Inspection on 28/06/07 for Henry Street Residential Home

This inspection was carried out on 28th June 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Henry Street Residential Home 27/11/08

Henry Street Residential Home 06/12/07

Henry Street Residential Home 06/06/06

Henry Street Residential Home 28/02/06

Henry Street Residential Home 15/12/04

Henry Street Residential Home 05/07/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Henry Street Residential Home 21 Henry Street Debenham Stowmarket Suffolk IP14 6RH Lead Inspector Mary Jeffries Unannounced Inspection 28th June 2007 16:30 Henry Street Residential Home DS0000024412.V344778.R02.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 Henry Street Residential Home DS0000024412.V344778.R02.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. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henry Street Residential Home Address 21 Henry Street Debenham Stowmarket Suffolk IP14 6RH 01728 861122 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.mencap.org.uk Royal Mencap Society Mr Richard Baker Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: Henry Street was first registered as a care home for four people with learning disabilities in 1989. It is a purpose-built bungalow situated in a residential housing area on the outskirts of Debenham, Mid Suffolk. The home is managed and staffed by Mencap but the property itself is owned and maintained by Sanctuary Housing. The building is spacious and simple in design and layout. It incorporates lounge and dining facilities in addition to single bedroom accommodation. All areas of the home are wheelchair accessible. The home also has the advantage of a spacious secure garden and small sensory room. The home has easy access to local shops and amenities including a leisure centre, post office, pubs, café and public transport. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to younger adults. The report has been written using accumulated evidence gathered prior to and during the inspection. A random inspection was undertaken on 26th October 2006, and an Annual Quality Assurance Assessment (AQAA) was provided by the home in June 2007. The inspection occurred over two days, commencing on a late afternoon, when it was hoped that all residents would be at home. This was suspended due to the fact that there were only two staff on duty and one resident who has challenging behaviour made it very clear that they did not want their routine disrupted, and required constant attention from staff. The inspection recommenced the following day, and took seven hours in total. The process included a tour of the building, observations of staff and resident interaction, and the examination of a number of documents including residents care plans, medication records, the staff rota, recruitment, training records and records relating to health and safety. Two residents were tracked. All of the residents were observed. One carer who was on duty on both days facilitated the inspection. Three agency workers who were on duty over the period were spoken with, and the domestic worker was also spoken with. The acting manager was not on duty, but attended the home on the second day and was willing and able to give some input. What the service does well: What has improved since the last inspection? At the random inspection undertaken in October 2006 it was found that that action had been taken on all seven requirements and eight recommendations made at the previous key inspection. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 6 A copy of the agreement to the resident and/or their representative specifying the arrangements made had been supplied to the each resident or their representative. The home had a record of all complaints made with the date of complaint, made by whom and the action taken. Arrangements had been made so that the registered person does not act as the agent for service users. What they could do better: The home must review its ability to continue to meet the needs of the two residents tracked and take any necessary appropriate action, to ensure the safety of all residents and to enhance the well being of the other. Risk assessments must be comprehensive and be updated to include any significant risks that become apparent, so that appropriate consideration can be given to any safeguards that can be put in place. The medication policy must be reviewed, to include instructions regarding altering Medicine Administration Records on verbal instructions. All medicines provided must be signed for. Two signatures are required to evidence financial transactions made on behalf of residents to protect them form abuse. It must be established whether any inappropriate purchases were brought on residents’ behalf, prior to the acting manager clarifying instructions, and any monies owed returned to residents. The external grounds must be kept free from hazards and properly maintained, for the safety and comfort of residents and staff. Mops must be stored properly, in line with good infection control procedures, to reduce the risk of the spread of infection. Temperatures of cooked meats must be taken and recorded to ensure that it is sufficiently cooked to be safe. Residents’ day care plans/records are part of the residents care plans and must be completed to enable the home to demonstrate and assess the impact of the daily living activities residents participate in. Staff files must contain a photograph for identification purposes, and staff files must contain evidence of training undertaken to evidence that at all times there are suitably qualified, experienced and competent persons as are appropriate to meet the health and welfare needs of residents. Staff require access to and knowledge of operational policies. Regulation 37 reports must be provided to the CSCI in respect of any event that affects the welfare of residents, to ensure the accountability of the home. The Registration Certificate must be on display in the home. Henry Street Residential Home DS0000024412.V344778.R02.