Inspection on 17/08/07 for Drey House

This inspection was carried out on 17th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Drey House 05/02/08

Drey House 15/11/06

Drey House 18/04/06

Drey House 10/10/05

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Drey House Cambridge Road Eynesbury Hardwicke St Neots Cambridgeshire PE19 6SR Lead Inspector Nicky Hone Key Unannounced Inspection 17 August and 7 September 2007 10:30 th th Drey House DS0000064870.V339981.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 Drey House DS0000064870.V339981.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. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drey House Address Cambridge Road Eynesbury Hardwicke St Neots Cambridgeshire PE19 6SR 01480 880022 01480 880805 simon.belfield@psycare.co.uk 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) Psycare Hostels Limited Mr Simon Eric Belfield Care Home 33 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (33), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (33) Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: Drey House is a large Edwardian House set slightly back from the main A428 Cambridge to St Neots road in grounds of over three acres. A detached house and outbuildings (formerly stables) form part of the property. The busy market town of St Neots is within a few minutes drive, the city of Cambridge is within 20 miles and there are good local road and rail links to London. Drey House was extended some years ago and accommodation is offered on two floors. In total there are 32 single bedrooms. There are two large lounges plus a visitors’ lounge and a dining room on each floor, as well as bathrooms and toilets. On the ground floor there is the main kitchen, laundry, and offices. There is a small domestic-style kitchen on the first floor, for the use of residents to prepare their own meals. Since the last inspection, some residents have been admitted to the first floor, and the two floors are run as separate units. The people on the first floor are working towards living more independently. The expansive gardens at the rear of the house back on to fields and offer a private and peaceful setting. All residents at Drey House are funded by local or health authorities. Fees for accommodation and care at the home range from £948 to £1287 per week. Inspection reports are made available for residents or their representatives in the reception area of the home, and in the residents’ lounges. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of Drey House included two visits to the home. These were unannounced and took place on 17th August 2007 and 7th September 2007. Before the visit to the home, we asked the manager to complete an AQAA (Annual Quality Assurance Assessment) to tell us how the home is supporting the people who live there to have the best possible quality of life, including how it is meeting the standards, and we sent a survey form to residents and relatives so we could get their views on the service. Ten residents and three relatives completed the surveys and returned them to us. Apart from one of the residents, who made it clear s/he does not want to be at Drey House, the responses were reasonably positive. The surveys give people the opportunity to tick one of four boxes: ‘always’; ‘usually’; ‘sometimes’; or ‘never’, and to write any further comments. There were a number of positive comments written, and some answers given as “always”, but some of the answers were “usually” or “sometimes”. Some of the comments have been included in the summary and in the main body of the report. During our visits we looked at some of the paperwork the home has to keep. This included assessments, care plans, medication charts, and records such as staff personnel files, rotas, menus and fire alarm test records. On 17th August two inspectors spent six hours at the home. They were assisted by an expert by experience. This is a person who, by having a shared experience of using services, helps the inspectors to get a picture of what it is like to live in the home. The expert by experience spent four hours at Drey House, speaking with several of the people who live there, and giving feedback to the manager. People the expert by experience spoke with had mixed views on all the subjects discussed, but recurrent themes were the poor choice of food and the evening meal not being adequate. On 7th September a CSCI specialist pharmacist inspector visited Drey House with the two inspectors. He spent four hours looking at the way medicines are handled: his findings are included in this report. He was concerned that a number of failings in the way medicines are handled had been raised at previous inspections and improvements had not been maintained. Our first impressions, on arrival at Drey House for this inspection on the first day, were not good. The entrance to the home had been moved to the opposite end of the building since the last inspection. The doorbell was answered by a person who did not introduce themselves, did not ask who we were, did not ask us to sign the visitors’ book, did not know whether the manager was on duty, and did not know who was in charge. This person was wearing a bunch of keys round her neck, so we assumed that she was a member of staff: she confirmed this when we asked her. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 6 We were led through the house and left in the dining room, with no explanation to the residents who we were. Eventually one of the staff introduced herself as being the senior person in charge. We explained what we wanted to do and asked her if it would be alright to sit in the dining room while we looked at some of the paperwork. We specifically asked if anyone would be upset by this and she told us they would not. She did not introduce us to any of the residents or other staff, and did not explain to anyone who we were or why we were there. This resulted in one of the residents getting extremely upset by what we were doing, which the senior member of staff should have been aware of. The expert by experience noted that the home appeared pleasant from the outside, set in lovely grounds, but “struck me immediately on entering as ‘clinical’ and ‘institutional’ ”. During the morning, on the ground floor, there were few staff around and very little interaction between staff and residents was taking place. After a short time, the person in charge of the upstairs unit came to introduce herself to us. She was very courteous and helpful, and keen to spend time talking to us about the service. She was enthusiastic about what is being achieved at Drey House, and what the team hopes to achieve in the future. At the beginning of the AQAA there is a section for the provider to comment on ‘Barriers to Improvement’, and at the end a summary of ‘What we could do better’. In both these sections the manager wrote that CSCI reports are the reason the home has not been able to admit more residents, and therefore why improvements (for example the building of an OT (Occupational Therapy) suite in the outbuildings) have been slower than the company hoped. It concerns us that the manager/provider fails to recognise the CSCI reports as a reflection of the service, including areas that need improvement, and to use the report as a tool to ensure these areas are improved. What the service does well: One relative who answered our survey wrote, “Provides a safe, clean, calm, friendly and supportive environment for my relative. Having had experience of several homes….I feel this is the best yet and am on the whole very happy with the place, the people, and the way they look after my relative. I feel it is a very good place”. A second relative wrote “Since my relative joined the residents at Drey House, his/her life has improved dramatically……s/he is comparatively content.” A third said that when s/he has been unable to visit the home, s/he “always felt confident that my relative was being well cared for”. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 7 We all, including the expert by experience, found a difference between the ground floor and the first floor, and felt we could have been in two different homes. We accept that these two floors serve different needs and cater for different residents but even so we felt the ground floor could benefit from the way the first floor unit is run. Some of the staff we spoke to acknowledged this. Staff have started to use the ‘Recovery Process’ with the residents on the first floor. Each person has a WRAP (wellness recovery action plan). This is written by the person themselves and reflects what that person wants to achieve from their life, and how they will achieve it. Staff and one of the residents said how positive this is already proving to be. The records we looked at showed that thorough assessments are undertaken before new residents are offered a place, and that new residents are able to visit and have frequent overnight stays before they make the decision whether or not to move in. The registered provider had given staff clear and detailed procedures for the safe and appropriate handling of medication. People who live at Drey House, and their relatives, know how to make a complaint if they need to, and we had lots of positive comments about the staff, both from the people we spoke with and from the surveys. What has improved since the last inspection? What they could do better: Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 8 This inspection has resulted in thirteen requirements being made, seven of which are carried forward from the previous inspection. Four of the requirements relate to issues with medication. Some of these have been requirements at previous inspections and improvements have not been maintained. The things the provider could do better include: • Make sure that the information in care plans is up to date and easily accessible so that staff know how to support each person to meet their individual needs; Improve procedures for the recording, handling and safe keeping of medication; Draw up a contract/terms and conditions with each person so that they are clear about what they can expect from the service, including who pays for it; Offer a greater range of opportunities for personal development, occupation and leisure activity so that people can lead full and meaningful lives; Improve the choice and amount of food offered to residents; Develop clear and open procedures about residents’ finances, and make sure that if money is handled on behalf of individual residents, it is accounted for accurately; Make sure that all staff receive all the training they need, including in areas relating to health and safety, so that they can do their jobs well, and keep records available to show this has happened; Ensure that all notes made about residents are on their personal files so that they can read what staff have written about them if they want to; and Improve the entrance to the home and the ground floor bedroom corridor. • • • • • • • • We also recommend that staff carry their keys in a less obvious way than jangling round their necks, and that the staff have a think about whether it is necessary for so many of the doors to have coded locks on both sides. The home must remember that, although they have a duty to keep people safe, they are not legally allowed to detain people. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 9 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. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 10 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 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 11 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, 4, 5 People who use this service experience adequate quality outcomes in this area. Full assessments of new residents’ needs are carried out so that the home is sure it can meet those needs, and the person is given the opportunity to visit Drey House so that s/he can decide if the home will suit them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a Service User Guide (SUG) to give information to people about the service they should expect from the home. The current version is adequate, but we were pleased to learn from the AQAA that the company has plans to produce simplified, user-friendly information about the home. The organisation has a ‘Statement of our belief and our mission’ which is quoted in the SUG. We looked at the paperwork the home holds for four residents. We found that thorough assessments were carried out before these people were admitted, and included reports from a number of professionals, including social worker, psychologist and psychiatrist. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 12 On the file of someone recently admitted to Drey House, we saw a clear record of the visits, including overnight stays, that they had made to the home before they decided to move in. We did not see contracts/statement of terms and conditions between residents and the company. When he completed the AQAA the manager indicated that residents do not have a contract/statement of terms with the home. Each person must agree with the home the fees being charged and who is responsible for paying them. Information about residents’ financial affairs is unclear (see Concerns, Complaints and Protection section of this report). Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 13 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, 9, 10 People who use this service experience adequate quality outcomes in this area. Care plans contain a lot of documents, but information is difficult to find which means that the detailed needs of each individual might not be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each resident has a care plan, called ‘action plans’ at this home. Action plans are based on risk assessments carried out in all areas of each person’s life. Parts of the action plans we looked at were personal to each resident. For example, for one person there was information about them being a smoker and how this should be managed so that everyone, including the person, is kept safe. This person had agreed a strategy to reduce the amount they smoke. We saw that the plans are reviewed regularly and changed when needed. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 14 However, although we found some of the information we looked for, the files were very full, the documents were quite muddled up and there was some out of date information. For one person the word “diabetes” was written on the person’s assessment, yet we found no other reference to diabetes throughout the rest of the file, so we were not able to assess how, or even, whether their diabetes was being managed. We could not find clear information about which, if any, section/s of the Mental Health Act are still applicable to people. Nor could we find any clear discharge arrangements, or planned rehabilitation. Action plans for people upstairs were clearer, although the files were still too full. When the files are so full, it is difficult for staff to find information and use the action plans as working documents. The plans include space for the residents to comment, and to sign. One of the people we spoke with said s/he did not know all that was in their care plan. S/he can not read, so staff had read parts of it to them, but not all of it: this person had refused to sign the care plan. S/he felt staff do not treat him/her with dignity and respect. The home has started to use the Recovery Process with the people upstairs, as well as the action plan. Staff have written some information about what Recovery is: “a deeply personal, unique process of changing ones attitudes, values, feelings, goals, skills and/or roles….. Recovery involves the development of new meaning and purpose in ones life as one grows beyond the catastrophic effects of mental illness”. The information defines Recovery and explains how it works in practice. Each individual has a WRAP (wellness recovery action plan). We looked at the WRAP for one person. The floor manager told us the words were all the resident’s own: she had just scribed it for him. He confirmed that he had done this. He said how different his life is now that he is upstairs: he now has hope that he will be helped to ‘recover’ and be able to move back into the community. The home was also using “handover” books. These books, one for upstairs and one for downstairs were completed for each time the staff shift changed, and contained information about all the residents. The majority of information was repeated in each resident’s individual daily records. This practice is outdated, means unnecessary duplication of information, with the potential to miss information, and is not in line with data protection. It also means that residents would be unable to see what has been written about them (which they have a right to do) as the book contains information about all the other residents. We recommended that this practice should stop, and handovers done from each person’s daily notes. The manager agreed and said the books would cease to be used. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 15 One of the relatives who responded to our survey said “My relative has been in five different institutions/care homes. Drey House is the first care home I have witnessed the clients’ dignity being maintained at all times”. Staff were carrying bunches of keys on cords jangling round their necks, which adds to the institutional feeling of the home. We also asked the staff to think about whether it is necessary for so many of the doors to have coded locks on both sides. The home must remember that, although they have a duty to keep people safe, they are not legally allowed to detain people. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 16 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): 11, 12, 13, 14, 16, 17 People who use this service experience adequate quality outcomes in this area. The home does not provide enough individual opportunities for all the people who live there to lead full and meaningful lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a dedicated activities room on the ground floor that has a range of electronic equipment such as TV, a DVD recorder and a computer. There is also a piano, a large table to work on, and smaller side tables set up. We did not see the room being used on either of the days we were in the home. An activities sheet was posted in the corridor in the downstairs area for general activities open to everyone. There was a record of sessions of activities which one of the registered nurses showed to us. The folder contained weekly records of attendance for the listed activities of walking, current affairs, bingo Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 17 and games. However, the records had not been maintained, or no activities arranged, or nobody had attended on several occasions. Records for week commencing Monday 03/09/2007 had the record completed only for the Monday. An Occupational Therapist (OT) works at the home every Tuesday and Thursday. She has a file that contains an index of activities, attendance, aims of activities and how to construct the sessions. The only attendance records contained in the OT folder were for the week commencing 20/08/07 and this showed very few entries for attendance. The only entry for bingo was on 10/06/07. There was no evaluation of any activity recorded and almost no details of individuals attending or taking part in any activities. In an adult mental health care setting we would expect to see people’s aspirations and aims recorded in an individual and person centred way. On the residents’ files we looked at on the ground floor we saw that a detailed checklist had been completed to find out what the person’s interests are. However, we did not find any individualised activity plans in these records. Residents we spoke with had mixed views about what there is to do. One person spoke of activities such as bingo and gardening but prefers not to get involved. One person goes to band practice and plays his guitar. One person said s/he is bored, there is nothing to do all day, nothing to help regain independence. This person said they had been on a trip to the seaside recently and another said they had been to the seaside twice this year, and had a trip into Huntingdon. One person said they had been to a wildlife park and several people talked about going for walks every few days. The expert by experience, who spent the morning on the ground floor, did not see any activities taking place. In our survey we asked ‘Can you do what you want to do, during the day, in the evening and at the weekend?’ Six of the ten residents who replied said ‘yes’ to all three and one person said ‘no’ to all three. Two people said ‘no’ to the evenings, and one said ‘no’ to weekends. One resident wrote, “The OT lady is always helpful and obliging”. Drey House has its own vehicle. At the time of the inspection a hired vehicle was being used as the home’s own was stolen. In their responses to our survey, two relatives commented on the theft of the house vehicle and how it had taken a long time to replace it. During this time they said people were unable to go out. One resident said the home has a van and a car but sometimes neither is available to take people out, although “that situation is improving”. In the AQAA the manager wrote that a new, larger (15-seater) vehicle is on order: we discussed whether one large vehicle, “to take more people out together”, is in line with a modern way of offering people support and rehabilitation to a more independent life. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 18 People upstairs are being encouraged to be independent and being given some opportunities for this. On the first day of the inspection, all three residents were out during the morning, and in the afternoon they enjoyed a game of bingo. People who spoke with us said there are lots of activities on offer and they are encouraged to go out as much as they want to. They were concerned that taxis are quite expensive. Staff said since people have moved upstairs they are engaging more in activities. They choose not to mix with the people downstairs. People’s spiritual needs appear to be met in an ad hoc way. Two people said they are satisfied that a member of staff holds a service and they watch ‘Songs of Praise’. Several people said they are not interested in going to church. One person said s/he would like to go to church. People upstairs said they are encouraged to clean their own rooms, and are supported to use the small kitchen to cook meals. There is a whiteboard in the dining room which has the menu for the week. The menu we saw offered no choice and was very basic. On most days breakfast is cereal. The main meal is served at midday. The menu for the midday meals seemed balanced, but the evening option looked inadequate. Several people we spoke with said they do not get enough to eat in the evenings. One person said s/he had no complaints about the meals and that the cooks are good at preparing meals which suit diabetic needs and are healthy. People said birthdays are celebrated with a cake. One person said “we don’t have a say in what food we have”, and another agreed that the food could be better. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 19 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, 20 People who use this service experience poor quality outcomes in this area. The handling and recording of some medication was not satisfactory and could potentially put the health and well-being of residents at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During the inspection we spoke with a visiting Community Psychiatric Nurse. She said that there have been “dramatic changes” for the better for one person since he moved upstairs. He now has a full programme of activities and receives intensive support from the care team on the upper floor. Two of the people whose care plans we looked at had ‘diabetes’ mentioned somewhere in the documents. For one person this was just a word in the assessment with no further information (see Individual Needs and Choices section of this report). For the second person there was no mention in the assessment about diabetes, but there was a letter on file from the diabetes nurse and the action plan included a risk assessment detailing how this Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 20 person’s diabetes would be managed. We found records to show that this person’s blood sugars are monitored regularly. We found some evidence to show that people’s weights are monitored and other healthcare needs such as visits to the doctor, optician and dentist are met, but the information was not easy to find in the files (see Individual Needs and Choices section of this report). A senior staff member said there are still some issues with secondary health care for people as their psychiatric teams are all at some distance to the home. However, the home employs a psychiatrist who visits every two weeks and briefly re-assesses all the residents. The specialist pharmacist inspector examined practices and procedures for the recording, handling, safe-keeping and disposal of medicines. He found that clear and detailed medicine handling procedures were available to the nursing and care staff. He also found that clear records were kept of most medicines coming into and leaving the home, but there were some medicines in stock for which no record was made. Records were kept when medication was given to residents. However there were some problems with these records. • There was no record of some medicines having been given to the residents when they were due, as the entries on the charts had been left blank. This means that it is not possible to tell whether residents got their medicines on these occasions. The home had introduced an auditing system to detect these problems. Although this audit system had picked up some the errors there were still a worrying number of deficiencies. If medicines were not given to residents the reason why was not being clearly recorded. In some cases, medication had not been administered as prescribed by the resident’s doctor. • • Most residents had their medication given to them by designated trained nursing staff. Some people did hold and administer some of their own medications. Their ability to safely hold and administer their medication and any risks to other people living in the home had been assessed. When hand-written additions or alterations were made to the computer printed medication administration record charts, supplied by the pharmacy, these were not signed, dated or checked for accuracy. The records showed that a number of medicines had been or were out of stock. This means that some residents did not get the medicines their doctors prescribed for them on these days. This could be putting their health and welfare at risk. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 21 One nurse was watched giving medicines to a resident and was seen to give the medication with respect and to handle the medication safely but the record of administration was signed before the medication was taken, not afterwards. Controlled Drugs were being stored in suitable locked cupboards that meet the Misuse of Drugs (Safe Custody) Regulations 1973. But the cupboard in the ground floor medication room was used to store medication other than controlled drugs. The usage of Controlled Drugs was being recorded in the Controlled Drugs register and a stock count was done regularly, so as to audit their usage and readily detect any loss. There were, however some discrepancies in the records of controlled drugs including unexplained loss of a large quantity of medication. Medication was stored securely for the protection of the residents. Medication cupboards and trolleys were reasonably clean and orderly but the keys were left unattended on a desk in the office on the first floor. This is an unacceptable security risk. Staff keep daily temperature records of both the medication storage rooms and of the refrigerators used to store medicines, but no action had been taken when the readings were outside of the required temperatures. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 22 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, 23 People who use this service experience poor quality outcomes in this area. Systems in place to deal with residents’ finances are not good enough to make sure people are protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents who spoke with us all said they would feel comfortable raising any issues they have at the residents’ meetings that are held regularly. Several people said they are happy with the home and don’t have any complaints to make. One person said “We could complain but we don’t have anything to complain about. Staff would look into complaints…..”