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Inspection on 22/06/05 for Houndswood House

Also see our care home review for Houndswood House for more information

This inspection was carried out on 22nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

There are some staff who engage with service users with a kind manner and assisted those with challenging behaviour in a calm and competent way. The laundry was well organised and the laundry assistant takes an obvious pride in her work.

What has improved since the last inspection?

Some paintwork has been updated. A chef has been employed and service users and visitors spoke highly of the meals. Some areas of care plans have improved since the previous visit by inspectors. The high numbers of Agency staff employed in the home has reduced due to a successful recruitment programme. Risk assessments have been incorporated into care plans to enable staff to better meet service users` needs.

What the care home could do better:

The home was unclean and had a strong odour. Service users were expected to remain in the house despite the high temperature outside. No garden furniture was available and the focus in the main house appeared to be about containing residents. The increased member of service users in the home hasled to a frenetic atmosphere. Poor care was observed: a nurse was seen to mimic a resident who was shouting rather than intervene and attempt to calm and reassure them. Another service user was blocked from leaving a lounge area and he became agitated as he was told he could not go out alone but noone volunteered to accompany him. He eventually swore and pushed past the nurse who then had to follow him. This scenario could have been avoided by her initially accompanying him outside. One service user was ignored whilst he shouted ` I want to ****ing die`. Two service users were involved in a fight resulting in a service user sustaining an eye injury. The inspector observed poor moving and handling despite appropriate aids being available to assist staff; they did not use them properly. When the inspector drew a nurse` s attention to a service user whose trouser had fallen down and were exposing him whilst he was sat having a drink they were informed that service users were going to be toileted and no effort was made to adjust his clothing. Loud announcements were made in front of service users about who required their pad changing. One service user was wearing a thermal vest and jumper despite it being extremely hot outside and warm within areas of the home. The majority of staff did not appear to be aware of service users primary needs or take a pride in their work. Some service users were wearing unclean clothes, dirty shoes and slippers. Service users` dignity was compromised by the culmination of poor care in a poor environment.

CARE HOMES FOR OLDER PEOPLE Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU Lead Inspector Angela Dalton Unannounced 22 June 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 Older People. 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. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Houndswood House Address Harper Lane Radlett Hertfordshire WD7 7HU 01923 856819 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) Speciality Care (REIT Homes) Limited Care Home with Nursing 65 Category(ies) of DE(E) Dementia over 65 (4) registration, with number OP Old Age (55) of places PD(E) Physical Disablity over 65 (4) TI(E) Terminally Ill (3) Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 4 older people with physical disability who require personal care. This home may accommodate 4 older people with dementia who require personal care. This home may accommodate 3 older people in need of terminal care who require nursing. This home may accommodate 4 older people who require personal care. This home may accommodate 55 older people with need for convalescent and respite care who require nursing care. Houndswood House may admit service users with elderly needs until a maximum total of 55 service users are resident. The condition will be removed once the Commission for Social Care Inspection is satisfied the home is able to comply with and maintain regulatory requirements. Additional visit - 10th February 2005 Additional visit - 20th April 2005 Brief Description of the Service: Houndswood House is a care home providing nursing and personal care and accommodation for 65 older people including people with Dementia (DE), Physical Disability (PD) and Terminally ill (TI). The home is owned by Craegmoor and registered under Speciality Care (REIT Homes) Limited. The home was opened in 1997 and is situated in a rural area between London Colney and Radlett. It is a period house with modern extensions, set in extensive parkland gardens with pathways and a large patio area, which can be reached via the lounge, dining room or conservatory. The home is divided into two areas, identified by staff as the ‘main house’ and the ‘extension’. The older part of the house has one large ground floor lounge and a small sitting room. The ‘extension’ has communal areas all on the ground floor, which include dining, lounge and conservatory areas. All bedrooms in the new area have ensuite facilities with toilets. Bathrooms have hoists fitted to baths. A lift serves each end of the home and a new wheelchair lift has been added to enable improved access to one part of the older building. The home is reached via a driveway from Harper Lane. Car parking facilities are provided to the front and rear of the building. Houndswood House is not served by public transport, but is close to Junction 22 of the M25 Motorway.The majority of the bedrooms are for single accommodation (47) and there are 9 double rooms. 