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Inspection on 04/09/07 for Homeside

Also see our care home review for Homeside for more information

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home maintains excellent records in relation to both service user plans and risk assessments .The manager and staff have worked hard to produce these documents in a pictorial format, which is very appropriate to this service user group who are unable to interpret the written word. The manager and staff have worked extremely hard to improve and develop the environment, which often used to require constant maintenance and repair due to the specific needs and challenges of people with autism. However the inspector was pleased to find that there has been a concerted effort to introduce items such as ornaments, pictures and shelving into the home, which would have been impossible to imagine in previous years. Service users have been encouraged to respect and enjoy their living environment and hence the introduction of these items. The home also provides day care on site, which includes, a well-equipped multi-sensory room. The home also benefits from a large garden area and orchard/vegetable plot in which service users are supported to grow a range of vegetables and fruits.

What has improved since the last inspection?

Since the last inspection was carried out in November 2006 two en-suites have been built by extending the existing building. There is currently a full compliment of staff which is essential in providing consistent support to service users with autism.The manager has also introduced some new health action plans to ensure all needs are identified and met. The environment has been further improved with the whole of the ground floor being re-decorated and magnetic door closures have been fitted throughout the home. The manager has also improved the frequency of staff supervisions and these now meet the required standard.

What the care home could do better:

The inspector considers that all documentation relating to the service users should be produced in a format that is more easily understood by the people living at the home, this includes the Statement of Purpose and Service User Guide. The grounds to the front of the home appear quite shabby and unkempt. This was discussed with the manager who stated that this area was due to be resurfaced and a small area o f garden will be retained. The manager has agreed to keep the inspector informed of the progress of the garden area.

