Inspection on 05/01/06 for Houndswood House

This inspection was carried out on 5th January 2006.

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

Houndswood House 02/12/08

Houndswood House 03/06/08

Houndswood House 13/02/08

Houndswood House 11/04/07

Houndswood House 09/11/06

Houndswood House 18/04/06

Houndswood House 22/06/05

Houndswood House 20/10/04

Houndswood House 04/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU Lead Inspector Angela Dalton Unannounced Inspection 5th January 2006 11:00 X10015.doc Version 1.40 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 Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000019459.V276791.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Houndswood House Address Harper Lane Radlett Hertfordshire WD7 7HU 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) 01923 856 819 01923 853 509 Speciality Care (REIT Homes) Limited Viginia Cheytan Care Home 65 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (65), of places Physical disability over 65 years of age (4), Terminally ill over 65 years of age (3) Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 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. This home may accommodate 3 older people in need of terminal care who require nursing. This home may accommodate 4 older people with dementia who require personal care. This home may accommodate 4 older people with physical disability who require personal 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 that the home is able to comply with and maintain regulatory requirements. 22nd September 2005 Date of last inspection 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 newer 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 sized rooms. 41 single rooms and 4 double rooms have en-suite facilities. The home has extensive gardens that are well maintained and easily accessible. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two Inspectors between 11am and 7pm on 5th January 2006. Some good care delivery was observed but this was overshadowed by the negative findings during the inspection. Only one of the requirements previously made has been met. It is disappointing to see that as in other inspections the majority of the standards inspected were not met. Staff morale is clearly affected by the uncertainty of the future of their sister home Ravenscroft in Barnet which has been empty since a fire in 2005. Houndswood House has since accommodated staff and service users from Ravenscroft. Staff stated that they felt tired from working long days and that they would benefit from additional staff. A recruitment programme is underway. Inspectors observed the poor availability of staff when a member of staff did not receive assistance with a service user, as none was available due to staff breaks not being staggered. Some service users were unkempt and it appeared that no pride had been taken in their appearance by staff. This transferred to the environment, as towels, linen, clothing, pads and aprons were not put away. This may be attributed to the low morale of staff. The home is currently under statutory notice to limit the numbers of residents within the home to no more than forty-five service users. A fire drill took place during the inspection and Inspectors were able to observe the fire protocol. What the service does well: What has improved since the last inspection? What they could do better: There has been little progress with the Requirements made in previous inspections. Fire doors were again seen wedged open. This is unacceptable and has been previously identified. The fire alarm was activated during the inspection and fire doors did not shut. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 6 Some were wedged with chairs and footstools. This could be extremely dangerous had there been a fire. A number of service users - especially those in the ‘main house’ were unkempt. Slippers and shoes were trodden down and dirty, clothes were creased and grubby (despite the care taken in the laundry) and ladies were wearing shoes without tights or stockings. As stated earlier staff stated they felt tired and under pressure. Poor moving and handling of a service user was observed and a nurse was observed to give directions to a care worker in an aggressive manner. Both were reported to the manager. One bedroom corridor was without heating and felt extremely cold. Two service users still reside in the corridor and temperatures were taken which showed that rooms were well below a comfortable temperature. Despite the outside temperature being only 3ºC windows throughout the home were open. Bedroom windows were still open during the early evening. Some did not close properly. Cleaning agents and used needle bins were accessible to service users as they were stored in unlocked areas. This could leave service users at serious risk of injury. The Commission will be considering the merits of regulatory enforcement action against a number of outstanding requirements. 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. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Not inspected on this occasion Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 & 10 Care plans do not fully identify how service users needs are to be met. Service users are not protected by safe medication practices. Observation of dignity and privacy of service users is severely lacking. EVIDENCE: Care Plans continue to require attention. Work appears to be ongoing but there are still gaps in information. Risks were identified in the care plans examined but there was no care plan to guide staff to monitor and record to determine improvement or decline of a condition. This was seen several times relating to nutritional needs and pressure care where risk of decline was noted and staff assistance was required but there was no further information in place. Considering the serious issues that arose with pressure care leading to a joint investigation it is disappointing that care planning remains a concern. Regulatory action may be considered. There are no relatives’ signatures in place to evidence their involvement in the care plan although some have clearly contributed to personal histories. As discussed in the previous inspection information is not easily found in the care plans due to the wealth of paperwork. In one care plan a record of seizures was in place but with no associated care plan. There is confusion and a lack of knowledge about the type of seizures and whether they were epileptic or a ‘mini stroke’. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 10 In others bruises are being recorded but again without additional information. Risk assessments have been completed but do not advise what to do if the risk occurs. Care plans for managing challenging behaviour identify strategies to prevent the behaviour but not what to do if behaviour is exhibited. Service users and staff are not protected. A number of service users - especially those in the ‘main house’ were unkempt. Slippers and shoes were trodden down and dirty. It must be recognised that badly fitting shoes or slippers can leave to an increased risk of falls. Clothes were creased and grubby (despite the care taken in the laundry) and ladies were wearing shoes without tights or stockings. A bottom set of dentures was on top of a resident’s wardrobe. The hairdresser was styling service users hair in a corridor on the lower ground floor, as there is no suitable room for her to use. The dignity of service users is not observed. Medication practises had improved a little but amounts did not reconcile. Amounts are checked in on the Medication Administration Record (MAR) sheet and the date precedes the start date on the MAR sheet. Therefore when medication was checked the totals bore no resemblance to the records. Storage temperatures are not recorded for the drug trolleys where medication is held but are for the medication cabinets. MAR sheets reflected that staff were signing before administering medication to service users as their signatures had been overwritten with the code letter to reflect medication had been refused. This is poor practise. Controlled drugs were in good order but records of the address where medication comes from and returns to must be kept. There has been very little improvement in the past six moths with the issues cited above. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 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 the following standard(s): 12 & 15 Service users can participate in a small selection of activities. Meals are varied and appetising. EVIDENCE: Lunch was sampled by the Inspectors and was hot and tasty. Vegetables were fresh and pureed food was served in separate portions. The assistant cook has commenced NVQ training and this is a positive step. Menus were on display but were only changed to the current choices close to lunchtime. The activities co-ordinator continues to be calm and gentle in her approach. She records any activities that service users are involved in. Activities in the home are still 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, as she is only able to lead activities in one area of the home at a time. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 18 Service users are not protected from abuse. EVIDENCE: Poor moving and handling of a service user by a staff member was observed by Inspectors. The staff member was asked to stop the handling process and the Inspectors sought assistance for the member of staff as no one responded to the call bell. On investigation two staff had gone on their break together and one member of staff was with a service user having a cigarette. This left one careworker to cover the main part of the house. The manager was notified and went to assist the staff member with the service user. The care plan for the service user stated that they were at risk of bruising and photographic evidence was in place. The manager said that staff were aware that the service user needed two staff for moving and handling. When Inspectors spoke to the staff member they were not aware of either of these facts. All staff have had moving and handling training. Staff who spoke with Inspectors said that they felt they were not always providing the best level of care as they felt tired from long days (twelve hour shifts) and from the pressure of work. When Inspectors visited the staff room they observed that staff were sleeping during their break. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19,21,24,25 & 26 The home is in need of refurbishment. The standard of furnishings is unsatisfactory and reflects a lack of respect for service users. Items are inappropriately stored within the home. The home does not assure service users’ warmth and comfort. EVIDENCE: There were areas of the home with strong odours: the reception area of the main house and the lounge in the extension. On the manager’s return from a meeting the carpet in the extension was cleaned. Cleanliness has improved but further efforts are needed. The stairs in the home had not been vacuumed, faeces was seen on a light switch and medication spillages are not being cleaned in the clinical room. The soap dispensers and hand sanitizer dispensers are now fixed and product was available. On a previous inspection they were empty and broken. Items had not been put away in the home: towels, linen, clothing, pads and aprons were in bathrooms. Hoists, wheelchair friendly weighing scales and laundry stands were some of the items in corridors and bathrooms. This impacted upon the accessibility of bathrooms and the space for service users and staff to move freely around the home. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 14 The toilets in the main house on the ground floor are still not accessible to wheelchair users and are often used for storage. Razors were in bathroom drawers. They posed a high risk to those residents with dementia. Service users are at risk from used needle bins and cleaning products in unlocked rooms and cupboards. One bedroom corridor was without heating and felt extremely cold. Two service users still reside in the corridor and temperatures were taken which showed that rooms were well below a comfortable temperature. Despite the outside temperature being only 3ºC windows throughout the home were open. Bedroom windows were still open during the early evening. Some did not close properly. One service user has an ensuite shower but a chest of drawers bars access. There is no explanation within the care plan. The home has interior design boards on display but all refurbishment plans have ceased since the additional residents have arrived from Ravenscroft last autumn. Some furniture within the home is worn and in need of replacement e.g. veneer is missing from tables, chairs were old and chipped. The home has potential with period features but this has not been realised. The dining room floor is still sticky. The environment is not welcoming although the company has recognised that refurbishment is needed but no dates have been confirmed. This is extremely disappointing as service users are not living in acceptable standards and despite a number of meetings with the providers there has been no recognisable action taken. Further regulatory enforcement action will be considered. The home has a large amount of land and landscaped gardens and has an enclosed area for service users to stroll around which has been fenced off recently. The lead Inspector had hoped that advantage would have been taken of securing a larger area of the garden and ensuring that service users are not at risk of wandering down the driveway to the main road. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 15 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Staffing levels do no not assure the safety of service users. Adequate personnel documentation was not in place. EVIDENCE: As previously stated staff complained that they felt fatigued and under pressure. The home provides transport from pick up points but some staff who were previously at Ravenscroft have additional travelling time to Houndswood House. The situation has not been resolved at team meetings and some staff reported that they had been told that the door was open for them to leave if they wished. It was unclear who had stated this. Staff interaction with service users has improved since the previous inspection. Inspectors observed the poor availability of staff when a member of staff did not receive assistance with a service user, as none was available due to staff breaks not being staggered. Earlier reference has been made to the aggressive manner in which a nurse spoke to a careworker. Training is provided but with regard to safe moving and handling (as discussed earlier in the report) it is not being observed by all staff. Recruitment documentation did not reflect current visa conditions and this must be evidenced to the Commission. This requirement was made at the previous inspection and a requirement has again been made in relation to a newer member of staff. When copies of documents are kept on file a record should be made to reflect that the originals have been seen. The fire alarm was activated during the inspection. All the staff bar one left the unit to go to the fire panel. This does not assure the safety of service users and staff and must be addressed as a matter of urgency. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 16 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 The home is not run in the best interests of the service users. The health and safety of service users and staff is not assured. EVIDENCE: The company have not provided the manager with timescales within which the home is to be refurbished. Plans have not yet been revealed regarding the future of Ravenscroft, although the Commission was informed that they would kept aware of any arrangements and this should have been by the end of September 2005. The manager is aware of low staff morale and feels that the uncertainty of the current situation is a major contributor. The fact that so many previous requirements remain unmet does not reflect positively upon the manager or company. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 17 There are several health and safety issues: Bedroom windows do not shut properly, an external fire door still does not shut properly, internal fire doors and bedrooms doors continue to be wedged open, parts of the home are too cold, the sensor on an external fire door had been turned off enabling undisturbed access onto the fire escape, a safe fire protocol is not in place and staff were unaware of safe evacuation procedures, razors, used needle bins and cleaning products were accessible to service users, the car park at the rear of the house is not lit and access is unsafe. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 18 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 X 1 X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 1 Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 & 15(2)(b) Requirement Service users needs must be identified (e.g. pressure care, sensory, nutrition, challenging behaviour) and details recorded of how they will be met, monitored and managed. This requirement was made at previous inspections. AN ENFORCEMENT NOTICE MAY BE SERVED. Timescale for action 31/01/06 2. OP8 12(1)(b) 13/01/06 Health needs must be fully met e.g. oral hygiene and dental care. This requirement was made at previous inspections. On this occasion a bottom set of dentures was on top of a wardrobe. Poor cleanliness of nails was noted. AN ENFORCEMENT NOTICE MAY BE SERVED. Accurate records must reflect correct amounts of medication. Medication amounts must be carried forward onto Medication Administration Record sheets to ensure that reconciliation can take place. This requirement was made at previous DS0000019459.V276791.R01.S.doc 3. OP9 13(2) 09/01/06 Houndswood House Version 5.1 Page 20 inspections. MAR sheets reflected that staff were signing before administering medication to service users as their signatures had been overwritten with the code letter to reflect medication had been refused. Storage temperatures in medication trolleys must be kept. Addresses of origin and exit for controlled drugs must be recorded. AN ENFORCEMENT NOTICE MAY BE SERVED. 4. OP10 12(4)(a) The dignity of service users must be observed. This requirement was made at previous inspections. Poor moving and handling manoeuvres were observed. Service users were unkempt and poor condition clothes, shoes and slippers contributed to this. AN ENFORCEMENT NOTICE MAY BE SERVED The home must be homely, well maintained and comfortable for service users. A plan to illustrate how the home is to be improved mus be submitted to the Commission for Social Care Inspection . 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. This requirement was made at previous inspections. A plan of action must be submitted to the Commission for Social Care Inspection . The comfort of service users must be assured regarding the temperature within the home. If ensuite access is denied a record DS0000019459.V276791.R01.S.doc 13/01/06 5. OP19 23(2)(b) 28/02/06 6. OP21 23(2)(n) 28/02/06 7. OP24OP25 OP38 23(2)(p) 09/01/06 Houndswood House Version 5.1 Page 21 7. OP26 12(4)(a)& 13(3) must be in place. The home must be clean and free from offensive odours. The home is under Notice regarding odour. 13/01/06 8. OP30OP27 18(1)(a)& (b) Staff must meet the needs of the 13/01/06 service users and demonstrate that their dignity and safety is assured. This requirement was made at previous inspections. A copy of the worked rota must be supplied to the Commission at the end of each month. Adequate staffing levels must be evidenced to avoid enforcement action being implemented. Recruitment documentation did not reflect current visa conditions and this must be evidenced to the Commission. This requirement was made at the previous inspection. 09/01/06 9. OP29 17(2)19 (1) 10. 11. OP31 OP38 9 13(3)&(4) &23(4) The manager must meet the 28/02/06 outstanding requirements to demonstrate fitness. Health and Safety must be 09/01/06 observed within the home: Bedroom windows do not shut properly, an external fire door still does not shut properly, internal fire doors and bedrooms doors continue to be wedged open, a safe fire protocol is not in place and staff were unaware of safe evacuation procedures, parts of the home are too cold, the sensor on an external fire door had been turned off enabling undisturbed access onto the fire escape, razors, used needle bins and cleaning products (COSHH) were accessible to service users, the car park at the rear of the house is not lit and access is unsafe. DS0000019459.V276791.R01.S.doc Version 5.1 Page 22 Houndswood House COSHH items must be securely stored. Door wedges must not be used. Bedrooms must be of a comfortable temperature. AN ENFORCEMENT NOTICE MAY BE SERVED AS HEALTH AND SAFETY ISSUES HAVE BEEN RAISED AT PREVIOUS INSPECTIONS. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP29 Good Practice Recommendations Where copies of recruitment documents are kept on file a record should be made to reflect that the originals have been seen. Houndswood House DS0000019459.V276791.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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. 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