Inspection on 06/02/08 for Hertha House

This inspection was carried out on 6th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 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 04/10/07

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 Unannounced Inspection 6 and 7 February 2008 09:30 th th Hertha House DS0000069133.V357227.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.V357227.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.V357227.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.V357227.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. 4th October 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.V357227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 February 2008 and included two site visits to the home by two inspectors on the first day and one inspector on the second day. Surveys were handed to the link resident to distribute to other people living at the home and four were returned during the visits. Surveys were also given to staff. People living at the home were observed during the visits and spoken to about the care they receive. Staff were also spoken with. The acting manager was present throughout and the Community Service Manager was present for parts of each visit. Visiting relatives also gave some feedback as well as health care professionals involved with people living at the home. A range of records were examined including care plans, staff files, health and safety systems, medication records and quality assurance audits. The acting manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. Regulation 26 reports and copies of a complaint to the home (copied to us) also provided evidence for this inspection. 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. Hertha House DS0000069133.V357227.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.V357227.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.V357227.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 and 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. People have access to a range of information enabling them to make a decision about whether they wish to use the service. Completing a care needs assessment that provides a holistic summary of people’s needs will ensure that an appropriate service is provided. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 9 EVIDENCE: There was evidence that each person living at the home had been given a copy of the Service User Guide including the terms and conditions of their placement. However the latter had not been signed or dated on files examined. The Community Services Manager confirmed that the acting manager would be producing a Service User Guide in accessible formats. The Quality audit also indicated that there would be a review of the Aspects and Milestones Licence Agreement. The home has not had any new admissions since the last inspection. Several people had looked around the home for visits and the acting manager had completed assessments as part of this preliminary process. These had however been destroyed when people decided not to continue with the admission process. A blank copy of the Community Services Assessment was examined. This would provide a holistic assessment of the person’s needs. The acting manager was heard asking a social worker for an assessment of needs as part of the admissions process. This meets with requirements issued at the previous inspection. In the absence of any evidence on which to base outcomes for people, this standard has been rated as adequate. The person who had moved into the home around the time of the last inspection had settled in well and had a three-month review. Although no paperwork was available for this, Gloucestershire Community Adult Care Directorate (CACD) confirmed that this review had taken place and that a care plan would be forwarded to the home. Hertha House DS0000069133.V357227.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): 6,7,9 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. Introducing an assessment tool will ensure that person centred plans are based on people’s changing needs and reflect their wishes and desires. Risk assessments safeguard people from possible harm. EVIDENCE: New person centred plans had been put in place for each person since the last inspection. Three members of staff had received training in this area and a project manager was to be joining the team one day a week to help implement person centred planning and geographical mapping for social and leisure activities in the area. The care for three people was case tracked which included looking at their plans, other records, observing them and talking to staff about the care they receive. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 11 Plans were clear and written in the first person. The acting manager said that people had been involved in the development of the plans. People spoke about positive relationships with their key workers. Staff also commented that each day they were being allocated named people to work with, who they were not necessarily the key worker for. They said this was working well. Plans provided information and guidance for staff on how people’s needs should be met and the ways in which to do this. For instance an eating and drinking plan described the support a person needed, that the food must be cut up and the type of equipment –spoon and dish – to be used. Staff were observed doing this during the visit. Plans provided a holistic analysis about people’s needs covering such areas as personal care, mobility, communication, social and leisure, nutrition and finance. Not all care plans had been signed and dated. Plans were being reviewed on a regular basis, with comments being recorded about any changes to need. It was not clear what assessment process the home was using. Some people had annual reviews with their placing authority who had supplied an assessment and care plan but others did not have this information. The acting manager stated that the Community Services Assessment could be used for this purpose. Communication profiles had been put in place which provided clear information about each person’s verbal and non