Inspection on 24/06/08 for Hartfield House

This inspection was carried out on 24th June 2008.

CSCI found this care home to be providing an Poor service.

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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hartfield House 16/12/08

Hartfield House 03/03/08

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Hartfield House 170 Roehampton Lane London SW15 4EU Lead Inspector Davina McLaverty Key Unannounced Inspection 24th June 2008 09:00 Hartfield House DS0000070866.V364750.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 Hartfield House DS0000070866.V364750.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. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hartfield House Address 170 Roehampton Lane London SW15 4EU 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) 020 8780 0057 m.saddler@southsidepartnership.org.uk www.southsidepartnership.org.uk Southside Partnership Mark Saddler ( Subject to CSCI approval) Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 18 3rd March 2008 Date of last inspection Brief Description of the Service: Hartfield House is a care home providing respite/ rota and emergency care for up to eighteen service users with a learning disability, five of whom may also have a physical disability. Accommodation is provided in single bedrooms, double bedrooms and two semi-independent flat-lets. Since September 2007, the service has been owned and managed by Southside Partnership, having been previously run by Wandsworth Council. Hartfield House is located close to shops, pubs and other amenities. It has good access to public transport. A limited number of parking spaces are available outside the home. At the time of this inspection the weekly charge for respite/ rota care and emergency care is £1086.63 per week. Additional charges are made for some outings. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This inspection included an unannounced visit to the service on the 24th June 2008 by two Regulatory Inspectors. We met with the interim manager (as the home’s manager was on sick leave and would be away for three months) and staff on duty. We looked at records, the environment and things at the home that had changed since we last visited. We had asked the Manager to complete an Annual Quality Assurance Assessment (AQAA), a self assessment of the service, which helped us to form some of the judgements made in this report. The form was returned having been completed by the organisation’s Head of Services for People with Learning Disabilities. We also looked at all the information we had received from the home since the last inspection carried out in March 2008. Prior to this inspection, surveys were sent to the home to distribute to the people living there, their relatives, professionals working with residents and staff, to comment on their experiences of the service. At the time of the inspection, three surveys were received from resident’s relatives and two from people who use the service. One professional survey was received. Responses from surveys were mainly positive and where relevant, are reflected in the report. What the service does well: Five residents spoken with said that they liked living in Hartfield House. They said, “It’s nice here”, “we can do what we want”, and “staff are nice and the food is good”. When asked if they liked their rooms, they all said yes, with the exception of one, who said that she’d like her window to open wider, but the safety restrictors on it prevent her to do so. The staff are friendly, helpful and keen to listen to residents, and encourage them to participate in activities of their choosing. The atmosphere in the home continues to be relaxed and laid back with residents who are able, moving freely around the home and grounds. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is up-to-date information about what residents can expect from the service, however, this must be accessible within the home. Resident’s needs are not always assessed appropriately to ensure the service can meet their needs. EVIDENCE: At this inspection the current Statement of Purpose and Service User Guide could not be located and the previous one was seen. Assurances were given that the document had been amended as recommended at the previous inspection. The Statement of Purpose states that Hartfield House provides respite and emergency care for service users for a period of one to seven days. At the previous inspection, five residents had been at the home for several years. We were informed that alternative placements had been found for three of the residents who now had leaving dates. A review for another was due to take place the day after the inspection and plans were in place to review the last resident with a view to moving them on. