Inspection on 06/12/07 for Henry Street Residential Home

This inspection was carried out on 6th December 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 4 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 28/06/07

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 Claire Hutton Unannounced Inspection 6th December 2007 11:30 Henry Street Residential Home DS0000024412.V356281.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 Henry Street Residential Home DS0000024412.V356281.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. Henry Street Residential Home DS0000024412.V356281.R01.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 vacant post Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2007 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. The fees for this home start at £600.00 per week rising to £670.00 per week depending upon the assessed needs. More information about this can be obtained from the home. Henry Street Residential Home DS0000024412.V356281.R01.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 that focused upon the core standards relating to Adults (18 – 65). It took place over 2 days and lasted 7 ½ hours in total. The inspection process included visiting all areas of the home, meeting with 3 residents and discussions with 3 care staff that supported them. The manager was present on the second visit to the home. The process also included observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, recruitment, training records, menus and records relating to health and safety. The report has been written using accumulated evidence gathered before and during the inspection. The Commission had received in June 2007 an Annual Quality Assurance Assessment (AQAA). We received 1 completed residents surveys, this was positive about the care received, staff and privacy. Since the last inspection at the home the acting manager has stepped down and has been replaced by a newly appointed manager Mrs Lucinda Daykin (Lucy) who was in the process of applying to become registered. What the service does well: What has improved since the last inspection? Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 6 Since the last inspection at the home in June 2007 there has been significant improvement upon the 14 requirements made at that time. The home has been reviewing their ability to meet the needs of one individual and have found that they are not meeting all that individuals needs and have therefore served notice. This will ensure the safety of all residents and enhance the well being of others. Risk assessments have been updated and additional safeguards put in place. Recording in day care plans have improved and there was a marked improvement from day 1 and day 2 of the inspection. This recording enables the home to assess the impact of the daily living activities residents participate in. Further opportunities for residents are set to improve. Medication policies/procedure had been reviewed. There is now guidance available for staff to follow when receiving verbal orders from a GP. Records relating to medication administration had improved. This will improve the safety of medication for residents and protect the staff. The external grounds had been maintained and cleared of equipment no longer needed. In relation to staff there was a photograph of each staff member for identification. They had undergone training in safeguarding and now had policies and procedures available to them. Information required is sent to the Commission. We now receive notification of incidents in a timely manner. (Regulation 37’s) There was also evidence of regular Regulation 26 visits to the home. This ensures and supports the quality of management within the home. What they could do better: Whilst there have been measurable improvements at this home one matter is still outstanding and this relates to one individual whose needs the home can no longer meet. The violence and intimidation that has occurred over the past months has placed the resident group at risk of injury and even though staffing levels have been increased staff say that the incidences are unexpected and quick and they have difficulty in intervening in time. Notice of 2 months has been served, but in that time residents and staff will remain at risk. Finances of the residents have been examined and changes made, however long standing arrangements such as the entwined agreements around transport and disability living allowance (DLA) need to be reviewed and monies due or owed would need to be calculated and paid to individuals for this system to be fair. In addition reimbursement of previous inappropriate expenditure such as carpets must also be actioned. The financial protection of the residents must be continuously safeguarded. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 7 Currently daily activity programmes undertaken from the home base are not full and structured as the residents might benefit from, but this is set to improve due to the plans the manger has in place. 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.V356281.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 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 reassessed, this ensures the service can continue to meet their needs. People that use this service can expect to be provided with a licence agreement, signed either by a resident or their representative and therefore agreements and contracts are known. EVIDENCE: In relation to information available about the Manager said the Service Users Guide was in the process of being updated. This is to be in pictorial/symbol format to make it more accessible to the residents. The current information available was seen on a residents file. There was also a Statement of Purpose and this information needed to be reviewed as there were some updating needed. The new manager agreed to update the document. The group of residents at the home have all been there for a number of years and have been placed by the local authority. There have been ongoing reviews of the placements by the local authority. The local authority had last reassessed the needs of all the residents in the summer of 2006. One individual had recently had a reassessment by the Intensive Support Team at Walker Close. This gave staff information and strategies to use when the resident presented behaviour that may challenge. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 10 Contracts and agreements were seen to be in place. Evidence of fees agreed with Social Services was seen on residents’ files. The licence agreement in place for one individual was seen, signed either by a resident or their representative. Notice had been served on this individual and all relevant parties were aware. The local authority was seeking a more appropriate placement. Henry Street Residential Home DS0000024412.V356281.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. Residents can be confident that changes to their needs will be identified but residents cannot be assured that their needs will be met to a satisfactory level, or that decisions about their care will be followed through in a timely manner. EVIDENCE: Care plans and associated records for two individuals were examined, one at length. 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. Five personal goals were set out for one individual. These covered areas such as running a bath, tidying their room and laying the table. The plan sets out clearly the care needs and actions required by staff. The file also contains risk assessments on matters such as bathing, access to the kitchen, taking milk bottles out and going out in the car. In total there were 10 risk assessments in place for one individual. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 12 One element of the support plan was a communication summary. Only one of the four residents can communicate without difficulty, however others comprehension is better than their verbal communication. From observation staff with residents it was indicated that day-to-day decisions about what to eat and where to go were respected and the choice could be offered in a meaningful way. At the previous inspection at the home we reported that there was a plan in place to move on one resident and that they had been referred to the ‘moving on team’ within Social Services. This plan was based upon the assessment from Social Services in 2006 had not been actioned. We at the Commission had come to this inspection of the home to clarify what was happening with regard to this resident at risk. Examination of notifications to the Commission prior to the inspection and examination of incident records at the home found that the one resident was displaying behaviour that was challenging. The behaviour was physically aggressive towards all the other residents and staff. Residents and staff had sustained injury from this one resident. The manager had been grabbed from behind and now was wearing a neck collar due to an injury sustained. There was a plan in place to minimise the occurrences of this behaviour and this had evidence of review. The Intensive Support Team from Walker Close had been part of the developed care plan in place. Staff explained that staff were present, but the incidences were so quick they had little time to intervene. Therefore there is evidence that the plans do not protect people at the home all the time. The manager explained that notice lasting 2 months had been served to one resident as the home could no longer meet their needs. Henry Street Residential Home DS0000024412.V356281.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): 12,13,15,16,17. Quality in this outcome area is good. 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 activity programmes undertaken from the home base will be as full and structured as they might benefit from, but this is set to improve. EVIDENCE: On the first day of inspection one resident was out to their usual day care centre. They attend the day centre 5 days a week. Another resident was out with a permanent staff member shopping and then planning to eat lunch out. The two remaining residents had had a lie in and were being helped to breakfast and lots of cups of tea at 11:30 am by 2 agency staff. Three of the residents receive their day care from the home. We had previously made a requirement around these arrangements and had said in the Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 14 last report ‘There were no current daily activity notes for the two residents tracked… 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.’ We had received an improvement plan that said ‘Review all support plans within the service to ensure they cover all the needs of the individuals particularly ensure day activities are included within the individuals plans.’ Records examined on the first day of inspection found: There had been evidence of review and one individuals plan stated that they went once a week to Genesis and also once a week to the Stowmarket Resource Centre, However, there was no recent record of attending this Resource Centre and when speaking with staff they said that this individual had not been there for sometime. In looking at the records of the of the 2 individual residents tracked at the last inspection their daily notes of activities undertaken consistently had 2/3 days each week with no entry. The last entry for one of these individuals was 14 days previously. However when looking at these records on the second day of inspection 2 weeks later the daily notes were now being completed every day. These two individuals were kept apart in the best interests of them both. Typically they were helping to do the house food shopping, or going for a walk, a drive to a seaside resort, going out for lunch or staying at home to rest or participate in the running of the home like tidying their room. Staff