Inspection on 04/10/07 for Hertha House

This inspection was carried out on 4th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 20 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 24/04/07

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 4 , 5 and 12th October 2007 07:30 th th Hertha House DS0000069133.V350957.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.V350957.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.V350957.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.V350957.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. 20th September 2007 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. Two self-contained flats on the first floor are managed under the supported living scheme. Aspects and Milestones Ltd have recently become 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. 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.V350957.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 inspection took place in October 2007 and was scheduled in response to concerns raised during a random inspection of the home in September. The commission received a complaint in September that was forwarded to the management of the home to deal with. Another random inspection was completed in June with an Officer from the local Environmental Health Department over concerns about an incident which was not reported to them. An evening inspection was carried out in response to comments from people living at the home and visitors that people were often in bed around 20.00 hours. The inspection continued the next day with another inspector during which the management of the home including the area manager were present. A return visit was needed to complete the inspection. People living at the home were observed and spoken with. Some staff were spoken with and feedback was obtained from relatives and healthcare professionals. A sample of records were examined including care plans, staff files, health and safety records and financial and medication systems. What the service does well: What has improved since the last inspection? Person centred plans continue to be put in place involving people living at the home identifying their needs and wishes. A person said that they were enjoying being able “to bake cakes in the kitchen.” Pen pictures have been put in place providing new staff and agency staff with a summary of information they need to know about each person’s needs. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 6 New carpets were being fitted during the visits to the home. A quality assurance system is being put in place although this has still to be completed. 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.V350957.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.V350957.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): 2 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 home is not obtaining up to date assessments of people wishing to move into the home which may result in the placement failing. EVIDENCE: Two people have moved into the home since the last key inspection. One person was staying at the home for a few months whilst their home was being refurbished after the recent floods. The other person had been living with their parents. There was evidence that the home had obtained information from the placing authority prior to admission. However the assessment and care plan for one person was completed in December 2005. An assessment from a Domiciliary Care Agency providing care in their home had been provided and this was dated February 2006. There was a copy of a partially completed assessment conducted by the home prior to admission. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 and 10. 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. Changes to the care planning system need to be consolidated to ensure information is up to date and relevant. People’s independence and autonomy is being hampered by limited access to their personal finances. EVIDENCE: The care of three people was case tracked which included reading their care plans. Person centred plans were still being put in place. At the time of the visit two types of care plan were in use. The service delivery plan had information about the social, emotional, physical and intellectual needs of each person. There was evidence that this plan was being reviewed every two or three months. Each file contained records dating back to 2006 making it difficult for staff to access information easily and quickly. The plan for one person noted significant changes to the person and sections were crossed through. Reference was made to new systems that had been put in place but evidence could not be found of a new care plan to reflect this. Management Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 10 said that the new person centred plan would include this information. However this change in need had occurred almost twelve months ago. Person centred plans were being put in place for four people to reflect their wishes and aspirations. The deputy manager stated that people living at the home had been involved in this process as well as their relatives where possible. Plans examined had not been dated or signed by the author or people living at the home and did not provide details of when people were admitted to the home. At the last inspection it was noted that care plans were not specific in the details they gave to staff about bathing or the preferred gender of staff providing personal care. New guidelines have been put in place providing a pen picture of each person giving a snapshot of their needs and how they would like to be supported. However information about their preferences for the gender of staff providing support could still not be found. Communication profiles had been put in place but did not provide sufficient information about how people communicate their needs and how staff may interpret their non-verbal communication. One person living at the home sees an advocate on a regular basis and other people were involved with Gloucestershire Lifestyles who can also provide advocacy