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. Henry Street Residential Home DS0000024412.V344778.R02.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 Henry Street Residential Home DS0000024412.V344778.R02.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): 2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have their needs and aspirations assessed. People who use this service can expect to be provided with a tenancy agreement, signed either by a resident or their representative. EVIDENCE: The resident group at Henry Street have been there a number of years and there have been no new residents admitted for some time. The local authority had placed each person at the home. At the random inspection it was found that Social Services had recently been to the home and reassessed the needs of all the residents. The tenancy agreements for residents, signed either by a resident or their representative, and evidence of fees agreed with Social Services was seen on residents’ files. Residents’ main files contained a Statement of Purpose and a Service User Guide. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 10 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 poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their needs will be met to a satisfactory level, or that decisions about their care will be followed through. EVIDENCE: Care plans were well set out and included a number of elements. Each resident had a ‘support plan’. This folder contains a pen picture of the individual, a brief introduction that has been written in the first person about the individuals’ likes and dislikes and how they relate to the world and people around them. This also contains each element of care and support individuals require and sets out clearly the actions required by staff to meet the needs of the individuals. The file also contains risk assessments, including one on any impact of the resident’s behaviour upon others in the home. Records also included a summary/plan of treatment. One element of the support plan was a communication summary. Only one of the four residents can communicate without difficulty, however others Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 11 comprehension is better than their verbal communication. From discussions with staff it was indicated that day-to-day decisions about what to eat and what to wear, and where to go were respected and the choice could be offered in a meaningful way. Within Social Care Services reassessment of the needs of all the residents one resident’s changing needs and vulnerability were particularly discussed. CSCI recommended that Mencap record the outcome of the review for this particular individual, who they believe has needs that have changed beyond the scope of Henry Street, and also the strategy agreed by the placing authority. The Area Services Manager wrote to CSCI advising that Social Care Services had classified the risk to the individual as critical, and that they been referred to the “Moving on Team” with their agreement. They also advised that Social Care Services would be asked to arrange a formal review with regards to the placement at Henry Street. Internal reviews of the care plan had taken place regularly, however this resident’s care planning had been allowed to drift. The last full review, including Social Care Services of the resident considered to be at risk was dated September 2006. It was unclear what had become of plans to seek alternative accommodation for them. Staff spoken to were aware that an alternative placement had been sought for the resident but were unclear why they were still at the home. This was despite the fact that since October 2006 CSCI had received reports of six incidents in which the resident had received minor injuries. In at least four of these another resident (who was also tracked) had been witnessed to cause these by pushing them over. These incidents had been reported to CSCI, however an incident of alleged sexual abuse by the other resident had not been. This alleged incident occurred in April 2007, and had, appropriately, been referred to Customer First. A copy of the referral was available, however there was no record of the outcome or subsequent strategic actions. Measures had been taken in the home to protect the resident, and a lockable door that the resident could operate from the inside, which has an override facility for staff with a key, had been fitted. In the AQAA section, “ what we could do better”, the acting manager had advised, “ reassessing people’s needs, moving on to more appropriate housing?” The plan stated for the next 12 months was to “ continue to investigate moving on possibilities and whether this would improve (residents) lives or not.” The care plan of the other resident tracked, who had exhibited dominating and abusive behaviour towards the first resident referred to above, had also been regularly reviewed. They had also caused minor injuries to a different resident on two occasions in February 2007. This resident had a risk assessment around them dominating other residents, but it did not include the risk of them entering other residents’ rooms at night, which they had allegedly done. There Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 12 were no records to indicate that the appropriateness of their placement had been considered. Henry Street Residential Home DS0000024412.V344778.R02.