explained that they tended to be guided each day by how the individual resident was presenting as to what they did. The manager explained that she is developing activities and new pursuits are being tried. One of these included a visiting dog for the benefit of the residents who appeared to welcome the dog and like its presents. Recently there had been a Bodyshop party at the home and the local Vicar had started to call once a week. The manager was currently consulting with and seeking advice from a specialist within Mencap who could offer advice on developing day services for adults who had a severe learning disability. Two of the resident group have regular contact with relatives as stated in the previous AQQA and by staff. Staff spoke of recent telephone conversations and letters to relatives. However two of the residents do not have relatives nor do they have access to advocacy services. The manager agreed to look into this should the need arise. The last residents meeting at the home was on 21/11/07 and there were minutes kept. Issues that were discussed and decided upon were the recent decoration of the communal areas and choosing the new floor coverings. The manager had obtained samples from which the residents could choose. The one survey completed by a resident said ‘I go to Day Centre. I quite like 2 other residents in my house. XXX played snooker with me yesterday’. They Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 15 also indicated that there are ‘sometimes’ good activities and ‘yes’ they like the food at the home. In relation to mealtimes, on the first day one resident had lunch out and the two remaining residents had a late breakfast, but they were offered lunch too. Lunch was a sandwich and celery and cucumber sticks. This was declined – but cups of tea were drunk. There are records kept of what individuals choose to eat. There is not a set menu, but residents choose what they would like at the mealtime. The record shows that there is a varied choice made of chicken, pork, sausages, pizza, fish, salad and yogurts. The food stocks in the cupboards and fridge and freezer were good quality allowing a good choice. There were also plans to go to the local large supermarket the next day. The typical budget spent was said to be between £120.00 and £140.00. Henry Street Residential Home DS0000024412.V356281.R01.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 and 20. 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 will find that personal care and support is provided in a discreet and respectful way and that the outcomes around health matters are satisfactory. Residents and staff are protected by the medication practices within the home. EVIDENCE: Plans were seen to be in place for matters relating to personal care such as having a bath, going to bed and having a haircut. Staff kept daily notes on the support and care given to each resident in the form of a personal diary. Staff spoke of the hairdressers recent visit and how this had gone for the residents. Two residents were seen to have very smart recent haircuts. In the survey returned by one resident they indicated that they did feel well cared for and that the staff treated them well and that their privacy was respected. The home had installed new locks to bedroom doors that allowed the person within to open the door and leave when they needed to, but anyone externally would not be able to enter. However staff and the individual resident had a key. This not only ensures the safety of the resident but also the privacy. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 17 Throughout the 2 days visit staff were seen to offer personal care in a discreet and respectful way. 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 changes made to their medication. Visits by the provider (Regulation 26 visits) had highlighted areas for development in their report. These included completing a form when visits to a medical professional had taken place along with details and reason for visit. The report also recommended completing health action plans and ‘how to help me in hospital’ documents. These documents were not found to be completed in the 2 residents records tracked. In talking to staff it is believed that their knowledge of health matters is good because they have known the individuals for sometime, therefore the outcomes around health matters are satisfactory, but may not supported by written evidence as indicated as good practice by Mencap. The medication practices within the home were examined. The storage was secure. Staff have access to policies and procedures relating to medication. The new manager had developed a procedure for booking in medication to the home and a procedure of dealing with verbal orders, should they be received from the GP. Recently a resident had has their medication changed by a GP over the telephone, therefore this procedure is relevant to this service. Residents had a new medication profile with their photograph for identity. There was a PRN (as and when required medication) procedure in place for two residents. These had been signed by staff to indicate their understanding of the process to follow before administering the medication. The medication administration record (MAR)was examined and found to be appropriately completed. Stocks of medication match that indicated as being held by the MAR. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent systems set up within the home protect the residents finances, but previous, still outstanding, agreements may not have financially protected residents. Residents can be assured that the manager and staff aware of their duties and responsibilities to report any suspected abuse appropriately and know how to do so. However residents are not adequately protected due to the potential threat of harm and intimidation from their fellow residents. EVIDENCE: Residents have information available to them on how to make a complaint. This was seen in their files. The one resident who completed a survey said that they ‘sometimes’ knew who to speak to if they were unhappy. At the last inspection there was concern relating to a neighbour and the garden. It was confirmed that this was now all resolved. Residents finances were discussed and examined. The current policy and procedure was written in 1997. Accounts have been set up for each resident that require two signatures to access money. In the accounting system within the home there is a procedure that calls for 2 signatures when handling residents money. A staff member had been auditing these records as an error had occurred. This highlighted the need for consistently following the agreed procedure as the error was found to have been when one staff member had incorrectly completed records and a second staff member had not checked the process. A memo had been sent to all staff to remind them of the process to follow. There was also another financial issue that required resolving and this Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 19 related to the car-sharing scheme currently in operation at the home. The cars at the home belong to the residents; one between two, and that this was set up through Motability. The current system is 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, one resident is leaving and has not had access to their DLA at the home to pay for petrol for several months. This situation must be resolved and any monies due or owed would need to be calculated and paid for this system to be fair. At the previous inspection to the home we had made a requirement that 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. A staff member confirmed that the residents finances had been audited, however no reimbursement had been paid to one individual who had paid £337.22 to replace their bedroom carpet. This was discussed with the new manager who agreed to ensure this money was reimbursed to the individual. In relation to protection, comment has been made in section Individual Needs and Choices. We said the behaviour of one resident ‘was physically aggressive towards all the other residents and staff. The behaviour was pushing, scratching, grabbing, slapping, throwing objects and throwing drinks. Residents and staff had sustained injury from this one resident.’ Therefore currently all residents and staff are not protected. In the days before the inspection there were several incidences, which have been appropriately referred through the local safeguarding procedures and have been dealt with. A notice that terminates the licence to occupy has been sent to this individual and additional staffing for a one to one member of staff has been put in place until the individual leaves the home to minimise the risks the residents. All staff at the home have received training in safeguarding. Staff spoken with were aware of protection issues. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a comfortable, ordinary home that is clean and meets their needs. 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. Decorating at the home had started on 03/12/07 by an external contractor. The long hallway, office, sitting room and laundry room were all to have a fresh coat of paint and the gloss work redone. The dining room would be touched up where needed. The new hall flooring looked very nice. Residents had been involved in choosing the new colours and floor coverings. The small relaxation room looked tidy and welcoming to residents. The bathroom still Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 21 needs more attention, as it does not look warm and welcoming. The cream tiles on one wall had been painted black and with cleaning were now peeling. There was a patch of damp/mould on one area of the ceiling. The manager agreed to look into this matter. Wooden shelves had been replaced with more appropriate shelving fit for cleaning. All residents had their own single bedrooms. All four bedrooms were see and they was decorated in a way that reflected the resident’s personality and interests. The AQAA stated that the domestic cleaner cleans the home on a daily basis, although residents are encouraged to clean their own rooms. On the first day of inspection not all areas seen were odour free. One bedroom had an odour, however on the second day this was being better managed. The home was generally clean throughout. The home has a laundry room that has appropriate equipment to meet the needs of the individuals living at the home. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 22 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): 31, 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. Residents, and their representatives can be confident that the home employs staff that are adequately recruited. Staff may well be trained to meet the needs of the residents, but little evidence is available to demonstrate this. 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, although this is set to improve. EVIDENCE: On the first day of inspection there were 3 staff on duty and three residents at home. The resident with the highest needs had been taken out by a permanent staff member who knew them well. Two agency staff had been left at the home. The roster revealed that these agency staff were covering for one staff member on sick and another on annual leave. The roster was examined for the previous 2 weeks and found that adequate staff had been employed, but that the home were consistently using agency staff. In the previous 2 weeks 14 shifts a week were agency. The manager confirmed that recruitment was well under way and that they were awaiting the CRB before a Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 23 new staff member could start work. The home had also recruited 2 staff on a relief basis. At our previous visit to the home we inspected staff records and found the recruitment process followed had all the required