services. People were observed being supported to make decisions about their day-today life. For instance one person was offered a range of options about where they would like to be in the lounge and whom they would like to be with. Another person was offered a choice of drinks rather than assuming they would like their usual cup of tea. One person wanted to speak to a parent and staff supported them to make a telephone call in private. Concerns were expressed at previous inspections about accessibility to people’s personal finances when management were not in the building. Comments in the communication diary indicate that this is an ongoing concern. It was necessary for staff to pay for wheelchair repairs out of their own pocket because they did not have access to sufficient funds to pay for this. Additional comments had been made by some staff about having to support people to budget over weekends or when they knew management would not be in the building to ensure there would be enough cash for people. This was not however the view of all staff. Management confirmed that £20 cash is left for people when they were not in the building. This may remove the spontaneity of people being able to make purchases or go on activities inhibiting their independence and ability to make choices for themselves. The manager stated that the reasons for this were to ensure that cash was secure. The organisation’s financial policy and procedure states that no more than £40 can be kept in the home for each person. Giving staff access to the safe or providing an additional safe would go some to way to alleviating this problem. Systems for the administration of personal finances were satisfactory. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 11 Financial records were being kept for all transactions and receipts were being kept and cross-referenced with purchases. Risk assessments were in place for a range of hazards. New risk assessments had been put in place to cover hazards during moving and handling and using the home’s transport system. Pen pictures were in place with a recent photograph of each person which double as missing person’s information. At the time of the visits a folder containing personal information about people for new staff and agency staff was left on the desk in the office accessible to not only staff but also visitors. Information about people living in the home must be stored securely. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 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. Further improvements need to be made to ensure that people have the opportunity for personal development and fulfilment. Providing structured routines for their day-to-day lives will significantly improve their lifestyle. EVIDENCE: Aspects and Milestones Quality Assurance Audit has a section entitled “Meaningful activities” which assesses whether people ‘have a daily routine that is designed around his/her needs and capabilities and that resembles as closely as possible a typical adult routine. Such a routine is likely to include vocational, domestic and leisure activities. The person’s activities provide opportunities for personal growth and increased life satisfaction’. Despite an increase in the opportunities for people living at the home such as day trips there was still no evidence to suggest that all people were having regular structured daytime activities. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 13 One person living at the home said that they “need more outings”. Comments in the review of a care plan for another person stated that they “need more activity but Social Services will not fund this”. A parent commented, “Young people such as these should be out and about not sitting watching television”. Improvements have been made. One person said that they love to help bake and cook on a regular basis. One person had started going to church with another person from the home. There was evidence that arts and crafts sessions take place in the lounge and people may use the sensory room and Jacuzzi. Some people were involved with Gloucestershire Lifestyles and have access to a wide range of activities through them. Other people continue to go to day centres or the Guildhall on a regular basis. However for a core group of people there appeared to be long periods of time spent in the lounge with the television or radio for company. During the evening visit four people spent almost two hours in the lounge with very little company or stimulation. A news programme was on the television. People living at the home have said that staff “were really good but that they are struggling”. From 8.00 pm in the evening two members of waking night staff support the eight people currently living at the home and were observed busily supporting people in their evening routines. This clearly did not leave sufficient staff to supervise or spend time with all people living at the home. A three-week period during August/September was sampled for three people. One person visited the pub once, had several visits home and went into town twice. The rest of their time according to daily records was spent colouring, watching television or listening to radio and playing dominoes. Another person went for day care twice each week, into town once and the pub once. The rest of their time was recorded as singing or using the computer. The third person went to the pub once, did exercises four times and visited family twice. The remainder of their time was spent watching television and resting either in a comfy chair or bed. During the second visit to the home one person was at college and everyone else went into Gloucester to do shopping and have lunch out. People have regular contact with relatives and friends. They were being supported to keep contact over the telephone, by going to see them and by visits to the home. The home employs a cook and she had completed the ‘Safer food better business’ course. She had stated that budgets were sufficient to provide a nutritional and healthy diet for people. A freshly cooked meal was being provided at lunchtime and a snack was prepared for tea. People living at the home said that they enjoy the food. Individual menus were being kept for each person providing sufficient information about their diet. One person has Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 14 a Percutaneous Endoscopic Gastrostomy (PEG)feed and staff have received the appropriate training they require. Hertha House DS0000069133.V350957.