Inspection on 06/09/05 for Hardy Drive (23)

This inspection was carried out on 6th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hardy Drive (23) 07/06/07

Hardy Drive (23) 10/07/06

Hardy Drive (23) 06/01/06

Hardy Drive (23) 21/02/05

Hardy Drive (23) 16/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Hardy Drive 23 Hardy Drive Royston Herts SG8 5LZ Lead Inspector Alison Jessop Unannounced 6 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hardy Drive Address 23 Hardy Drive, Royston, Herts SG8 5LZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01763 243 684 01763 245 972 Royal Mencap (Housing & Support Services) Jaynee Ramsurun CRH Care Home 6 Category(ies) of LD-6, PD-1 registration, with number of places Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate a person with physical disability associated with learning disability. Date of last inspection 21 February 2005 Brief Description of the Service: Hardy Drive is a small home which accomodates six service users, one who may have a related pysical disability. The home is situated on a housing estate in Royston and blends in with the local housing. It offers a large lounge, conservatory, kitchen/dining room, relaxation room on the ground floor. One bedroom with ensuite is on the ground floor which accomodates one service user with a physical disability. There is a chair lift offering access to the first floor for some one with a physical disability. The first floor contains five further bedrooms, a bathroom, shower room and the staff office/sleep-in room. A large garden to the rear of the house offers a relaxing area for service users to enjoy the nice weather. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day by one Regulatory Inspector. On arrival all of the service users were out at day services and arrived back later in the afternoon. Most of the time was spent inspecting records and talking to staff. One service user had been shopping that afternoon to purchase some new items of clothing for her holiday, she seemed very pleased with her purchases and appeared to be excited about going on holiday. Other service users were observed enjoying the garden when they returned and looked very happy and relaxed. What the service does well: What has improved since the last inspection? What they could do better: All though risk assessments are in place these could be more descriptive with clear action plans recorded. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 6 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. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None if these standards were inspected on this occasion. EVIDENCE: Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 & 10 A person centred approach is maintained ensuring that service users are involved in making decisions in all aspects of their lives thus promoting independence. EVIDENCE: The staff team gave evidence that service needs are being constantly reviewed. A letter had been sent to Adult Care Services as it was no longer felt that one service users needs can be met and that other service users were being put at risk. The manager stated that to move someone would be the very last resort as they would usually hope to offer service users a home for life. The manager also focussed on the positives and felt that the service user may have outgrown the home as she was very independent in many ways and may benefit from a home where service users can be supported to develop further. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14, 15& 16 Due to the size of the home and the staffing levels, staff have the ability to organise outings and activities spontaneously, promoting integration into community life. EVIDENCE: The previous week the nice weather prompted staff to take service users on a bus ride to Cambridge where they sat near the river and fed the ducks. A photograph album filled with photos of a day at the steam railways was also observed. One service user arrived back at the home at the end of the afternoon after a day out shopping for new clothes for her holiday. She appeared to be very excited about the holiday and took great pleasure in showing everyone her purchases. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 & 21 Care plans observed demonstrated that service users were supported to gain access to specialist healthcare services thus promoting the good health of the service users. EVIDENCE: Of those care plans observed a lot of information in relation to a service users personal and healthcare was observed. One service user who has been displaying some challenging behaviour recently has required a lot of support and in put from external agencies. Multi disciplinary meetings had been held and action plans put into place in order to effectively manage this behaviour. The service user had been involved in reviewing her care plan and her behaviour had been discussed with her and her family. The staff team had also looked at ways of how they could reduce the anxiety of other service users. Procedures in relation to medication were satisfactory, however several homely remedies were found in the medication cabinet and were not labelled. Although the home has a Policy on the use of homely remedies, a risk assessment had not been completed for all remedies. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22&23 Awareness of policies and procedures in relation to the protection of vulnerable adults had enabled staff to ensure that the safety of all service users in the home is protected. EVIDENCE: No complaints had been received since the last inspection. One member of staff stated that they would involve family, friends or advocates if a service user required assistance in making a complaint. Staff had requested a strategy meeting in relation to the abuse that service users are subject to from one service user who is displaying violent and aggressive behaviour. The staff team along with other professionals have attempted to reduce the effects this is having on other service users. The manager stated that in order to protect the welfare and safety of all service users, it may be more appropriate to move the perpetrator to a more suitable environment. It was recommended that service users passports, birth certificates or other forms of identification are stored more securely in order to further safeguard them from financial abuse. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 & 30 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home is extremely clean and well maintained and bedrooms are personalised offering a homely, lived in feel. EVIDENCE: The home has large communal areas where service users enjoy meals, socialising, and relaxation. A conservatory on the side of the house offers a separate private area to dine. A relaxation room, attractively decorated with various pieces of relaxation equipment provides a quiet area for service users to escape. The manager stated that one service user uses this area on a daily basis or when he is feeling upset by others behaviour. The large garden at the back of the house offers an open space for service users to enjoy the nice weather. A large specially designed dining table can seat all service users and more. The table can also accommodate wheelchairs. The manager stated that service users spend a lot of time in the garden and enjoy dining out doors. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 14 The shower on the first floor has been out of use for some time however service users do have access to other facilities. A large damp patch on the ceiling looks unsightly and some decoration work is required. The manager stated that the extractor fan has not been working and therefore this has caused the damp on the ceiling. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff appeared to have a wide knowledge of all service user needs. Most care staff including the manager have worked there for a long period of time, which has provided the service users with a sense of stability. EVIDENCE: On the day of the inspection a new member of staff was receiving her IT induction. An IT trainer had come to the home to carry out the training. The care worker spoken to was very complimentary about Hardy Drive and the service provided by the staff team. She had received an induction and some mandatory training with more to follow. She also confirmed that she had received training on administering medication. This involved a session with the manager of the home, work shadowing and observing and then a competency observation. The carer confirmed that she was aware of the companies Whistle Blowing Procedure and had an awareness of the Hertfordshire Protection of Vulnerable Adults. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41 & 42. All records in relation to Health & Safety in the home were adequately maintained ensuring the home offers a safe environment to its service users. EVIDENCE: Service user finances were inspected and appeared to be accurate. Money is stored safely and records are maintained in order to protect service users from financial abuse. It was pointed out that staff must not use tippex or sticky labels to correct errors in recording. The home is very well maintained and records in relation to Health & Safety in the home are adequately maintained. A review of the fire risk assessment is required. The risk assessment in relation to violent and aggressive behaviour of one service user should be more detailed with a clear action plan available to all staff. All staff involved in the care of this person must receive adequate training on how to deal with challenging behaviour and procedures must be in Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 17 place for dealing with physical aggression. Consideration must also be made in relation to the protection of care staff working in the home against Hepatitis B. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hardy Drive Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 x I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 20 23 Regulation 13(2) 13(6) Requirement Risk Assessments must be in place for all homely remedies. The registered person shall make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. A risk assessment must be sent to CSCI. The damp in the first floor shower room must be eliminated. The shower and extractor fan on the first floor must be in full working order. The homes Fire Risk Assesment must be reviewed. Risk Assessments must include clear instructions and guidelines on action to be taken. Timescale for action By 30/9/05 By 30/9/05 3. 4. 5. 6. 7. 24 24 42 42 23(2)(b) 23(2)(c ) 23(4)(a) 13(4)(c ) By 31/11/05 By 31/11/05 By 30/9/05 By 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 20 Hardy Drive 1. 23 It is recommended that all formal identification documents be stored more securely to further protcect service users from fincial abuse. Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House, 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hardy Drive I52 s19404 Hardy Drive v247640 060905 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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