checks. One new staff file was examined at this inspection. It had appropriate references, Criminal Records bureau checks and proof of identity with a photograph. This individual had completed the Skills for care Induction and had completed the Mencap induction. There was evidence of fire safety training, unisafe training, safeguarding training and food hygiene. The manager confirmed that all staff had undertaken safeguarding training and that all staff were booked on training in January 2008 for dealing with violence and aggression. The manager was also planning for diabetes and epilepsy training in the coming months. The manager believed that all staff had training in first aid, health and safety, fire and food hygiene. However due to the chaotic nature of the files she had inherited she could not evidence this in every case. It had been noted at three previous inspections that staff files did not consistently contain evidence of training and 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. One staff member confirmed that training courses had been undertaken but that certificates had been misplaced. The manager was in the process of developing a knowledge folder for each staff member that would contain the required certificate evidence and said that this would also include person centred planning and working with families. One staff member was booked on training on how to get the best out of rosters. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 24 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, and their representatives will find that appropriate persons manage the home. The health and safety of people using this service is being promoted and the monitoring of quality is being developed. EVIDENCE: The newly appointed manager for Henry Street is Mrs Lucinda Daykin (Lucy). We spoke about her recruitment and she confirmed an appropriate recruitment process that included taking appropriate references and Criminal Records bureau (CRB) checks. The manager confirmed that she holds two NVQ 3 qualifications in health and social care and administration. It was her intention to enrol upon the NVQ 4 and registered manager award combined course. She also confirmed that she had undertaken her CRB through the Commission and was applying to become registered manager. On the second Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 25 day the manager was present and was open, positive and highly motivated to improve and maintain standards with this small home. In relation to monitoring quality within the home the manger confirmed that both resident and staff meetings were taking place. There were recent minutes available to show this was the case. The manager also spoke about the continuous improvement plans that she had in place. She was able to show these working documents that had the task, the date by which it would be done and the responsible person and showed where improvements had been made in the short time she had been in post. An example of this was the improvement in the environment. The home does have regular visits from designated staff within Mencap to ensure quality. These are in the format of Regulation 26 and occur once a month. There were action points from the August 2007 visit that the manager agreed to pick up on such as photographing food to enable choices and a photograph roster to enable residents to know who was on duty. In relation to health and safety – staff training is covered in the section relating to staff. A folder of weekly, monthly, and three monthly and annual checks was inspected. The manager confirmed that the fire safety systems had been inspected and serviced on 7th November 2007. There was evidence of regular recording of fridge and freezer temperatures and meat when it was cooked. The hot water from the bath was tested and found to be within safe limits. Regular records are kept of these temperatures. Chemicals are safely stored and the manager had changed the supplier of chemicals within the home to one supplier who also provided the safety data sheets for staff in case they needed them. Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 26 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 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1.. Standard YA6 Regulation 12(1) Timescale for action The home must review its ability 29/02/08 to continue to meet the needs of one resident tracked and take any necessary appropriate action, to ensure the safety of all residents and enhance the well being of the other. An audit must be made of the 29/02/08 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. (This is a repeat requirement) The current system in place 29/02/08 around transport and benefits such as DLA must be reviewed to ensure the system is fair. Monies due or owed would need to be calculated and paid for this system to be fair. Staff files must contain evidence 29/02/08 of training undertaken to evidence that at all times there are suitably qualified, experienced and competent DS0000024412.V356281.R01.S.doc Version 5.2 Page 28 Requirement 2. YA23 13(6) 3. YA23 13(6) 4. YA35 18(1)(a) Henry Street Residential Home persons as are appropriate to meet the health and welfare needs of residents. (This is a repeat requirement) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations To ensure good recording around health matters the Mencap recommended documents should be completed for each resident. Two signatures should consistently evidence all financial transactions made on behalf of residents to protect them from abuse. The bathroom should be made more comfortable and welcoming by having matters such as the peeling tiles and damp patch on the ceiling attended to. 2. YA23 3. YA24 Henry Street Residential Home DS0000024412.V356281.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester 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.V356281.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!