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. Whilst personal and health care needs in some areas are being met there are serious concerns about the inconsistencies in personal care and failure to respect the dignity and wellbeing of people living in the home. Some shortfalls in the handling of medication need to be addressed in order to promote the safety and wellbeing of people living in the home. EVIDENCE: The way in which people would like to be supported was being incorporated into the new person centred plans and had been included in the pen pictures provided for agency staff. On arriving for the evening visit a person was being taken from the Jacuzzi to their room along the main corridor wearing only a small towel. Ways of ensuring the dignity of people using the Jacuzzi must be discussed with staff. Three people were in their pyjamas in the lounge and one person was waiting to have a shower. One person went to bed around 20:30 and was asked by staff whether they wished to continue watching television and they said, “no could I go to bed”. Daily records monitor sleep systems Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 16 used by several people and these indicated that bed times varied between 21:00 and 22:00. One person said that they regularly go to bed after 22:30. Staff confirmed that bed times were flexible and dictated by people’s wishes although bath times and getting ready for bed were largely in response to staffing levels and shift times. People were observed using their comfy chairs and spending time out of their wheelchairs. There appeared to be some inconsistencies in practice with one member of staff propping a person’s head up with a pillow that was later taken away by another member of staff. The person was then observed to have problems keeping their head up. There appeared to be a large number of monitoring forms in use including one for recording when people had completed physiotherapy exercises. Over a three-week period in August/September records indicated this was not being done each day. On the first visit records showed that for the week starting 29th September until 4th October people had done exercises on two or three days out of the six day period. This information was backed up with entries in daily diaries. People living at the home said that some agency staff were unsure of how to help with the exercises and one person said that they occasionally refused to do the exercises. The expectation of staff to complete these monitoring forms was discussed with management. It was unclear whether records were not being maintained because there were just so many forms to complete or because staff were not completing exercises. Management had just introduced another monitoring sheet summarising all other charts/records being kept. Again staff were not completing this consistently. Records of healthcare appointments were being kept with a summary of the outcome of the appointment. For those people being case tracked there was evidence of regular consultations with their GP, chiropodist and access to the Community Learning Disability Team. An entry in one person’s records indicated that in April 2007 the dentist suggested a referral to a specialist dentist. There was no evidence that this referral had been made. Health action plans had not yet been put in place. There was evidence that a person had been referred promptly for advice from a dietician when changes were noted to their circumstances. Also where there were concerns about people’s health they received quick attention from their GP or District Nurse. Medication was kept in a lockable cupboard within which was stored a portable, locked trolley for day-to-day administration. There was additional medication stock on shelving. A record was seen of daily temperature checks in the room. Staff reported that this was usually between 24°C and 27°C. The temperature had been recorded Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 17 as 26°C on several occasions during September 2007. This is too high. The reliability of the thermometer should be checked and if the temperature in the room is sometimes in excess of 25°C then measures will need to be taken to reduce this. A double locked cupboard was available for storing controlled drugs. A book was seen for the recording of twice-daily checks on stock levels. However, on many occasions there was just one check recorded per day. A dedicated fridge for storing medication needing to be kept at low temperature was provided in the home. A staff member described the medication administration process, demonstrating awareness of appropriate procedures and of the need to avoid ‘potting up’ in advance of a round. They described the system for handling medication if it was refused or fell on the floor, and the procedure to be followed if an error was noted. A sheet with the signatures of staff members trained/authorised to administer medication was seen. It was reported that staff received training about the safe handling of medication from the supplying pharmacy for half a day, and that there was an in-house competency assessment followed by the person being shadowed when first administering. It was stated that two agency staff members were on the signatory list. Records indicated that the home had received evidence from the agency that these staff had received training about the safe handling of medication. Permanent night staff were also pointed out on the list of people trained and authorised to administer medication. Consideration should be given to offering staff further training about medication to enhance their knowledge and understanding in this area. There was discussion with the manager about possible options such as in-depth distance learning courses overseen by local colleges. Staff reported that there had been training for the team about feeding and administration of medication for one person via their PEG and that a dietician visited regularly to monitor this and to refresh the team’s knowledge. It was also reported that some staff had been trained in the administration of a rescue medication, and that the district nurse or the home manager and deputy manager (through delegation) provided training for new staff and annual updates. Records of training in specialised techniques were not checked on this occasion. Examples were seen of the medication administration competency test undertaken in the home. This appeared to be thorough. A copy of the British National Formulary (BNF) from September 2006 was seen in the home along with another reference manual. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 18 Evidence was seen of medication received into the home being appropriately recorded. Records were also seen of periodic audits of stock levels by the manager. These were around monthly, though on occasion slipped to every two months. Copies of the organisation’s medication policies were seen along with local policies about medication and homely remedies which provided more detailed information about procedures in the home. At the time of the examination of medication systems consent to medication by people living at the home could not be found. This was provided during the last visit to the home. Examples of protocols for ‘as required’ medication were seen. These provided clear guidance and there was generally evidence of them being up to date, although in some cases there was no date recorded. Some handwritten entries were seen on administration records. Some had been signed and counter signed but others had one or no signature. One person who had moved in about a month previously did not yet have a photograph in the administration record. This should be obtained as soon as possible. The current administration record was sampled. Whilst in most cases this appeared to be appropriately completed, the following was noted: • • One person was prescribed Movicol for administration once a day, but this had not been signed for on September 27th and 28th 2007. Another person was also prescribed Movicol. An entry had been written on the chart stating that it was not a PRN (as-required) medication. However, the record for the end of September 2007 largely consisted of gaps or of the code ‘N’ (PRN not required). The same person was also prescribed Senna solution. There was another handwritten entry stating that this was not PRN. However, the only entries seen on the chart were for 28/09/07 and 05/10/07. The medication was variable dose but only the second entry recorded how much was actually given. • A daily communication entry indicated that medication for one person had been left at their day centre and so staff had used another person’s medication and replaced this when the medication had been returned from the day centre. The manager when questioned was unaware of this. Hertha House DS0000069133.V350957.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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to a complaints process that takes on board their views and gives a response within the organisation’s timescales. Not all people feel confident in using this procedure. Systems are in place that safeguard people from possible harm or abuse. EVIDENCE: The home has a complaints system in place. This is produced in a format appropriate to the needs of people living at the home. Two complaints were received by the home since the last inspection. Aspects and Milestones responded to these within 28 days. The Commission initially received one of these complaints which was referred back to Aspects and Milestones for investigation. This inspection monitored the response to that complaint and noted any action taken as a result. One complainant indicated to the Commission that they were unsatisfied with the response to their complaint. Management of the home said they were unaware of this. Both complaints raised concerns about cleanliness within the home and complained about bedding which was soiled or odorous. In response to one complaint the manager stated that beds were changed each week or sooner if required but this was not addressed in the response to the other complainant. There was evidence that staff had been reminded to ensure that beds were being changed regularly. Other aspects of the complaints referred to poor communication during the recent flood crisis and the quality of food. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 20 A person living at the home said that they would talk to the manager or staff if they had concerns. Relatives said that they would talk to firstly to the manager and then to the Commission if they had any complaints. However concerns expressed during the inspection from staff, people living at the home and relatives indicate that the systems the home has in place are not creating an environment which promotes open discussion of concerns. The area manager expressed concerns that people were coming directly to the Commission rather than approaching Aspects and Milestones. Training records indicated that staff had completed training in the safeguarding of adults. Staff spoken with confirmed that they had attended training with the local adult protection team and appeared to have a good understanding of the systems in place. Hertha House DS0000069133.V350957.