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): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to participate in daily living tasks to the extent of their abilities, and can expect to be supported in maintaining contact with relatives. They cannot be assured that daily activities programmes undertaken from the home base will be as full and structured as they might benefit from. EVIDENCE: The AQAA stated that the home does well in promoting choice in regard to buying and eating food ad participating in activities, and that this is something which has been developed in the last twelve months. It noted that day care activities folders evidenced the activities, but also, under the “what we could do better” section, the AQAA stated “ensure that the activity plans are filled in accurately.” One resident goes out for day care. The others have “day care” at home. On the second day of the inspection, one resident was out at a day care service. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 14 They returned and sat watching tennis, which they were actively enjoying in the small lounge. Another resident was seen to be sleeping in an armchair between 11am and 3.30 pm. Staff advised that this resident had some days like this, and that they had a day care worker in to work with them on Mondays, Tuesdays, Wednesdays and Thursdays. One carer was wrapping birthday presents for a resident during the late morning. The two residents tracked both went to Felixstowe for part of the day, on the second day of the inspection. Two carers accompanied them. This was in line with the risk assessments on file for both residents for going out in the car. The two agency workers who took them out, between them told one resident that they were going out, – seemingly imminently - four times before the group actually went out. The residents kept sitting down again each time the event did not transpire. This was discussed with a permanent member of staff who was on duty, they advised that they had been aware of this but said that that with agency workers it was hard to know how much to pick up with them. There were no current daily activity notes for the two residents tracked. A carer advised that the residents’ diaries would include the activities that they had participated in. The residents’ diaries noted the trip to Felixstowe; one included that they had sat on the sea front and had sausage and chips. One of these residents had a “drive round” noted in their diary for the previous day; tidied own room (with help) the day before that; and had no activity noted for the day before. The other resident tracked had another day out in Felixstowe recorded, and one day the diary stated only, “ spent most of evening in the music room.” The social worker who reviewed residents needs in July 2006 described the activities in the home as chaotic, and took the view that one resident in particular would benefit from more structured day care. The lack of daily activity notes made this difficult to assess, fully. A carer advised that the sort of activities undertaken included going out to feed the ducks, going out to lunch, going for a drive round, and that that it depended on the day what they would do. One of the residents tracked had been on a holiday, and listened as the carer spoke about this. The team meeting notes for April noted that they had enjoyed this. The carer spoke of the resident being a happier and different person on holiday. One resident had a short break to see their relative, and will have another in the autumn, and plans were in hand for the other two residents to have a holiday in late summer early autumn. A carer spoken with advised that residents are now going out more at weekends and evenings. The AQAA stated that only one of the four residents have active family or advocacy support. This was discussed with a carer, who advised that the other Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 15 three residents all had some family contact. They advised that the resident who is well supported visits their parents fortnightly, and their parents visit them alternative weeks at the home. One resident has family in the south of England, and staff take this resident to see their family. The home’s diary showed that another relative had visited a resident in June. A menu of what had been eaten by individuals was kept on the fridge. This was due to choice being offered at the point a meal is decided upon. A resident was working with the carer preparing the evening meal which was nutritious and home made. The weekly shop was said to be done regularly at a local supermarket, but in between time they use the local village store. Residents were able to part take in the weekly shop if they chose. Food stocks in the cupboards, fridge and freezer were good and able to offer a choice. The home did not take the temperature of any cooked meals. This had been advised in an environmental health inspection. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported to get their physical health needs met, but cannot be assured that the home will make sure that full information or support from other agencies involved with their care is obtained. EVIDENCE: On both of the shifts on duty there was a male and a female carer working. For much of the time residents have 1 to 1 care, whilst the high use of agency workers means that this is not a consistent person. Section 2 of this report, individual need and choices, details a resident who cannot communicate their needs and feelings, and who has incurred a number of injuries in the home, having not been fully protected from another resident. The residents tracked had their health needs identified and the associated professionals detailed in their plan, this included GP’s, community nurses and outpatients appointments with specialists for learning disability. Records seen showed that one of the residents had recently had new spectacles; the other had a recent dentist appointment. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 17 One of the residents had been admitted to Walker Close for a period in May, as a consequence of an increase in their aggressive and dominating behaviour. There was no discharge letter or report from this period away on file, and apart from a medication review the acting manager advised they were not aware of any other aspects of the intervention. A requirement was made at the random inspection that the registered person must take further steps to review the policies and procedures at the home to include instructions on receiving and actioning ‘verbal orders’. This arose out of the inspector noting that where the Registered Manager had, properly, queried the dosage of a prescribed medication, they had amended the Medicine Administration Record (MAR) sheet on the strength of telephone advice and had not made any other record. In response to this, the Area Services Manager wrote to the CSCI advising that interim guidance had been given to the home, to log fully any verbal instructions on an incident sheet as well as on the medication record. They also advised that a policy was being developed based on the Royal Pharmaceutical Society guidelines and that a copy would be forwarded to the CSCI once completed. A copy had not been forwarded prior to the inspection, and the AQAA provided did not give dates of any policy reviews. The acting manager was asked for the medication policy, they advised that they did not think there was one apart from the general policy on safe use. At the random inspection one medication administration record was examined and found to be completed. This included details of administration and disposal of medication. Refresher medication training had taken place and a certificate seen. The Registered Manager has developed a way of monitoring medication administration, by adopting the workbook ‘safe handling of medication’ supplied by the chemist used by the home. A record of staff initials showing who has signed for medication has been developed and the Registered Manager now audits medication on a monthly basis. Medicine Administration Records (MAR) sheets for all residents were inspected on the second day of this inspection. The MAR sheet for one residents was missing. The acting manager wrote immediately afterwards to advise this had been found. The medication given that morning to this resident had not been recorded. There were no gaps found in the recording on MARs sheets available for inspection. One of the residents tracked had some hand written alterations on their MAR sheet. An entry for tablets had been changed to a liquid, this entry was not signed. Two other medications were written on MAR sheets by hand. One of these was an “if required” medication, and the profile stated the circumstances under which it should be given, up to four times a day. No time was recorded when this was given on several entries. The carer advised that this would be written in the communication book. There was no entry in the communication book of this having been given for either of the last two dates that MAR sheet Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 18 indicated it had been. The carer advised that these new medications had been given by Walker Close, and would appear on the next set of printed MAR charts. An audit was done of the medications for three residents, those for whom there were MAR sheets. There was one additional tablet in a bottle to the number indicated by records for one resident. Henry Street Residential Home DS0000024412.V344778.R02.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. Residents can be assured that the acting manager and staff aware of their duties and responsibilities to report any suspected abuse appropriately and know how to do so. EVIDENCE: At the random inspection, two staff members shared major concerns relating to the protection of vulnerable adults. This information was shared with the Registered Manager and he made two referrals. The concerns related to events alleged to have occurred in prior to the inspection and witnessed by other staff, and also concerns around the management of the home which had allegedly prevented staff sharing these concerns at the time. It was subsequently agreed that the Area Manager for Mencap would record these concerns and ensure they were investigated whilst the Commission monitored the process. At the time of the inspection disciplinary action had been taken and there had been personnel changes within the home. The Area Services Manager wrote to advise CSCI that all staff had subsequently been issued with a letter with regard to their responsibilities in reporting any incidents where the protection of Vulnerable Adults was an issue. The Area Services Manager also advised that a deputy manager had been appointed who staff had expressed confidence in. They confirmed that the Registered Manager and deputy manager (who is now the acting manager) had Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 20 been booked onto a course, ‘train the trainer on protection of vulnerable adults’. They advised that all staff had been booked to attend a one day training course on the protection of vulnerable Adults, which was additional to their previous ‘Respond and Respect’ training, which staff had considered insufficient. The permanent member of staff spoken with however, advised that they had not received PoVA training recently. The acting manager advised that they were not sure whether all staff had had the training, but that more was planned for this year. The member of staff did say, however that they would have no hesitation in discussing any concerns of this nature with the acting manager, and understood that it was their duty to do so. An appropriate Protection of Vulnerable Adults referral had been made to customer first since then. In response to