Inspection on 24/04/07 for Hertha House

This inspection was carried out on 24th April 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hertha House 22/10/09

Hertha House 15/10/08

Hertha House 06/02/08

Hertha House 04/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hertha House 14a St Michael`s Square Gloucester GL1 1HX Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 24th April 2007 13:30 Hertha House DS0000069133.V339807.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 Hertha House DS0000069133.V339807.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. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 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 Ms Marilyn May Halford Care Home 11 Category(ies) of Physical disability (11) registration, with number of places Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 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. N/A 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. Aspects and Milestones Ltd have recently become the registered providers for the home. They have had delegated responsibility for managing the home since 2005. The building is owned by Gloucestershire Housing Association. Single en suite accommodation is provided on two floors with access to the upper floor via a shaft lift. Three flats are provided on the first floor for people independent of the home. 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 wheelchair users. Fee levels at Hertha House range from £660 to £1500 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.V339807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. This is the first inspection of Hertha House under the new registered providers Aspects and Milestones. This inspection took place in April 2007 by three inspectors including a pharmacy inspector. Two visits were made to the home and comment cards were received from people living at the home and relatives/visitors. The registered manager was present for part of the visit on the second day. Time was spent observing one person in depth and the care they were receiving over a period of one and a half hours. Time was spent observing and talking to all other people living at the home and with staff. Several visitors were spoken to about the service provided and feedback was received from healthcare professionals. A range of records were examined which included care plans, risk assessments, staff files, health and safety records and quality assurance documents. At the time of this inspection a complaint was received from a relative about an incident that occurred involving the transport of people using wheelchairs in the home’s mini-bus and concern about access to activities. There were breaches in the regulations, some of which have already been addressed. What the service does well: Hertha House provides purpose built accommodation for people with a physical disability, providing single rooms with en suite facilities and access to well maintained and accessible grounds. The home has a Jacuzzi and sensory room which people enjoy using. People have rooms that reflect their personalities and lifestyles, in some cases providing a sensory environment. Some people said they have chosen the colour scheme for their rooms. People said they are involved in the choice of menu and enjoy the meals prepared. People were observed having positive interactions with staff. The atmosphere was jovial and light hearted during the visits. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home have access to information, which when updated will provide them with an overview of the service enabling them to make a decision about whether it will meet their needs. EVIDENCE: The registered manager confirmed that the Statement of Purpose and Service User Guide are being reviewed to reflect changes in the ownership of the home and systems that have been introduced. Copies will be given to people living at the home, new admissions and to the Commission. The home will have five vacancies. The registered manager confirmed that several people are visiting the home with a view to moving in. Visits are initially arranged with people being accompanied by parents or care managers. Copies of assessments from the placing authority are obtained. These were not available for inspection having been forwarded to the head office. The registered manager stated that she would then visit people in their homes to complete an assessment before arranging further visits and overnight stays to the home. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 9 We received a copy of the new terms and conditions during the registration of Aspects and Milestones. The registered manager confirmed that these would be put in place for each person living at the home. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have some say in their day to day lives and as a person centred approach is adopted within the home they will have an increasing role to play in planning the care and support they receive. Improvements in the assessment of risks and hazards will safeguard people from possible harm. EVIDENCE: The care of three people living at the home was examined in some depth. People have a service delivery plan that identifies their social, emotional, intellectual and physical needs. There was evidence that these are being reviewed on a periodic basis. Key workers note any changes to assessed need on a review sheet. The content of the service delivery plans was discussed with the registered manager. They do not appear to give staff any specific guidance on how to provide support to people. For instance a plan relating to bathing stated that the person is to have ‘ a bath or shower in the mornings and bed bath at night’. There is no reference to how this personal care should Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 11 be provided, the gender of the staff or how privacy and dignity are respected. The registered manager explained that person centred planning is being gradually introduced at the home and that these issues would be resolved as each person has their new plan in place. One person talked through their new