verbal communication. From these it was possible to understand how to interpret people’s needs and wishes. New staff confirmed that these profiles had helped them to develop ways of communicating with people. People were being supported to manage their personal finances. Each person had a plan in place detailing the support needed and consent for staff to do this. Records were examined and found to be satisfactory. Staff confirmed that they check balances twice a day. They were observed doing this during the visits. Receipts were being numbered and could be cross-referenced with records. Staff said that concerns raised previously about access to monies had been resolved. Records confirmed that money was regularly being made available to them before funds ran too low. One person regularly sees an advocate who either meets them at the home or goes out for lunch. Another person was involved with Gloucestershire Lifestyles who would also provide advocacy if needed. Risk assessments were in place for a range of activities including moving and handling, transfers, travelling on transport, safety at night and epilepsy. These had been regularly reviewed and were signed. At the time of the visits information was being stored securely and safely. This meets with a requirement issued at the last inspection. Hertha House DS0000069133.V357227.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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home are being supported to make choices about their lifestyle, and to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 13 EVIDENCE: Since the last inspection the home has been sending copies of the weekly activities of people living at the home. There has been some improvement in the range of activities available to people both at home and in the local community. This needs to be sustained and further opportunities explored. Indications were that the home was endeavouring to do this. Several people were going to church on a regular basis and records showed that where problems arose due to lack of drivers, taxis were being accessed. The home has one mini bus and one person has their own vehicle. One person said that they had more access to social and recreational activities. They had recently enjoyed a holiday and staff said others were planning to go away later in the year. People had recently been to an evening concert at the Guildhall and several more were planned. Shifts for staff end at 8.00 pm so these activities were only available as a result of their flexibility and willingness to work additional hours. People said that the improvements were also due in some respect to having four drivers on the staff team. Staff also spoke about the enthusiasm and motivation of the staff team to seek out opportunities for people. Comments from surveys included “we should continue to arrange outings and group get togethers whenever feasible” and “clients do a lot of activities which suit them”. A project manager was due to join the team one day a week to enable staff to research further opportunities in the local community and further away. People continue to go to colleges and day centres on a regular basis. More people were taking the opportunity to attend these. Some people were also going to classes at the Guildhall in Gloucester each week. A Regulation 26 report indicated that people had been involved in fire training with staff. Daily records confirmed activity schedules that people have had access to a wider range of social and recreational activities including day trips, concerts, shopping and walks. During the visits one person was supported to go for a manicure and lunch out to celebrate their birthday. Other people went out for a walk, shopping or played games at home. People were having access to a range of activities when at home such as using the sensory room, Jacuzzi, cookery, crafts, bingo and music. People were observed spending time with staff who supported them to make choices about the music they wished to listen to or playing games rather that sitting in front of the television has had been observed at previous visits. People said that they were being more involved in helping in the kitchen. They were also supported with cleaning, laundry and helping around the home. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 14 Daily notes keep a record of this. The AQAA indicated that staff would be providing “more opportunities for involvement in household tasks”. People were being supported to maintain contact with friends and family. A relative visited during the visits. People keep in touch using the telephone and email as well as visits to their relatives. At Christmas staff said that everyone enjoyed a party at the home with friends and relatives and another event was being arranged. A card from the family of one person thanked staff for the party and for the support provided. House meetings were being held although no minutes were available in the home for the last meeting. A newsletter had been produced in January and sent around to family and friends providing information about the home, people living there and staff. One person said they had taken part in a video for Aspects and Milestones telling people about life at the home. Since the last inspection the cook has moved across to work on the care team and the staff were taking responsibility for preparing meals with opportunities for people living at the home to help out. Staff said that this was working well. Most staff have received training in Food Hygiene and further training was scheduled for March. Nutritional meals were provided using fresh ingredients and fresh vegetables. Fresh fruit was provided in the lounge. Staff have been trained in supporting a person with a Percutaneous Endoscopic Gastrostomy (PEG) feed. They were observed (with the person’s permission) doing this sensitively and discreetly following procedures outlined in the care plan. Hertha House DS0000069133.V357227.