CARE HOME ADULTS 18-65
HERONSMEDE 88/90 Straight Road Old Windsor Berkshire SL4 7RX Lead Inspector
Stewart Mynott Unannounced 05 July 2005 10:40am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Heronsmede Address 88/90 Straight Road Old Windsor SL4 7RX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01753 855694 CHOICE LIMITED Vacant Care home only (PC) 8 Category(ies) of Learning disability (LD) registration, with number of places HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11 January 2005 Brief Description of the Service: Choice Ltd, an independent organisation, owns and manages Heronsmede which is a registered service offering personal care and accommodation for up to eight people, under the age of 65, who have a learning disability and associated challenging behaviour. The home is situated on a main road in Old Windsor with good access to local shops and amenities. Heronsmede is a detached house and bungalow that have been joined together by an extension to provide a variety of areas for residents to use. There is a large garden, mainly laid to grass, with various outbuildings that offer additional accommodation for service users to use for leisure and activities. All accommodation is in single bedrooms. The communal areas consist of two lounges, one dining room and a dining area. There is limited car parking in the front of the property. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection during the day lasting for 5 ½ hours. The acting manager was on leave and the senior support worker and assistant manager were available to assist the inspection process. During the inspection the day-care organiser provided a full tour of the home. A limited amount of time was spent with service users who were busy engaged in activities both inside and out of the home. Time was spent in discussion with new staff members. Time was also spent assessing some the homes records and care records. What the service does well: What has improved since the last inspection? What they could do better:
There is still no Registered Manager at the home. This has had an impact on some of the record keeping within the home. Care records seen were currently being reviewed. The “current file” for three service users contained out of date information. Some more updated information was available in a separate file, which could lead to confusion. One service user had a minor injury and this was not recorded on all documents, as the company procedure requires. There is no key working system within the home, as most of the support workers are new to post. This has led to no keyworker meetings since March. The complaints log was not available on the day of the inspection.
HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 1-5 were not assessed during this inspection. EVIDENCE: HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Annual reviews clearly identify progress and changing needs. Service user plans are in the process of being updated and contain information that is out of date. Risk assessments are thorough and protect service users in their daily life. EVIDENCE: Service users have a “current file” and “daily log”. Three service users files were examined. Each had an annual review in the past year, which was very thorough and detailed. This includes progress reports from day services, psychologist reviews in relation to behaviour and a review of current risk assessments. The assistant manager advised that care plans are currently being updated. This process was noted at the prior inspection and current care plans are still not available for all service users. Behaviour guidelines are in place as required and those seen were self-explanatory and included pictures in one case to assist staff. Detailed information in regards to service users care needs were also available in the “daily log” and some if this information may require updating.
HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 10 Risk assessments are completed with the psychologist and were seen to protect service users in all aspects of daily life. Some risk assessments viewed on the “current file” not have been reviewed and in some cases were out of date. More up to date versions are contained in a separate file and all staff were observed to have signed as having read and understood. A recommendation to keep this information in one place to avoid confusion has been made. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users personal care needs are met but would be enhanced with a key working system. Healthcare needs are met except with recording minor accidents where the company policy should be followed. The homes policy for medicines is fully adhered to and is safe. EVIDENCE: Service users were observed to have a high dependency on care staff for personal care and support. Staffs were seen to treat service users with dignity and respect at all times during the inspection. One service user displayed behaviour that was challenging. This was dealt with in a professional manner and prevented escalation in accordance with written guidelines observed in care records. Service users have a clear “client profile” record, which was seen to detail likes, dislikes and preferences. New staffs spoken to were fully aware of this information and demonstrated a good understanding of service users personal support needs. There is currently no key working support system, as new staffs are required to complete 6 months employment before undertaking this task. This has led to no monthly reports being completed since March 2005 as established in the homes procedures. The assistant manager was confident this would be reintroduced in due course to further enhance support to service users.
HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 13 Three care records examined showed that service users have annual health checks and access to local NHS healthcare facilities. An assistant psychologist visits each week to review behavioural observation charts and assist staff to plan care. Accident and incidents are required to be recorded on a number of documents. One spot check revealed that a minor injury to a service user on 6/6/05 was not recorded on an “injury/bruise” form, as the company procedure requires. A senior support worker explained the medicaton system. The system for storage and administration of medication was organised and safe. Medication records were fully signed and witnessed. The staff member was clear on how to deal with any medication error should this ever arise. Homely medication and records were cross-checked and found to be correct. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Service users are protected from harm and abuse by robust procedures and staff awareness. Complaints are handled appropriately but the “complaints record” needs to be available for staff at all times. EVIDENCE: There was a large investigation at the beginning of the year about an allegation using unauthorised restraint. Other agencies were fully included during the investigation. The conclusion of this led to five members of staff subsequently being dismissed by the company and referred to Protection of Vulnerable Adults Register for inclusion. From records inspected the vulnerable adults procedures were followed and the provider at each step took appropriate actions. The senior team described a heightened awareness of the policy and procedures within the home. New staff confirmed their full understanding of in house policy and procedure and its importance in protecting service users. Some service users display behaviours that challenge the service and such behaviour from one service user was witnessed during the inspection. Staff followed written guidelines available for that service user in a calm and professional manner. Records of behaviour and recording of SCIP interventions for prior incidents for that service user were inspected and all staff spoken to understood the use of these records. Training records indicated new staffs are receiving training in managing behaviour and SCIP guidelines. The complaints policy is full and detailed with a further pictorial procedure available in the service users guide. The assistant manager discussed the last complaint, which was from a neighbour and described the action taken and outcome in regards this, which was effective. However the complaints record was not available to inspect as it had been misplaced.
HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Service users live in a clean and comfortable home. EVIDENCE: The daycare organiser gave a full tour of the premises and grounds. The home was seen to be clean and tidy and generally well maintained. Service users bedrooms were personalised and tidy. All bedroom doors are kept locked during the day. Service users were given access during the day on request and this was observed throughout the inspection. Communal areas seen were clean and homely. A requirement to complete work on the back door by the laundry in relation to a fire officer’s report has been completed. Outside the garden there is a summerhouse used for activities and a sensory room. The laundry has been refurbished since the last inspection with provision of equipment that meets the requirements of services users. The laundry was clean and hygienic. A wall dispenser for red bags, gloves and aprons would enhance cross infection control, although these are available in a nearby cupboard.
HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 31-36 were not assessed during this inspection. EVIDENCE: HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 37-43 were not assessed during this inspection. EVIDENCE: HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
HERONSMEDE Score 2 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 19 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. 2. 3. Standard 37 6 22 Regulation 8 15 17(3a) 17(3b) Requirement Timescale for action 31/10/05 A manager is recruited and registered for this service. A current up to date plan of care 31/10/05 is available on each service users file. the complaints record is 31/08/05 available for inspection 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. Refer to Standard 41 18 19 Good Practice Recommendations Service users risk assessments are stored in one place. A keyworker system is introduced to further support service users and monitoring of their care needs. The Providers accident/incident policy is followed in relation to the recording of minor injuries. HERONSMEDE v226530 h52-h01 s11297 herons mede v226530 050705 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 2nd Floor Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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