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 9 The interim manager is keen for all key documents to be produced in a more user friendly format and hopes to address this during his management of the home. Most of the service users who stay at Hartfield House have done so over a number of years, staying for periods of one to seven days, on a rota basis, throughout the year. At the previous inspection a Team Leader stated that when a new service user first comes to the service an assessment is carried out through meeting them, their carer and social worker. Referral and assessment information is obtained and the service user is invited to stay for a trial visit, in which time the staff would carry out their own assessment of their needs and abilities. However, evidence of this was not seen on the files examined. In discussion with the interim manager, he stated that a new referral format had been developed which he is currently discussing with various teams within Wandsworth Social Services who refer service users. A copy of the document was given to inspectors. The document is comprehensive and requests appropriate information. Of the five care files looked at during this inspection the information varied and the new assessment form was not seen on any of them. One file had a “Transitional assessment” report dated 25th October 1999 on it. Another contained an individual programme plan as the resident received one to one support and another contained an assessment by a speech and language therapist, which was dated January 2005, with no evidence that it had been updated. An emergency client had been admitted on the 6th June 2008, however the client profile/ flash sheet was not fully completed. An OT assessment dated 5th June 2007, which referred to activities of daily living skills report was seen on the file. Another file starts with basic information, a photo and information regarding next of kin, doctor,, etc. A community care assessment form, dated Feb 2000, was completed by their care manager. No homes assessment was seen although there was an end of stay report’ done by the Residential Support Worker which addressed residents stay with regard to health issues, activities/ involvement – e.g. went to theatre and out for meal, social interaction and any medication issues. The care plan consisted of the area of personal care only. A risk assessment dated July 2003, regarding going out, travel skills, road safety was seen and an annual review dated 23/11/99. The requirement made at the previous inspection has therefore been restated. Despite new forms being introduced there was no evidence to show Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 10 that they are being used, and it was unclear as to how residents ongoing needs were being assessed and met. Hartfield House DS0000070866.V364750.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is little evidence to demonstrate that the needs of the service users have been planned for or are being met. Risk assessments do not fully ensure the safety of the service users. EVIDENCE: Feedback from relatives is that they generally feel that their relative receive a good level of care during their stay at Hartfield House. Comments from surveys included, “the care home staff are very caring and patient”, “the staff are helpful, and if you need to contact them you can”, and “they care well for the clients”. Two service users spoken with said they are involved in making decisions about their life at the home and enjoyed being there. They said that “staff are good, they take us out”, “we can go to bed when we want” and it’s nice to Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 12 meet up with my friends”. They both knew who their key worker were, as the home endeavours to give service users the same key worker, so that there is consistency when they visit and that both, resident and Key worker can get to know each other. As stated above, the care files for five service users were looked at during the inspection and again inconsistencies were seen in the information in them. The interim manager stated that the organisation is in the process of introducing new support plans, which key workers will complete from individuals assessments and following stays at the home. The new plan will cover a number of very relevant areas. A copy of the support plans document to be used was given to inspectors; however, the new support plan was not seen on any of the files examined. As stated previously, information varied in the support plans examined. For two service users there was an ‘Individual Programme Plan’, which contained information such as cultural needs, likes and dislikes, dietary needs, what they like to do and places they would like to visit. However, it was not person-centred and there was no evidence that the service user had been involved in drawing up the plan. Other files seen contained “previous end of stay reports” and Hartfield House’s “resident feedback form.” We were informed that this was usually completed by the person’s key worker at the end of their stay. In discussion with the interim manager, he stated that he intended to look at making forms more user friendly and person centred, which will encourage more residents to input into. Staff will also receive training in Person Centred Planning and Person Centred Active support. The interim manager reported that the home is revising the approach in developing activities to focus on individual wishes and needs and enabling residents to have more choices in relation to meals and that menus and meal times better reflect the needs of particular residents. Three of the four files had no current risk assessments in place. The file that did, covered the following areas health, mobility, travel skills, safety, personal safety, behaviour and fire. There was no evidence to show who had been involved in writing the risk assessment and whether the resident had been involved. Again, the interim manager stated that this was in the process of being addressed and will be completed as part of the reviewing process being introduced. Enforcement action is being taken due to the homes failure to comply with previous requirements, such failure compromises the health and welfare of residents. Hartfield House DS0000070866.V364750.