person centred plan explaining how they had been involved in putting it together. The plan gives a holistic summary of the person’s needs and the way in which they wish to be supported. This will be a significant improvement. There was evidence that reviews are taking place with people and their parents and care managers. Care plans are provided from their placing authorities. Several people living at the home have access to advocates. One advocate was seeing a person during one of the visits. People were observed being able to meet in private, using either their room or a lounge on the first floor. People were noticed being supported to make choices about their day-to-day lives. Staff asked them what they would like to do, how they would like to spend their time and what they would like to eat. Occasionally a member of staff was observed moving a person in a wheelchair without first talking to them or consulting them about what they were doing. For instance taking them from the dining room and putting them in front of the television. (See also Standard 32) Service delivery plans for two people also referred to people’s communication needs although no communication profile was in place. For example one plan stated that the person can communicate with one or two word answers and advised staff to be patient and listen carefully. There was no information about the words that this person may use or understand or whether they could use any other form of communication. There was also no guidance on how to interpret their body language or mood. Several entries in the communication book indicated that people are having difficulty accessing their personal monies when they wish. The registered manager explained that she and the deputy manage personal finances and leave limited amounts of money for people to access when they are not available. Two people spoke about their concerns about how they are unable to access their money when they wish to. One person would like to purchase new equipment for their room and said they had been waiting to do this for some time. Financial records were examined and these are mostly satisfactory. Receipts can be cross-referenced with purchases. Some receipts were queried with the registered manager. They appeared to indicate that people living at the home are paying for staff expenses when they go out for a meal or a snack. The home’s policy and procedure in relation to finances clearly states that staff Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 12 expenses up to the value of £5.00 must come from petty cash. The registered manager confirmed this is the correct procedure. Risk assessments are in place, a number of which are generic including a risk assessment for people who experience seizures using the bath or transport. As a result these risk assessments fail to indicate the hazards each individual may face due to their condition or disability. Risk assessments for people using the home’s minibus have been reviewed in light of an accident when a person drove their wheelchair off the rear of the bus. They state that all wheelchairs are switched to manual when put onto the lift of the bus and are clamped whilst in transit. The clamps remain in place until the person is being taken off the vehicle. A seat belt is also worn. Staff and people living at the home verified this practice. Observation of people using the home’s vehicle also confirmed this procedure is followed. Some people have an escort. This appears to be determined by how many people are using the vehicle and whether people are at risk of having a seizure. A protocol in place for one person who occasionally uses their wheelchair as a weapon indicates that under extreme circumstances the electric wheelchair can be switched off. A risk assessment for the same person states that the wheelchair cannot be switched off. The protocol also states that if the wheelchair is switched off then this is a form of physical intervention and under Regulation 37 we are to be notified. An incident record in March stated that the chair had been switched to manual but no notification was received. Hertha House DS0000069133.V339807.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): 11,12,13,14,15,16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are limited opportunities for people to make choices about their life style and their day-to-day lives. Plans to involve people in a greater range of social, educational, cultural and recreational activities will improve this. Relationships with family and friends are supported and respected. Freshly cooked meals are produced which provide a nutritional and balanced diet. EVIDENCE: Each person has a schedule of activities and a daily planner in the office indicates what is planned. Some people attend day centres or colleges on a regular basis both locally and in neighbouring towns. People access day and evening courses. Where people choose not to go to a scheduled activity this is occasionally being recorded in their daily records. Daily notes confirmed that one person is being supported to go to the local library. Two people attend a Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 14 local church. Another person’s care plan states that they will be supported to go to church but staff said that they do not go. Several people spend a considerable amount of time in the home. Some were observed being taken to the local park or shops. Staff were also observed supporting them to play games. One person said they enjoy playing ball games in the garden. A range of craft materials are provided in the lounge on the first floor. Another person said that people like to use the sensory room and to have a Jacuzzi. The deputy manager stated that a member of staff had been given the responsibility of supporting people to access a range of activities. There are indications that staff are trying to enable people to access an increased range of opportunities locally and to arrange activities within the home. One person was observed in discussions about plans to go to a social evening with a local group they belong to. Staff were also noted trying