the requirement made at the last key inspection that the registered person must ensure as far as practicable that they do not act as the agent for service users, Mencap, rather than individual staff members have taken on this role. At the random inspection this was evidenced on giros. Also the building society books were seen to have two signatories in place. There is a safe in place. Finances were discussed at this inspection, and the records for one of the four residents checked. On one transaction, only, which was a withdrawal of petty cash there was only one signature. Other transactions were as the acting manager advised they should be, with two signatures at the time. The total amount held tallied with documentation. The current record sheet of residents’ expenditure, only, was maintained in the home. All expenditures listed for the resident checked were appropriate. The acting manager advised that they had clarified this when they took over their role, and had been advised residents should not pay for any fixtures and fittings. They advised that they understood that residents had previously paid for “a lot of things”. Payment for transport was discussed with the acting manager. They advised that the cars are belong to the residents; one between two, and that this was set up through Motability. The manager advised that each car is paid for with Disability Living Allowance (DLA) of one resident, and that the other residents who receive their DLA at the home, pay for the petrol. At the end of two three year periods this will have evened it self out, however in the event of any resident leaving any monies due or owed would need to be calculated and paid for this system to be fair. At the random inspection it was seen that the Manager had developed a record of all complaints made with the date of complaint, made by whom and the action taken. There were no new complaints in the book, however this was queried at the AQAA had indicated one complaint had been dealt with. The Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 21 acting manager advised that they thought this was a complaint from a neighbour about the impact of the home’s garden on their garden. They were aware that quotes had been sort, but did not know whether the matter had been fully resolved with the neighbour. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 22 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): 24,26,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a comfortable, ordinary home, but may find that areas of it are not routinely maintained to a good standard. EVIDENCE: The home is spacious and simple in design and layout. Communal areas included a lounge, dining room, kitchen, small ‘relaxation’ room, bathroom and a shower room. All areas had appropriate facilities and were furnished with ‘domestic’ type furniture. There was also a small office that ‘doubled up’ as a staff sleep in room. The “music” room looked to be in a poor state. Although called the music room there is a television in the room and it operates as an alternate lounge at times. Given that the residents’ behaviour can impinge on others, for example one makes noises, this is a valuable space, and one resident spent the late afternoon in this room watching T.V. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 23 It is a small room, however there were unnecessary items stored in it – including a large box of Christmas decorations which prevented the door from being opened fully and thus decreasing the size of the room. There was also a fold up bed, positioned away from the walls; the member of staff on duty could not remember when it was last used. There were two easy chairs; the top of the arms were badly ripped, through the covers and into the padding. Hanging from a wall light was a long electrical flex, which was moved when it was pointed out. In the AQAA the acting manager had stated that they planned to replace these chairs in the next twelve months. All residents had their own single bedrooms. One of the four bedrooms was seen with the permission of the individual resident and it was decorated in a way that reflected the resident’s personality and interests. In the outside garden there was a half deflated paddling pool that was full of stagnant water. The carer spoken with advised that this had not been used this summer and was from last year. A metal washing line prop was leaning against a wall, this was moved when it was pointed out. Some old chairs were stored behind the garden shed, and there was also a wheelbarrow full of water there. The carer advised that residents do not go into the garden unaccompanied. The AQAA stated that the home is cleaned on a daily basis, by the domestic cleaner, although residents are encouraged to clean their own rooms. On the day of inspection all areas seen were odour free. The home was generally clean, but the hall carpet was marked. The cleaner was spoken with, as two mops were stored head down outside of the back door. They confirmed that this was where they were always kept. The cleaner advised that they found it had to ensure a brick-a-brac type shelving unit in the bathroom with a rough surface was always spotlessly clean, particularly given incontinence and smearing problems some residents have. The infection control policy did include procedures for cleaning, and the domestic cleaner said that they had never had any training on infection control. It was found at the random inspection that Alginate bags had been purchased for transportation of soiled linen and the walls had been painted to make them washable. Staff confirmed these were used. Protective clothing was available in bathrooms. Henry Street Residential Home DS0000024412.V344778.R02.