41 single rooms and 4 double rooms have en-suite facilities. The home has extensive gardens that are well maintained and easily accessible. Date of last inspection Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two Inspectors between 12.15pm and 7.30pm. Houndswood House has been under ‘special measures’ due to the numerous care issues present in the home discovered in Summer 2004. This was a deeply disappointing inspection. The home has admitted twenty additional service users following a fire in one of Craegmoor’s Barnet homes. This has increased the challenge to the manager of the home as there are two staff teams co-existing and an increased number of residents who have complex needs. The environment was less than desirable as a strong odour associated with urine and vomit was present within various areas of the home. The planned refurbishment programme has failed to commence. Dilapidated furnishings remain and some bedrooms occupied by the ‘guest’ residents were stark and without stimulation i.e. no books, television or radio. The main house was noisy and chaotic. There was nowhere for service users to escape and seek peace and quiet unless they returned to their rooms. Some of the findings during the inspection caused great concern to the inspectors. What the service does well: What has improved since the last inspection? What they could do better: The home was unclean and had a strong odour. Service users were expected to remain in the house despite the high temperature outside. No garden furniture was available and the focus in the main house appeared to be about containing residents. The increased member of service users in the home has Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 6 led to a frenetic atmosphere. Poor care was observed: a nurse was seen to mimic a resident who was shouting rather than intervene and attempt to calm and reassure them. Another service user was blocked from leaving a lounge area and he became agitated as he was told he could not go out alone but noone volunteered to accompany him. He eventually swore and pushed past the nurse who then had to follow him. This scenario could have been avoided by her initially accompanying him outside. One service user was ignored whilst he shouted ‘ I want to ****ing die’. Two service users were involved in a fight resulting in a service user sustaining an eye injury. The inspector observed poor moving and handling despite appropriate aids being available to assist staff; they did not use them properly. When the inspector drew a nurse’ s attention to a service user whose trouser had fallen down and were exposing him whilst he was sat having a drink they were informed that service users were going to be toileted and no effort was made to adjust his clothing. Loud announcements were made in front of service users about who required their pad changing. One service user was wearing a thermal vest and jumper despite it being extremely hot outside and warm within areas of the home. The majority of staff did not appear to be aware of service users primary needs or take a pride in their work. Some service users were wearing unclean clothes, dirty shoes and slippers. Service users’ dignity was compromised by the culmination of poor care in a poor environment. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home assesses the needs of service users to identify that the home is able to meet them. EVIDENCE: A recently admitted service user had evidence of an assessment that had gone onto form their care plan. The home had liaised with other professionals to ensure that all relevant information was obtained. The quality of assessments has improved in comparison to the level of information that was previously sought regarding existing service users. The home does not provide intermediate care and therefore Standard 6 does not apply. Twenty service users have been admitted as an emergency following a fire in a sister home. These service users are supported by an integrated team of staff from Houndswood and those from their own care home. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10&11 Care plans do not fully identify how service users needs are met. Service users are not protected by safe medication practices. Observation of dignity and privacy of service users is severely lacking. EVIDENCE: The quality of care plans of care plans is improving. Further information is required regarding management of sensory needs, dementia and challenging behaviour. Risks have been identified but preventative measures or strategies are not evident specifically relating to challenging behaviour. Care plans do not equip staff to know what to do if challenging situation presents itself but are aware that it is likely to occur. Two service users were involved in a fight during the inspection and injuries were sustained. Weights were recorded but there is a lack of monitoring. One service user’s weight increased by 25kg (equivalent to five stones) but this had not been identified. On further exploration it appeared that the previous weight had included his wheelchair. The home employs a high number of male carers and care plans do not reflect whether this has been a consideration to the provision of personal care. The episodes observed by Inspectors in the main house demonstrate that care plans are inadequately informing staff about how to appropriately assist service users in meeting their needs. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 10 Health care needs appear to be met but personal requests from family e.g. oral care were not reflected within care plans. Poor oral hygiene was observed by inspectors and some service users appeared not to have had their hair washed. Some improvement had been made regarding medication but totals of medication were inaccurate. Numbers of medication were not being transferred onto Medication Administration Record Sheets and not all medication could be assured of accuracy. Medication was left in a broken blister pack rather than being disposed of appropriately. Service users privacy is compromised in the main house, as there is no private area apart from a bedroom to seek respite from the chaos. In the extension the conservatory was being utilised in a calmer atmosphere prevailed. Service users dignity is far from being fundamental to the care provided. Examples cited earlier (Service users being mimicked, ignored, able to fight, unclean appearance) emphasise in the opinion of the lead inspector that residents in the main house are seen as lower class citizens. One service user was photographed wearing a ‘bib’ and this photograph is the one held on file for recognition. This illustrates that staff have little awareness of dignity issues. It is difficult to explain why this approach and attitude exists. The ‘guest’ residents’ rooms are bare and uninviting. One service user found it difficult to use his door handle and had previously become trapped in his room and panicked. He now manages his anxiety by jamming his pyjama top in the hinges of the door to prevent it fully closing. Funeral wishes were recorded in care plans. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14&15 Service users can participate in a small selection of activities. Choices are limited within the home and are further compromised by the sudden increase in service user numbers. Meals are varied and appetising. EVIDENCE: The activities co-ordinator was calm and gentle in her approach. She records any activities that service users are involved in. Activities in the home are recorded as diversional techniques, which raises questions regarding how activities are viewed within the home. The co-ordinator may benefit from additional support either by another activities co-ordinator or by some enthusiastic staff members. One inspector observed a service user being informed that they had to attend art therapy because another staff had instructed them. The service user was informed that they would not get their cigarette until completing art therapy. Predictably, the session was disrupted because the service user did not wish to attend and they began to shout and swear. The inspector had previously observed them sitting peacefully in the reception area. Art therapy is offered to a small group of service users in the extension. Service users cannot meet family members in private in the main house without travelling into the extension or returning to their room. There are visits to the home from entertainers and armchair exercises are anew activity, which appear well received. Because of its remote location, the home has limited opportunities to integrate with the local community. There was a noticeable lack of newspapers and magazines within the home. Staff Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 12 were not proactive in occupying service users which may have calmed some of the stresses experienced. Service users and visitors commented on the improvement of food and the approachability of the chef. This inspection took place when the weather was hot and service users were not kept supplied with fluids. This is not the first time this has occurred and a requirement has been made. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16&18 Service users are not adequately protected from abuse. Complaints are not appropriately referred where they clearly relate to Adult Protection issues. EVIDENCE: The home holds records of complaints. A page had been ripped from the book used to record complaints and no explanation for this could be given. There had been two complaints that clearly raised concerns relating to Adult Protection but neither had been referred to Adult Care Services, the police or the Commission at the time of the incidents. This was done retrospectively regarding one incident. There have been a number of strategy meetings regarding allegations made relating to the Adult Protection procedure in the past eight months. The incidence of reports has settled since a permanent staff team has been employed. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25&26 Service users live in a poorly maintained environment. The standard of furnishings is unsatisfactory and reflects a lack of respect for service users. Infection control is not observed. EVIDENCE: There were areas of the home with strong odours. Cleanliness was of an extremely poor standard. One bathroom had a clinical waste bag placed open on the floor and the odour of the used incontinence pads on display was obviously one of the sources of the strong smell. The cupboards in one bathroom were damp and mouldy and unclean. A bathroom which housed a toilet was inaccessible to service users using a wheelchair as a hoist was stored there and the door width was too narrow. There were empty soap dispensers and hand sanitizer dispensers so poor infection control is observed. The manager explained that the sanitizer dispensers are awaiting repair. A hoist to assist standing (although it had been professionally checked) has the padded knee rest covered with strong adhesive tape to provide obvious repair. The ‘guest’ residents are living in stark, Spartan bedrooms, as their home has been Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 15 inaccessible and personal effects. No effort had been made to provide home comforts. No books, televisions, radios or newspapers were available in the ‘guest’ residents’ bedrooms. One service user had difficulty opening their door handle and was anxious about being trapped in their room. They had wedged their pyjamas in the hinged edge of the door to prevent it closing. This potentially compromised the fire safety of the home, but no safe alternative measures had been introduced. Bathrooms were not clean. Razors and personal toiletries had not been returned to their owners. They posed a risk to those residents with dementia and illustrated that items may have been used communally. The home has interior design boards on display but all refurbishment plans have ceased since the additional residents have arrived. Furniture within the home is worn and is falling apart in some bedrooms. Chairs were dirty and stained. The environment was not welcoming and it was evident that it must be distressing to live in current conditions. Despite having a large amount of land and landscaped gardens there is no enclosed area for service users to stroll around. Despite having patio areas no garden furniture was available. As stated earlier the weather on the day of inspection was hot and sunny. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29&30 The majority of staff are not competent to meet service users’ needs. Service users are not protected because of poor recruitment checks. EVIDENCE: Although the numbers of staff have increased the skills of some staff do not currently meet client needs. Staff did not seem to be mindful of service users’ fragile state of mind. One female member of staff mimicked a service user who was shouting whilst another prevented a service user from going out of the patio doors for a walk outside. There were staff who were gentle and appropriate in their interaction with service users but they were in the minority. There was a high proportion of male carers on duty. Care plans did not reflect the service users’ preference and this is recommended. Poor moving and handling was observed despite the correct equipment being available. Recruitment records did not demonstrate that documentation for overseas staff was validated by the home or company if they were sent by e-mail. It was therefore not possible to evidence that references were valid. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36,37&38 The home is not run in the best interests of the service users. The management structure of the home does not facilitate high quality care. The health and safety of service users and staff is not assured. EVIDENCE: The home manager was officially appointed to the role of manager in March 2005 but was acting manager prior to this. An application has been submitted to the Commission but the process is delayed as additional paperwork is required. There has only been one deputy manager as opposed to two and the deputy has since resigned. However, there are now two acting deputies in post. One of the senior staff transferred from the ‘guest home’ is acting deputy manager whilst the two deputy manager vacancies are being advertised. There have been three different Area Managers in post since August 2004. The current Area manager is on secondment for 12 months. A solid Senior Management structure has to exist to enable the home to progress. The Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 18 manager has a huge task to rectify the difficulties experienced by the home. It is almost twelve months since the home faced closure and the home has not made as much progress as was anticipated. Staff confirmed that the manager was approachable as did service users. Formal supervision of staff is sporadic but induction programmes have been completed by new and visiting staff. Door wedges were in use which compromises service users and staff health and safety. Sharps bins containing used needles were in two open areas in the home. They must be stored safely and securely. The same applies to razors that were left on display. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION 1 1 1 2 1 1 2 1 STAFFING Standard No Score 27 1 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 1 2 1 x x 2 2 1 Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 20 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 OP7 Regulation 12(1)(2) & (3) Requirement Service users needs must be identified (e.g. sensory, nutrition, challenging behaviour) and details recorded of how they will be met, monitored and managed. Health needs must be fully met e.g. oral hygiene and dental care Medication must be disposed of approriately and not stored in open blister packs. Accurate records must reflect accurate amountes of medication. Medication amounts must be carried forward onto Medication Administration Record sheets to ensure that reconciliation can take place. The privacy and dignity of service users must be observed. Any complaint that relates to the protection of vulnerable adults must be reported to the Commission for Social Care Inspection. Any incident that relates to the protection of vulnerable adults must be reported to the Commission for Social Care Inspection. Service users who do not wish to Timescale for action 31/07/05 2. 3. OP8 OP9 12(1)(b) 13(2) 30/06/05 30/06/05 4. 5. OP10 OP16 12(4)(a) 12(1)(a) & 37 30/06/05 30/06/05 6. OP18 37 & 12((1)(a) 30/06/05 7. OP13 12(3) 30/06/05 Page 21 Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 8. 9. 10. OP19 OP12 OP20 11. 12. OP19 OP21 13. OP23 OP24 14. OP15 15. OP26 participate in an activity must not be made to do so. 23(2)(i) Service users must be able to meet their visitors in private. 23(2)(o) The garden must be suitable for and safe for use by service users. 23(2) The furniture must be in good condition and clean. Any furniture that is broken must be replaced. The dirty chairs in the lounge must be replaced as attempts to clean them have failed. A REQUIREMENT WAS MADE REGARDING A MAINTENANCE PLAN AT THE PREVIOUS INSPECTION 23(2)(b) The home must be well maintained. The environment is not currently well kept. 23(2)(n) The toilets in the main house on the ground floor are not accessible to wheelchair users. This is not acceptable with the current needs of service users. 16(2)(c) Bedrooms must be equipped to adequately meet the needs of service users. Bedrooms are currently Spartan and without televisions, radios or books. 16(2)(i) Service users must be provided with adequate fluids. On service user had to collct a jug of water as there was not any in his room. Small glasses are in use and jugs of juice are kept at the side of the room at mealtimes. Service users are unable to refill their glass without asking for more. 12(4)(a) The home must be clean and A free from offensive odours. AN statutory IMMEDIATE REQUIREMENT WAS enforceme MADE TO CLEAN THE HOME. nt notice has been served I52 s19459 Houndswood House v233619 220605 Stage 4.doc 31/07/05 31/07/05 14/07/05 31/07/05 31/07/05 30/06/05 23/06/05 23/06/05 Houndswood House Version 1.20 Page 22 16. 17. OP27 OP29 18(1)(a) & (b) 17(2) Schedule 4 & 19(1) Schedule 2 17(1)(b) 18. OP37 19. OP38 13(3) 13(4) Staff must meet the needs of the service users and demontrate that their dignity is observed References must be validated. Emailed references from overseas had not been checked to ensure service users were protected by stringent recruitment procedures. An immediate requirement was made. Records must be kept securely. Pages must not be ripped from official records (e.g complaints records) Health and Safety must be observed within the home. Doors must not be wedged open and a safe appropriate alternative authorised by a fire officer must be implemented. Service users must be able to access entry and exit from their rooms were they are able and not be impeded by the door handle. Sharps boxes must be stored safely and securely. Razors are to be stored securely and safely and not available for communal use. Effective infection control must be observed within the home by availability of liquid soap . It had run out from several dispensers within the home. Two of the three fire sensors were turned off on the fire exits and a fire door was not shutting properly. These issues must be rectified. A REQUIREMENT WAS MADE REGARDING ITEMS POSING A POTENTIAL RISK AT THE PREVIOUS INSPECTION. 30/06/05 23/06/05 30/06/05 30/06/05 Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 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. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP15 OP22 OP25 OP30 OP31 OP32 OP33 OP36 Good Practice Recommendations Condiments should be available to service users rather than staff offering each table (this was observed with a staff member offering service users pepper) The standing aid should be in good condition as the knee pad is repaired with tape. It is recommended that additional cooling units be distributed to relieve the hot areas of the home during the warm weather. Staff should be trained in meeting service users needs. Their practice did not reflect knowledge of basic needs e.g. dignity and respect. A competent management team should be appointed to enable the home to progress. The manager should provide a clear sense of direction and leadership within the home. The home should be run in the best interest of the service users. The manager should be able to identify and rectify the issues that were noted during the Inspection. Staff should recive regualr formal supervision. Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ 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. Extracts may not be used or reproduced without the express permission of CSCI Houndswood House I52 s19459 Houndswood House v233619 220605 Stage 4.doc Version 1.20 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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