Inspection on 22/10/09 for Hertha House

This inspection was carried out on 22nd October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hertha House 15/10/08

Hertha House 06/02/08

Hertha House 04/10/07

Hertha House 24/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Hertha House 14a St Michael`s Square Gloucester GL1 1HX Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 22nd October 2009 09:15 Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Hertha House Address 14a St Michael`s Square Gloucester GL1 1HX 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) 01452 313113 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Manager post vacant Care Home 11 Category(ies) of Physical disability (11) registration, with number of places Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Physical Disability - (Code PD) The maximum number of service users who can be accommodated is 11. 15th October 2008 2. Date of last inspection Brief Description of the Service: Hertha House is a modern fully equipped Care Home which opened in early 2001 to provide accommodation for 11 service users with a physical disability. Some people living at the home also have a learning disability. It is located in a residential area very close to the centre of Gloucester. There are three selfcontained flats on the first floor that fall under a supported living scheme. Care being provided by other domiciliary care providers. Aspects and Milestones Ltd are the registered providers for the home. They have had delegated responsibility for managing the home since 2005. Gloucestershire Housing Association owns the building. Single en suite accommodation is provided on two floors with access to the upper floor via a shaft lift. Hertha House has a sensory room, an assisted bathroom with a hydro-massage bath and spacious communal facilities. There is also a small garden and upper balcony. The home has a mini-bus that is accessible to people who use wheelchairs. Base fee levels at Hertha House begin at £1200 per week. Additional charges are made for day care, travel, holidays, chiropody and hairdressing. Each person living at the home has a copy of the Statement of Purpose and Service User Guide. Further copies are available in the office, where a copy of inspection reports can also be found. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over two days by one inspector in October 2009. The manager was present for the first visit to the home. She had completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We had received surveys from three people living in the home and health care professionals. We (the Care Quality Commission – CQC) talked to three people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these three people. This is called case tracking. We spent time observing the care people were receiving and their interactions with staff. We examined a range of records including staff files, health and safety documents and quality assurance systems. We walked around the environment and spoke to the manager about long term plans for the home. This included developing the first floor as a separate service enabling people to become more independent eventually looking into the possibility of developing a supported living service. At the time of our inspection the ground and first floors were being run independently of each other, with a separate staff group and people’s records being managed and kept on the relevant floor. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 6 Eight requirements were issued at the last inspection and six of these had been met and two others were repeated. The Statement of Purpose and Service User Guide had been reviewed to reflect changes in the home. New person centred care plans were starting to be put in place from assessments of people’s needs but again there were no care plans or risk assessments for a person who had moved back into the home. Advice had been provided to staff from a dietician about the nutritional needs of people and this was being followed. Systems for the administration of medication were being safely implemented. We had not been notified of any staffing shortages. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. Care plans for people moving into the home need to be developed from their assessments as soon as possible, making sure that their needs are being met. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed and amended since our last inspection. These documents had been made available in a format appropriate to people’s needs using pictures and symbols. They were written in plain English. Each person also had an updated copy of their licence agreement which provided information about their individual fees and their rights and responsibilities. The manager said that these had been discussed with people at a house meeting. Since our last visit to the home a person who had moved to another home had returned to live at Hertha House. An assessment of need and current care plan had been provided to them from the placing authority. The person said they were happy to be living in the home. There were no care plans or risk assessments in place for this person. The manager thought that they had taken their old care plan and other information with them to their new home Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 9 and these had not been returned with them. This information must be put in place as soon as possible. The delay in developing new care plans and risk assessments for new people was highlighted at our last inspection. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CQC considering enforcement improvement to secure compliance. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Greater consistency in care planning will ensure that the assessed and changing needs of people are identified and their needs can be met. Risks are being managed safeguarding people from possible harm although assessments need to be monitored and reviewed. EVIDENCE: We case tracked three people, two who live on the ground floor and one who lives on the first floor. We also sampled care plans for other people. A person centred approach to care planning was being introduced in the home, staff had completed training and care plans were in different stages of completion. There were inconsistencies in the quality of care planning, the content of plans and the review of care plans and risk assessments. For those people living on the first floor there did not appear to be any current care plans or risk assessments Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 11 in place but the new pro forma for the person centred plans were on their files. These had not yet been completed. Staff thought the care plans and risk assessments had been archived. We looked at all of the files available in the office but could not find any of these documents. Care plans and risk assessments need to be accessible to staff and updated until the new plans are in place. Those people living on the ground floor had a new person centred file which was in the process of being completed but also had copies of the old style care plan which was being reviewed and monitored. These indicated that a holistic assessment of people’s needs had been completed from which plans had been developed for such areas as personal care, mobility, communication, social and leisure, nutrition and finance. There was evidence that people’s changing needs were being monitored and amendments made to care plans as needed. Daily records were being completed as well as a range of monitoring forms. These records had been revised to improve communication and provide staff with easy access to essential information about changes in people’s care needs. These also indicated where the monitoring forms had been used and also cross referenced to other documents such as incident and health care records. Each person had a communication profile or passport in place indicating their preferred form of communication, how to interpret non verbal behaviour and how they like people to communicate with them. For one person there was considerable information providing the reader with guidance about how to communicate with them and their likes and dislikes. Staff were observed enabling this person to interact with other people. There was evidence of involvement with a Speech and Language Therapist. They had held a best interests meeting to discuss the use of video as an aid to develop a new communication aid for this person. There was evidence of increased use of photographs around the home to improve access to information for people such as illustrating the rota, menus and activities. People have access to advocates from local advocacy groups. Some were also involved in local organisations providing them with access to independent peer support from other people with physical disabilities. The manager described how she had been asked to apply for a Deprivation of Liberty Authorisation for the use of bed rails. She had contacted the local supervisory body for advice. We also discussed the practice of switching off a person’s wheelchair when they were distressed. There were records in place to indicate the rationale for this and that the person had requested staff to do this to prevent harm to other people. This had been discussed with a trainer who had said it was not a Deprivation of Liberty. There were no other restrictions to liberty or freedom of choice in place. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 12 A range of risk assessments were in place minimising hazards whilst enabling people to take managed risks. As mentioned for those people living on the first floor these were not accessible. There were incident records for one person living on this floor who was having a number of falls during the night. There was no risk assessment in place. We discussed this with the manager who said night staff were supposed to agree with people how often checks should take place during the night. This needs to be reviewed urgently for this person and steps taken to ensure their safety. The risk assessments for people living on the ground floor were considerably out of date and need to be reviewed. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People living at the home are offered a range of freshly produced meals giving them choice about their diet. EVIDENCE: Each person had an activity schedule in place and daily records indicated whether they had been involved in these activities. People said they continue to go to a nearby church each week and were involved in social clubs organised by the church. Some people were also using local colleges and day centres on a regular basis. We observed one person going out for work experience at nurseries, supported by a relative. People said they enjoyed Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 14 going out to the pub or for a coffee and liked shopping in town. We observed two people being supported to do this during our visits. People were also supported to go swimming or to hydrotherapy, attend dance classes and social clubs on a regular basis. People had access to the home’s vehicle or their own, used taxis or were able to walk the short distance into town. The manager said people were being supported to obtain a bus pass. We sampled daily diaries for two weeks in October and they indicated that the people we case tracked had been supported to follow their activity schedules as well as going on a boat trip, to a Football match and to watch the Rugby. When at home people liked to help out with the cooking or baking, listen to music, watch the television or do art and craft. Broadband had been provided in communal areas as well as to people’s own rooms if they wished. People were also