Inspection on 30/01/07 for Gombards

This inspection was carried out on 30th January 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gombards 14/09/07

Gombards 24/05/06

Gombards 27/02/06

Gombards 04/05/05

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 Gombards 6 London Road Welwyn Herts AL6 9EL Lead Inspector Claire Farrier Unannounced Inspection 30 January & 5 February 2007 12:30 th th Gombards DS0000063291.V329743.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 Gombards DS0000063291.V329743.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. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gombards Address 6 London Road Welwyn Herts AL6 9EL 01438 712892 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) www.unitedresponse.org.uk United Response Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2006 Brief Description of the Service: Gombards is a purpose built home first registered in 2005. It was purpose designed with full wheelchair accessibility and was built as two self contained units each catering for four service users with learning and physical disabilities. Health, Social Services and Aldwyck Housing Association jointly own the home. It is managed and run by United Response (a voluntary organisation). The home is situated in Old Welwyn, ideally for service users to access amenities and local services. Local shops and entertainments are only a short distance away from the home. The home has ample bathrooms and shower rooms to meet the needs of the service user group. Additional aids and adaptations are sited within the home and include the use of overhead tracking systems as required. The home is spacious and presents as a homely environment for service users. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges were not available so please refer to the provider. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried over one day, with a return visit a few days later. The focus of this inspection was to assess all the key standards. Some additional standards were also assessed. The majority of time was spent talking to and observing residents and staff, and discussions were held with the home’s manager and the company’s area manager. Some time was also spent looking at records, care plans and staff files, and the inspector made a tour of the premises. One immediate requirement was left regarding a health and safety risk. An appropriate response has been received since the inspection from the provider. An additional random inspection took place on 8th August 2006 in order to follow up on requirements made at the last key inspection, and the findings are included in this report. The inspection was conducted in an open forum with a number of key staff on duty and the deputy manager. Time was spent with all staff seeking their views, opinions and discussing works that have been implemented in order to meet requirements in the last report. Improvements have been made over the last year to establish provision of a good quality of care, but further improvements are needed to ensure that the needs of all the residents are fully met. What the service does well: The home provides a good quality of personal care and health care. There is good relationship between the staff and residents, and staff are aware of the residents’ individual needs and preferences and enable them to make appropriate choices and decisions about their lives in the home. The staff spoken to feel well supported in their work and said that there is a good training programme available for them. The residents were observed to be relaxed and happy. The care plans have a person centred format, which emphasises and encourages each person’s independence. They provide good details of each resident’s needs, and procedures for any actions that are needed. The risk assessments for each resident are also clearly written, with good details of the risks involved and the measures needed to enable the residents to manage the risks safely. The daily schedules are very detailed, and specify which support worker will provide care or support for each resident for all periods throughout the day. This ensures that the residents’ assessed needs are fully met as described in their care plans. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: One requirement has been repeated from the last inspection report, to ensure that each member of staff takes part in a fire drill at least once a year. An immediate requirement was made to ensure that all cleaning materials are stored securely, so that there is no risk to the residents. An appropriate response has been received from the provider. Although the care plans that were seen were good, not all residents have a current care plan, and not all residents have appropriate and current risk assessments in place. These are needed to ensure that the staff have sufficient information to enable them to meet each resident’s assessed needs. The care plans are not stored securely, which means that confidential information is easily accessible to anyone in the home. Notifications of incidents that affect the welfare of the residents have not been sent to CSCI, and there was no evidence of the proprietor’s monthly monitoring visits to the home. The process for quality assurance does not include the views of the residents, relatives and visiting professionals. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: One resident has been admitted to the home since the last inspection. There was a detailed process of assessment and admission. The person made several visits to the home, to meet the other residents and the staff. This ensured that the resident was happy to move to the home and the staff had sufficient information to meet their needs appropriately. The referring social worker provided a detailed assessment that was updated before admission. The home also carried out their own comprehensive assessment, which includes good information on all the person’s needs, and the process of pre-admission visits to the home. The staff said that they have sufficient information and training to enable them to meet the residents’ needs. The assessments and care plans address the residents’ cultural and spiritual needs, and how the service will meet those needs. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 10 The service user agreement contains the terms and conditions of the services provided by the home, and the rights and responsibilities of the residents. Copies were not seen in all of the residents’ files that were inspected, and they have not been completed and signed for all the residents. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents’ care plans contain detailed information on all their personal care and health care needs, and comprehensive risk assessments related to each individual, which enable the staff to provide a good quality of care. However not all risk assessments have been reviewed therefore they may not contain most current information essential in meeting residents’ needs. EVIDENCE: Detailed case tracking was carried out through the files of four residents, which showed what care is provided for the residents and how it is recorded. Most of the care plans are clearly written, with good details of all the residents’ needs and procedures and guidelines for meeting those needs. The care plans have a person centred format, which emphasises and encourages each person’s independence. The care plans for personal care are written in the first person and include how to communicate with the resident, and praise for their participation. Each person’s assessed needs are detailed in Active Support Plans, with goals such as socialising and communication. The Active Support Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 12 Plans are clearly written, with good details and procedures for any actions that are needed. For example, one resident has a plan for helping to prepare a meal. The procedure includes encouraging them to wash and feel the texture of the vegetables, and stirring food. There are photographs of the resident carrying out each part of the activity. Another resident has a plan for rolling from side to side. The goal is to help them mobilise and to help them-self to get dressed. The file for the newest resident, who was admitted in August 2006, had no care plan or Active Support Plans. The file contained some guidelines, for example there was a speech and language therapy assessment with guidelines for how their food should be prepared. Further details were given in the daily recording. It was not clear what the most up to date guidance was. Appropriate risk assessments are in place for each resident, and these are also clearly written, with good details of the risks involved and the measures needed to enable the residents to manage the risks safely. However the risk assessment for the new resident for eating and drinking had not been updated with the Speech and Language Therapist’s latest advice. The staff spoken to were aware of this guidance, and the inspector observed that the person’s food was prepared properly. However there is a risk that the wrong procedures may be followed, with a consequences for the health of the resident The care plans are reviewed regularly, and all the residents have a yearly Whole Life Review. The staff spoken to said that they use the care plans, and that any new staff who come into the home read them before they work with the residents. The care plans are stored on open shelves in the kitchens on the ground floor and first floor. They contain personal information on each resident, and they are available for anyone to see. All the residents of Gombards have limited communication, and most have no verbal communication. POWhER provides an advocacy service. None of the residents are able to take any responsibility for their own finances. The home has satisfactory procedures for managing each person’s spending money, and for one person there is a care plan for money awareness. The manager is appointee for the benefits of one of the residents. Alternatives to this were discussed, such as the possibility of the company or an independent person being appointee. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. They have good relationships with their families and with the local community. The menus offer a balanced and nutritious diet. EVIDENCE: Six residents attend day services three or four days a week. It was reported that the remaining two residents are currently being assessed for new day services. Outings into the local community are arranged with the residents, and the home has its own vehicle for longer trips. Records of outings are maintained in each person’s daily notes. Planning for trips occurs on the shift planner, which enables each member of staff to arrange and support the service user in making choices to attend. The activities that are currently listed include lunch out, going to the library, aromatherapy, touch and taste, cookery, board games, and writing to family and friends. One resident was out Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 14 with a member of staff in the morning of this inspection, and during the afternoon some residents and staff were observed socialising in the lounge. It was reported that an activities co-ordinator visits the home once a month to review the Active Support Plans and to suggest new ways to do things. The home has a portable sensory machine that encourages the residents to interact. Residents are encouraged and enabled to take part in daily living activities in the home. The Active Care Plans include activities such as making tea (putting the tea bag in the cup), holding a spoon and turning on the washing machine. There is a two weekly alternating menu, which is the same on both floors. The meals are cooked separately in the kitchen on each floor, and the daily shift planner details what should be cooked each day. On the day of the inspection the evening meal was liver and bacon with mashed potatoes, gravy and vegetables. It was all cooked from fresh ingredients. One resident has pureed food, and there are guidelines in their file for preparing this and helping them to eat. All the residents sit together at the kitchen table, and the staff assist those who need help to eat. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. Medication procedures are generally good, but PRN medication is not recorded effectively. EVIDENCE: The care plans that were inspected provide good details of the residents’ personal care and health care needs (see Individual Needs and Choices), and a good relationship was observed between the staff and the residents. The home has a good relationship and professional support from medical professionals. A Speech and Language Assessment was seen for two residents, with guidelines for how to prepare their food and how to assist them to eat. All the residents have had a recent Occupational Therapy assessment to ensure that the staff have appropriate procedures for assisting them with mobility. One resident has a care plan for walking regularly, to enable them to become more mobile. This activity was observed during the inspection. The care plans contain guidelines for management of challenging behaviour and for epilepsy where needed. Food Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 16 and fluid charts are maintained for every resident, and they are weighed regularly. Medication is stored separately for the residents on the ground floor and the first floor. There are appropriate procedures for administering medication, and the records appeared to be accurate. There is a weekly audit of the MAR (medication administration record) charts and of the stocks of medication to check for any errors. The temperature in the storage cabinets is monitored to ensure that it does not go above the safe limit for storing medication. Some residents have a supply of PRN (when required) medication, including paracetamol and rectal diazepam. One resident has rectal diazepam. It was reported that they never take it, but two doses were missing from the package. It was not possible to audit the accuracy of this medication without going through all the previous monthly MAR charts. The guidelines for epilepsy in the residents’ files contain clear procedures for when rectal diazepam should be administered. However there is no indication in the care plans or on the MAR chart for when paracetamol should be administered, and what the indications are for the residents who have no verbal communication. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Policies and procedures are in place to ensure that service users are protected from abuse and neglect. Although residents are encouraged and enabled to make their views and concerns known, there is no record of complaints maintained. EVIDENCE: In the last two inspection reports, mention was made of ongoing investigations into allegations made by whistleblowers among the staff. These have now been concluded, and it was reported that several staff have left as a result. A further allegation was made in August last year concerning an agency support worker. This was dealt with according to the home’s and Hertfordshire County Council’s safeguarding adults procedures. All the staff have received training in prevention of abuse as part of the company’s comprehensive induction programme (see Staffing). The support workers who were spoken to during the inspection were aware of their responsibilities and the procedures for reporting any concerns. The complaints policy contains clear definitions to differentiate concerns and complaints, and appropriate procedures for investigating any complaints. Two complaints have been received by the home during the last month, both concerning activities in residents’ Whole Life Reviews that were not happening. The letters are stored in the home’s correspondence file. There is no clear record of complaints, which shows the process of investigation, the outcome, and any actions taken as a result. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness. EVIDENCE: The building is detached house. It was designed and newly built for the service and it is situated on an access road behind Old Welwyn High Street. It was built as two self contained units each catering for four service users with learning and physical disabilities. It is furnished and decorated in domestic styles that produce a homely, comfortable environment, which allows the residents to relax and feel at home. The residents all have their own rooms, arranged and decorated to reflect their particular interests and tastes. One bedroom is sparsely furnished, due to the risks of injury from epileptic seizures, and this is well recorded in the person’s care plan. Although sparse, the room still looks homely. The lounge, dining room and kitchen are domestic in style and are comfortably furnished and well equipped. There are plans to create a sensory room in the bedroom on the first floor that is no longer Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 19 required for staff to sleep in. The home has a small garden that is accessed from the ground floor lounge. Two bedrooms on each floor share an ensuite bathroom with full track hoist access from each. There is another shared bathroom, and all residents have access to both bath and shower. The home has appropriate equipment for the residents, including track hoisting in the bathrooms and lounges, and in the bedrooms of the residents who need it. One resident has a specially designed toilet seat, and several residents have their own specially designed seating systems and wheelchairs. The home is situated on a steep hill, and the some of the staff said that it is too steep for easy access for wheelchairs, even when the chairs are fitted with power packs. This inhibits easy access to the local community (see Lifestyle). The home is generally well maintained. The walls of one lounge are very scuffed and marked, and it was reported that this room is due to be redecorated. In some bedrooms there are labels on the drawers and wardrobes to indicate where the different items of clothing should be. This detracts from the otherwise homely appearance of the rooms. It was reported that there had been some problems of residents being given the wrong clothes. However there should be alternative methods of ensuring that the staff and the residents know where their clothing is. The home appeared to be clean, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. Cleaning materials, including toilet cleaner, kitchen cleaner, oven cleaner and descaler, were seen in unlocked cupboards and on surfaces, accessible to the residents. (See Conduct and Management of the Home.) Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is staffed by sufficient support workers to meet the needs of the residents. The staff spoken to all feel well supported in their work and said that there is good training programme available for them. Many of the support workers are agency staff, and there is an active recruitment programme in process to increase the number of permanent staff. Due to the large number of new staff and temporary staff very few have appropriate qualifications for their work. EVIDENCE: Several members of staff have left since the last inspection. Most of the support workers currently employed have been recruited within the last year, and many of the current support workers are agency staff. Most of the agency staff are experienced in working in the home, and know the residents well. However there are some shifts when all the staff are from agencies, with no permanent staff on duty. There is always at least one permanent member of staff on duty at night. There is an active recruitment programme in process, and one of the agency workers said that they had applied for a permanent post Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 21 in the home. The staff who were spoken to feel well supported in their work, and said that they have the training and information that they need to provide a good quality of care for the residents. Several members of staff commented that staff morale has improved, and the staff now work well together as a team. Staff rotas show that there are five or six support workers in the home during the day and evening, and two waking night staff during the night. These levels are adequate to meet the complex needs of the residents. There is no longer an additional sleep-in member of staff at night. The daily schedules are very detailed, and specify which support worker will provide care or support for each resident for all periods throughout the day. This ensures that the residents’ assessed needs are fully met as described in their care plans. United Response provides comprehensive training for staff that covers all mandatory training in first aid, moving and handling, fire safety, food hygiene, etc, and training to meet special needs the residents have such as epilepsy and behavioural problems. There is a comprehensive induction programme that includes 5½ days of mandatory training. Due to the changes in the staff group and the large number of agency staff, the number of support staff with NVQ qualifications is very low. Only one support worker and the deputy manager currently have NVQ qualifications. The company is aiming to ensure that all the staff have completed their mandatory induction training, and they should then register for NVQ training. The staff files of three members of staff were inspected. They contained all the required information to show that they are fit to work in the home, including references and CRB (Criminal Record Bureau) disclosures. The manager confirmed that the recruitment procedures followed by the company are robust and that he sees all the information on each applicant during the recruitment process. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff generally follow the home’s policies and procedures. However improvements are needed in some areas of record keeping and maintaining a safe environment. The quality assurance system does not include an effective way of obtaining the views of the residents and their families, which is essential to underpin all self-monitoring, review and development of the home. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 23 EVIDENCE: A new manager was appointed in October 2006. He was deputy manager at another United Response home for three years. He has completed NVQ level 4 in Health and Social Care, and he intends to undertake the Registered Managers Award. He is qualified as a NVQ assessor and as and moving and handling trainer. At the time of this inspection he was preparing the paperwork required to apply for registration. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff generally follow the home’s policies and procedures. The regular audits in the home include a monthly hazard check of the premises. However improvements are needed in some areas of record keeping and maintaining a safe environment. 1. A fire risk assessment has been completed and the fire drills include a full evacuation of the premises. However the names of the staff who take part in the fire drills are not recorded, and there is no evidence that each member of staff takes part in a fire drill at least once a year. 2. Notifications of incidents in the home that affect the welfare of the residents have not been sent to CSCI. Examples of these that were seen include a hospital admission and medication errors. 3. The residents’ personal files, containing care plans and details of epilepsy monitoring, are stored on open shelves in the kitchens on each floor. They are openly accessible to any visitor to the home. All personal information must be stored securely in the home. 4. During the inspection cleaning materials, including toilet cleaner, kitchen cleaner, oven cleaner and descaler, were seen in unlocked cupboards and on surfaces, accessible to the residents. The storage cupboards in the utility rooms on both floors are fitted with padlocks, but the padlocks were not locked. 5. The water temperatures are recorded regularly, but several are regularly very low. This indicates that the water is frequently not hot enough for providing a comfortable bath or shower for the residents. It was reported that there have been problems with the boiler for the ground floor, and on several occasions there has been no hot water on that floor. However at other times it has not been reported that the water temperatures are too low, and it is possible that the water temperatures are not recorded accurately. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 24 United Response has established a robust system for quality assurance, which includes quarterly service audits of the home, with recommendations for any actions needed. However the process does not include the views of the residents, relatives and visiting professionals. It was reported that the manager contacts all the residents’ families regularly. All the residents have very little or no verbal communication. The staff understand their needs, and record how they appear in their daily diaries. These contacts with relatives and residents are not formulated and recorded as a tool for monitoring the quality of care in the home. It was reported that the company makes regular monitoring visits to the home, but the reports of these visits have not been sent to CSCI, and they were not available in the home during this inspection. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 25 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 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 1 33 2 34 3 35 3 36 X 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 X 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15(1) Requirement The file for one resident, who contained no clear care plan. A care plan must be in place for every resident, that provides details of the person’s assessed needs and the procedures for meeting them. A risk assessment for one resident for eating and drinking had not been updated with the Speech and Language Therapist’s latest advice. There is a risk that the wrong procedures may be followed, with a consequences for the health of the resident. All risk assessments must be reviewed and updated as required to ensure that they provide accurate information to safeguard the residents. Timescale for action 31/05/07 2. YA9 15(2)(b) 31/05/07 Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 27 3. YA10 17(1)(b) Care plans were displayed 30/04/07 openly in the dining rooms on both floors of the home. Personal records, including care plans that contain personal information, must be stored securely and confidentially. The home has a complaints policy, but there is no record of complaints. 4. YA22 22(8) 31/05/07 5. YA32 18(1)(c) The registered person must ensure that a record of complaints is maintained in the home, which shows the process of investigation, the outcome, and any actions taken as a result. 31/07/07 A large proportion of the support workers employed in the home are agency staff, and most of the permanent support staff have been newly recruited. Only two members of staff have NVQ qualifications. Measures must be put in place to ensure that all members of staff are given the opportunity to take appropriate NVQ qualifications. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 28 6. YA39 24(3) Regular audits are carried out in the home, but the audit process does not include the views of the residents, relatives and visiting professionals. 31/07/07 7. YA39 26 A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. It was reported that the 30/04/07 company makes regular monitoring visits to the home, but the reports of these visits have not been made available. The proprietor must make monthly monitoring visits to the home that focus on the provision of care and include the views of residents and staff. A copy of the report must be sent to CSCI. Cleaning materials were 05/02/07 seen in unlocked cupboards and on surfaces, accessible to the residents. All substances that may be hazardous to health must be stored securely at all times. An immediate requirement was made and an appropriate response has been received. 8. YA42 13(4)(a) Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 29 9. YA42 23(2)(j) The water temperatures are recorded regularly, but several are regularly very low. 31/05/07 10. YA42 23(4)(e) 11. YA42 37 Measures must be put in place to ensure that water temperatures are recorded accurately, and that water is maintained at an appropriate temperature for the welfare of the residents. The names of staff taking 31/05/07 part in fire drills must be recorded to ensure that every member of staff takes part in at least one fire drill a year. Previous timescale of 31/08/06 not met. 30/04/07 No notifications of incidents, as required under Regulation 37, have been sent to the Commission. Notifications for all incidents that affect the wellbeing of service users must be sent to the CSCI without delay. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations The service users’ agreement has not been completed and signed for all the residents. Completed and signed copies of the service user’s agreement should be maintained in the home. Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 30 2. YA7 The manager is appointee for the benefits of one of the residents. Measures should be put in place to ensure that the manager is not required to be named as appointee for any of the residents. The stock of PRN medications should be carried forward onto the current MAR chart for each service user in order to enable an accurate audit to take place. A procedure should be in place to indicate when to administer PRN medications for each person. Access to the home is too steep for easy use of wheelchairs, even when the chairs are fitted with power packs. This inhibits easy access to the local community. Consideration should be given to enabling residents to have unrestricted access to the local community. In some bedrooms there are labels on the drawers and wardrobes to indicate where the different items of clothing should be. It is recommended that alternative methods should be found of ensuring that the staff and the residents know where their clothing is. A large proportion of the support workers employed in the home are agency staff, and several shifts each week are staffed only by agency staff. Measures should be put in place to ensure that the high number of agency staff employed in the home is reduced and the residents have the benefit of a permanent and stable team of staff. 3. YA9 4. YA13 YA24 5. YA26 6. YA33 Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hertfordshire Area Team 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 Gombards DS0000063291.V329743.R01.S.doc Version 5.2 Page 32 - 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!