CARE HOME ADULTS 18-65 Homeside 6 Great North Road Welwyn Hertfordshire AL6 0PL Lead Inspector Julia Bradshaw Unannounced Inspection 4 September 2007 10:00 th Homeside DS0000019434.V349474.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 Homeside DS0000019434.V349474.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. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homeside Address 6 Great North Road Welwyn Hertfordshire AL6 0PL 01438 716442 01438 718929 candourcare@aol.com 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) Candour Care Services (Homeside Limited) Mr Rosario Fernandes Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2006 Brief Description of the Service: Homeside is registered to provide care and accommodation for up to four adults with a learning disability, of whom up to four may be over the age of 65 years. The home is owned and operated by Candour Care Services and consists of a detached bungalow, situated in the Oakland’s area of Welwyn. There is a garden and parking area to the front and a large rear garden, which can be accessed by service users with appropriate supervision. The home is conveniently situated for local facilities, with public transport available in nearby villages and the shopping and leisure provision of Welwyn Garden City can be accessed using the homes own minibus. Current charges are from £1938 - £3059 per week (as at 04/09/07). Additional charges are made for hairdressing, personal toiletries and social outings. Information about the service can be obtained from the Statement of Purpose and Service User Guide. These and copies of the previous inspection report by the Commission for Social Care Inspection (CSCI) are available in the home. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 4/09/07. The registered manager was on duty at the time of the inspection as well as the deputy manager and several support staff, including the activity workers. There were three service users at home on the day of the inspection and the fourth service user was away on holiday with their family in Turkey. General observations were made of the staff performances and interactions. Written records and care plan files were examined. Staff files, quality assurance and training records were also inspected. The service users appeared well cared for. Comments about the care and service provided were all positive. Care staff appeared confident and said they felt supported and happy to work in the home What the service does well: What has improved since the last inspection? Since the last inspection was carried out in November 2006 two en-suites have been built by extending the existing building. There is currently a full compliment of staff which is essential in providing consistent support to service users with autism. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 6 The manager has also introduced some new health action plans to ensure all needs are identified and met. The environment has been further improved with the whole of the ground floor being re-decorated and magnetic door closures have been fitted throughout the home. The manager has also improved the frequency of staff supervisions and these now meet the required standard. 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. Homeside DS0000019434.V349474.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 Homeside DS0000019434.V349474.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 –5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information for people who may choose to use the service is available. Full assessments are carried out prior to the admission of an individual. EVIDENCE: There is in place both a Statement of Purpose and Service User Guide, which were both last updated in May 2006. Although both these documents give a detailed view of the services provided they should be produced in a format that is easily understood by both its current service users and prospective service users. The bulk of the current documentation has been produced only in the ‘written word’. Full assessments are carried out prior to the admission of an individual. All service users have current contracts in place and can be found in their personal file. Homeside DS0000019434.V349474.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- 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. To ensure appropriate support is provided residents’ goals are identified and assessments are detailed in their care plan. To ensure people are kept safe risk have been identified and minimised where possible. Service user feel secure within the home and staff treat them with respect and promote their privacy. EVIDENCE: The manager and staff should be congratulated on producing some excellent examples of person-centered planning. Three of these care plans were inspected. They are produced in a pictorial format and have been clearly produced with the involvement of the service users and their families. The manager has introduced new health action plans, which was a requirement made at the last inspection. These have also been produced to an excellent standard and are both detailed and comprehensive in their content. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 10 Individual notes and guidelines for the service users were observed. The service users are supported within the care management and whole life reviews frameworks and reviews have been carried since the last key inspection took place. This ensures changing needs are continuously assessed and reviewed. Ranges of risk assessments are completed within the home for necessary actions. These are detailed and contain all the required information. Activities and outings enjoyed by the service users determine that service users are supported to take risks as part of their every day lives. Staff work with people to assist them to lead safe and enjoyable lives, consulting with them as appropriate, regarding decision making and offering guidance where needed. Positive interaction was observed between the staff and the service user living at homeside during this inspection, demonstrating a high level of respect and patience. Service users living at the home are unable to communicate verbally and therefore staff have to intpret service needs through a variety of alternative communication methods such as makaton and non verbal communication methods outlined in individual care plans. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 –17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal development opportunities are encouraged for all service users ensuring interaction with the outside community are encouraged. Service users health and welfare is supported through a healthy eating programme. EVIDENCE: Service users care plans contain individual daytime activity programmes and day care is provided within the onsite building located to the back of the home. There are two activity workers who provide a range of the activities including, art and craft, gardening, aromatherapy, musical activities, puzzles and games. Trips out are also part of peoples daily activity programme. There is slso has a multi-sensory room in the home, which provides both a relaxing and stimulating environment in which service users can enjoy. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 12 The manager stated that one service user would like to go swimming to the local public swimming pool. This is an activity that requires careful planning and assessment due to the high needs of the service user. However it was encouraging to hear that this option was being pursued rather than disregarded due to its complexity. The manager and staff should be congratulated for providing holidays to the service users for the first time in the homes history. Three service users went to Wales for a ‘ Haven’ holiday with four staff. This is a huge achievement considering the very high needs of the service users and the many challenges they present. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 –20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current medication and healthcare practices are sufficient to ensure service users needs are being met. EVIDENCE: The current arrangements for the storage and handling of medication are adequate and meet the current standards .The medication cupboard is situated within the main office of the home and therefore easily accessible for staff. There is currently no controlled medication held in the medication cupboards, however there is a robust procedure in place for the administration of these medications, if required. There were no gaps in the recording of medication. The home has a contract with a local pharmacy in who supplies all medication in blister packs. Full details of the personal and healthcare support required were contained in the care plans examined, including the individual preferences of service users. Daily records showed that staff continuously monitored individual progress. Staff spoken with demonstrated a good understanding of individual needs and Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 14 how to act to meet them. A key worker system is operated to ensure extra individual attention and help service users participate in the care planning process. Risk assessments in place indicated a structured approach to maintaining individual safety. Where necessary, outside health professionals such as community learning disability nurses and local psychiatric services are involved to provide specialist advice. All non-blister pack medication has the date of opening recorded on it. The home has good links with the local community mental health team and local psychiatric services. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 15 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 –23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is sufficient and adequate in order for the residents to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure residents are protected and safe. EVIDENCE: A detailed complaints procedure is in place. A record is maintained of any complaints made, detailing actions and outcomes as necessary. The manager and staff should be congratulated on providing this document in a pictorial form. There have been no complaints since the last inspection was carried out. A detailed procedure is in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate safeguarding adults. All staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Two Staff personnel files were inspected and all the required information was held within these files. The home also benefits from a core staff team who have known the service users for several years and know and understand the needs of service users who are unable to communicate. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents with a safe and comfortable environment in which to live. EVIDENCE: The manager and staff have worked extremely hard in improving the internal environment of the home with the whole of the ground floor being decorated since the last inspection took place. Two bedrooms have been re-fitted with en-suites, which has helped reduce the issues relating to the challenging behaviour of one particular service user. Also the staff have introduced additional soft furnishings including pictures, shelving and ornaments which in the past has been an on-going challenge to maintain due to the needs of the service users, living with the difficulties of autism. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 17 Bedrooms have also been improved with rooms displaying pictures, photographs and all rooms now having suitable bedding, carpeteing and curtains. All of which would have been difficult in maintaining in the past. The rear gardens are maintained to a high standard and provide a safe environment in which service users can enjoy. There is also a vegetable plot and orchards, which service users, are encouraged to assist with. However the garden to the front to the home appears quite shabby and unkempt. The manager stated that this is due to waiting for quotes to re-surface the parking area. The manager agreed to keep the inspector informed of this work and when it is due for completion. Once completed the front of the home will provide an area for parking and a small area of plants and lawn. The service users also benefit from a multi-sensory room, which is fully equipped with light boxes, fibre optics, music and a body massage chair. There are adequate bathing and toilet facilities with two new en-suites being fitted since the last inspection. All areas of the home were maintained to a high level of cleanliness. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 18 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): 31 –36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate to provide the attention that the service users require and to achieve the aims of the home. The members of staff are enthusiastic, knowledgeable, experienced and well trained to support service users effectively and meet their needs. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. The home has a loyal and long standing core staff team that appear to have a good understanding of the current service users needs and abilities. Staff were seen to support the main aims and values of the home. There were four staff on duty, including the manager and deputy on the day of the inspection. The home has one manager, a deputy manager, 4 key workers and 7 support workers, one waking night care worker and one sleeping in person. The home has clearly defined job descriptions and person specifications in place. All staff will or have received a series of mandatory Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 19 training course in order for them to meet the complex needs of the service users. The company has rigorous recruitment procedures that involve thorough vetting of applicants. Two staff files examined contained photographs of the person, application forms, two positive references and CRB disclosures. All new staff receives structured induction and foundation training and the company provides good access to training. Recent courses undertaken include medication training, fire training, and care planning, food hygiene and breakaway techniques. The manager provides monthly staff meetings and staff now receive supervision on a more regular basis. The manager is in the process of providing supervision training for the deputy manager and who will then be able to cascade down the supervision of staff. Seven staff currently have NVQ level 2 and three staff are about to commence their NVQ level 2 training. The deputy manager has just completed NVQ level 3. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 20 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 –42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, with residents benefiting from the support and guidance of the manager and the committed and enthusiastic staff team and residents health and welfare is protected. EVIDENCE: Service users appeared to be happy with the home and appeared to be generally comfortable in their environment. The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The management approach of the home endeavours to create an open and positive atmosphere, staff commented that they feel supported and feel the home is well managed. A clear commitment is made to equal opportunities, Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 21 with staff expressing positive views with regards to this. Adequate training is being provided to ensure all staff have the necessary underpinning knowledge to carry out their role effectively. The manager is in the process of implementing annual appraisals and these will have been fully completed before the next inspection takes place. Supervision sessions appear consistent and improved from the last inspection. Quality assurance systems are in the process of being further developed in order to assure that the service users views underpin all self-monitoring, review and development of the home. The manager should endeavour to obtain the service users views on the service provided through pictorial methods. All service users have a bank account where their monies/benefits are paid into. The manager is signatory for these accounts. Service user finances were checked and reconciled. Separate ledgers are maintained for each person and a running record is kept and audited every time a withdrawal is made. Data Protection Act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Records regarding staff were inspected and contained all the relevant information. The manager must endeavour to produce all documentation relating to the service users in a more user-friendly format e.g. the Statement of Purpose and Service User Guide. Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 3 3 x Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations The manager should endeavour to produce all documentation relating to service users in a more appropriate format in order to ensure that people have the opportunity to fully contribute in the running of the service. The manager should endeavour to improve the area to the front of the home as currently it appears shabby and unkempt. 2. YA24 Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Homeside DS0000019434.V349474.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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