Inspection on 03/05/06 for Cheshire Drive

This inspection was carried out on 3rd May 2006.

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 no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cheshire Drive 15/06/07

Cheshire Drive 29/01/07

Cheshire Drive 17/11/05

Cheshire Drive 29/04/05

Cheshire Drive 02/12/04

Cheshire Drive 17/05/04

Cheshire Drive 18/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cheshire Drive Cheshire Drive 51-53 Cheshire Drive Leavesden Watford Hertfordshire WD25 0GP Lead Inspector Marian Byrne Key Unannounced Inspection 2 , 3 8 May and 7th June 2006 10:00 nd rd th Cheshire Drive DS0000039939.V292533.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 Cheshire Drive DS0000039939.V292533.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. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cheshire Drive Address 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) Cheshire Drive 51-53 Cheshire Drive Leavesden Watford Hertfordshire WD25 0GP 01923 682671 www.pentahact.org.uk PentaHact Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 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 DS0000039939.V292533.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over four visits. It was not a positive inspection. One member of staff had recently been attacked and injured by a service user in the home. Not all the staff in the home had been trained appropriately in strategies for crisis intervention and prevention (SCIP) despite this being a condition of this particular person’s admission to the home. During the inspection a complementary therapist treated service users in the sitting room. The dignity of service users must be upheld at all times by ensuring that treatments are carried out in private. More care must be taken at mealtimes to ensure that service users are assisted with eating through the use of appropriate cutlery and good interaction with staff. Staff appeared to know service users very well and some good interaction was observed. Staff spoken with were aware of the shortcomings of the home and were keen to undertake training to ensure a better service was offered to service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 6 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 Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 7 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): These standards were not inspected. EVIDENCE: No new service users have been admitted since the last inspection. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 8 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 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. Care plans did not meet identified needs. Some service users have good involvement in their lives and the drawing up of their care plans. Information is stored appropriately. EVIDENCE: Two care plans were inspected. One of the service users displays violent behaviour towards the staff and other service users. There are no effective guidelines or boundaries on how to deal with his behaviour. For instance the plan states ‘the first time xxxx hits in a firm but non aggressive voice say – no xxxx don’t hit’. This would appear to indicate that the procedures in place do not work. ‘ when extremely distressed xxxx will hit very hard and can cause serious injury to people’. Training and guidelines must be put in place to ensure the safety of staff and service users. This service user is over weight, there was not dietary regime in place to assist him in controlling his weight. He does not have a programme of activities within the home and does not attend any daytime activities out side the home. On the day of the inspection two service users were in the home. They were not engaged in any planned Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 9 activities and one female service user spent the entire day looking out the window. Data is stored appropriately. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 10 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): 11, 12, 13, 15, 16 & 17 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. The judgement would have been adequate had it not been for the fact that one service user had no organised programme of activity and mealtime as described below. Most service users have opportunities and relationships outside the home. Clear evidence was not produced to establish if personal development is achieved. Mealtimes are not enjoyed in relaxed and communal settings. EVIDENCE: One service user does not have a programme of activities, the remaining service users have programmed activities which include attending college or day centres and are part of the local community. One service user goes to work on one day a week, he is accompanied by a member of staff who remains with him. All service users have contact with their families and spend weekends and holidays with them. It is difficult to establish if service users rights and responsibilities are recognised in daily living as coping with one service user’s Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 11 challenging behaviour is in the fore front of the running of the home. Service users rights and responsibilities are respected. Staff did not join service users at meal times and one service user was not given appropriate cutlery to eat with. The meal was not supervised at all times. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 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 the following standard(s): 18 & 19 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. This judgement would have been adequate had the service user’s dignity been seen to have been respected. Personal care is given in an appropriate manner but additional complement therapy was not. There was no evidence that emotional health needs are being met. EVIDENCE: In the main personal care support is being met, however on one of the inspection visits a complementary therapist was delivering care to service users in the sitting room where all the other service users and staff were present. If service users prefer to be treated in the communal areas, evidence that they were offered a choice must be available. Screening could also be used to uphold the dignity of the service users. It was difficult to establish whether service users were having their emotional needs met, as managing the challenging behaviour was foremost in the delivering of care. Two service users are probably in a position to use their present home to move on to more independent living. Details of medication can be found in the inspection report dated 17th November 2005. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service, this is despite the hard work put in by staff and manager in the home. Service users are not fully protected from abuse, neglect and self-harm. There was not evidence to show that service user’s have their views listened to and acted on. EVIDENCE: Care plan details do not bring all information together to make decisions regarding the care of service users. Staff do not have adequate training to deal with challenging behaviour. Care must be taken to ensure that agency staff have the same training as permanent staff to ensure continuity of care. A member of staff was seriously injured by a service user, two weeks prior to the first site visit. At the time of the attack there was not adequate guidelines or training in place to protect staff and service users despite his admission to the home being subject to all staff having SCIP training. Some work has been done to ensure that service user’s views are listened to, however due to the current mix of service users it is difficult to make a positive judgement on this. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30 Quality in this outcome is adequate; this judgement has been made using available evidence including a visit to this service. The environment was clean, fresh and odour free. EVIDENCE: On the days of the inspection the home was clean, fresh and odour free. The additional space downstairs gives the home a spacious feel. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 15 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): 32, 34 & 35 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. The staff are not sufficiently trained to meet the service user’s needs. The home has a robust recruitment policy. The staff team do not work effectively to meet service user’s needs. EVIDENCE: Individual staff work hard to meet the service user’s needs, however they are not provided with sufficient guidance on boundaries or how to ensure that the service users get a uniform reaction when boundaries are being pushed. One service users care plan stated that one of the conditions of his admission was that all staff must have SCIP training. This was not found to be the case. The home follows robust recruitment policies. All staff appointed had had the appropriate security and identity checks. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 16 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, 39 & 42 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. The manager and staff strive to ensure the home is well run and the service users’ health and safety is protected, however they are not always successful in achieving this. Service users are involved where possible in the development of the home. EVIDENCE: The manager and staff strive to ensure the home is well run and the service users’ health and safety is protected, however they are not always successful in achieving this and one very serious incident has occurred resulting in injury to a staff member. The mix of service users in this home makes it very difficult to ensure that all service users needs are met. Detailed reviews must take place to ensure the home can meet the needs of all the service users who live there and detailed care plans drawn up on meeting the diverse range of needs within the home. Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 X X 1 X 2 X X 1 X Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 18 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 YA6YA7 Regulation 12 Requirement The Registered Manager must ensure that service users make decisions about their lifestyles with assistance where needed. Care plans must incorporate all relevant information in relation to service delivery. The Registered Manager must ensure that the home is managed in a manner that ensures the safety of service users and staff. The Registered Manager must ensure that all service users in the home have their needs reviewed to ensure the home can meet their needs. Timescale for action 30/06/06 2. YA9 13 03/05/06 3. YA12YA11 14 (2) 30/06/06 4. YA18YA19YA17YA16 12 The Registered manager 30/06/06 must ensure that service user’s dignity is respected at all times including mealtimes. That the DS0000039939.V292533.R01.S.doc Version 5.1 Page 19 Cheshire Drive 5. YA22YA23YA35YA32 18 6. YA37 24 (1) 7. YA39 18 (1) (a) home must evidence that all service users are supported in a manner they prefer. The Registered Manager must ensure that staff are trained in all aspects of managing complex behaviour. Service users must be protected from abuse, self harm and neglect. The Registered Provider must ensure that the registered Manager has adequate support and resources to meet the requirements of this inspection. The Registered Provider must ensure that the home is managed in a manner that ensures the health, safety, welfare and aspiration and views underpin the service. 30/06/06 30/06/06 30/06/06 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 Cheshire Drive DS0000039939.V292533.R01.S.doc Version 5.1 Page 20 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 © 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 DS0000039939.V292533.R01.S.doc Version 5.1 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!