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 this service. Service users are supported to pursue activities and maintain community links. EVIDENCE: Confirmation was received that there had been no changes to how residents arrive at Hartfield House. Residents coming to stay for a week usually arrive around 4:30pm on a Monday from their day centres, where they are shown to their room and given time to settle in before joining the other residents for dinner. The following morning residents are assisted to get ready and go to the day centre. That evening, a meeting is held with all residents to discuss activities, menu ideas, and for them to raise any suggestions or complaints. Records of these meetings were seen. Evidence was also seen on a timetable that most residents attend a variety of day and college placements throughout the week. Depending on need, different modes of transport is used to take people to their placement. For Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 14 those who do not attend day care services, one-to-one support is offered by the staff on duty. In the evenings and at weekends residents can spend time in the games room, the dining room, which has a juke box, or go out to the pub, cinema or bowling with staff. Feedback from residents is that they enjoy these activities and staff are committed to ensuring that they enjoy their stay. In discussion with the interim manager, outings regularly take place and he is currently looking at the modes of transport used, as currently there is one mini bus which only one person has passed the test to drive. By obtaining a couple of seven seater cars, more staff would be prepared to drive and it would provide greater flexibility for residents wanting to go out at the weekends. Feedback from relatives was positive regarding the activities, although one of the surveys stated that their relative would like more outings, but acknowledged that this depended on the staffing level in the home. Two other relatives said that they were very happy with the service and could not think of any ways it could improve. Meals at the home are chosen by the service users and prepared by the cook. There was seen to be a wide range of foods, fresh, frozen, tinned and dry goods to ensure that balanced meals are provided by the service. Several residents said that they liked the food and were offered a choice. One resident was seen choosing baked potato and beans for lunch. Staff support was minimal and the person was left in the kitchen by themself. The kitchen has a combination lock on it, which prevents resident’s access. The interim manager stated that he is looking at the need for this, as with good risk assessments the lock could possibly be removed and enable freer access and more positive work with residents around cooking and enabling them to help themselves to drinks/snacks. The interim manager stated that the organisation is improving the menu by using pictures of meals as well as introducing more choice of meals. The requirement made at the previous inspection has been repeated as we saw opened jars of jam, peanut butter and sandwich spread with no labels on then. Hartfield House DS0000070866.V364750.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 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents receive support with personal care that meets their needs. The systems for storing and managing medication still do not ensure the health and safety of the residents. EVIDENCE: Three staff spoken with explained that a number of residents need support with their personal care, and that they support them with this. Four residents spoken to said that they felt cared for by the staff and that their privacy is respected. Examples of this given is that staff will knock on the doors and wait for them to be invited in. Staff listened and gave them the help they needed not taking over. However, one recent notification received, evidence a lack of concern regarding a resident’s privacy when using the bathroom, which resulted in the resident becoming extremely angry with the staff involved. In some of the care files there was evidence of input from specialist health services including the speech therapist and consultant medical professionals. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 16 However, there was little evidence to demonstrate that annual reviews of residents care, take place on an annual basis. Only one of the four files seen contained an annual review and of those seen, one had been carried out by the residents key worker, on their own. Again the interim manager acknowledged this and is endeavouring to review residents with their care managers and carers when they come to Hartfield House for their rota care. As stated earlier in this report, residents usually arrive on a Monday evening and bring their medication with them from home, which is then put into the medication cabinet and a Medication Administration Record (MAR) is implemented by staff to record this. At the last inspection, six requirements were made regarding administration of medication. At this inspection some of the requirements had been met, e.g. the medication cupboards in use are now attached to the wall in the office. There is a controlled drug cabinet, which is secured to the wall. There is also a record for the disposal of medication as well as a medication weekly checklist, which audits medication in the home. However, this sheet had only been completed for weeks in May and the sheets for June could not be located. Training certificates in the medication file were not current. We were informed that