CARE HOME ADULTS 18-65
Denecroft 1 Denmark Road Guildford Surrey GU1 4DA Lead Inspector
Helen Dickens Announced 07 July 2005 09:30 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. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Denecroft Address 1 Denmark Road Guildford Surrey GU1 4DA 01483 301315 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) SeeAbility Seeability House, Hook Road, Epsom, Surrey, KT19 8SQ To Be Confirmed Care Home (CRH) 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 2 of places Learning disability (LD) 6 Sensory impairment (SI) 6 Dementia (DE) 2 Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The age/age range of the persons to be accommodated will be: 30 years to 65 years. 2 The 6 (six) adults with learning disabilities (LD) accommodated may also have a sensory impairment (SI). 3 Of those 6 (six), up to two may have an additional mental disorder (MD). 4 Of those 6 (six) up to two named individuals may also Dementia (DE) Date of last inspection 16 November 2004 Brief Description of the Service: Denecroft is a large detached property situated in a pleasant residential area of Guildford and is close to all local facilities and amenities. The service provides personal care and facilities for up to six adults with learning disabilities, visual impaiment, and challenging behaviour. The homecurrently has six residents, all of whom are female. All residents have single rooms; some have en-suite facilities. The accommodation is on two floors and there is no lift to the upper floor. However, current residents do not require this at present. There is a terraced area and car parking to the rear of the property. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 6 hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Helen Dickens, Lead Inspector for the service. Laura Newcombe, Manager, was present as representative for the establishment. A full tour of the premises took place. The inspector met all the residents and spoke to two in particular. In addition to the manager, two other staff were interviewed during the inspection. The inspector also used the pre-inspection questionnaire and returned ‘comments cards’ in writing this report. One comment card was completed (with assistance) by one of the residents, others came from professionals who work with the home, and relatives. Residents and staff were observed throughout the day. This was a positive inspection. The inspector would like to thank the residents, staff and manager of Denecroft for their time, assistance and hospitality during this inspection. What the service does well:
Staff had a good understanding of resident’s support needs and positively promoted their independence. Residents were comfortable and contented. The majority of residents have difficulty in communicating but the inspector witnessed many instances of good communication between staff and residents. Residents reacted well to staff approaches. The environment was clean and tidy and had a homely feel. A nurse who visited during the inspection was heard to comment ‘This is such a lovely place.’ Resident’s rooms were very personalised and shared areas comfortable and accessible. Staff demonstrated an honest and open approach to the inspection process. Staff morale was good and the manager demonstrated good leadership and team building skills. The staff were observed to be very committed to the home and to this group of residents. Members of staff interviewed, commented that SeeAbility was a good organisation to work for. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
There are two outstanding requirements from the last inspection. The policy on ageing is still in draft form and needs to be finalised and implemented. Contracts with placing authorities were still not available for some residents. More generally, contracts between Denecroft and residents were not in a format which would be accessible to them. In addition, a user-friendly version of the complaints procedure could be displayed in shared areas of the home to give residents and visitors a visual reminder about how to raise concerns. The Surrey version of the vulnerable adults policy in the office was out of date and needs to be replaced by the more recent version. The fire service had made three recommendations in November and only one had been implemented so far. The hazardous substances cupboard was not securely locked on the day on the inspection and an Immediate Requirement was made in this regard. When the home was revisited the following week the cupboard was locked and the procedure for storing these keys had been reviewed. The home needs to review the call alarm system. The manager of Denecroft needs to complete her application to be registered with CSCI as soon as possible; this has been outstanding since 2004. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 7 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. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 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 Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 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) 1,2,3 and 5 The home’s statement of purpose and service user guide provide residents and prospective residents with enough information to make an informed decision about admission to the home. Assessments and care plans are thorough and likely to result in a good level of care for residents. EVIDENCE: The statement of purpose has recently been updated and has been submitted to CSCI as per regulations. Both the statement of purpose and service user guide provides the residents with up-to-date information about the philosophy and services of the home. The assessment of one resident, admitted since the last inspection, showed detailed background information, essential for the provision of appropriate care. Care plans viewed were also detailed and thorough, especially on the subject of vision and learning disability, which were the overriding needs of this client group. The home demonstrated its capacity to meet the special requirements of its residents. The inspector noted many examples of very effective communication between staff and residents who had particularly challenging communication needs. Residents were observed to be treated as individuals thus promoting their confidence and self esteem.