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): 32,33,34,35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a good level of support, but it will not necessarily be provided by workers who they have learnt to know and trust, as the home relies heavily on agency staff. EVIDENCE: The home’s AQAA noted that in addition to the domestic, the home has three full time and six part time staff. It also notes that in the three months up to 13th June, 116 shifts had been covered by temporary of agency staff. A carer spoken with advised that the team notes state that there were currently 3 x 20 hour posts available. The acting manager confirmed that one of these had been offered. This is a high use of agency staff, and the acting manager advised that it is sometimes difficult to get agency staff who will work with one resident, so that they still spend time providing care them self. There were two carers on duty on the late afternoon of the first day of the inspection, one of them was an agency worker. This worker advised that it was their first visit to the home, and did not know the residents. One of these carers also had to prepare the evening meal for the residents. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 25 There were three staff, plus a cleaner on duty on the second day of the inspection, two of the staff were agency carers. The permanent member of staff had also been on duty the previous day, and had done a sleep over. The agency workers were spoken with and advised that they had both been to the home before, one regularly, one three times before. These staffing levels were normal, however the high ratio of agency staff to permanent staff on duty on both days of the inspection put added pressures on the carer in charge of the shifts, as noted elsewhere in this report. For example, the carer in charge did not challenge the number of false starts to the trip out being undertaken by two agency workers, or the impact of this on residents. The staffing roster showed that there are 2 workers on shift between 7am and 3pm, with another carer working between 9am and 4.30 pm, and two or three staff on duty between 3 and 10pm. The carer employed by the home advised that one resident was very dominant in the house, and that this detracted also from time that could be spent with other residents. It was noticeable on the first late afternoon of the inspection, that this resident required all of the carer’s attention. In the AQAA provided by the home, the acting manager had noted that long term sickness and absence in the staff team had made resulted in low morale, and made it difficult to achieve the improvements they would have liked. A member of staff spoken with confirmed that the staffing situation affecting the home was getting them down. It stated in the AQAA that regular supervisions and team meetings were held. The carer spoken with confirmed this, but advised that there had been difficulty in getting all staff together for team meetings, and that communication was not good. The acting manager advised that team meetings were now being held six weekly, the last set of minutes available in the home was for March 2007. The area manager, deputy manager and four staff were listed as attending that meeting. Two staff files were inspected, one was for a worker who had started with Mencap in 2007. Both had appropriate references, Criminal Records bureau checks and proof of identity. The most recently recruited did not have a photograph on file. It had been noted at two previous inspections that staff files did not consistently contain evidence of training. The AQAA states that of the 9 permanent staff only one has NVQ2, but that 5 are working towards it. It also noted that they had not filled in the Skills for Care national minimum data set on staff qualifications. The acting manager advised that training records were not up to date for staff, but that they had focused on ensuring appropriate training was available for the coming year. A schedule of training was available. Three staff undertook a half day course on safe handling of medicines, most staff attended a first aid course in June, and three more were Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 26 booked to attend in August. Training on food hygiene, moving and handling course and epilepsy were scheduled for the Autumn. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42,43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has been through a difficult period, and whilst staff and management changes have been made, residents cannot be assured that the current management arrangements will ensure that matters are fully addressed and seen through to a conclusion or resolution. EVIDENCE: The home’s Registration Certificate was not on display in the home, and could not be found. On checking the Registration Certificate in the office it was established that The Registered Manager had not been amended since the last certificate was signed in 2004. The CSCI had been informed that this Manager had left the home, and the deputy manager was currently in the acting manager post. This had not yet been confirmed in writing. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 28 At the random inspection, five care staff were spoken to individually about the home, including about the management of the home as it was then. A number of concerns were raised and a requirement was made that the management approach of the home must create an open, positive and inclusive atmosphere, with strategies in place for staff and residents to voice their concerns. In response to this a deputy was appointed from within the staff group whom it was known staff could relate well to and raise concerns with. At this inspection, the acting manager advised that another deputy had been appointed. A member of staff spoken with advised that they found the acting manager very approachable. Following the random inspection the Area Services Manager had advised the CSCI that they would increase the number of spot visits, and include evening and weekend visits as a response to these concerns. The Area Services Manager had subsequently not been working at this project, and another manager had undertaken regulation 26 visits. There was no record of a visit being undertaken in February, or May – although two had been undertaken in April a fortnight apart. There was no indication that any additional visits had been made. The visitors’ book only had one entry for the Area Services Manager, this was undated but the order of entries indicated in was October 2006. There was another entry for Area Manager dated March 2007. The Area Services Manager attended to conduct a regulation 26 visit for June on the second day of this inspection. The carer who was in charge of the home was asked for the policy file. They did not know where or if there was one. They were asked how they knew how to do something, and advised that they used their initiative and confirmed that they did not refer to policies. The home’s certificate of public liability insurance was on display. There was no copy of the last inspection report on display in the home. The carer spoken with said she had never seen it. The AQAA provided by the home stated that health and safety checks are carried out on a weekly basis. A folder of weekly, monthly, three monthly and annual checks was inspected. The fire risk assessment had been reviewed on 06/07/06. A risk assessment of legionella had been conducted in August 2006, and the water had been tested in June 2007. Visual Portable electrical appliance tests were scheduled monthly; although these had not all occurred they are not required. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 29 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 X 4 X 5 3 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 2 25 X 26 3 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 1 X 2 2 Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 30 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 YA6 Regulation 12(1) Timescale for action The home must review its ability 31/08/07 to continue to meet the needs of the two residents tracked and take any necessary appropriate action, to ensure the safety of all residents and enhance the well being of the other. Risk assessments must be 31/08/07 comprehensive and be updated to include any significant risks that become apparent, so that appropriate consideration can be given o any safeguards that can be put in place. Residents’ day care 31/08/07 plans/records are part of the residents care plans and must be completed to enable the home to demonstrate and assess the impact of the daily living activities residents participate in. The registered person must take 31/08/07 further steps to review the policies and procedures at the home to include instructions on receiving and actioning ‘verbal orders’. This is for the safety of residents and the protection of staff. This is a repeat DS0000024412.V344778.R02.S.doc Version 5.2 Page 31 Requirement 2 YA9 13(4)(c) 3. YA6 YA12 15(1) 4. YA20 YA40 13.2, 13.4 Henry Street Residential Home 5. YA20 6. YA23 7. YA23 8. YA28 9. 10. YA34 YA35 11. YA39 12. YA40 requirement from the 26/10/2006 13(2) All medicines administered must be signed for, and the time PRN tablets are given should be recorded, to that all staff know when a resident has received medication. 13(6) Two signatures are required to evidence all financial transactions made on behalf of residents to protect them from abuse. 13(6) An audit must be made of the current residents previous recorded financial transactions to ensure that any cost incurred were in line with the homes Statement of Purpose, so that residents can be reimbursed for any inappropriate expenditure. 13(4) The external grounds must be kept free from hazards and properly maintained, for the safety and comfort of residents and staff. 19(1)(b) Staff files must contain a photograph for identification purposes. 18(1)(a) Staff files must contain evidence of training undertaken to evidence that at all times there are suitably qualified, experienced and competent persons as are appropriate to meet the health and welfare needs of residents. 26 Regulation 26 visits must take place as per regulation to ensure and support the quality of management within the home. 12(1)(a)(b) Staff must have access to copies of up to date policies, to enable them to understand and apply all policies, procedures and codes of practice. DS0000024412.V344778.R02.S.doc 29/06/07 31/07/07 10/09/07 14/08/07 31/07/07 30/09/07 31/08/07 31/08/07 Henry Street Residential Home Version 5.2 Page 32 13. YA42 13(4) 14. YA43 37 Temperatures of cooked meats must be taken and recorded to ensure that it is sufficiently cooked to be safe. Regulation 37 reports must be provided to the CSCI in respect of any event that affects the welfare of residents, to ensure the accountability of the home. 31/07/07 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA19 YA22 YA24 YA30 YA30 YA33 Good Practice Recommendations The manager should write to request a discharge summary if and when a resident is discharged from hospital. It should be ascertained whether the complaint received about the impact of the property had been fully resolved and an outcome fed back to the complainant. The chairs in the music room should be replaced. The freestanding bathroom shelving in rough wood surface finish should be replaced. A suitable storage place should be designated for Mops. The home should further reduce its reliance on agency staff. Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Henry Street Residential Home DS0000024412.V344778.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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