to arrange an evening out for people. Other activities being arranged include day trips to places of interest and a holiday. One person said they were supported to go to Nottingham for the weekend. A recent care plan for one person living at the home indicated that they do ‘not appear to be having adequate support from staff with social stimulation at present’. Comments from parents, relatives and visitors also support this viewpoint. Staff spoken with indicated that they hope that they will be able to sustain opportunities for people to participate in activities inside and outside of the home. People are supported to maintain close contact with their families and friends. One person has a telephone in their room and said they speak to friends each evening. A person said that staff support them to maintain contact with friends taking them to visit when they wish. Parents visit regularly and people go home for short stays. Parents and relatives were spoken with during the visits. People are involved in the choice of meals and are asked each mealtime about what they would like to eat. A main meal is provided at lunchtime that is freshly prepared by a cook and alternatives are offered. Staff prepare tea. They have completed a basic food hygiene course. The cook confirmed she would be attending the ‘safer food better business’ course. People were observed enjoying their meals in a relaxed atmosphere with bantering and humour between people and staff. Support is provided where needed and specialist equipment is available where needed. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A consistent approach is required to ensure that the personal and healthcare support provided to people reflect their individual needs. People who use this service are generally protected by the home’s policy and procedures for dealing with medication but the report indicates some areas where more attention to details are needed. EVIDENCE: Staff were observed supporting people with respect and sensitivity. Those spoken with have a good understanding of the needs of people. Some agency staff are still used and although provided with an induction this does not appear to cover the personal and healthcare needs of people. Discussions with agency staff confirmed they were not aware of some of the needs of people such as whether they have allergies or how they would like to be supported. Daily diaries provide a record of people’s routines that appear to be flexible. Several people have a rest in the afternoon particularly if they spend a considerable amount of time in their wheelchairs. Some people have comfy Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 16 chairs provided but do not tend to use them a great deal. Staff indicated that people did not like to use these chairs because they lose their independence. It is important that staff are aware of the risk of pressure sores developing for people who use wheelchairs and how to prevent this. After discussions with one person about whether they use their comfy chair they were observed asking staff to help them transfer into the chair whilst they listened to their music. A number of people have physiotherapy exercises to do on a daily basis. A physiotherapist has provided comprehensive guidelines that include a photographic sequence of exercises. Staff record when the exercises are completed. Records indicate that these are not being done daily. People have regular access to the local Community Learning Disability Team for physiotherapy, occupational therapy and speech and language therapy input. The Wheelchair Assessment Centre is also closely involved with the home. Records are kept of appointments with a range of healthcare professionals. Due to the way in which they are recorded it is difficult to ascertain at a glance when appointments are due with the dentist or optician. Records appeared to indicate for one person that they were overdue for a dentist appointment. Health action plans are being developed for each person and would provide a clearer system of recording than is presently in place. A medicine policy and procedures are available to staff in the medication room. Trained staff administer medication and where medicines are administered by more specialised methods district nurses or hospital staff provide training to the home staff. An up to date medicine reference book is kept so that staff have information about the medicines they use. The home keeps records of medicines received, administered and disposed of which helps make sure there is no mishandling and people living in the home receive the correct medication. Sample checks of the records and medication in stock indicated the records were in order and that people who live here receive their medicines correctly. There were some examples where records had not been made of medicines received in between the usual monthly order. Records are also needed when people go to a day centre and their medicines are sent and returned. The pharmacy provides printed medicine administration charts each month. There were some handwritten additions on the printed charts where medicines had changed or additional items prescribed. It is best practice if the member of staff responsible for this signs the entry and a second member of staff checks and signs that this has been copied correctly. This was not always done. There were three examples where the strength of the medicine was not included on the handwritten entry so it is not possible from the records to tell what dose was given to this person. One medicine is prescribed to give a dose Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 17 of 5ml or 10ml. Not all staff are recording what dose is given which is important to help make sure the correct level of that medicine is given. There is a personal medication sheet for each person with a photo, details of allergies and the method of taking medication. For one person this sheet recorded an allergy to trimethoprim but the allergy box on the medicine chart said ‘none known’ which is confusing. For the same person the method of taking medication had been blanked out and