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 & 30 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. Whilst the environment is generally clean, well-adapted and in a reasonable state of repair, some improvements are needed in order to promote people’s safety and comfort. EVIDENCE: All of the bedrooms were checked. They were seen to be personalised and to contain appropriate specialist equipment. The rooms were fresh and décor was reasonable, although showing signs of wear and tear in areas, often related to wheelchair use. The following needed attention: • • One person’s room had a chest of drawers with a missing front to one drawer. In the same person’s en-suite the cover for the electrical connections at the top of the pull cord was coming away from the ceiling. DS0000069133.V350957.R01.S.doc Version 5.2 Page 22 Hertha House • • • • • One person’s mattress had a covering of crumbs of food. Their easy chair also needed to be brushed to remove food particles. One bedroom had a carpet in two sections with a frayed piece of tape joining them. The carpet was also quite stained. It was reported that quotes had been obtained for the carpet to be replaced and that the work was imminent. One room at the end of a corridor had a very stained carpet. Again, it was reported that this was going to be replaced in the near future. The same room had a sheet used as a temporary curtain for reasons which were explained. This will need to be replaced with appropriate curtains or blinds. The above room also had a very stained covering for the shower chair which needed replacing. One person’s room felt quite hot, and two fans were on. This should be investigated to establish the cause and the person should be consulted as to whether they are happy with the temperature. Communal areas were also checked. Aside from some general wear and tear, the atmosphere was fresh and the home found to be clean and with reasonable décor. The following was noted: • • • The dining area/lounge had a badly stained carpet in need of replacement. It was reported that this was going to be done at the same time as the bedroom carpets noted earlier. The plastic wall covering beneath a section of handrail by a fire exit to the car park was buckled and coming away from the wall. Some household chemicals were found around the home and were potentially accessible to service users, posing a hazard. These were pointed out to the manager. It was also suggested that pure essential oils be subject to a risk assessment if it were proposed to continue leaving them out/accessible. The carpet by the staff lockers was stained. This should be cleaned or replaced. Some mop buckets were found to be encrusted with a significant layer of dirt and grime. • • The kitchen was clean and well organised. However, some chemicals were stored in an unlocked cupboard including corrosive oven cleaner. Some corn flour was stored in a tub stating ‘best before July 2007’. The worktop had two damaged patches next to the hob, which could pose hygiene hazards. It was reported that the service had received a five-star rating from Environmental Health, which is a commendable achievement. Hertha House DS0000069133.V350957.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): 32,33,34,35 and 36. 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. Staff are not being supported to fulfil their roles and responsibilities effectively and as a result people living at the home are receiving a poor quality service. EVIDENCE: There had been some stability in the staff team over the past six months with two new people joining the team. The manager confirmed that over 50 of the team have a NVQ Award in Health and Social Care. The team consists of staff with a diverse range of knowledge and skills. Concerns were raised by staff after the random inspection in September when morale appeared to be low. Staff reported that there was no consistency in the staffing levels at the home with occasions when they felt overstaffed and on other occasions there were three or even two staff on duty. One staff member stated that “staff don’t have confidence in the rota it is often running low/below levels”. It was also stated that sometimes there were two male staff members on shift which led to difficulties providing personal care to females living at the home. Other staff spoken with said that this had not Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 24 been a problem on their shift. Rotas confirmed that at times there were four staff scheduled to work rising to six at other times. Daily records over a twoweek period indicated that on two occasions there were three staff on duty. Feedback from management after the random inspection stated “currently the home has eight service users out of a possible eleven living at the home. Staffing consists of four staff on duty during the day and two waking night staff”. A response to an urgent action letter sent to the responsible individual after the inspection stated that staffing levels are based on eleven people living at the home. The Commission continues to have concerns that the staff levels and the diversity of their roles were impacting on the outcomes for people living at the home. We will continue to monitor this. The staff team at present support eight people, seven of whom use a wheelchair and need help with personal care. They also have responsibility for helping people keep their rooms clean, do the laundry, drive the mini bus, prepare the evening meal and maintain recording systems. A parent commented “staff have long shifts, with additional cleaning and laundry duties which impact on the home”. The present structure within the home was discussed with management. There are no team leaders so a member of staff is appointed as the key holder each shift. At the random inspection staff commented that with no one responsible for monitoring staff, some people take advantage. For instance when staff go out for a cigarette guidelines state they do this one at a time, when management were not present, this was being abused and all staff were taking a break together. Also as mentioned previously staff do not have access to people’s full personal allowances when management were out of the building. A team meeting was held in October and management stated that they have plans to hold short quizzes at future meetings to ensure that staff are aware of key policies and procedures. Staff commented that meetings were being held irregularly. Copies of staff meeting minutes indicated that they were being held every two or three months, with a total of four having taken place during this current year. Staff information for two new members of staff was requested. One had started in April 2007 and the other had been transferred from a service in Bristol. Neither person had any recruitment or selection information on file. This information was provided on the third visit to the home. There were gaps in the employment history for one person. The manager stated that this was usually questioned at interview but could not provide evidence that this had been obtained. A new induction programme was being introduced which follows the Skills for Care Foundation Programme. There was evidence that this new member of staff had started their induction programme in May 2007 but it had not been completed. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 25 Aspects and Milestones provide a comprehensive training programme that staff have the opportunity to participate in. There was evidence that staff have completed mandatory training. A number of courses offered were specific to the needs of people with a learning disability as well as epilepsy and diabetes. It did not appear that staff have accessed these yet. Staff did not have access to guidance specific to the needs of people with a physical disability such as the social model of disability, disability awareness or equality and diversity. The deputy manager had begun to collate information about specific conditions which were being included in people’s person centred plans. The manager stated that values training would be arranged. Staff driving the vehicle cascade training in the use of safe passenger transportation to new drivers. The provision of training accredited by organisations such as MIDAS was discussed. Supervision sessions were being scheduled but were not taking place on a regular basis. One staff member had received two supervision sessions this year and another had received three. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 26 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 poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is not being run in the best interests of the people living there. Weak management leads to inconsistencies in practice which restricts their independence and choice. 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. Concerns were expressed during the random inspection that the manager is not always available or present at the home. Some staff and parents stated Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 27 “management are never in the home”, “staff complain to them but nothing ever gets done”, “there is no support from Aspects and Milestones” and that things could be “improved efficiently and quickly”. Parents commented there is a “lack of leadership and it feels like there is no investment in the home”. “The home needs clear decisive management by someone who has the interests of the residents at heart”. Some staff were supportive of the management team saying that they had management support when needed and knew who in the organisation to contact for advice if the manager was not available. Management stated that staff morale had been affected by the change of ownership of the home and changes to working practices. The manager confirmed that she was scheduled to work 37.5 hours a week, which was normally spread over four long days. The deputy manager worked alongside her also working every other weekend. At the end of the inspection it was confirmed that the manager would be working every other weekend and a variety of shift patterns in future. Aspects and Milestones have a quality assurance system in place which the manager stated was being conducted by a manager from another home. This manager had completed the first stage of the process. Evidence of this was not available for examination although a blank pro-forma was provided. She stated that people living at the home would be involved in the next stage of the process. Unannounced Regulation 26 visits take place each month and a report produced. Copies of this were being forwarded to the Commission. A random inspection in June 2007 was conducted with Environmental Health over concerns that an accident involving a person living at the home resulting in emergency treatment at hospital was not reported to them under RIDDOR. Systems monitoring health and safety within the home were in place. Certificates confirmed that servicing of equipment and systems takes place on a regular basis. Any problems with specialist equipment were being referred promptly for attention. A broken hoist was being mended during the second visit. The following issues were noted during the visits: • The fire exit was blocked with a chair – this was not removed until late afternoon when the area manager questioned why it was there. • A car was parked outside the rear fire exit and plant pots had been positioned along the pavement – these may cause a problem if having to evacuate the building from this door. • At the time of the inspection the door to the lift machinery was open, this was closed upon prompting, no one was sure why this had been left open. Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 1 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 1 X 1 X X 2 X Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 29 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 YA2 Regulation 14(1) Requirement Timescale for action 30/11/07 2. YA10 3. YA14 A comprehensive and current assessment of people wishing to move into the home must be in place before a person moves into the home. This is to ensure that the home can meet their needs. 17(1)(b) Information about people living at the home must be stored securely. This is to ensure that confidentiality is respected. 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. (This requirement has been repeated from the last inspection-timescale for action 31/05/07). 12(1)(a)(b) People must be assisted to complete daily physiotherapy exercises promoting their health and wellbeing. (This requirement has been repeated from the last inspection-timescale for action 31/05/07)). DS0000069133.V350957.R01.S.doc 30/11/07 31/12/07 4. YA18 30/11/07 Hertha House Version 5.2 Page 30 5. 