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 10 The contracts with placing authorities are not yet on each residents file, and the contracts with Denecroft need to be put into a format which is accessible to residents. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Resident’s care plans reflect the individual care being afforded to residents. Support is structured to allow residents to take reasonable risks and enjoy a degree of autonomy within their capabilities. EVIDENCE: Care plans viewed accurately reflected the care being offered and the social skills, which were being encouraged. The plans had been regularly reviewed and updated. The inspector observed residents being given opportunities to be independent, and risk assessments showed that the philosophy of promoting independence was carried through all aspects of life in the home. Weekly activity plans were in resident’s own rooms. These were in the form of a magnetic board with actual objects depicting reminders of the various activities such as a wooden house to show time at home, a whisk, to show cookery sessions, and a small brown bottle to depict the aromatherapy session. The recent illness of one resident demonstrated the home’s capacity to advocate on behalf of residents at Denecroft. The home was making a formal complaint about discriminatory attitudes, which had adversely affected the
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 12 dignity, and self esteem of this person whilst being treated in hospital by other professionals. There was some evidence in the minutes of resident’s meetings that residents were involved in making decisions about day to day life in the home, especially the menu planning and leisure activities. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14 and 16 The range of activities and support available to residents at Denecroft enables them to maintain appropriate and fulfilling lifestyles. EVIDENCE: Certificates displayed in resident’s rooms, together with information in their care plans, showed the opportunities residents had had for learning life and social skills. They were all encouraged to assist with personal and household tasks and the inspector observed their participation in some of these on the day of the inspection. Residents were indeed part of the local community and shopped locally (residents had a weekly period for personal shopping) as well as using local pubs, takeaways and restaurants. One member of staff had been given the responsibility of co-ordinating individual and group activities and there was clear documentation about what was currently happening and what had been tried. The enthusiasm of this
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 14 member of staff was clearly having a positive impact on the quality of life of residents. Residents were treated with respect. There were no examples of staff talking to each other to the exclusion of residents; indeed residents were included in all activities and conversations on the day of the inspection. Minutes of the resident’s meeting showed that either individually, or as a group (as happened on one occasion) residents were free to attend resident’s meetings or not as they chose. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 21 Denecroft ensures that residents get the health and personal care that they require and are entitled to. EVIDENCE: Personal support was being offered in a sensitive way and staff were observed to be gentle and considerate towards residents. Residents were dressed in clothes which they had chosen and in the colours they liked. Each resident had a designated key worker. Residents files showed excellent records of health needs, appointments, treatments and follow-up. There was particularly good information about eye conditions and ongoing observations and treatment. The assessment of residents with special needs was particularly problematic for professionals in other spheres and the home was knowledgeable about these issues and had taken practical steps on behalf of their residents. For example, eye tests are usually conducted using letters of the alphabet. A special book of objects in varying sizes was kept by the home to take along to optician’s appointments for those residents who cannot read letters of the alphabet. The visit of a nurse to a resident, during the inspection, was observed to take place in the privacy of that resident’s room.
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 16 There has been an illness and death policy introduced since the last inspection but as yet the policy on ageing has not been implemented. Given that the home will soon be applying to accommodate residents over the age of 65 (to cater for the ageing of existing residents), it is crucial that the policy on ageing is implemented as quickly as possible. This is an outstanding requirement from the last inspection. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Denecroft demonstrates the ability to deal effectively with complaints and the manager was knowledgeable on issues to do with protecting vulnerable adults. EVIDENCE: There is a complaints procedure at Denecroft which meets the requirements of this standard. The home have also adapted the methods used in order to suit the communication needs of the residents. For example, the complaints folder contains pictures of each resident so that the complainant can easily point out if it is another resident who has upset them. Staff photographs in the kitchen on the notice board can be used in the same way. The inspector suggested that a resident-friendly version of the procedure might be placed in public/shared areas within the home to remind residents (and their visitors) about how to raise issues. The complaints log was accurate and up to date and the three complaints received since the last inspection were well documented and had been dealt with sensitively. The manager had recently been on the up-to-date County training for the protection of vulnerable adults. She had a good knowledge of how the new procedure differed from the previous version and was intending to cascade this down to staff in team meetings and in training. Unfortunately, there was no copy of the new procedures in the home and the inspector asked for this to be obtained and made available to staff as soon as possible. , Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 18 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) 24,26,27,28,29, and 30 Denecroft provides a homely and comfortable environment for its residents. However, the lack of call alarm systems within the home may compromise the safety of some residents. EVIDENCE: The home offers a bright, airy and clean environment for its residents, and is close to local amenities. Furnishings and fittings are comfortable and all residents are accommodated in single rooms. Bedrooms were very individual and there was some evidence that residents or their relatives had chosen the colour schemes. The communal bathrooms were suitable for existing clients and some residents had ensuite facilities. Specialist assessments had been carried out regarding the safe use of one bathroom for a particular resident and the occupational therapists report was on file. Some minor adaptations had been made in the home to accommodate those with visual impairment. In addition the needs of those with dementia had also been considered.