no new information added. Some medicines are prescribed to use ‘as required’ so plans need to be in place to describe what this direction means for each person and each medicine with this direction. A plan was only seen for one person who lives in the home but this person also has alternating treatments of two medicines every month. The medicine chart in use was clearly marked but as this cycle is repeated every month this should be part of a medication care plan. Eye drops for another person were prescribed to use ‘as required’. One member of staff spoken to understood that these drops should be used regularly during a particular season to prevent symptoms but the records indicated not everybody is aware of this. A clear protocol for use is needed. The home orders repeat prescriptions from the GP and these are seen in the home to check before they are sent to the pharmacy for dispensing, which is good practice. It is important to check that all the directions on the prescriptions are complete and accurately reflect the way the medicines are used. Careful liaison with the GP and the pharmacy can help to make sure the home records are up to date. There was an example where the medicine container was labelled ‘as directed’ which is not acceptable. Other directions indicated medication to be administered regularly but in fact is used ‘as required’. One person is prescribed a medicine to use in a particular emergency. There is a clear protocol in place but the medicine should be included on the medicine chart so that a record can be easily made if the medicine is given. Stock levels of medicines were better controlled since the last inspection. All medicines needed were in stock and there was no evidence of any items not being available to give this period. Most medicines had an opening date so audits were possible and stock was rotated correctly. There is evidence of the manager’s monthly checks of medicines. One person living in the home has complex health care and feeding needs. Records are kept of the feeds given and there are protocols in place from the hospital about how this treatment is managed. Staff spoken to during the inspection clearly described how they managed the treatment and administered the medicines. The care plan needs updating to include the latest medication used. The home should ask the GP to indicate the route by which medicines are administered on prescriptions for this person so that there is a clear authority on the way the medicines are administered. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 18 Improvements have been made in the medication room. Safe arrangements must be in place for the storage of medicines at the correct temperature. The cover on the fan unit needs cleaning and some containers and parts of the medicine trolley were sticky. Some medications for external application were found in a bedroom. One item should be kept in the fridge and the items included on the medication records. This is necessary so that staff know when the treatment is applied and helps make sure this is done correctly as the doctor has directed. The shift leader attended to this during the inspection. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns in the knowledge that they will be listened to and action taken as a result. There are safeguarding adults procedures in place and staff training is given in their use, providing staff with the knowledge and awareness to recognise and report incidences of abuse. EVIDENCE: At the time of this inspection a complaint was received from a parent. In essence the complaint covered two areas: • • Concerns that the health and safety of people using the home’s transport was put in danger due to unsafe practices Concerns that people are not having access to a range of social, educational and recreational activities The complaint was referred initially to Aspects and Milestones to investigate and a full account was given to us and to the complainant. This was not to the satisfaction of the complainant. We found that a person was transported on the home’s vehicle and on reaching their destination the member of staff unclamped both wheelchairs on the vehicle. The member of staff then left the vehicle with one person, leaving the other person unsupervised. The wheelchair had not been switched to Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 20 manual and so this person was able to try to leave the vehicle whilst the lift was on the ground. At the time of the incident there was no risk assessment in place to advise staff what they should do. Staff confirmed that training consists of another member of staff explaining the process for securing wheelchairs onto the bus. Since the incident a risk assessment and guidelines have been put in place describing what needs to be done. Staff stated that wheelchairs are now put into manual when using the vehicle and escorts are provided when appropriate. This was confirmed through observation and also in discussion with people using the vehicle. At the time there was a breach of the regulations but the home have reviewed their procedures to minimise the risk of this occurring again. The member of staff no longer works for the home. A recommendation has been made to ensure that staff training in the safety of wheelchair passengers is put in place and recorded. As mentioned under standards 11-14 people have access to some activities and staff are researching other opportunities for people to be involved in their local community and engage in appropriate activities. This is dependent upon the staffing levels being sufficient to enable this to happen. At the time of the inspection staff feel that they are mostly able to support people if they wish to go out. A breach of the regulations has been upheld and a requirement has been issued in respect of this. People have access to a complaints policy and procedure that is available in a text and symbol version and explained to them. A complaints folder is kept with outcomes of complaints recorded. No other complaints have been received by the home. Staff receive training in the safeguarding of adults with the local adult protection team and those spoken with have a good understanding of their responsibilities in recognising and challenging poor practice and possible abuse. The registered manager confirmed that staff have also had training in the management of challenging behaviour. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is designed to provide safe and well maintained accommodation for people with a physical disability which encourages their independence. EVIDENCE: Hertha House provides accommodation that was designed to meet the needs of people with a physical disability. Each person has a room with en suite facilities and also has access to a Jacuzzi style bath. Rooms on the ground floor have overhead hoists. Specialist adaptations and equipment are provided where needed. People are supported to decorate their rooms that reflect their interests and lifestyles. Several rooms have new carpets and have been redecorated. Some people have also been supplied with new beds with pressure relieving mattresses. There are spacious communal rooms including a lounge/dining room, sensory room and first floor lounge and conservatory. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 22 The carpet in the lounge/dining room has been cleaned but is still very stained and in a poor condition. Likewise carpets in the hallways on the first floor need attention. Aspects and Milestones have put in arrangements for the day-to-day maintenance of the home. Any issues are recorded in a log which the maintenance team action during their two visits to the home each month. At the time of the visits the home was clean and tidy. The home has a cleaner but staff also support people to clean their rooms. Personal protective equipment is provided. Each toilet or communal hand washbasin is supplied with liquid soap dispensers and paper towels. Hazardous products are stored securely and COSHH data sheets are in place. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from the support of a diverse staff team who have not had the opportunity to further develop their knowledge and skills in areas which reflect the needs of the people living at the home. EVIDENCE: The staff group consists of staff who have worked at Hertha House for a number of years, newer staff to the home and agency staff. Two new staff are being recruited. The diverse range of skills and knowledge is evident when talking to staff and it is important that all staff have access to information about the people they support. Staff stated that morale within the team is improving and that good communication systems are in place. The registered manager confirmed that staff have access to a NVQ programme and that they are being registered to start their awards. Staff confirmed that staffing levels are being maintained at a minimum of three per shift rising at times to five if the schedule of activities indicates this is needed. The home will be running with five vacancies and it is important that Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 24 staffing levels are maintained and/or increased when new people are admitted, as their needs dictate. Staff were observed treating people with dignity and sensitivity. On both visits positive interactions were observed dealing with anxieties and concerns of people. There was also a relaxed and jovial atmosphere. The files for two new members of staff were examined and these were found to be satisfactory. Where there were gaps in the employment history there was evidence that these had been questioned at interview. Two written references and a satisfactory Criminal Records Bureau check are being obtained prior to employment. The registered manager confirmed that a person doing voluntary work was offered a position after completion of the same checks as for a new employee. Their records had not been returned from head office and were not available for inspection. Staff have access to a range of training courses and open learning through Aspects and Milestones. A copy of the current programme was examined. Copies of certificates of attendance are kept on staff files and a training matrix is maintained by head office. There was no evidence that staff are accessing training specific to the needs of the people they support apart from Learning Disability Award Framework. Such key issues as physical disability awareness, tissue viability and total communication have not been covered. It was noted that some staff did not have an awareness of how to prevent pressure sores, or how to approach people using wheelchairs. Some staff were observed moving people in their wheelchairs from behind without talking to them or consulting them, or coming up to people from behind and touching them without announcing their presence. Some staff were observed talking with people prior to moving them and also talking to them at their level by making sure they were sitting down to have a conversation with them. This is good practice. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 25 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The quality assurance system has not been implemented and as a result people are not being involved in the evaluation of the service being delivered by the home. People are being put at risk due to unsafe health and safety practices. EVIDENCE: The manager is a registered nurse and has completed the registered managers award. She has over 20 years experience in this area of care. She is also a NVQ assessor, health and safety auditor and moving and handling trainer. She is continuing her professional development by completing courses in the mental capacity act, the grievance procedure and safer food better business course. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 26 Concerns were expressed by people living at the home, parents and staff that there is not always access to management on a daily basis. The manager is presently working four long days each week and supported by a deputy manager who works a mixture of shifts alongside her and on days when she is off duty. The manager said that when not in the home she is on call and contactable by the telephone. Aspects and Milestones are based in Bristol and support for the manager is provided from there. This means that the manager may spend part of her working week in Bristol at meetings or training. Aspects and Milestones have a quality assurance system that the registered manager confirmed would be put into operation in the home. Regular unannounced monthly visits take place and copies of the written regulation 26 reports are forwarded to us. The registered manager confirmed that a survey would be conducted with people living at the home in the next few months. Systems are in place to monitor aspects of health and safety within the home. Fire records are maintained and equipment checked on a regular basis. A recent visit from a fire officer made several recommendations one of which was to ensure that fire exits are kept clear. During the visit two fire exits were blocked with wheelchairs. The registered manager confirmed that three other breaches of the fire regulations have now been complied with. The fire risk assessment needs to be put in place and the home’s fire policy and procedure needs amending to reflect changes to the evacuation of people living at the home. It currently states that people can be left in their rooms; this is no longer the case. The registered manager needs to ensure night staff are aware of these changes. It was noted during the visits that the portable appliance tests for electrical equipment were overdue. Arrangements were made immediately to have these tests completed. Servicing of hoists, slings and the lift is in place. Good food hygiene practice is in place with consistency being maintained by the staff team when the cook is not on duty. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 27 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 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 2 X Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 17(1)(a) Sch 3.3(l) Requirement Timescale for action 31/08/07 2. YA7 3. YA7 4. YA9 5. 6. YA11 YA14 7. YA18 Communication profiles need to be put in place to give staff guidance about the specialist communication needs which may be appropriate to people. 16(2)(l) Arrangements must be made to return to people any money or valuables placed with the home for safekeeping. 12(5)(b) All staff need to be aware of the home’s financial policies and procedures to protect people from possible financial abuse. 37 In cases where physical intervention is used, such as switching an electric wheelchair to manual, to prevent harm to other people, the Commission must be informed. 16(3) People must be assisted (as far as practical) to attend religious services of their choice. 16(2)(m)(n) All people must be assisted to engage in local, social and community activities and be consulted about a programme of activities with regard to recreation, fitness and training. 18(1)(a)(b) Induction training that includes DS0000069133.V339807.R01.S.doc 31/05/07 31/05/07 30/04/07 31/05/07 31/05/07 31/05/07 Page 29 Hertha House Version 5.2 8. YA18 12(1)(a)(b) 9. YA20 13(2) 10. YA20 13(2) 11. YA24 23(2)(b)(d) 12. YA32 12(5)(a)(b) 13. YA35 18(1)(c)(i) 14. YA37 8(1)(b)(i) information about the personal and healthcare needs of people must be provided for agency staff. People must be assisted to complete daily physiotherapy exercises promoting their health and wellbeing. Arrangements must be made to make sure that the prescription directions and medicine chart directions are complete, up to date and accurately define how each medicine is to be given. There must be up to date medicine care plans to clearly describe how to use medication prescribed ‘as required’ or administered in a more complex manner. This will help to make sure people living in the home receive the correct levels of medication. Records must be kept of all medicines received into the home and sent to or returned from a day centre as part of the audit trail to make sure there is no mishandling. Where a variable dose of medication is prescribed the actual dose given must be recorded to help make sure people receive correct levels of medication. The carpet in the dining room and hallways on the first floor need to be kept in a good state of repair and kept clean. All staff must treat people with dignity and respect encouraging and maintaining good and professional boundaries. All staff need to have the knowledge and skills to support people with a physical disability. The registered manager must ensure that she provides dayDS0000069133.V339807.R01.S.doc 31/05/07 31/05/07 31/05/07 31/08/07 31/05/07 31/08/07 30/04/07 Hertha House Version 5.2 Page 30 15. YA39 24 16. 17. YA42 YA42 23(4A)(b) 23(4A)(b) to-day management of the home. A system for evaluating the 31/08/07 quality of care provided at the home must be put in place that involves people living there. A report must be produced providing a summary of this process and what measures the home are taking to improve services. Fire exits must be kept clear so 30/04/07 that people may evacuate the building should there be a fire. A fire risk assessment must be 31/05/07 in place that complies with the Regulatory Reform (Fire Safety) Order 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA9 YA9 YA19 YA20 YA20 Good Practice Recommendations Care plans should give staff specific guidelines about how they should support people to meet their assessed needs. Each person should have a risk assessment that indicates the hazards they face due to their particular condition or disability. Where protocol and risk assessments exist side by side, the information contained must be consistent. Health action plans should be developed for each person. Staff should have training in the safety of wheelchair passengers using the home’s vehicle. This should be noted in their training record. A second member of staff should check and sign any handwritten additions or changes on medication charts to make sure that all details are correct. Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Hertha House DS0000069133.V339807.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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