Inspection on 01/07/05 for Hope House

This inspection was carried out on 1st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hope House 04/09/08

Hope House 20/09/06

Hope House 27/04/06

Hope House 13/12/05

Hope House 28/01/05

Hope House 04/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Sandford House 5-7 Sandford Close Wivenhoe Essex CO7 8JN Lead Inspector Gaynor Elvin Unannounced 1 July 2005 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 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 Stationary 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. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Sandford House Address 5-7 Sandford Close Wivenhoe Colchester Essex CO7 8JN 01206 823647 01206 823647 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashraf Hussain Ahmed Hussain Aktar Hussain Julie Greenland Care Home (CRH) 5 Category(ies) of Learning Disability (LD), 5 registration, with number of places Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 5 persons). Date of last inspection 28/01/2005 Brief Description of the Service: Sandford House is located on a residential estate situated in the small quayside town of Wivenhoe. The home is within walking distance to shops, pubs and cafes and a regular bus route provides access to Colchester. The home provides accommodation for five service users of both sex. Single bedrooms and one communal bathroom are located on the first floor. A lounge/dining area and games room are situated on the ground floor. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on one day in July 2005 over four and quarter hours. The Manager was not on duty and the senior support worker accommodated the inspection. The inspection process included a tour of the premises; discussion with two service users, the senior and two support workers; examination of records, four staff files, service users files and supporting documentation. Sandford House is registered to provide care for people with learning disabilities. It was highlighted during this inspection that three service users, currently accommodated, have mental health needs predominant to learning disability needs, which may fall outside the condition of registration. What the service does well: What has improved since the last inspection? What they could do better: Overall this inspection gave rise to some serious concerns in respect of increasing requirements and a failure to take the home forward in ways expected to achieve quality care outcomes and meet National Minimum Standards. Little progress had been made to address seven requirements from the previous inspection; two of which were already repeated. A further ten requirements and four recommendations have been made within this report. Sufficient investment had not been put towards structured staff training, individualised care programmes and related documentation, to better equip staff to understand and meet needs more appropriately and effectively. Staff presented a caring and well meaning approach, but did not have the knowledge or skills to constantly underpin care delivery and monitoring for satisfactory care outcomes for service users. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 6 Sufficient systems and robust procedures were not in place with appropriate staff training to protect service users from abuse. The home required maintenance, decoration and repair, in some areas, appropriate risk assessments were not carried out to reduce risk and staff had not received appropriate training to ensure the health, safety and welfare of service users. These are matters that therefore must now be addressed fully by the Registered Manager who must consider her current position in terms of role, responsibilities and day-to-day management of the home. Sandford House will be subject to close monitoring by the CSCI during the year 2005 – 2006. 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. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 & 5 The homes Statement of Purpose does not contain the relevant information required for prospective service users to make an informed choice or judgement. A service user guide or the current contract did not specify the agreed services and facilities the home would provide to meet their assessed needs. Appropriate pre admission assessments were not carried out to ensure the home could adequately meet the needs of the service users. Some Service users admitted to the home have specialised needs, which fall outside the boundaries of the conditions of registration. Staff had not received the appropriate training to meet the specialised needs of the service users admitted to the home with regard to mental health. EVIDENCE: No further action had been taken to address the outstanding requirement repeated in the last report with regard to further developing the Statement of Purpose; to accurately reflect and inform prospective service users of the services and facilities provided to meet needs, wishes and aspirations. A service user guide was not produced as a separate individualised document providing information and reference for the individual. A house member, admitted in Nov 2004, was unaware of a service user guide or statement of purpose, but had visited the home and had a weeks trial prior to her admission, which helped her make a choice about permanently moving in. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 9 Residency contracts were basic and did not contain information regarding the care and support agreed to meet the individuals assessed needs and aspirations. A Care Management Assessment or a home’s pre-admission assessment was not evident in the house member’s care files containing the relevant information to generate the care planning process. The support workers indicated that some service users had been discharged from a Mental Health Section. Supporting documentation and a collaborative Care Programme Approach was not evident of this. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8 & 9 Overall care management requires review, which needs to address relevant issues to the specific needs of the individual. Appropriate care planning with associated risk management strategies was not in place. Care plans required more detailed information and monitoring of the actions required of staff to deliver appropriate care and reduce risks. The homes review process needs to be more regular and would benefit from improvement in terms of evaluation and focus on outcomes. Care approaches and support management was not structured to ensure consistency and continuity, which may potentially place the service user at risk. EVIDENCE: All the service users care files were examined, the quality of content was poor and did not reflect the care or support given. They contained information pertaining to their likes and dislikes, most specifically to food items and a brief assessment of strengths and needs with a brief note regarding risk reduction, Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 11 this was not dated and one assessment which had been altered and written over, was very messy and not easy to follow. A behaviour monitoring form was incomplete and only had one entry in February 2005. It was unknown when the monitoring started or when it was to be reviewed. A tick box chart was kept to record mood types; describing mood from good to threatening and happy to unhappy. There was no indication what the information was for or how it was being used, it was not incorporated into a care plan or risk management plan and did not identify any outcomes for the individual. A care file for a service user who experiences paranoia and an eating disorder contained an undated piece of writing of her thoughts and an incentive star chart system. The stars would be awarded for getting up and taking medication, having a bath, being weighed on Wednesdays, cooking a meal and waiting an hour after food and trying not to vomit. An agreed amount of stars was rewarded with a trip to London. There was no set structured care planning process in place with regard to this support programme or evidence of guidance or specialist input from a dietician or community psychiatric nurse. There was no evidence of discussion, understanding or agreement by the service user, with associated risk management or regular monitoring of food intake or weight. This individual did not eat anything for lunch on the day of the inspection. Some work with another service user who had an eating disorder was evident; an undated piece of writing by the service user detailing her feelings about food was enclosed. A form to monitor coping skills had been drawn up but this was incomplete, coping strategies were not identified or monitored for outcome. A loose piece of paper recording a trip to supermarkets and collecting menus from restaurants looking at healthy eating, was enclosed in the file and identified tasks for the week, which included eating healthier foodstuffs and keeping a journal. An evaluation report was included but it was unclear what was being evaluated. Staff said they did not participate in the care planning process and the manager did the care plans at home. Discussion with staff suggested that needs were being addressed, even though they recognised there was a lack of care plans and guidance. Staff were observed supporting the service users to take responsibilities and informed choices throughout the day. Their approach relied heavily on good verbal communication systems and intuition, which may fail at some point and potentially put the service users health and welfare at risk. Service users had appointed key workers. The key worker system needs to be developed and work effectively to aim to ensure good care, resident participation in care, recognising changing needs or identifying new ones and taking responsibility for care planning and overall needs. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 12 The home must ensure that all aspects of psychological, behavioural and health care needs are planned for; that staff have the information to deliver appropriate consistent care and be aware of how to manage and reduce identified risks, to better reflect care given and outcomes. More development work is required to ensure that the care management is an active and proactive planning tool. A link needs to be established between the key working system and the care planning process. Staff were unaware of any advocacy provision for the service users or how to access this if required. One service user stated she did have an advocate, which a service she received prior to her admission to Sandford House. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 &14 There was an absence of a planned approach to activities and stimulating service users interests. The home does not ensure that the more dependant service users take part in valued and fulfilling activities and have access to and choose from, a range of appropriate leisure activities. EVIDENCE: Service users were observed to be rather unoccupied for extended periods, with little organised activity or engagement between staff and service users. Care plans did not contain evidence of activity planning and recording, or support programmes for the development and maintenance of daily living skills. Staff said that each morning they discussed and agreed with the service users the activities for the day taking into account any prior arrangements or appointments and the number of staff available. It seemed activities for those that could not go out independently were limited. When asked the sort of activities service users participated in, staff replied going for a walk or out in the minibus. One service user said life was generally boring and she didn’t do much, although there was usually an opportunity to go out in the minibus, today they were taking a service user to a hospital appointment. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 14 One service user displayed attention-seeking behaviour and was reminded about earning her points. When asked, this individual described the point system, put in place by staff, to reward good behaviour. Points were awarded for domestic tasks she participated in or achieved. A scrap of paper on the notice board identified the tasks and the amount of points awarded for each task. A point chart she had helped make was in the office but staff indicated it was not up to date. Staff were unable to tell her how many points she had or if she had earned enough for a treat or to go out. Staff explained that this individual did not go out much due to inappropriate behaviour. Some staff spoken with felt that not everybody was consistent in their approach to maintaining this management strategy, which was a verbal arrangement and not incorporated within a care plan and this sometimes led to confusion for the service user. The staff spoken with stated that this was a reward system and points were not deducted, although another member of staff was heard to say that she was considering deducting a point. It was not clear that this approach focused on or encouraged positive behaviour, or that the individual was appropriately or adequately supported. In contrast two service users went out independently; one attended college, went out socially and visited his girlfriend, the other had a voluntary job at a charity shop in Colchester and collected bric a brac to send to Africa. She also knitted dolls for charity and walked dogs. Staff indicated that service users had accessed courses from two colleges in Colchester, but were unable to confirm who, when and what. Service users were encouraged to develop and maintain basic living skills by being involved in the cleanliness and general care of their rooms. One member of staff was observed prompting and supporting a service user to tidy and hoover his room. Menus were planned weekly with the service users and some service users took it in turns to prepare the meal of their choice, with support. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 Healthcare needs were not reflected within the individual care planning system. Self-medication assessment and management plans were not evident for service users where appropriate and necessary. Safe practices were not carried out for the recording, administering and disposing of medication. EVIDENCE: Information regarding service users healthcare needs was not reflected within the individual care plan, particularly with regard to mental health, asthma and epilepsy. There were no care plans detailing an action plan to meet and monitor healthcare needs; or a risk management strategy informing staff of how to reduce the risk and/or manage a significant event. The care file for one individual stated he suffered with epilepsy, there was no indication of past or current fits, management, review or risk assessments associated with this specific condition. The service user with Asthma received medication via inhaler delivery systems, prescribed for the prevention and relief of symptoms. Regular review and monitoring with the GP/Asthma clinic was not evident. Appropriate risk assessment and management or information for staff on action to be taken in Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 16 the event of an asthma attack was not available. The inhaler for the relief of symptoms was in the locked medication cupboard and it was not evident the service user was on a medication self-management plan for the use of the inhaler as and when it was required. The inhalers were not dated and signed indicating when they were opened, one inhaler was prescribed six months previously, and one box was not labelled with the service users name. Staff indicated that the loose, out of date medication stored in the medication cupboard was no longer required; this had not been returned to the pharmacy according to medication policy to ensure no mishandling. Medication Administration Receipt sheets (MARs) were inspected, one sheet had entries of ‘F’ indicating the medication had been omitted for ‘other’ reasons, in this case the ‘other’ was not defined or recorded in a care plan. Staff were unable to give any explanation for this, one staff member said she ‘hadn’t got her head round the medication packs or the MARs yet’. A local pharmacist had recently visited the home to give an update in medication administration. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 17 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 standard(s) 23 The home has not ensured that service users are protected from abuse. Staff are managing challenging behaviour without appropriate training, which has the potential to be harmful to service users health and welfare. Procedures in place for managing service users money were not robust enough to protect service users from financial abuse. EVIDENCE: The policy and procedure for the protection of vulnerable adults (POVA) was brief and did not incorporate Essex County Council local guidelines or referral to the POVA list. No action had been taken to address the requirement made from the previous inspection with regard to training and raising awareness in the protection of vulnerable adults. A POVA allegation made in June 2004 was upheld and the member of staff dismissed. To date the Commission has not been informed of any conclusion of a police investigation or whether a referral has been made to include the ex member of staff on the POVA list. Staff indicated that they had never received any form of training with regard to this subject and were unable to give a precise account of the steps they would take if an incident was observed or reported in the absence of the manager. When asked if they were aware of the Blue book produced by Essex Vulnerable Adult Committee staff knew of its whereabouts but did not know of its contents. They were also unaware of the ‘No Secrets’ document produced by the Department of Health. The staff were advised that they were required to have the relevant knowledge to protect the service users in their care and to raise these issues with the manager on her return. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 18 From discussion with staff and service users and from documentation in service users care files, it was evident that services users displayed various degrees of challenging behaviours. The majority of staff had received training in SCAPE – avoidance and management strategies for staff in confrontational situations, provided by Essex County Council; they had not received appropriate training in the management of challenging behaviour. The home kept personal monies for some service users, the money was kept in a named envelope and receipts of purchases were kept in another envelope. There were no records available detailing a running balance including receipt and outgoings of money, date and by whom and therefore the total of money could not be checked for accuracy. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 19 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 standard(s) 24, 25, 26, 27 & 28 The home was in poor decoration and state of repair and did not provide a comfortable, safe environment. EVIDENCE: Single accommodation was provided and some rooms were overly cluttered with personal belongings. Adequate storage space was not provided for one service user who collected items to send to the third world. Rooms were not provided with lockable storage space. One room had five dirty mugs on the floor. In another, a double plug socket behind a wardrobe had a long six plug extension lead plugged into it, which was in the middle of the room with four leads from various electrical appliances plugged into it, a further double plug socket was available on the opposite wall. A bedroom window had an opaque plastic coating obscuring view through the window, staff indicated this was because the room was overlooked from neighbouring houses, a net curtain was suggested as a better option. The carpet was in urgent need of cleaning. The stairway and upstairs corridor was dark and dismal and did not have natural light, requiring artificial lighting at all times, on this occasion one bulb had blown and had not been replaced. The most recently admitted service user confirmed she was able to choose the colour and decoration of her room. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 20 The home provided one communal bathroom with shower facilities for five service users of both sexes. The bathroom was bare and clinical and used to store the mop and bucket. The shower tray was in need of replacing. The kitchen was very small, non-perishable food provisions were stored in the garden house along with other items and equipment no longer used or broken. The garden house had some shelving, but mostly items were just on top of one another on the floor. The freezer was kept in the laundry room. A lounge/diner and a games room provided communal space. The games room had a small pool table. It also contained a broken bed and two clothes-horse’s for drying washing, which took up a large amount of the useable floor space and did not provide a conducive environment for an additional room for service users use. The clotheshorse blocked service users access, through the patio doors, out onto a raised decking area with garden furniture. The garden was unkempt and one of the deep concrete steps leading down into the garden had broken and crumbled away, staff indicated they were still waiting for this to be repaired. The fence on one side was falling down into the garden and in an urgent state of repair; staff indicated that the fence belonged to the neighbour. A hammock frame was partially dismantled and staff indicated that the hammock sling was torn, one service user in particular liked to use the hammock. Staff were unaware of a maintenance, repair or redecoration programme. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36. Correct recruitment procedures were not carried out to ensure the protection of people living in the home. Structured training would better equip staff to understand and meet the needs of the service users more effectively. EVIDENCE: There were three members of staff on duty supporting four service users in the home. Staffing levels had increased since the last inspection. There were no references or a satisfactory Criminal Record Bureau check evident in the file of the most recently employed member of staff in November 2004. References were not evident in the file of a member of staff who was employed less than a year ago, however, a CRB check had been received and the file also contained a CRB for another person. The third file examined for a member of staff employed in 2003 had one reference and a CRB had not been obtained. The staff indicated that they had submitted the paperwork to the manager for CRB applications approximately two weeks ago. A fourth file contained a driving licence with a photograph for a different person. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 22 During discussion staff indicated they had not received any training in behaviour management and therapeutic approaches with regard to mental health or learning disability and most of the approaches taken were intuitive and not knowledge based. The staff were unaware of a training and development programme linked to the homes aims and service user’s needs. Staff indicated that training was only accessed as and when the home was made aware of it. None of the staff had an individual training and development plan and none of the staff spoken with had received any of the mandatory training required with regard to understanding and promoting health, safety and welfare of the service users in their care. Staff contracts did not include at least five paid training and development days (pro rata) per year. The induction programme did not meet Sector Skill specification and did include principles of care, the experiences and particular need of the service user group or the particular requirements of the service user setting. One out of the three members of staff on duty had achieved an NVQ level 2 in care and had commenced NVQ level 3. Staff contracts did not include five paid training and development days (pro rata) per year. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40, 41, 42 & 43 The Registered Manager did not ensure the home met its stated purpose, aims and objectives to benefit service users. Records, policies, procedures and working practice did not ensure the health, safety and welfare of service users. EVIDENCE: Records examined were not accurate or maintained in a secure manner with regard to staff files and policies and procedures had not been reviewed or monitored. The staff presented two files of policies and procedures on request; one file contained procedures that were very brief and staff demonstrated very little understanding of their content or relevance to their working practice. The second file contained policies written for another establishment called Greenacres, dated July 2002. It was evident staff were not given the opportunity to be involved in the development of policies and procedures to ensure understanding and application in practice. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 24 Staff indicated that a service user had several dog walking jobs in Colchester in response to an advert placed in various shops by the service user. Staff said that the manager had interviewed the owners of the dogs but there was no documentation recorded in the care files to this effect. Food in the fridge was covered but not dated. One service user was offered the remains of a previous meal plated up in the fridge as an alternative to the lunch being served, it was not evident when this meal was originally prepared. A current food hygiene and environmental health certificate was available. Some risk assessments with regard to health and safety for use of the dishwasher, lawn mower, cooker, extension lead, shower and bath were dated 27/07/03 and had not been recently reviewed. Risk assessments with regard to the darkened corridors, stairs and medication cupboard; the broken crumbling step leading down into the garden and the half assembled hammock and torn canvas had not been carried out. Staff stated they had not received mandatory training in any of the required areas with regard to safe working practices such as; Health and Safety, Fire Safety, First Aid, Infection Control and Food Hygiene, to ensure the safety and welfare of service users. Discussions with staff concluded that care issues were discussed on a day-today basis during hand over or individually with the manager during supervision. Formal meetings with all the staff were not held. Staff indicated that house meetings were held for the service users at their request but were not aware of any minutes kept. One service user had not participated in, or was aware of, any meetings held which gave an opportunity for service users to discuss any issues related to the running of their home. Quality assurance and monitoring, the homes business plan and Regulation 26 reports were not inspected on this occasion due to the absence of the manager and the staff indicating that they did not participate or were aware of any part of this side of the work within the home. Therefore the related requirements made in the previous report have been carried over and repeated. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 1 2 3 2 Standard No 22 23 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 1 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 2 x x Standard No 11 12 13 14 15 16 17 x 2 3 2 x x x Standard No 31 32 33 34 35 36 Score x 1 3 1 1 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sandford House Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 2 1 1 1 I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 26 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 1 Regulation 4,5,6 Schedule 1 Requirement The Registered Person must further develop the Statement of Purpose and ensure it accurately reflects the services and facilities provided by the home. The Registered Person must produce a Service User Guide for each individual admitted for their reference. This is a second repeat requirement not met within the previous given timescales. The Registered Manager must ensure new service users are admitted only on the basis of a full assessment undertaken by people competent to do so and for individuals referred through Care Management, has obtained the Care Management Assessment. This is a repeat requirement not met within the given timescale. The Registered Manager must demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. The Registered Manager must ensure the contract agreed Timescale for action 1st Oct 2005. 2. 2 14, Schedule 3(1)(a) 1st September 2005. 3. 3 12 1st October 2005 4. 5 5( c) 1st October 2005 Page 27 Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 5. 6, 9, 41. 14, 15. 6. 7, 13. 12 7. 12, 14. 16 8. 19 12 9. 20 13 10. 23, 41 13 between the service user and the home specifies all arrangements as detailed in NMS 5.2 and the individual is provided with a copy. The Registered Manager must ensure an individualised care plan is developed and agreed with each service user, setting out how specialist needs will be met through positive planned interventions and programmes, reviewed within the agreed times and updated to reflect changing needs and/or outcomes for the service user. This is a repeat requirement not met within the previous given timescales. The Registered Manager must ensure rights are only limited through an assessment process, recorded in the care plan and regularly reviewed. The Registered Manager must ensure all Service Users take part in valued and fulfilling activities in and outside the home. The Registered Manager must ensure that the physical and emotional healthcare needs of service users are assessed and recognised, procedures are in place to address them and ensure service users are supported to access NHS Primary and specialist facilities. The Registered Manager must ensure staff receive appropriate medication training and formal assessment of the carers competence to safely administer medicines. This is a repeat requirement not met within given timescale. The Registered Manager must safeguard service users from all 1st September 2005. 1st September 2005. 1st September 2005. 1st September 2005. 1st October 2005. 1st september Page 28 Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 types of abuse by ensuring robust policies and procedures are in place and followed. The Registered Person must ensure staff receive appropriate training in the areas of protecting vulnerable adults. This is a repeat requirement not met within timescale. The Responsible Person must ensure the premises are safe and well maintained, and suitable for its stated purpose. The Registered Person must ensure that all staff have the knowledge, skills and experience necessary for supporting and meeting the needs of the service users with mental health problems. The Registered Person must obtain in respect of persons being employed at the home the documents specified in Schedule 2 of the Care Homes Regulations. This is a second repeat requirement not met within timescale. The Registered Person must ensure that the home has a training and development plan, and that all staff receive at least five paid training and development days. The Registered Person must ensure staff receive structured induction and foundation training to Sector Skills specification. The Registered Person must establish and maintain a system for reviewing the care within the home.This is a repeat requirement. The Registered Person must ensure that unecessary risks to service users are identified and 2005 11. 24,26, 28. 13,16,23. 1st September 2005. Action plan of how the home will meet this requiremen t. 1st september 2005. 12. 32 12 13. 34, 41 19 14. 35, 41 18 1st October 2005. 15. 8, 39 16, 24 1st October 2005. 16. 42 12, 13 1st september 2005. Page 29 Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 17. 37, 43 12 so far as possible eliminated. The Registered Person must ensure suitable training is provided for staff to ensure the health, safety and welfare of service users. The Responsible Persons must ensure that the home complies with the Care Standards Act and Regulations. The Responsible Persons must ensure that action is progressed within agreed timescales to implement requirements identified in CSCI inspection reports. Immediate action on receipt of report. 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 7 Good Practice Recommendations The Registered Person should ensure staff are aware of independant advocacy services and are able to support service users in accessing advocacy services if they require this. The Registered Person should ensure service users are encouraged and supported to retain and administer their own medication where able, within a risk management framework. The Registered Manager should ensure unused medication is disposed of or returned to a pharmacy. The Responsible Individual should consider additional bathroom facilities to meet the needs of five service users. The Registered Person should ensure policies and procedures are service specific and staff are aware of and understand the contents and apply these in practice. 2. 20 3. 4. 27 40, 23. Sandford House I56-I05 S17926 Sandford House V231240 010705 - Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester Essex, CO1 1RJ National Enquiry Line: 0845 015 0120 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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