. People were not aware of a mechanism to make confidential complaints, other than the individual approaching a member of staff. Generally residents and relatives who responded to our survey were positive about how the home responds to complaints, and several people said they had not needed to complain. However one person wrote, “There have been two occasions when they have fallen short of expectations”. On one of the files we were checking, we looked for information about the support this person needs regarding his finances. We found no reference to any financial planning, or support or control of finances. The expert by experience spoke with this person who said he has issues about his money Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 23 being withheld from him. Other people we spoke with did not know how much money they were entitled to each week, leaving staff to dole it out as they saw fit. It was an indication of how institutionalised some people have become (having been in care settings for a lot of years) that they said how grateful they were for whatever the staff gave them. Two of the people who live upstairs told us that they are in complete control of their own money. The manager explained that there have been some difficulties for the company in getting people the benefits they are entitled to, and in accessing the savings they accumulated while they were in long-stay hospitals. He said some people have not been receiving money for months. The company will not let them go without and is supporting them financially. The manager told us that cash is given/paid to some of the residents through the organisation. The manager stated that he receives cheques made payable to “cash” at monthly intervals which he cashes and puts in the safe for each person. There is no record of the cheques received by the home apart from an amount being entered in the record book kept for each person. We found no way to verify if this figure is the amount that should be received; no account for what these cash payments are in respect of; no record in care plans for people’s financial care or financial support; and no references to the role adopted by the organisation or any other person in these matters. There is no transparency about any person’s finances when the organisation is involved in their money. Cash records kept for one person on the 13/07/2007 showed that £40 had been taken for a “town trip” and no receipt of any kind or any evidence that the money had been given to the person had been provided. In general, these ‘personal allowances’ or amounts of cash that people have to spend are not professionally accounted for and were not accurate. Some people are assisted to obtain cash using their PIN and debit card (which are held in the office with their cash). It was impossible to know when and if money had been withdrawn. We checked the money which is held in the home’s safe on behalf of some of the residents. Each person has a record in the office of the amount of cash held, how much has come in and how much has been given to or spent on behalf of the resident. We checked these records and found that for five people the records were not correct. The amount of cash was different to the amount stated on the record that should have been there. The discrepancies ranged from 10 pence to £8.60. These financial procedures place the staff dealing with the money at risk of being suspected of abuse, should there be any reason to doubt the financial figures and also place the people living at the home at risk of potential financial abuse. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 24 A more open procedure regarding people’s finances must be put in place, and clearer policies must be drawn up. The policies should include references to mental capacity and people’s capacity to manage finances, and the role of the organisation in supporting people to manage their affairs. The home’s ‘Safe Custody of Residents’ Property and Cash’ Policy should be reviewed. Staff we spoke with said they had attended the Cambridgeshire County Council course on Protection of Vulnerable Adults. They were clear about reporting any suspected abuse to their line manager. They thought they had contact numbers for the county’s POVA team in their file so that they could report abuse, but did not know where in the home they would find the numbers. On investigation, we found the relevant numbers were not available. We asked the senior person on the first day of our inspection to make sure these numbers were made available and staff were clear about where to find them: this was done before we left. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 25 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, 25, 27, 28, 30 People who use this service experience adequate quality outcomes in this area. The standard of furnishings, decoration, maintenance and cleanliness is adequate to give people a reasonably comfortable place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are several entrances to Drey House. Since our last inspection the main entrance has been moved from the west end of the house to the east end, which is where the main car parking area is. There is a large entrance foyer where people can wait for staff to open the door. As the shared areas of the home, (lounges, dining rooms, activities room, visitors room and so on) are in the centre of the building, visitors have to pass through long corridors (both upstairs and downstairs) which have bedrooms on both sides. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 26 The home benefits from large lounges with high ceilings, fireplaces and big windows, on both floors. These rooms have been pleasantly decorated and comfortably furnished to give a homely feeling, but with lots of space. French doors have replaced the windows in the lounge and smoking lounge downstairs so that residents will have access to the garden once the garden is secure. The manager said the patio areas outside these doors will be improved. The large gardens at the back of the home are mainly lawns. The expert by experience noted that downstairs there was nothing visually exciting or informative on the walls: some of the information on a notice board was a year or so out of date. People we spoke with were satisfied with their bedrooms. We only looked into one bedroom when we were invited to do so: the person said he has as many personal items in the room as he wants. One person complained to the expert by experience about the bathroom. We noted that it was hospital-like, cold and impersonal. There was nothing to make it feel homely or personalised. On the first day of our inspection, there was an unpleasant odour in the corridor on the ground floor as we entered. This corridor is long and narrow with no windows and there is no circulation of air so it felt very warm and stale, as well as being quite dark. Even though the small had gone later in the day, this was not a good introduction to the home. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 27 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, 36 People who use this service experience adequate quality outcomes in this area. Recruitment and supervision of staff is good so that staff are suitable and supported to work well with the residents. There was no evidence to show that staff have had sufficient training to make sure they can meet each individual person’s needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Relatives who responded to our survey were generally full of praise for the staff. Examples of what they wrote include “Drey House cares for my relative very well. I admire the staff immensely, and am very grateful for their effort. So is my relative”; “The staff are extremely tolerant with my relative’s emotional needs, dietary requirements, husbandry and complaints”. One person wrote “It is sometimes hard to get information from staff who cover weekends when I visit”. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 28 Residents we spoke with were happy with the staff, and we saw that some of the staff related well to some of the residents. One resident wrote “The staff work hard to help us all every day”. The staff rota showed that there are seven members of staff on duty on each daytime shift, including at least one trained nurse. One of the senior staff said that recruitment of trained staff has been good and the home relies far less on agency staff than it used to. There seemed to be an adequate number of staff on duty, except that only three people from upstairs had gone out and we saw no activities taking place downstairs. It is difficult to know whether there would have been enough staff if residents had been pursuing individual activities. One of the personnel files contained a very comprehensive induction programme which had been completed by the staff member and the senior nurse. The other person was still doing their induction: this person’s file contained details of training courses they had completed before they started work at Drey House. A training manager works across all of the company’s homes. Several of the staff spoke with us about training. Staff said the training manager is approachable and listens to suggestions about training that staff feel they need. She lets them know what training is available by putting notes in their individual post boxes in the staff room. They confirmed they had received moving and handling training, and training in Protection of Vulnerable Adults. On the second day of the inspection we asked the senior nurse in charge of the ground floor for training records. He could not find a training plan or records and said the training manager would have these: he told us that the computer was not working. Neither he nor other staff we spoke to were able to tell us of any specific training that was planned. The team leader on the first floor said some staff would be doing training for ‘Participation and Recovery’. Staff felt they needed further training in dealing with difficult and challenging behaviour. We looked at the personnel files for two staff. The home had got all the information it must get about each staff member, such as two written references, a Criminal Record Bureau and POVA check, and a full employment history, before they started work. All the required documents were on the files. Staff said that while they are working they receive supervision from the nurse on duty, and they have regular one-to-one sessions with one of the two team leaders. One of the team leaders could not locate supervision records: we found these are kept in the manager’s office. The records showed that regular supervision takes place and is recorded. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 29 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, 40, 41, 42 People who use this service experience adequate quality outcomes in this area. Management of this service is not good enough to make sure that residents are protected and are able to have the best possible quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager, Simon Belfield, is a Registered Nurse (Mental Health) and has a Diploma in Higher Education (Nursing) and a BA in Health Care Management. He has an office in the detached house next to the home. Some of the staff on duty in the home when we arrived did not know if the manager was on duty. Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 30 People who spoke with us told us about the community meetings which take place regularly, run by two members of staff. They said that everyone is encouraged to contribute or criticise the service (see Complaints and Concerns section of this report). We were told that minutes from the meetings are kept in the residents’ lounges (we did not ask to see these). We looked at some of the records the home must keep. Records of tests of the fire alarm system showed that tests had been carried out, but there were some gaps so that the alarms have not been tested weekly as required. The maintenance man told us that he tests the emergency lighting at the same time as the fire alarms, but he does not record these tests. The manager said that the fire officer had visited in August 2007, but he could not find the report of this visit, so we do not know whether the fire officer was satisfied with the fire prevention measures in place at the home. The Responsible Individual (RI) is the person who represents the company in any contact with CSCI. The RI has worked full time for the company since the end of 2006 and visits Drey House at least once a week. He writes a monthly report about the visits he makes to the home (which is required under Regulation 26 of the Care Homes Regulations 2001), and sends a copy to the CSCI. We did not look at all the policies. In the AQAA the manager stated that the home has all except nine of the thirty-one policies listed as an appendix to the National Minimum Standards which care homes should have. He said they had all been reviewed either in August 2006 or July 2007. Although some of the nine ‘missing’ policies might not be relevant to this home, some of them are, and should be available. The manager must make sure that the policies have been amended to take any new legislation into account, for example the Mental Capacity Act (see Concerns, Complaints and Protection section of this report). In the AQAA the manager gave dates on which a list of equipment in the home had last been tested or serviced. He should check whether the last test of the lift and of fire detection and fire fighting equipment are within the requirements of the relevant legislation. According to the dates he gave us, all other equipment has been maintained as required. During our walk round the building we did not see any other health and safety issues that gave us cause for concern. Staff told us they had received moving and handling training. In the AQAA the manager stated that 5 staff have had infection control training. Training records were not available for us to check whether staff have received training in other mandatory health and safety topics, that is first aid, fire safety awareness and food safety. Drey House DS0000064870.V339981.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 2 2 3 3 X 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 2 X 2 2 2 2 X Drey House DS0000064870.V339981.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 YA5 Regulation 5(1)(b) Requirement Each person who lives at the home must have a written contract/statement of terms and conditions with the home. This must include information about the fees. Care plans for each of the residents must give clear guidance to staff on the way in which each person’s individual needs are to be met. Goals must be included, and broken down into measurable tasks with specific timescales. The number and range of opportunities for people to participate in fulfilling and meaningful activities must be improved. This requirement is carried forward. 4 YA17 16(2)(i) Residents must be offered a choice of healthy, nutritious, varied and attractively presented meals. 31/10/07 Timescale for action 31/12/07 2 YA6 15 31/10/07 3 YA12 16(2)(m) 31/12/07 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 33 5 YA19 13(1) Residents’ healthcare needs must be met. Evidence must be available to show that all the healthcare needs of each resident are met. This requirement is carried forward. 31/10/07 6 YA20 12(1)13(2) Medication must be administered in accordance with the prescriber’s instructions. Previous timescale of 16/11/06 not met. 31/10/07 7 YA20 13(2) 17(1)(a) Records of medicines prescribed, received, administered (or not administered) must be accurate and up to date. Previous timescale of 31/12/06 not met. 31/10/07 8 YA20 13(2) Medicines controlled under the 31/10/07 Misuse of Drugs Act 1971 must be stored and recorded in accordance with the Act and associated Regulations. Previous timescale of 31/12/06 not met. 9 YA20 13(2) Records of medicines received into the home must be accurate. Previous timescale of 31/12/06 not met. 31/10/07 10 YA23 13(6) Clear information about each person’s finances must be available for inspection at the home. 31/12/07 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 34 11 YA23 13(6) Records of money held on 07/09/07 behalf of residents must be accurate, so that residents are protected from financial abuse. Staff must receive training appropriate to the work they are to perform, and specific to the needs of individual residents, such as diabetes and challenging behaviour. This was a requirement following two previous inspections when it had been partly met. Records must be available to show that staff have received training. Staff must be trained in all topics related to health and safety (such as food safety, fire safety, first aid, moving and handling, and infection control) so that residents are kept safe. Records must be available to show that staff have received this training. 31/12/07 12 YA32 18(1)(c) 13 YA42 13(6) 31/12/07 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 35 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 YA10 YA24 Good Practice Recommendations Residents should be able to read all the information that is written about them. The provider should consider using a different entrance to the home so that residents have greater privacy in their bedrooms. Find a way to improve the airflow, lighting and general ambience in the ground floor bedroom corridor. 3 YA30 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Drey House DS0000064870.V339981.R01.S.doc Version 5.2 Page 37 - 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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