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. People’s health and personal care needs are being met helping them to stay well. Access to regular physiotherapy exercises is benefiting people living at the home. Whilst arrangements for handling medication are generally sound, some aspects could be improved in order to promote the safety of the people living in the home. EVIDENCE: The way in which people would like to be supported was clearly indicated in their care plans. People’s likes and dislikes were identified. People have also been asked about the gender of staff providing their personal care and this had been recorded. Discussions had taken place with people about the use of bedsides and other equipment that may be restrictive such as wheelchair belts and standing frames. There was documentation to indicate that this was being explored although was still to be finalised. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 16 Since the last inspection health action plans have been put in place providing information about the way in which people have been supported to access health care professionals. Evidence of regular appointments and the outcome of appointments were in place. People have been referred for outpatient appointments. One person was due for major surgery and the home was liaising with the Community Learning Disability Team and CACD about their rehabilitation and the support needed after surgery. People have been registered with a local dentist and there was evidence that two people have recently had appointments. Feedback from health care professionals indicated that some staff have worked with them to ensure that their recommendations for such areas as physiotherapy and personal care were being implemented. Records showed that people were having more support to complete their physiotherapy exercises on a regular basis. Staff reported that benefits to people had been noted. The acting manager stated that a physiotherapist attended a recent team meeting to outline the need and importance of regular physiotherapy for people who have a sedentary lifestyle. Concerns were expressed that there was occasionally a problem with consistency with some staff being enthusiastic and others resistant to the advice of professionals. Records also indicated that people who use wheelchairs were being offered greater periods of time in comfy chairs, resting on their bed or using a standing frame. Concerns about possible pressure areas were being noted. It was suggested that a pressure risk assessment was put in place for those people identified as being at risk. Arrangements for handling medication in the home were checked. Medication was kept in a locked cupboard within which was stored a portable locked trolley. There was additional medication stored on shelving. In the last report the temperature in the room was found to exceed 25°C on several occasions in one month according to records. A check of temperature records during this visit showed that there had been an improvement. However, the temperature remained on the high side (often at or just below 25°C), and was recorded at 26°C on 30/01/08. A member of staff thought this was because the light had occasionally been left on. It is recommended that measures be taken to reduce the ambient temperature in this area. Administration records for some of the people living in the home were sampled. These included photographs, documentation around consent, and reference to any known allergies. The administration records appeared to be complete except for one gap noted on 05/02/08 for a medication given at 22:00. A new audit system was planned which included a daily check on administration. When introduced this system should therefore pick up omissions such as this. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 17 Templates for the new audit system were seen. Staff felt that these represented an improvement on the previous system, records for which were seen. Some aspects of this new system had already been implemented. The new audit system should be fully introduced as soon as possible, and periodically reviewed to check that it is effective and covers all relevant areas. The administration file included information about homely remedies approved by the person’s GP. There were also protocols for PRN (as required) medication. It was reported that these were being reviewed and updated, and that these had been sent to people’s doctors for approval. Some protocols were still therefore awaiting return. Whilst the majority of handwritten entries on the administration record were double signed, some were just signed by one person. There should always be a check by a second designated person who checks the entry for accuracy. The medication trolley was found to contain several small bags of medication for returning to the pharmacy. Whilst these had been labelled, they had not been entered into the returns book and were not in the designated area for medication being returned to the pharmacy. One bag had a recent date but the other two were dated September 2007 and February 2007 suggesting that they had been overlooked for some time. In addition to the above, some blister packs for one person from October and November 2007 were found. Some of the medication had been used, but the majority had not. Some of the seals were broken though the medication had not been used. Staff spoken with were not able to explain what had happened in this case. It was agreed that the medication needed to be returned to the pharmacy. The above suggests that there have been shortfalls in keeping medication storage in order and in auditing aspects of the handling of medication. It underlines the need for a more effective and systematic auditing process. A student nurse commented that she and a team member were in the process of implementing a new system both of storage of medication and of record keeping. A double locked cupboard was used for the storage of one medication. Checks on the stock levels of this medication were generally taking place twice a day as evidenced by a record book. The home has a dedicated fridge available for storing medication as necessary. Staff described arrangements for managing medication taken off the premises. Staff said that training was being provided by the supplying pharmacy. Some certificates were seen in staffing files confirming this. These were accompanied by competency checks. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 18 The acting manager said that these should be repeated annually and that some were overdue. This was confirmed by checking some staffing files. In the last report a recommendation was made to offer staff further training about the handling of medication to enhance their knowledge and understanding of this area. The acting manager had obtained some information about possible courses though this had not yet been actioned. Training records were also seen for use of the PEG feeding tube and administration of medication by this route. The acting manager confirmed discussion was taking place to provide training for staff in the administration of buccal midazolam and she thought that the local Community Learning Disability Team would provide this. A relative notified us of a medication error in December 2007. It appeared that the pharmacy had supplied one person’s medication at the wrong dose. This had not been picked up when the medication was checked/booked in. The relative made the home aware of this error. This was treated as a complaint. A letter was seen from the acting manager to the complainant explaining how the error was thought to have occurred and outlining the action that would be taken. There was a note in the communication book reminding staff to be vigilant when checking medication, and to check if they noticed a possible anomaly. We had not been notified of the above error, as required under Regulation 37 of the Care Homes Regulations 2001. Reference guides about medication were available in the home. The organisation’s medication policies were not checked on this occasion. These had been looked at during a visit in October 2007 and found to cover general aspects of medication handling as well as specific issues such as the use of homely remedies. Hertha House DS0000069133.V357227.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. Systems are in place to enable people to express their concerns and they are confident that they will be listened to. People are safeguarded from possible harm or abuse. EVIDENCE: People living at the home said that they would talk to staff about their concerns. In their surveys 100 of people said they knew how to complain and who to talk to. People had a copy of the complaints procedure in their personal file and there was also a copy displayed in the home. This had been produced in a format accessible to people living at the home using text, symbol and picture. Information about our contact details needed to be changed. The acting manager said this would be done. The AQAA stated that there had been three complaints in the last twelve months. The manager stated there had been one complaint since the last inspection. This was fully recorded with details of the outcome of the complaint and action taken as a result. This meets with a recommendation issued at the last inspection. Staff training records confirmed that they had attended training in the alerter’s guide with the local adult protection team. Those spoken with had a good knowledge of safeguarding issues and who to contact if they had concerns. The acting manager had missed training in the Mental Capacity Act but thought she would be attending this soon. A copy of the Act was available for staff. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 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. People live in a home that recognises their diverse needs creating an environment that matches their personal requirements. Greater care of specialist equipment and prompt action for repair would improve the well being of people living at the home. Improvements to the environment need to be sustained to ensure that the cleanliness and safety of the home is maintained. EVIDENCE: All of the occupied bedrooms and all shared spaces were checked, along with areas such as the kitchen and laundry. Bedrooms were personalised and fitted with appropriate aids and adaptations. Furniture and fittings were generally reasonable, although there were signs of wear and tear associated with wheelchair use. One person’s carpet was stained and worn and required replacement. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 21 Improvements had been made to many of the bedrooms. This included fitting a new carpet in one room, as well as new flooring and curtains in another bedroom. New flooring had also been fitted in upstairs corridors. In the last report one person’s shower chair was found to have a very stained covering. The acting manager said that this had been cleaned and that they were liaising with the Community Learning Disability Team to source a replacement. People spoken with said they were happy with their rooms. One person said they had been involved in the choice of carpet in their room and another had chosen the colour scheme when their room was redecorated. One person was considering changing rooms so that they could have more space. Some plastic wall covering adjacent to a handrail by a fire exit to the car park was buckled and coming away from the wall, as noted during the last visit. The lounge and dining area on the ground floor was clean. Improvements had been made to the carpeting in the room, which was found to be stained and worn during the last visit. The adjoining serving area was clean and tidy. The fridge was checked. This contained bottle and a carton of fruit juice, both opened. There was no indication of when they had been opened and they had short shelf lives once open. In the same fridge there was a bottle of orange juice with a use-by date of January 24th 2008. The acting manager said that all staff were responsible for appropriately labelling food once opened, and described arrangements for date checking. It was agreed that these checks should be made more systematic. The kitchen was found to be clean and tidy. The acting manager said that funding had been made available for a new cooker and that this was being sourced. An area of damaged worktop had been temporarily covered with some metal plating. Following a visit in May 2007 the local Environmental Health Department had awarded the service five stars. This is a commendable achievement. Some minor issues had been picked up. The acting manager described the steps taken to address these. The laundry was reasonably clean and tidy. This room was unlocked. However, a cupboard containing potentially hazardous chemicals, labelled as needing to be locked, was also unlocked. A door in the foyer leading to lift machinery and the fuse box was found to be open. This had been the case during the last visit. The acting manager said that this should be kept locked. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 22 Concerns were raised about the security of the building. An electronic gate needs to be opened for people to gain entry to the grounds and then an electronic door needs to be opened for access to the home. When we arrived we gained entry to the home but had to announce our presence by seeking out staff in the dining room. Other visitors to the home have had the same experience and were concerned that they could have had access to the office or bedrooms without people being aware of where they were. The home needs to put a system in place for meeting and greeting visitors to ensure they are accompanied by a member of staff to the person they wish to see. A visitor’s book was in place. The home has been fitted out with specialist equipment and adaptations. There was evidence that hoists and the assisted bath were being serviced. People have access to the wheelchair assessment centre to maintain their wheelchairs. Some concerns were raised about the lack of care of some equipment and that damaged or broken equipment needed to be referred promptly to the appropriate service for repair. This would then have less impact on the people living in the home. The acting manager said that staff would have access to infection control training. They were observed having access to personal protective equipment and using this when appropriate. Colour coded mops and buckets were in place and appropriate infection control measures were observed being followed in the laundry. Hertha House DS0000069133.V357227.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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a satisfactory training programme that provides staff with knowledge about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. EVIDENCE: At the time of the visits the staff team had no vacancies and a bank team was being built up which meant a significant decline in the use of agency staff. The management team were looking forward to developing the team to provide consistency and continuity of care. Staff spoken with said that new staff had integrated well and they were feeling positive about their responsibilities and the management of the home. In the surveys 75 of people living at the home indicated that staff usually treat them well and usually listen and act on what they say. Staff commented that “I am confident to say that the home have the full support of staff”, and “I have been impressed by the conduct of the staff and management alike”. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 24 Staff confirmed that they were registering or completing their NVQ awards in Health and Social Care. The AQAA indicated that one person had a NVQ award and 30 of the team were working towards them. Minutes from staff meetings revealed how the whole team celebrate the individual success of staff when they have completed units towards the award. Two files were examined for new staff who had recently started working at the home and one file for a person soon to join the team. Most of the information as required under Schedule 2 and Regulation 19 was present. However for one person there was no reference from their current/last employer for whom they had worked for just over three months. Two references were in place from previous employers in care. New staff confirmed that they were completing an induction programme and a copy of the induction booklet that they were working through was examined. This covers areas identified in the Skills for Care Foundation programme. Mandatory training had been scheduled for new staff for March and April and existing staff were completing refresher training where needed. Additional training had been provided in Epilepsy, in physiotherapy techniques and PEG feeding. A member of staff was being given lead responsibility for health and safety including the training of staff in the use of the tail lift in the mini bus. It was confirmed that she would be receiving additional training in these areas. The acting manager confirmed that values’ training was being arranged for the team. Staff also have access to Aspects and Milestones training programme. Hertha House DS0000069133.V357227.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. People living at the home will benefit from a registered manager who has a dynamic and creative approach, and who will provide direction and leadership. Effective quality assurance systems are in place involving people. There are some good health and safety systems in place but some shortfalls could compromise the safety and wellbeing of people living and working in the home. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager has been absent for several months. The deputy manager has been acting up in the interim with additional support from the Community Service Manager. A project manager was due to be working at the home one day a week to provide additional assistance and advice to staff. Staff commented that they felt supported by the acting manager, that she was accessible and worked occasional evening and weekend shifts. They also felt that the additional support from Aspects and Milestones had had positive affects on the morale within the home. Some staff recognised the pressures on the acting manager and were concerned that the support from senior management should be sustained until the restructuring of the home had been completed. The acting manager is a registered nurse and was considering undertaking the registered managers award. The home’s quality assurance system was discussed with the Community