all staff had received training in the administration and handling of medication. The medication and related records for nine residents was looked at during the inspection and a number of errors were found. Enforcement action is being taken due to the homes failure to comply with previous requirements, such failure compromises the health and welfare of residents. Of the nine residents, three were found to be satisfactory administered and recorded. Discrepancies were observed and outlined to the team leader during the inspection. These are listed below: Timodine cream states ‘keep in fridge’, it was kept in the medicine cabinet, and put into fridge by the Team Leader during the inspection. Germolene cream was stated on the MAR (Medication Administration Record) chart and as having been received, though there was none in the medicine cupboard. Instead there was some Savalon cream for the same resident, not recorded on the MAR chart, and with a label written by their parent attached to it. Lamatrigine – on the medicine label it states ‘take one twice daily for epilepsy as directed’. This labelling needs to be more specific, and the service must ask the prescriber to have this re-labelled. Similarly, another medication says, ‘follow the directions given to you by your doctor’, and this needs to be changed to be more specific. Some medication written on the MAR chart did not state the dose of the medication , e.g. the mg (milligram) next to the dosage. The Liquifilm eye drops for one residents states on the label ‘discard contents one month after opening’. The date the medication was prescribed - - Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 17 - - - - - - - - - - was 1st May 2008, and no date was given when this was opened. The date of opening must be put onto the bottle. The Salbutamol inhaler prescribed for one resident had the label of: ‘inhale one metered dose as directed by your doctor’, whereas staff had written on the MAR chart for this to be given regularly, twice a day and also twice a day as PRN (as required). Paracetamol label for another resident states 1-2 capsules four times a day, whereas written on MAR chart to be given as PRN. Therefore this resident was not getting their prescribed analgesic medication. The Ibuprofen label for one resident states to be given three times a day, whereas on MAR chart to be given twice a day. Therefore this resident was not getting their adequate, prescribed medication. Staff had written ‘foot cream’ on the MAR chart of one resident, where they need to write the actual name of the medication, ‘Flexitol’. The Daktarin cream for one resident had the label stating their to have this three times a day, whereas it was written on the MAR chart to be given twice a day, therefore causing unnecessary discomfort for the resident. The Daktarin powder for one resident had a label stating to be given ‘twice a day to groin’, whereas on MAR chart this was written as PRN, therefore casuing possible discomfort to the resident. Nivea soft cream had been written on the MAR chart for one resident, and this was not necessary. For one resident, one bottle of Thiamine has a label stating ‘take two tablets each day’, and another container of Thiamine for the same resident states to take one tablet three times a day. The MAR chart says one tablet to be taken three times a day, where the old medication needs to be removed to avoid confusion. Trimethoprin for one resident has a label stating ‘one tablet twice a day’, whereas on the MAR chart this was written to be given three times a day. Therefore this resident was possibly receiving too much medication. The Salbutamol inhaler for another resident stated ‘inhale two puffs when necessary’, whereas on the MAR chart it was written for them to ‘take two puffs every night’. This resident was possibly receiving more medication than they should be. Another incident of a resident not receiving enough medication, and being in possible discomfort is where the Paracetamol prescribed for them had the label stating for them to ‘take two tablets four times a day’, whereas on the MAR chart this was written to be given as PRN twice a day. A container of Ibuprofen in the cupboard had a faded label on and it was difficult to ascertain the prescription, where a new label needs to be gained from the prescriber. At the previous inspection requirements were made re: staff training and management around medication systems. We were informed that nine permanent staff have received training in medication. Copies of certificates were seen on some of the staff files examined. However, despite training, substantial discrepancies were found. The interim manager stated that he will Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 18 be liaising with Boots to regularly audit the home’s medication and further training for staff, which will involve a competency assessment following training. The Registered Persons must regularly assess staff competence in handling, administering and recording medication and take appropriate action as necessary where shortfalls are identified. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users know who to talk to if they are unhappy about anything. The lack of staff training in abuse issues does not help to reduce risks to the service users. EVIDENCE: Since the last inspection, new forms have been introduced this will detail the outcome of any complaint made. A copy of this form was seen and in discussion with the interim manager he will be discussing with staff when to record a complaint as currently some concerns are not recorded. There is organisational complaints policy and three people spoken with were aware of the complaints policy and knew what to do if they were not happy. There were no issues raised in any of the surveys received regarding complaints. There are policies and procedures in place for the Protection of Vulnerable Adults. At the last inspection only two staff members have attended Safeguarding of Vulnerable Adults training recently. The AQAA states that 8 out of 11 permanent staff have attended SOVA training within the last three months. All staff including bank and agency must undertake this training. A Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 20 leaflet re Safeguarding of Vulnerable adults was seen in the office on the notice board. Since the last inspection a referral has been made to Wandsworth safeguarding Team, which is currently being investigated. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 21 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,& 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lot of work is needed to improve the environment to bring this up to a good standard for the comfort of the service users. EVIDENCE: We observed very little change to the environment since the last inspection. A number of additional issues were seen and are detailed later in the report. The interim manager showed us an environmental action plan with details of maintenance work that will be carried out within the time frame given. New furniture and decorative items are being purchased. As stated at the previous inspection, overall there was a light and airy feel to many of the communal spaces and the bedrooms. The downstairs lounge was large and bright and contained a large, clean fish tank, widescreen TV, DVD player and comfortable sofas. The ground floor dining room has recently been decorated and is bright and clean, looking out over a large attractive garden. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 22 Areas identified at the last inspection which remain outstanding are as follows: • • Room 2 – curtains need replacing. Ground floor bathroom, opposite room 2 – need to cover up exposed pipe-work under the sink and where the shelf is along the back wall. Also need to replace flooring to make this more homely for the service users. The manager said that this room had been recently re-decorated, however, attention must be given to the areas addressed above. Games room – in need of re-decoration where the paint is cracked and peeling off the wall. Consideration should be given to carpeting the ground floor hallway. First floor bathroom – the vanity unit is damaged, old and worn, and in need of replacing. This also needs re-painting where the existing paint has cracked. Room 6 – re-painting needs to occur on the stained walls. The hole in the carpet that exposes floorboards needs to be repaired, or the carpet replaced. A number of chairs throughout the building have holes in and need replacing. The lounge on the first floor did not present as very homely. It contained four sofas. Two of these had no covers on the foam seating and the foam had chunks missing from them. Another sofa had a torn seating cover, whilst a cover was coming off the seating on another sofa. The sofas in this area must be replaced. During the inspection the service user accommodated in room 12 was observed having to walk through the lounge area to go to bathroom, whilst in their nightclothes. Consideration should be given to situating a bathroom near this room so that they do not have to walk through the lounge. Room 11 – needs net curtains and cleaning, as dirt was observed around the skirting boards and inside the vanity unit. Room 14 – picture on the wall needs cleaning or removing, as it has stain marks on it. The shower room – needs to have curtains installed on the windows. The shower unit has mould around the sealant and this needs to be made good. On the door there is a smaller door at bottom. The Team Leader said that this “…is for staff to get in if a service user is in difficulty…”. The use of this is must be detailed in each service users risk assessment. Consideration should also be given to installing a workable bolt on the door, which can be unlocked from the outside. A door was seen in the wall of the stairwell near room 13. It was marked ‘keep locked shut’ but was open, and not able to be locked. Behind it was a large dark attic space and the floorboards on this area had holes in places. This must be kept locked shut for the safety of the service users. • • • • • • • • • • • Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 23 • • • On the top floor the toilet had a stained cistern and there was black mould growing on the ceiling. The walls had chipped and cracked paintwork. The team leader informed us that the roof is leaking and needs to be replaced. This must be done. The shower room on the top floor was observed to have water stains on the ceiling. Fungus was also observed growing on ceiling. There was also stained flooring and a broken window. The Team Leader said that this bathroom was not currently in use, however, the door was unlocked and there was no sign on the door. These actions must be implemented to ensure that service users do not access this area. Consideration should be given to covering up all the exposed pipe work observed throughout the building. Additional areas identified were as follows: Ground floor dining area – institutional feel with the large tables – could make look more comfortable/ welcoming – e.g. Flowers on table, menus on table, pictures on