CARE HOME ADULTS 18-65
Hft - 34/36 Shipston Road 34/36 Shipston Road Stratford On Avon Warwickshire CV37 7LP Lead Inspector
Maggie Arnold Unannounced Inspection 12th January 2006 09:10 Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 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 Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 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. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hft - 34/36 Shipston Road Address 34/36 Shipston Road Stratford On Avon Warwickshire CV37 7LP 01789 261105 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) www.hft.org.uk Home Farm Trust Mrs Penelope M Barry Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Penelope Barry must achieve the Registered Managers Award before 31 October 2006 5th September 2005 Date of last inspection Brief Description of the Service: 34/36 Shipston Road is close to the centre of Stratford upon Avon, which has a wide range of shops, leisure facilities and medical services. The home provides care and support services to adults with learning disabilities. The home consists of two large semi-detached houses, each having their own separate entrances and staff team. The houses provide small group accommodation, with each house having a lounge, dining room, kitchen and laundry. All bedrooms are single rooms. There are no en-suite bedrooms, and wash hand basins are not provided in peoples bedrooms. The two houses share a sleep in member of staff, who is based at number 34; service users at number 36 are able to access the sleep in staff via a direct dial telephone. There is a large car parking area at the front of the properties and there are large, well maintained gardens at the rear of the properties. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between the hours of 9.20am to 1.00pm. Two residents and two staff were at home at the time of the inspection. The residents and one member of staff went clothes shopping at 10.00am. What the service does well: What has improved since the last inspection?
Both dining rooms have been redecorated since the last inspection. The dining rooms are decorated to a good standard in colours chosen by the residents. The office environment was well ordered and the staff easily located files and records. For example, a staff member knew where to find a copy of the Care Homes for Younger Adults: National Minimum Standards 2001. Both staff had ready access to their own training and development files. There was also a significant improvement in the safe storage and management of medication. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 6 What they could do better:
A number of concerns, largely relating to safe working practices were raised on this inspection. Records seen did not demonstrate that the residents’ healthcare needs are fully met. For example, there was no follow up details of the outcome of a number of tests a resident had undergone on 24th November 2005. Records (30th December 2005) also showed that a resident had been given pain relief but the home had failed to record what steps had been taken to monitor whether the medication had been effective and that there was no longer a cause for concern. It is of concern that suitably qualified staff had failed to apply their health and safety knowledge in the home. The laundry rooms, kitchens and toilets facilities all fell below an acceptable standard. A laundry basket full of clothes hangers and clothes airer were stored in front of the external door outside the laundry room in No 34. The external door is not a designated fire exit but the items presented a major trip hazard. In the event of a fire in the office, staff in the laundry or sleep in room may need to exit from this door. The rubbish bin in same laundry was filled to overflowing. Next to the overflowing bin, a giant sized empty soap powder box was being used as a second rubbish bin. In contravention of the Control of Substances Hazardous to Health (COSHH) legislation, the COSHH cupboard in No 34 was left unlocked with COSHH items left on view on work surfaces. Other areas of concern were raised regarding the laundry room in No 36. For example, COSHH items were not securely stored, soiled laundry was lying on the floor of the laundry. It was also noted that the small wash hand sink was very dirty and dusty indicating that staff are not routinely adhering to infection control procedures. A carrier bag of clothing was hung onto the fire extinguisher fixed to the laundry wall in No 36. A coat covered a fire extinguisher in the staff sleeping in room. Both laundries required cleaning and de-cluttering. The kitchen in No 36 was grubby and dusty. For example, there was a clear mark in the dust where the inspector had wiped a work surface. There were numerous COSHH items in the cupboard under the sink and the cover of the central heating unit was leaning against the side of the unit. Toilet facilities in both homes required cleaning and were slightly odorous. A number of plugs were off their chains. The light cord in one toilet facility required replacing. The same facility requires a lampshade. Landing light bulbs required replacing in No 36. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 7 Hot water temperatures are being monitored. However records did not show what action was taken when water temperatures were either too high or low. The provider must ensure that all staff receive regular formal supervision. 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. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 8 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 Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Fuller details in the individual written contracts will help to ensure that the residents are more informed regarding set and additional charges. EVIDENCE: A requirement arising from the last inspection for more details in the residents’ contract remains outstanding. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this occasion. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Daily routines and house rules protect residents’ rights and promote selfdetermination and independence. EVIDENCE: All of the residents have their own bedroom, which other residents do not enter without the occupants’ permission. Unless it is absolutely necessary, staff do not enter residents’ bedrooms in their absence and without their permission. The layout of the home allows residents to chose to spend time alone or in the company of others. Both houses have a separate dining and sitting room. This allows residents, not wishing to use their bedrooms, to see visitors in private in one of the communal rooms. The home consists of two large semi-detached houses, each having their own separate entrances. The residents respect the privacy of each others house and only enter after knocking and with the occupants’ permission. For example, residents knock the front door of the adjoining home and wait to be invited before entering. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 12 The dividing fences and walls between the front access and rear gardens of both homes have been removed allowing the residents to have unrestricted access to the grounds. Subject to risk assessment, residents take responsibility for looking after their own bedrooms and help with household tasks such as cleaning of communal rooms and meal preparation. This encourages independence. For example, without staff prompting, one of the residents offered to make the inspector a drink. This was done with the minimum of fuss. Subject to agreement with the providers the residents may keep pets. Both houses have large fish tanks and one resident has a pet rabbit. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &20 The failure to monitor and meet the residents’ physical healthcare compromises the health and well being of the residents. Residents are protected by the home’s medication policies and procedures. EVIDENCE: Written records did not demonstrate that the residents’ healthcare needs are fully met. For example, there was no follow up details of the outcome of a number of tests a resident had undergone on 24th November 2005. Records (30th December 2005) also showed that a resident had been given pain relief but the home had failed to record what steps had been taken to monitor whether the medication had been effective and that there was no longer a cause for concern. In compliance with a requirement arising from the previous inspection, medication records and storage facilities have improved. Medication is secured in an appropriate lockable facility. The cabinet was clean and tidy and did not hold excess amounts of medication. A check of the medication and daily record sheets found them to be in good order. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were met in full at the time of the last inspection. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 & 30 Residents’ comfort and safety is compromised as a result of a unclean and unhygienic environment. Residents’ independence is maximised by the provision of specialist equipment. EVIDENCE: Fire safety work has recently been undertaken which caused a great deal of dust and disruption to the home. The inspector was advised that plans are in progress for both homes to have a methodical spring clean. The dining rooms in both houses have been recently decorated. It was very pleasing to see that the two rooms had been decorated in different styles reflecting the preferences of the residents living in No 34 and No 36. The home provided documentary evidence to demonstrate that steps have been taken to address requirements arising from the previous inspection. A blind had been fitted to the bathroom window of No 36, but the residents still do not have a shower facility. A request for the work to be done has been
Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 16 submitted. Funding is awaited for the shower facility and to make good the uneven area to the back door of No 36. In the interim period a risk assessment has been undertaken and warning notices placed in the vicinity of the uneven paving. A number of concerns were raised regarding the physical environment. For example, the glass panel of the front door to No 36 was damaged and had been taped up to reduce the risk of accident. The inspector was advised that the damage was reported to the Trust on the 9th of January. There were no records to confirm this to be the case. The kitchen in N0 36 was particularly dusty and fell below an acceptable standard of hygiene. Poor hygiene and odour management in two toilet facilities resulted in an unpleasant and unsafe environment for the residents. None of the present residents require specialist transfer equipment such as hoists or stair lifts. Two residents have strobe lighting and a vibrating pad in their bedrooms. These are activated in the event of a fire. The equipment has recently been upgraded. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 &36. The failure of appropriately qualified staff to adhere to safe working practices places the health and safety of both residents and staff at risk. EVIDENCE: Staff recruitment and personal files were not seen due to the absence of the manager. Two staff were on duty at the time of the inspection. Two residents and one of the staff members were going clothes shopping for the day. Discussions with the staff confirmed that they had both undertaken an induction process. Both staff had well-organised and comprehensive training folders that held copies of training certificates. Training included food hygiene, medication, fire safety awareness and emergency First Aid. The more experienced staff member had also undertaken Epilepsy Awareness, communication and Person Centred Planning. The staff had already undertaken or were about to take, training in Vulnerable Adult Awareness. It is of concern that suitably qualified staff have failed to apply their health and safety knowledge in the home. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 18 Both staff said that they felt well supported in the home and received regular informal supervision. One staff member said that she received regular formal supervision but the second member of staff said that she thought it was about six months since her last formal supervision. Documentary evidence was not available to seen to confirm these statements. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41& 42 Poor health and safety practice places the health, safety and welfare of the residents at risk. EVIDENCE: Although there has been some improvement in the records, the requirement for more detailed maintenance records remains outstanding. A number of concerns were raised regarding safe working practice. Of most concern was the failure ensure the safe storage of a number of household cleaning and laundry products that are potentially hazardous to health. For example the designated COSHH cupboard in No 34, which is clearly labelled ‘Keep locked’, was unlocked and the door left ajar. In NO 36 an excess of household cleaning products were stored in an unlocked kitchen cupboard. Fire safety and infection control practice also fell below an acceptable level. For example, a carrier bag of laundry was hung on a wall-mounted fire extinguisher in the laundry of No 36 Both laundry rooms had an excess of clutter and required cleaning. Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 20 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 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 x 29 3 30 2 STAFFING Standard No Score 31 x 32 33 34 35 36 x x x x x x x x x x 3 x 2 x 3 x 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 3 x x x x x 2 2 x
Version 5.1 Page 21 Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc 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 YA5 Regulation 17(2) Sch. 4 Requirement Outstanding from the last inspection. The Service User contract requires more detail so that the residents have a clearer understanding of what is and is not included in the fees. The registered person must ensure that residents’ health care needs are met. The uneven area to the back door of Number 36 is to be made good. A shower facility is required for the bathroom in Number 36. The registered person must ensure that the home is clean and free from unpleasant odours. The registered person must ensure that suitably competent staff are working in the care home. The registered person must ensure that staff are appropriately supervised. Maintenance records are to detail what steps have been taken to follow up any delays in requests for repairs or
DS0000004242.V278446.R01.S.doc Timescale for action 30/04/06 2 3 4 5 YA19 YA24 YA27 YA30 12(1) 13(4)(a) 12(4)(a) 13(3) 16(2)(k) 18(1)(a) 28/02/06 30/04/06 30/04/06 28/02/06 6 YA32 30/04/06 7 8 YA36 YA41 18(2) 13(4) 30/04/06 28/02/06 Hft - 34/36 Shipston Road Version 5.1 Page 22 9 YA42 maintenance. Completion dates are to be recorded. 13(3)4 The registered person must 23(2)d,p(4)d address the health and safety concerns detailed in the summary of this report. 31/01/06 Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hft - 34/36 Shipston Road DS0000004242.V278446.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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