have hugely different needs and expectations. Because four of the service users have very high needs – physical and behavioural - this can result in the two service users who are less dependent not having their needs for stimulation and promoting independence met. The home should be preparing them to move on to a more independent life. One service users’ through his behaviour demands constant attention and achieves this by pinching, slapping and scratching staff as he needs are not being anticipated staff are reacting to his behaviour. This creates a stressful environment for other service users and staff. The staff at Cheshire Drive appear to be dedicated and responsible, this constant pressure in the evenings when all service users are present must be eased. The home must ensure the safety and welfare of all the service users and ensure they have the optimum quality of life available to them by ensuring they achieve their potential as individuals. What the service does well: Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 6 The interaction between staff and service users is very good. The staff were observed to be patient, caring and compassionate to service users under the most taxing circumstances. What has improved since the last inspection? What they could do better: At present and despite the best efforts of the staff, none of the service users appear to have all their needs met. A review of how the home meets the needs of all service users who live there must be carried out. The service users who are less dependent must have their assessed needs met. The size and layout of Cheshire Drive does not lend itself to meeting the needs of the present service users. The units in the kitchen are in a poor state of repair. It was identified in the last inspection that the kitchen units had been replaced with the same quality units that did not withstand the wear and tear previously, now one is missing a door. The management of the home must be addressed as a matter of urgency and a permanent Registered Manager put in place. It is difficult for staff and the temporary manager to conduct the home to its optimum performance while the current situation persists. Please contact the provider for advice of actions taken in response to this Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 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 standard(s) None of these standards were inspected. EVIDENCE: Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7,8 The individual decisions, choices and needs of service users are not being met. EVIDENCE: Despite the efforts of staff – through house meetings and care plans - service users do not have their needs met at Cheshire Drive. On both inspection visits, which took place late evening when the service users had returned home from day centres or college, the home had a chaotic atmosphere, which was both stressful and taxing for service users and staff. Four of the service users have very high needs. The care provided was reactive rather than proactive. This means that the staff had little opportunity to work with care plans to enable service users to live in a less stressful environment and to improve the quality of their lives and to promote their independence. The less dependant service users must have dedicated time to improve their life skills to prepare them to move on to more independent life style. The daily life of the home does not facilitate this need. The service user whose behaviour is very challenging does not have his needs met and runs the risk of being isolated from the other service users. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11 12 13 14 15 17 Service users did not have the opportunity for personal development within the home. Service users do take part in appropriate activities including leisure activities outside the home and have good family contact. Food appeared to be good and was freshly prepared. The staff endeavour to meet the service users rights and responsibilities the atmosphere in the home does not facilitate this. EVIDENCE: While all the service users go to day centres or college there was no evidence of this been expanded and developed in the home. The less dependant service users would benefit from one to one input to improve their living skills to enable them to live a more independent life. All the service users have a good social life where possible and good family involvement. On the day of the inspection one service user was out socially with his father another had a friend visit – with her carer - the three of them went to a local pub together. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 12 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 standard(s) 20 The administration of medication was not met on the first visit but had improved significantly and was met on the second visit. EVIDENCE: On the first visit the Inspector when inspecting the ‘day book’ noted, notes to staff asking them to fill in medical administration records (MAR) going back many days. MAR charts must be completed immediately the service users has taken their medication, or if the service users has refused their medication this should be noted immediately. On the second inspection visit the records were completed accurately. Medication was stored appropriately ie under 25 degrees Centigrade. Medication may deteriorate if stored over this temperature. Liquid medication was dated on opening, this is necessary as open medication has a limited ‘shelf’ time. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22,23 These standards were not inspected. EVIDENCE: Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24,25,26,28,29,30 The service users do not live in a homely, comfortable clean and safe environment. The home had specialist equipment where required. EVIDENCE: The environment in the communal areas has improved. It is cleaner, brighter and more welcoming. However, the bedrooms of the service users do not meet this standard are not welcoming. One service users’ bed was completely stripped at 6pm on the evening of the first visit. Other rooms had broken furniture and were untidy and cluttered. Some had holes in the walls where a service uses had punched the wall. The kitchen in the home has a door missing from one of the units. The units are flimsy and not suitable to a home where service users have challenging behaviour because it would be easy to break and cause injury to all who use the kitchen. The floor covering in the kitchen is coming away from the floor and is stained. All of this creates an atmosphere of neglect and despondency. Staff reported that service users do not spend private time in their rooms. The environment does not lend itself to this. If bedrooms were more inviting service users would be happier to use them thus relieving the tension in the communal areas. Because service users do not use their rooms for socialising or quite times there is a huge demand on the shared space. This does not accommodate six Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 15 service users with very different needs and four staff members. The communal areas of home were clean and odour free. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected. EVIDENCE: Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37. Cheshire Drive is not well managed. EVIDENCE: The Registered Manager of the home is currently under suspension from his post pending an investigation into his management practices. A temporary manager is in place pending the outcome of the investigations. Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score N/A N/A N/A N/A N/A Standard No 22 23 ENVIRONMENT Score N/A N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score N/A 2 2 2 N/A Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 2 N/A 2 3 2 Standard No 11 12 13 14 15 16 17 1 3 3 3 3 N/A 3 Standard No 31 32 33 34 35 36 Score N/A N/A N/A N/A N/A N/A CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cheshire Drive Score N/A N/A N/A 3 Standard No 37 38 39 40 41 42 43 Score 1 N/A N/A N/A N/A N/A N/A I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 19 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 7 Regulation 12(2) Requirement The Registered Manager must ensure that service users make decisions about their lifestyles with assistance where needed. The Registered Manager must enure that the home is managed in a manner that allows service users to participate in the day to day running of the home. The Registered Manager must ensure that all service users in the home have their needs reviewed to ensure they achieve their optimum lifestyle. The Registered Provider must ensure that the environment of the home is at an acceptable level of cleanilness. The Registered Provider must ensure the bedrooms of the service users are clean, nicely decorated and homely. The Registered Provider must provide and action plan to indicate how they are going to ensure that shared accomodation is adequate to meet the needs of the service users. An enforcement notice is being served by the Commission to ensure compliance. Timescale for action Henceforth and ongoing Henceforth and onggoing Henceforth and ongoing Henceforth and ongong Henceforth and ongoing 09/08/05 2. 8 12 3. 11 14(2) 4. 24 23(2)(d) 5. 26 23(1)(a) 6. 28 23(2)(a) (i) Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 20 7. 37 18(1)(a) The Registered Provider must ensure that the home is managed in a manner that esures the health, safety, welfare and asperation of the service users are idnetified and met. 30/06/05 8. 9. 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 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 Cheshire Drive I52 S39939 Cheshire Drive V224513 290405 Stage 4.doc Version 1.30 Page 22 - 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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