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 19 On the day of the inspection there was no operational call alarm system available to residents. An old system had not been removed and some noneoperational alarms were still in place. One resident who was unable to leave the bedroom unaided had been given a baby alarm which went through to the sleeping night staff room. In order to safeguard residents privacy, the use of such alarms is not usually recommended. In addition, having alarm fittings, which do not actually work, may mislead in times of emergency. The home will be required to review their arrangements for call alarm systems and ensure that residents can summon help when required. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 20 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) 32 and 33 Staff moral was high and there was evidence of good team working for the benefit of residents and the home in general. EVIDENCE: Those staff interviewed enjoyed their work, thought that they had had good training, and liked working for SeeAbility. All staff present on the day of the inspection, including the manager, were approachable and communicated well with residents. They had good knowledge of resident’s needs and there was evidence of training in a variety of specialist areas relevant to this client group. 50 of care staff already hold the NVQ 2 or above. The Residential Forum Matrix has been used to calculate staff ratios. There were regular staff meetings (almost weekly) and agendas and minutes were available to the inspector. On the day of the inspection the inspector noted that staff were under particular pressure due to external circumstances. There were no complaints from staff and individual members of the team were doing over and above what was expected to continue to provide a high level of service to residents. The staff team pulled together and the welfare of residents was paramount. Staff should be commended for good their team working in difficult circumstances.
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 21 Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 22 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, 38 and 42. The overall management of the home is good and this goes some way to ensuring that the care home fulfils its stated purpose and meets the needs of residents. However, there were some health and safety matters outstanding on the day of the inspection. EVIDENCE: The manager has suitable experience for this role and ensures that the home is well managed. However, she is not yet completed her registration with CSCI and this must be done as a matter of some urgency. There was an open, positive and inclusive atmosphere in the home and staff morale was good. The health and safety aspects of the home were generally well managed with identified risks being properly and regularly assessed and good records being kept. For example, taps available to residents in their rooms and communal areas had been fitted with thermostatic controls and were properly regulated.
Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 23 This was being monitored monthly. All those tested on the day of the inspection were around 43C as per recommendations. However, on the day of the inspection the inspector found the key left in the door of the hazardous substances cupboard. The member of staff who did this was under particular pressure that day and immediately apologised for their oversight. The manager locked the cupboard and removed the keys as soon as the error was discovered. A risk assessment should be carried out regarding the safe storage of this key. One resident was being moved in a wheelchair with no footplates. The wheelchair was a temporary measure for this resident whose mobility was impaired. However, in the interests of safety, even with short term use of a wheelchair, footplates must always be in place. The recommendations made by the fire service in November 2004 had not yet been implemented and these need to be dealt with as soon as possible. Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 24 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 3 3 4 x 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 3 1 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Denecroft Score 3 4 x 2 Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 1 x H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 25 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. 2. 3. Standard YA5 YA21 YA23 Regulation 5(3) Requirement Timescale for action 07.09.05 07.08.05 07.08.05 4. YA29 5. YA37 6. YA42.2 ii The home should obtain copies of agreements made with placing authorities for all residents. 12(a)(b) The draft policy on ageing should be finalised and implemented within the home. 13(6) The home should obtain a copy of the February 2005 Surrey Multi-Agency Procedures for the Protection of Vulnerable Adults. This should be kept in the home and made available to staff. 12(1)(a) The home should review its 12(4)(a) policy for call alarm systems. Quotes for an appropriate system should be obtained within the specified timescale. The home should inform CSCI of progress on this matter. 8(1) The current manager must CSA register with CSCI. Details of the Section 11 GP to be given to CSCI as soon as possible. The manager must present documents for the purposes of the CRB check at any CSCI office as soon as possible. The application cannot be progressed until the above outstanding items have been completed. 13(4)(c The home must review and risk
H58 S13625 Denecroft V226178 070705 Stage 4.doc 21.08.05 14.07.05 07.08.05
Page 26 Denecroft Version 1.40 YA42.4 xiii 7. YA42.3 i 8. YA42.1 assess their decision not to implement the recommendations given by the fire service regarding night time evacuation procedures, and take appropriate action. The home must fit the fire door recommended by the fire service last November.. 13(4)(a)(c The hazardous substances Immediate cupboard must be locked at all 07.07.05 times. The manager should review the current place of storage for the keys and a risk assessment should be sent to CSCI. 13(4)(a)(c Footplates should be obtained for 14.07.05 the wheelchair which one resident is using as a temporary measure. A risk assessment should be carried out to safeguard the user of the wheelchair until footplates can be obtained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 22 Good Practice Recommendations The contracts between the home and each resident should be in a format which is accessible to that resident. The home should consider displaying the complaints procedure, in a resident-riendly format, in shared areas of the home. This would serve to remind residents and visitors about their right to raise issues with the home. The manager should obtain a proper outdoor ashtray for the use of staff who smoke. 3. YA28 Denecroft H58 S13625 Denecroft V226178 070705 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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