wall. Ground floor lounge – carpet stained, sofas well-worn, need replacing Bedroom 1 – needs proper fitting curtains and net curtains. Clock situated very high up on wall. Bedroom 2 - vanity area needs modernising/ painting. Bedroom 3 – wallpaper coming away from the wall. Cleaning cupboard on first floor says ‘keep lock shut when not in use’ found unlocked with COSHH ( hazardous products) inside – informed manager and this was addressed, and locked during inspection. Fire exit on first floor, that leads to a flat roof - stiff to open First floor lounge – paper peeling from ceiling. Should consider installing net curtains for privacy in the lounge area. - - Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 24 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): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not receive enough support for their role and improvements are needed to information held about staff at the service. EVIDENCE: No surveys were received from staff at the time of the inspection, however, four staff were spoken to during the inspection. Staff commented on the positive time residents tend to have when they come to Hartfield House. They also said that they felt supported and worked well together. One staff member however, felt that staff and residents need more motivation to do activities at weekends and in the evenings, for example, increase use of the games room and garden. The staff team have worked at the service for varying periods of time. Three new staff have recently been recruited. Staff files were looked at, however, the interim manager stated that the requirement made at the previous inspection was still in hand. Performa’s was Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 25 available for all staff seen, but none of the files looked at contained all the required information. Two had no colour photographs, one did not have the CRB number on it and references were also not all seen to be in place. Requests had been made from Social Services for the information on staff who had previously worked for them. A record is being kept of staff training, but the record seen for four staff members failed to clearly evidence what training is outstanding. The organisation stated in their improvement plan that the manager is collating a list of all training carried out and all mandatory training to be identified and booked by the timescale given. The interim manager reported that this was in hand. The date for completion of the requirement had not passed at the time of the inspection, but had been extended to provide adequate time for completion. Copies of certificates were not all available. The interim manager said that he is in the process of addressing this. Files must evidence that all staff are up to date with mandatory training. This was not seen on the files examined, although the training certificates in some staff files indicate that some staff have had recent training in food hygiene, manual handling, fire safety and first aid. Since the last inspection, one to one supervision has started but needs to be more consistent. The manager must provide a minimum of six supervision sessions a year, at regular intervals. The organisation states that they aim for each individual to receive 10 a year. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 26 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some health and safety checks are carried out by the service but inconsistent recording which could put residents and staff at risk. EVIDENCE: Following the last inspection, a number of requirements were made to improve the quality of service being offered. The manager has submitted his application to CSCI for approval. An improvement plan was received, which along with the AQAA, stated that many of the requirements had been addressed. This was not found to be the case. Whilst we acknowledged that a lot of work has taken place and plans are in place to address environmental issues, many of the standards remain unmet and the requirement has been repeated. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 27 We still found gaps in some of the current health and safety checks being carried out e.g. weekly fire drills and weekly testing of the hot water, which in a couple of rooms was very low. There was still no evidence of what action, if any, had been taken. This was highlighted at the previous inspection. A team leader stated that action had definitely been taken in respect of the low water temperatures as a new form had been designed to evidence action taken. This form was seen, but was not the current one in use, which would evidence the steps taken. Likewise, in respect of fire drill records identified at the previous inspection no action appeared to have been taken. From the records it was not clear what the frequency of fire drills were as they varied significantly. There was still no names of who had attended. Also, on the last fire drill it is noted that ‘one client refused to respond’ however, there is no evidence to suggest that a risk assessment was drawn up as a consequence of this. Enforcement action is being taken due to the homes failure to comply with previous requirements, such failure compromises the health and welfare of residents. The home’s fire risk assessment seen was dated February 2000, and must be updated. The interim manager was advised to consult with the London Fire and Emergency Planning Authority. Checks regarding gas safety, electrical installation and legionella testing were in date at the time of the inspection. The Portable appliance testing had been carried out since the last inspection and the interim manager stated that the few items that had failed on the list had been removed from the rooms. As highlighted throughout this report, record-keeping in a number of areas at the service needs to be improve. The service carries out some quality assurance monitoring through regular resident and staff meetings. A new pictorial form has been devised to get their residents views about the running of the home. There is also a quality action group, which meets regularly with parents and representatives from Wandsworth Social services to discuss current issues at the service e.g. equipment, activities/social events cultural issues and staffing. Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 28 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 3 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 1 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 3 X 2 2 X Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement The Registered Persons must ensure that up-to-date, written assessment information from the social worker is received prior to the admission of any service user. This must be used by the service to inform their own assessment, to ensure the ongoing needs of the service users are met. Previous timescale of 30/04/08 not met 2. YA6 15 The Registered Persons must ensure each service user has an up-to-date care plan that details all their needs. The service user must be involved in planning their care, and this must be evidenced. Previous timescale of 30/04/08 not met 3. YA6 12(4), 15 The Registered Persons must ensure that a person-centred approach is implemented at the service, and that this is used to DS0000070866.V364750.R01.S.doc Timescale for action 30/09/08 30/09/08 30/08/08 Hartfield House Version 5.2 Page 30 enhance the care planning and record-keeping. Timescale of the 30/06/08 not expired - at the time of inspection 4. YA9 14(1) a & c The Registered person must ensure that there is in place an assessment of risk for each service user accommodated and ensure that arrangements are in place to address each of the identified risks The Registered Person must ensure that there has been appropriate consultation regarding the assessment of risk with the service user or a representative of the service user. Previous timescale of 30/04/08 not met. Enforcement action is being taken. 5. YA19 15(2) The Registered Persons must ensure that a review of each service users care, and their use of Hartfield House takes place on an annual basis. Previous timescale of 30/04/08 not met 6. YA20 18 The Registered Persons must regularly assess staff competence in handling, administering and recording medication and take appropriate action as necessary where shortfalls are identified. The Registered Person must DS0000070866.V364750.R01.S.doc 03/10/08 30/09/08 30/09/08 7 YA20 13(2) 03/10/08 Version 5.2 Page 31 Hartfield House ensure the proper recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Enforcement action is being taken. 8. YA23 YA35 13(4), 18(1) (c) The Registered Persons must ensure that all staff are trained in Safeguarding of Vulnerable Adults. Previous timescale of 30/04/08 not met 9. YA24 YA25 YA27 YA30 YA34 13(3)(4), 16(c),23 The Registered Persons must address all environmental issues as detailed on pages 19 - 21 of this report. The Registered Persons must ensure that records relating to the recruitment of staff are held at the home to demonstrate that appropriate recruitment checks have been carried out prior to employment. Previous timescale of 30/04/08 not met The Registered Persons must ensure that a Criminal Records Bureau check has been carried out on all staff prior to their commencing employment. Evidence of this must be held at the service. Previous timescale of 30/04/08 not met 12. YA35 13(4), 18(1) (c) The Registered Persons must ensure that all staff receive upDS0000070866.V364750.R01.S.doc 30/09/08 31/03/09 10. 17(2) Sched 2 30/09/08 11. YA34 19, Sched 2 30/09/08 30/08/08 Hartfield House Version 5.2 Page 32 to-date training in basic first aid, basic food hygiene, health and safety and fire safety. A log must be maintained of all training undertaken and of future training planned for each individual staff member. Previous timescale of 30/06/08 not passed at inspection. 13. YA41 17 The Registered Persons must ensure that all staff working at the service receive training in good record keeping techniques. The Registered Person must that by means of fire drills at suitable intervals persons working in the home and so far as possible service users accommodated are aware of the procedures to be followed in the event of fire, including the procedure for saving life. Previous timescale of 30/04/08 not met. Enforcement action is being taken. 15 YA42 13(4) The Registered Person must update the homes fire Risk Assessment. 30/09/08 30/09/08 14. YA42 23(4) 03/10/08 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 Good Practice Recommendations DS0000070866.V364750.R01.S.doc Version 5.2 Page 33 Hartfield House 1. Standard YA1 It is recommended that the staff dates of birth are removed from the Statement of Purpose. Consideration should be given to producing the Statement of Purpose into a more user-friendly format. Hot water temperatures should be maintained between 40/43 centigrade. 2. YA1 3 YA42 Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Hartfield House DS0000070866.V364750.R01.S.doc Version 5.2 Page 35 - 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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