Services Manager and although the audit was not available at the time of the inspection was forwarded to us within 48 hours. This audit took place over two visits and was conducted by a Peer Auditor. She said the resulting action plan would be monitored and reviewed at Regulation 26 visits to the home. An annual review of the quality assurance audit would be conducted. People living at the home had been part of this audit. Health and safety policies were briefly checked. These covered general principles as well as specific areas such as moving and handling. An internal monthly health and safety checklist was in place. Records were seen for December 2007 and January 2008. Aspects and Milestones had also conducted an audit of health and safety in the home in November 2007 and all areas checked had come out as ‘A’ rated, meaning that everything was found to be satisfactory. Records were seen evidencing routine servicing of most of the specialist equipment. (See Standard 29 re care and maintenance of wheelchairs.) Portable appliances had been tested in May 2007. The lift had been serviced in January 2008. Records for hot water temperatures were looked at. The most recent records seen were for October and November 2007. Another check should therefore be done. Temperatures appeared to be acceptable apart from one shower recorded at around 45-46°C. This should be checked and adjusted if necessary. Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 27 The fire safety file was looked at. The fire procedure dated from April 2007. The daytime procedure indicated that under some circumstances a full evacuation might not take place. The acting manager needs to discuss this with the local fire service. A fire risk assessment had been done, although this was in a checklist format and may benefit from review to include more commentary on how the home meets the various fire safety requirements listed. Records showed that emergency lighting, fire doors and fire alarms were being tested at reasonable intervals. Records of fire drills indicated that the two most recent exercises had taken place on 16/02/06 and 14/01/08. These should take place much more frequently to ensure that the people living and working in the home know what to do if there is a real fire. Hertha House DS0000069133.V357227.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 3 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 2 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 29 No 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 YA6 Regulation 14(2) Requirement Assessments of people living at the home must be regularly reviewed to reflect their changing needs. This is to ensure that the home can continue to meet their needs. For those people at risk of developing pressure sores a risk assessment needs to be put in place indicating possible intervention. Records must be kept of any pressure sores. This is to safeguard people from the need for further medical intervention. Any medication errors must be reported to the Commission. This is so that we can monitor the administration of medication and safeguard people from possible harm. The carpet in one bedroom needs replacing. This is to protect people from possible injury. All equipment and specialist adaptations must be monitored for wear and tear, and kept in a good state of repair. This is ensure that equipment is in DS0000069133.V357227.R01.S.doc Timescale for action 30/05/08 2. YA19 17(1)(a) Sch 3 3(m)(n) 30/05/08 3. YA20 37 29/02/08 4. YA24 23(2)(b) 30/05/08 5. YA29 23(2)(c) 29/02/08 Hertha House Version 5.2 Page 30 working order. 6. YA30 13(4)(c) Systems must be put in place to monitor the date of produce in the fridge in the servery and to dispose of any items, which are out of date. Items must be labelled with the date of opening. This is to reduce the risk of people becoming ill from consuming unsuitable foodstuffs. A reference must be obtained from the last employer, where the period of employment had been not less than three months. This is to clarify the reason for leaving and to safeguard people from possible harm. Staff who are delivering training to other members of the team must have completed appropriate training to cascade this information to them. This is to ensure that staff are competent in the subject matter which they are being asked to deliver. Fire evacuation procedures must comply with guidelines issued by the Fire Service. This is to protect people from harm. 29/02/08 7. YA34 19 Sch 2.3 31/03/08 8. YA35 18(1)(c) 30/05/08 9. YA42 23(4A) 31/03/08 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. Best interests documentation should be completed in line DS0000069133.V357227.R01.S.doc Version 5.2 Page 31 2. YA18 Hertha House 3. YA20 with recommendations from the Mental Capacity Act 2005. The temperature of the medication cupboard should be monitored and if consistently over 25°C then action taken to remedy this. 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. 4. 5. 6. 7. 8. YA20 YA20 YA20 YA24 YA24 Once the new audit system is in place it should be monitored for effectiveness. Annual competency checks for staff should be in place. Staff should be more vigilant about the return of medication to the pharmacy. This should be done on a monthly basis with an audit trail. Staff should complete an accreditation course in the safe handling of medication. The COSHH cupboard should be locked at all times. 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. Meet and greet systems for visitors should be reviewed to ensure greater security of the home. There should be greater vigilance of fridges in the servery. Hot water temperatures should be recorded each month. A shower outlet should be monitored and action taken if it continues to exceed 45°C. The fire risk assessment should be reviewed to provide detail to the check list in place. The door accessing the lift machinery should be kept closed at all times. 9. 10. 11. YA24 YA30 YA42 12. 13. YA42 YA42 Hertha House DS0000069133.V357227.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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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