having regular contact with their family and friends. People kept in touch by telephone, email, being visited and visits to their relatives. People were having regular house meetings. An agenda for the next meeting was displayed on a notice board in the lounge/diner along with the minutes from a previous meeting. Two people had recently attended a meeting with Aspects and Milestones senior management in Bristol and one person had been invited to join another group with other people from the South West. People had responsibility for keeping their rooms clean and tidy with the support of staff if needed. People on the first floor had access to a kitchenette to prepare meals and a laundry to do their personal washing. The manager said that concerns had been raised about the security of the home and they were considering putting keypads on some doors on the ground and first floors. We discussed with staff people’s access to keys and alternative technologies which were available to disabled people to make sure they can access keypads. One survey stated that the food was good although another said the cooking could be improved. Staff talked us through the four week menu which was currently in place and said that alternatives to the main meal would be provided. People were observed being offered a choice of cereals and toast at breakfast and when having drinks. Staff offered people a variety of alternatives using the drinks or items as an object of reference when needed to prompt people. Staff said they were collating photographs of meals to use as a visual display on notice boards in the dining room. People were observed having snacks and drinks as they wished during our visits. People who have special diets were given these discreetly and with sensitivity. A dietician had provided advice for staff and guidance was accessible in the kitchen. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Consultation must take place about people’s health care to evidence that it is provided in their best interests. Recommendations from health professionals must be followed to facilitate people’s safety and wellbeing. Staff must have the skills, knowledge and competence to dispense medication to make sure that it is safely administered. EVIDENCE: People had drawn up a list of likes and dislikes, about how they wished to be supported and their preferences for the gender of staff supporting them with their personal care. The AQAA confirmed this stating, “personal care provided as appropriate, in private with the same gender staff when this preference is identified.” Staff were observed treating people with dignity and respect. If people needed help with personal care this was done discreetly and sensitively. Staff knocked on people’s doors before entering. They used people’s preferred names as identified in their care plans. Daily diaries indicated that some people Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 16 liked to stay up later and this was respected. A survey from a person living in the home stated, “They care for me well.” People had access to a wide range of specialist adaptations and equipment which had been provided after assessment and consultation with the relevant health professionals. Guidance had been supplied by health professionals about moving and handling and a range of exercises to maintain people’s mobility. Daily records indicated that these exercises were not being completed each day but for most people were being done several times a week. It is vital that these exercises are completed to promote people’s wellbeing. Comments from health care professionals indicated that although some staff are developing their skills appropriately in relation to postural management not all staff follow their advice. People said they use their comfy chairs so that they are not sitting in their wheelchairs for long periods, although this was not observed during our visits. Some people also have bed rest during the day. Health care records were in place although these were not always being completed. One person had obviously had a significant amount of input from his General Practitioner (GP) and outpatient appointments but there were no records of these on their file. Health professionals had concerns that information from them was not always being passed onto the rest of the staff team effectively. The manager had said that she hoped the new daily forms would promote better communication. For some people there was evidence of appointments with a range of social care and health professionals with the outcome of the visit recorded. We were told that one person had attended hospital for a procedure to help reduce production of saliva. When this person had formerly had an invasive procedure a best interests meeting was held with relevant social care and health professionals to discuss their capacity to consent to the treatment and to explore whether this was in their best interests. There was no evidence that this had been done or whether an assessment had been made in line with the Mental Capacity Act. A follow up treatment is due and the manager must make sure that a best interests meeting is held to discuss whether the treatment should go ahead. (We discussed this treatment with our Pharmacy Inspector who advised us that the treatment is unlicensed and that informed consent would need to be evidenced for this to be performed). The systems for administration of medication were inspected and found to be mostly satisfactory. Most staff had completed training in the safe handling of medication and competency audits were in place. An initial medication assessment was in place for new staff administering medication. Concerns were expressed to us from various people that untrained staff had been asked to dispense medication. Staff must have the skills, knowledge and be assessed as competent to administer medication. New signature lists were being put in place although only one member of staff had signed these. Each person had a personal profile in place with a current photograph and summary of medication Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 17 prescribed and allergies. Protocols were in place for the use of ‘as necessary’ medication. The medication administration records were being completed satisfactorily. Handwritten entries were countersigned and stock levels were being monitored on this form. Creams and liquids were labelled with the date of opening. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an accessible complaints procedure which enables concerns to be raised by people living there or on their behalf. Records of these must be kept in the home to evidence that the process is open and transparent. Robust records must be in place to provide staff with the information they need to support people when anxious or distressed. EVIDENCE: People said they were aware of the complaints procedure and had access to complaints forms. The complaints procedure was available in an accessible format using pictures and symbols. One person described a complaint she had recently made to the manager and said she had received a letter in response to say Aspects and Milestones were looking into it. There was no evidence of this in the home’s complaints folder. Staff said they thought that the complaint would have been forwarded to head office. There were no other complaints for 2009 in this folder. The DataSet indicated that no complaints had been received at the time the AQAA was completed. The AQAA also stated, “We discuss making a complaint at Residents meetings and provide each service user with a copy of the complaints procedure.” Most staff had completed training in the safeguarding of adults in 2008. New staff were completing this as part of their induction. The manager had completed training in the Mental Capacity Act and Deprivation of Liberty Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 19 Safeguards and other staff were scheduled to complete this. The manager had made contact with the local adult protection team to inform them about concerns after an incident in the home. No further action was taken by the team. Staff had completed a Positive Behaviour Management course and were due to attend further training focussing on the needs of people living in the home. Staff reaction to this training was mixed although they hoped future training would provide them with the skills and knowledge to support people at the home during periods of anxiety or anger. A traffic light system was in place for one person using RAG (Red/Amber/Green) to identify how their behaviour may escalate. These indicated the triggers which may upset them and their behaviour when in the Red zone. There was no indication how this behaviour may escalate through Green to Amber. One member of staff explained what was likely to happen. Other staff commented that there appeared to be very few guidelines to help them understand how to support this person. There was no information about how staff should help this person to de-escalate, how to divert or distract them to enable them to calm down. Incident records also indicated that when the person was in the Red zone their electric wheelchair would be switched to manual and they would be taken to their room. This is a use of restraint and must be fully recorded with the rationale noted. The manager stated that the person had agreed to this procedure being in place to safeguard others from harm. They confirmed that they had agreed to this and staff said this would be used as a last resort. During our visit the manager produced a consent form to evidence agreement with the person and they had a copy of this in their room. If this procedure is used we must be notified under Regulation 37. Clear records must be kept of any use of this type of restraint or restriction of liberty. The AQAA stated that protocols and guidelines for all service users who challenge would be collated. These need to be put in place as a matter of urgency. Financial records were examined for people being case tracked and indicated that people were being supported to manage their personal finances. The manager said she was exploring alternative methods of withdrawing cash to improve security. Individual records were being kept with evidence of regular checking of balances and cross referencing of receipts. People said they could access their money when they wished previously there had been concerns about this. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: The home was purpose built for people with a physical disability. Each room on the ground floor and one room on the first floor had overhead tracking. This was also provided in the bathroom. All rooms have en suite showers. Since our last visit the home had been separated into two services which were running separately from each other with dedicated staffing groups and administration systems. The upstairs laundry and kitchenette were fully functioning and being used by people living on this floor. The lounge/dining room had also been refurbished to provide comfortable communal accommodation. There were Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 21 plans for further refurbishment of this room and the conservatory which was temporarily being used as a smoking room for one person. Security of the home and the first floor was being reconsidered. Doors with key pads had been suggested to provide greater security on the ground floor and first floor. Specialist adaptations and equipment had been provided for people after consultation with a range of health professionals. Servicing of this equipment was in place. At the time of our visits the home was clean and tidy. An industrial carpet cleaner had been rented to clean carpets on the first floor. The laundry was tidy and washing was placed into laundry baskets. Red disintegrating bags were provided for soiled laundry. Personal protective equipment was provided for staff and communal hand wash basins had liquid soap and paper towels. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a mainly satisfactory training programme that will provide staff with knowledge about the diverse needs of people living at the home. People may be put at risk by unsafe recruitment processes. Records required by us for new staff must be kept in the home so that we can judge whether this is the case. EVIDENCE: The manager stated that the staff team were almost up to full complement and that over the past twelve months there had been a significant reduction in the use of agency staff. The AQAA stated that “all staff are provided with the General Social Care Council standards and staff handbook as part of induction.” New staff said they had completed their induction programme along with mandatory training. A National Vocational Qualification (NVQ) programme was in place. An assessor was working with one member of staff during our visit. The DataSet indicated that 33 of staff have a National Vocational Qualification and a further 22 of staff were completing their awards. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 23 The manager stated that 3 staff worked during the day on the ground floor and 2 staff worked on the first floor. Two waking night staff were employed for the entire home between the hours of 20.00 and 08.00. She said that these levels were maintained and agency or bank staff would be used to cover any shortfalls. During our second visit one shift the previous day had been covered by 2 members of staff on the ground floor due to sickness but they had managed to cover other shifts with agency staff. Concerns were expressed that there were not sufficient drivers at times but the manager stated that a recently retired member of staff had been appointed to cover driving duties which should alleviate this problem. Surveys indicated that staff are good and respectful. The AQAA stated, “regular staff team are well motivated and know the service users well and promote individuality.” Two staff had been appointed since our last inspection and their files were examined. They did not contain any copies of the documents or records required by us under Regulation 19 and Schedule 4. The following must be in place on staff files in the home: • • • • • • Proof of identity An application form providing evidence of a full employment history Two satisfactory references Confirmation that a Criminal Records Bureau (CRB) check had been obtained prior to starting work in the home (a letter from Aspects and Milestones was in place for one person) Evidence of any qualifications or training A statement of the person’s mental and physical health The manager stated that this information had been provided to her prior to staff interviews but that this had been returned to Aspects and Milestones human resources department. Staff files for existing staff contained this information. An agency member of staff was being employed in the office on the ground floor. She did not have a current CRB in place. We discussed whether this needed to be a Standard or Enhanced disclosure and we agreed given the contact with people living in the home it must be at the latter. This must be obtained. A training matrix was in place which indicated that staff were having access to refresher mandatory training when needed and that the manager had identified who needed this. The AQAA stated that “training in specialist needs – peg feeds and invasive procedures” was being provided and that values and equality and diversity training was being arranged. The manager had identified that additional training was needed in Cerebral Palsy and Muscular Dystrophy. As we mentioned staff were completing their training in Positive Behaviour Management. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in some outcomes for people have meant that there have been shortfalls in other areas. There needs to be sufficient management support in the home to make sure these improvements are sustained and our concerns are addressed. EVIDENCE: The manager was confirmed in post in June 2009 and has applied to us to become the registered manager for the home. She has considerable experience in the field of learning disabilities and is a Registered Nurse and holds a National Vocational Qualification Level 4 in Care and Management. The rota indicated that she works 37 hours a week but in three long days. She Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 25 presently does not have a deputy manager in post. She stated that assistant team leader posts had been advertised to ensure the lines of accountability were in place when she was absent from the home. Concerns were raised about management cover during her absences. Staff said that they felt the home was gradually improving. The AQAA indicated that “We have had a period of intense change, particularly over the last six months, in setting up the upstairs project. Although this has been a very positive change, it has taken a lot of time and energy, minimising the time available for other advancements.” There appear to be a number of areas where improvement is needed including care planning, risk assessment and records required by us. The manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. This was returned to us before the deadline. Although the manager stated that thorough recruitment and selection procedures were in place, there was no evidence in the home to support this. Documents required by us when appointing new staff must be kept in the home. Some staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. As mentioned there was evidence that in some cases the necessary assessments and records were being completed by the home to assess people’s capacity to consent to treatment. This practice was not consistent. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection, although the manager had obtained assessments forms to complete an application for one person. At the last inspection Aspects and Milestones had completed a quality assurance audit for the home by a manager from another service. People had completed surveys as part of this process. The manager stated that this had not been completed this year and that she was waiting for confirmation of who would conduct the quality assurance audit. This must be done. Systems for the management of health and safety were inspected and found to be satisfactory. Regular checks were in place for monitoring fire systems, fridge/freezers, hot food and water temperatures. A new fire risk assessment was being developed to highlight how to evacuate people using wheelchairs from the first floor. During our visits each of the stairwells was being used to store fixtures and fittings and rubbish. An entry in the communication book stated that staff were to remove their coats from this area due to fire risks but this had not been done some two weeks later. During our second visit a fire exit was blocked with a large chair. We advised staff to move this and keep this area clear. Portable appliance testing and servicing of other equipment was being completed. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 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 2 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 3 X Version 5.3 Page 27 Hertha House DS0000069133.V378007.R01.S.doc 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 15 Requirement Care plans must be put in place for new people who have moved into the home so that their individual needs can be met. (The timescale for this requirement was not met.) Risk assessments must be put in place to minimize hazards for new people living in the home. Where a new risk assessment is needed as a result of an incident this must be put in place as soon as possible. This is to safeguard people from further harm. (The timescale for this requirement was not met.) 3. YA6 15 The registered person must make sure that each person has a care plan reflecting their assessed needs which is accessible to them and to staff. This is to that their individual needs can be met. The registered person must make sure that any hazards DS0000069133.V378007.R01.S.doc Timescale for action 30/11/09 2. YA9 13(4) 30/11/09 31/12/09 4. YA9 13 31/12/09 Hertha House Version 5.3 Page 28 people face are assessed and regularly reviewed. This is to safeguard people from possible harm. The registered person must make sure that recommendations from health professionals are implemented. This is to promote the safety and wellbeing of people living in the home. The registered person must make sure that any treatment undertaken by people in their care is done in their best interests and that this is evidenced after discussion with the appropriate social and health care professionals. The registered person must make sure that all staff who dispense medication have the skills, knowledge and competency to do this. This is to protect people from possible harm. The registered person must make sure that a record of all complaints made by people or their representatives are kept in the home. This is to provide us with evidence that the home’s complaints procedure is open and transparent. The registered person must keep a record of any limitations agreed with people in respect of their liberty of movement. This relates to switching an electric wheelchair to manual. This is to safeguard people from possible harm or abuse. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 29 5. YA19 12 31/12/09 6. YA19 12 30/11/09 7. YA20 18 30/11/09 8. YA22 17 31/12/09 9. YA23 17 30/11/09 10. YA23 37 The registered person must inform us if physical intervention is used to prevent people from possible harm, this includes switching an electric wheelchair into manual mode. This is to safeguard people from possible harm. The registered person must keep copies of all records required by us in the home for newly appointed staff. This is to safeguard people from possible harm. The registered person must make sure that agency staff have the necessary records in place and have a satisfactory CRB. 30/11/09 11. YA34 19 Sch 4 30/11/09 12. YA34 19 30/11/09 13. YA39 24 This is to safeguard people from possible abuse. The registered person must 31/03/10 maintain the quality assurance system which reviews the service at appropriate intervals. This is to make sure people living in the home are involved in and informed about improvements and developments in the home. The registered person must 30/11/09 make sure that fire exits are kept clear and that rubbish under stairwells is removed as this is a fire risk. This is to safeguard people from harm due to the risk of fire. 14. YA42 23 Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 30 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. 7. Refer to Standard YA16 YA18 YA19 YA20 YA20 YA23 YA37 Good Practice Recommendations If keypads are put in place on doors, the home should research ways in which people can access these. Exercises as recommended by health professionals should be completed with people as directed by them. Promote good communication between health professionals and staff, making sure their recommendations are implemented. The signature lists should be completed. The temperature of medication cabinets should be monitored and recorded. Traffic light records should include details about people’s behaviour when in Green and Amber zones. Management cover should be monitored to provide day to day charge of the home. Hertha House DS0000069133.V378007.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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