6. 7. YA18 YA18 YA20 12(4)(a) 13(1)(b) 13 (2) 8. YA20 13 (2) People using the Jacuzzi must do so in a way that respects their privacy and dignity. People must have regular access to dentists promoting their oral hygiene. Ensure that the temperature at which medication is stored does not exceed 25°C. If it does then measures must be taken to reduce this temperature to appropriate levels. Address the issues noted in the text about gaps in the medication record and apparent confusion over whether medication is ‘as required’ or not, resulting in failure to administer as prescribed. Where a variable dose of medication is prescribed the actual dose given must be recorded Attend to the seven bullet points made about people’s bedrooms. This is to ensure that the environment is safe and clean and reflects people’s needs. Clean mop buckets which have significant levels of encrusted dirt and grime. Dispose of food items when their use-by date is reached. Repair or replace the damaged areas of the kitchen worktop. There must be sufficient staff employed in the home to meet the needs of people living there as are appropriate to their health and welfare. (This requirement has been repeated from the last inspection-timescale for DS0000069133.V350957.R01.S.doc 30/11/07 30/11/07 31/10/07 31/10/07 9. YA24 23 (2) (b) & (d) 31/10/07 10. YA30 13 (3) 31/10/07 11. 12. YA30 YA33 23 (2) (b) 18(1)(a) 31/01/08 30/11/07 Hertha House Version 5.2 Page 31 action 30/09/07). 13. YA33 Care Standards Act Sect.31 17.2 Sch 4 Copies of staff rotas and activities provided for people living at the home must be forwarded to the Commission on a weekly basis. Recruitment and selection information for new staff must be kept in the home and be available for inspection. This is to ensure that people living at the home are being safeguarded from possible abuse. A full employment history must be obtained for new staff, with a written explanation of any gaps. This is to safeguard people from possible harm. All staff need to have the knowledge and skills to support people with a physical disability. (This requirement has been repeated from the last inspection-timescale for action 31/08/07). The registered manager must ensure that she provides dayto-day management of the home. (This requirement has been repeated from the last inspection). A system for evaluating the 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. (Work is in progress to meet this requirement) 16/11/07 14. YA34 12/10/07 15. YA34 19(1)(b) Sch 2.6 12/10/07 16. YA35 18(1)(c)(i) 31/12/07 17. YA37 8(1)(b)(i) 31/10/07 18. YA39 24 30/11/07 19. YA42 13(4) Ensure that household 31/10/07 chemicals which may pose a hazard to the people living in the home are securely stored at DS0000069133.V350957.R01.S.doc Version 5.2 Page 32 Hertha House all times. 20. YA42 23(4A)(b) Fire exits must be kept clear at all times so that people can be evacuated in the case of an emergency. 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care plans should provide the date people were admitted to the home, they should be dated and signed by the author and where possible the person living at the home. Information which is no longer relevant should be archived. Either staff should have access to the safe or alternative secure arrangements should be made for cash and valuables in the main office. Monitoring charts should not duplicate records maintained elsewhere. These should be consolidated. Health action plans should be developed for each person. Check stock levels of controlled medications twice daily as per local policy. Ensure that there is a photograph of all of the people living in the home in the appropriate part of the medication administration file, with reference to the person who had recently moved in. Consideration should be given to offering staff further training about the handling of medication in order to enhance their knowledge and understanding in this area. Conduct audits of medication stocks at least once a month. Ensure that all documents are dated such as protocols for ‘as required’ medication. 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. A response to complaints should take into account all aspects of that complaint. DS0000069133.V350957.R01.S.doc Version 5.2 Page 33 2. 3. YA6 YA7 4. 5. 6. 7. YA18 YA19 YA20 YA20 8. 9. 10. 11. 12. YA20 YA20 YA20 YA20 YA22 Hertha House 13. 14. 15. 16. YA24 YA24 YA24 YA33 17. 18. 19. YA35 YA36 YA40 The home should look at ways in which they can promote an open atmosphere where people feel confident to express concerns to management. With reference to the bedroom found to be hot, the cause should be investigated and the person should be consulted as to whether they are happy with the temperature. The plastic wall covering beneath a section of handrail by a fire exit to the car park which was buckled and coming away from the wall should be straightened out. The stained carpet by the staff lockers should be cleaned or replaced. Review the responsibilities and duties of staff in particular in response to laundry and cleaning, to ensure that they have sufficient time to meet the needs of the people living at the home. Staff should have training in the safety of wheelchair passengers using the home’s vehicle. This should be noted in their training record. Staff should have regular supervision sessions. The policy and procedure relating to accidents and incidents should include reference to the reporting of incidents resulting in injury which involves people not at work under RIDDOR. If it is proposed to continue leaving pure essential oils out/accessible then this practice should be subject to a risk assessment. The manager should report any incidents or accidents to Environmental Health which are notifiable under RIDDOR. The door accessing the lift machinery should be kept closed at all times. 20. 21. 22. YA42 YA42 YA42 Hertha House DS0000069133.V350957.R01.S.doc Version 5.2 Page 34 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. 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