Inspection on 10/10/07 for Huish House

This inspection was carried out on 10th October 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Huish House 16/04/08

Huish House 19/12/06

Huish House 15/03/06

Huish House 03/11/05

Huish House 23/11/04

Huish House 09/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Huish House Huish Episcopi Langport Somerset TA10 9QP Lead Inspector Sally Murphy Unannounced Inspection 10th October 2007 10:30 Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Huish House Address Huish Episcopi Langport Somerset TA10 9QP 01458 250247 01458 259384 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) Home First & Foremost Ltd Miss Lisa Jane Richards Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) 2. The maximum number of service users who can be accommodated is 12. 19 December 2006 Date of last inspection Brief Description of the Service: Huish House provides a home for up to twelve adults between the ages of 18 and 65 who have a learning disability and associated needs including autism, sensory impairments, physical disability and epilepsy. Huish House is owned by Milbury Voyage. The Registered Manager is Lisa Richards. The home is a detached property in a semi rural location near Langport. The home has been maintained to a high standard. Service user rooms have been decorated to reflect individual tastes and preferences. All service user rooms have en suite bathrooms. There are sufficient communal areas. Appropriate adaptations have been provided to meet service users needs. The current scale of charges is £1,102.57 to 1,839.25 each week. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and was completed by Sally Murphy, Regulation Inspector. Brian Brown Regional Lead Pharmacist visited the home during the second day of the inspection to examine the management of medication. The previous inspection was completed on 19th December 2007 and was unannounced. Prior to the inspection the Registered Manager completed an Annual Quality Assurance Assessment, and surveys were issued to relatives, staff members and health and social care professionals. The findings from these documents have been incorporated within this report. At the time of the inspection there were twelve service users residing at the home. During the course of the inspection, we conducted a tour of the premises, examined care records, staff files and health and safety documentation. Discussions were held with the Registered Manager, staff members, and service users and care practice was observed. Five immediate requirements were issued as a result of this inspection. These related to the storage and recording of medication, manual handling training, fire safety training, and fire safety records. The Inspector would like to thank the Registered Manager, staff and service users for their assistance during this inspection. What the service does well: Care plans have been developed to address a range of needs. A personal evacuation plan had been completed detailing the help required by each service user in the event of an emergency. Risk assessments had been completed for each service user. These were detailed and provided information regarding the existing control measures. There is an appropriate system in place regarding service users finances. All transactions are supported by a staff signature and receipt. Finance records are regularly audited. On the day of inspection there was a good range of activities available. However feedback obtained from staff members and relatives stated that this was not always possible due to reduced staffing levels. One relative stated that ‘leisure activities are not always met’. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 6 Service users are offered a healthy diet that reflects their individual dietary needs. Service users appeared well presented. Staff had given consideration to each service users individual tastes and preferences. One survey received from a relative stated that ‘personal care is excellent’. A clear procedure is followed when medication enters and leaves the home. Service users live within a comfortable and homely environment. Service users rooms have been decorated to reflect their individual tastes and preferences. Service users have the specialist equipment required. The home has been maintained to a high standard of cleanliness. What has improved since the last inspection? What they could do better: The Registered Manager must review use of the Communication Book and whiteboard in the office to ensure that the storage of personal information complies with the Data Protection Act 1998. Care plans must be reviewed on a regular basis. Risk assessments must be maintained regarding the use of bed rails. A staff signature must be recorded for all entries within behavioural care plans. Service users at this home have limited verbal communication; therefore it remains a recommendation at this inspection that staff be provided with further training in Total Communication. Appropriate plans must be developed where service users have lost weight, or are at risk of weight loss. Nutritional plans must be reviewed regularly. All medication must be stored securely. There must be a record in each individual care file to detail how their medicines are to be given. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 7 The complaints procedure should be amended to state that CSCI may be contacted at any stage. Staff must be made aware of the whistle blowing policy. The carpet has begun to ridge in one service users room. This must be addressed as this may pose a trip hazard to this service user who has poor mobility. On some occasions the level of staffing has impacted the range of activities available to service users. Staff have not been provided with appropriate updates in moving and handling training to enable them to safely undertake their roles. Service users may be at risk through failure by the home to operate a robust recruitment procedure. Comments received within the staff surveys stated that staff did not feel able to raise issues of concern. An Immediate requirement was made that the fire system must be tested weekly and an appropriate record maintained and staff must receive regular updates in fire safety training and appropriate training must be provided for newly appointed staff. Hot water outlet temperatures within some rooms were found to exceed recommended levels. These may pose a risk of scalding to vulnerable service users. Hazard analysis must be completed with regard to food preparation in accordance with the requirements issued by the Environmental Health Officer on 8/8/06. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their families are provided with appropriate information to make an informed decision about the home. Service users have been provided with a written contract that outlines the terms and conditions of their stay. EVIDENCE: The home has a Statement of Purpose and Service User Guide. The Service User Guide has been provided in pictorial format. This provides information on what Huish House can offer, Your rights, and what to do if there is something you don’t like. However this is a lengthy, and detailed document that may not be accessible to some service users residing at this home. Copies of the contract between the provider and placing authorities are held at Head Office. A copy of the Residency contract is provided in each service users care plan. This provides information on the terms and conditions of their stay. The residency contract states that the ‘The Manager will explain how you can complain’. The home should ensure that this includes a summary Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 10 of the complaints procedure. The residency contract confirms the amount that service users must contribute towards the vehicle each week. Huish House is currently fully occupied and there have been no new admissions since the last inspection, therefore it was not possible to assess admission procedures during this visit. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were person centred and reflected service users individual needs and preferences. Some care plans had not been regularly reviewed, and therefore may not be reflective of service users current needs. Service users may be placed at risk through the failure to develop and review risk assessments relating to the use of bed rails. Some information regarding service users had not been stored in accordance with data protection legislation. This practice does not promote the privacy of service users. EVIDENCE: Within the Annual Quality Assurance Assessment completed prior to the inspection, the Registered Manager advised that ‘The Care Plan is made Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 12 available in a accessible format, with the involvement of the service user, family, friends and relevant agencies’. The Registered Manager also stated that assessments are completed prior to admission to ensure that the appropriate aids and adaptations are available, and that service users receive support to access health care services, such as the Behavioural therapist, Occupational Therapist and Communication therapist. During the course of this inspection three care plans were examined in detail. It was found that care plans had been developed to address a range of needs including: health, medication, dental optical, diet, self help, daily living skills, activities, social, communication, and behavioural needs. A personal evacuation plan had been completed detailing the help required by each service user in the event of an emergency. Monthly summaries varied in the level of information provided. For some service users it was not possible to determine the number or range of activities that they had participated in. For one service user the monthly summary had last been completed in August 2007. Care plans were not available in a format that was accessible to the service users residing at the home. All service users at the home require assistance from staff to manage their personal finances. Service users financial records were examined and it was found that a system is in place where all transactions are supported by one staff signature and receipts. Financial records are audited regularly. Risk assessments had been completed for each service. These covered a number of areas and provided information regarding the existing control measures. General risk assessments had been completed and reviewed on 14/3/07. However a risk assessment had not been completed regarding the use of bed rails for one service user, and risk assessments regarding bed rails for two further service users had not been reviewed since 16/8/06. It should be noted that the term bed rails is preferable to ‘cot sides’ within the remit of adult services. Behavioural care plans were in place, however ‘ABC’ charts did not record a staff signature. Within the staff office it was found that a Communication Book was in use that in addition to messages between staff also contained personal information regarding service users, such as the outcome of GPs visits. This practice does not comply with the Data Protection Act 1998. Similarly there is a white board in the office where a record is held of the recent seizures experienced by all service users in the home. This information must only be recorded in service users personal records. These matters were discussed with the Registered Manager during the inspection. The Registered Manager agreed to give Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 13 consideration to how the management of personal information may be improved within the home. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to go college, and are able to participate in daily activities within the home. However on some occasions service users have not been provided with appropriate opportunities to access the local community and participate in leisure activities due to low staffing levels. Service users are generally supported to maintain links with their families. Service users are offered a healthy diet that reflects their individual dietary needs. EVIDENCE: Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 15 Within the Annual Quality Assurance Assessment the Registered Manager advised that service users are provided with regular access the community and attend external learning opportunities. At the time of the inspection, two service users had gone horse riding, six had gone out for lunch and there was music therapy and a walk planned for the afternoon. The Inspector spent some time in the lounge. Service users were listening to music. One service user was playing with tactile toys, whilst another was dancing with a member of staff. Service users appeared happy and relaxed. A further service user had chosen to spend time in their room listening to music. The Inspector was provided with a copy of the activities programme. This included a range of activities within and outside of the home. Three service users attend college. The notice board in the hallway provides service users with information regarding which staff will be on duty. This also specifies which service user will be assisting with the meal each evening. During the course of the inspection friendly interaction was observed between staff, and service users and relatives. Service users at this home have limited verbal communication; therefore it remains a recommendation at this inspection that staff are provided with further training in Total Communication. Prior to the inspection surveys were received from relatives. Many of these raised concerns regarding a high level of staff turnover, which they felt impacted the range of activities available, particularly outside of the home. One relative stated that ‘leisure activities are not always met’ and that service users needed ’more mental stimulation’. One relative stated that staff never help service users to keep in touch, whilst five stated that the usually do and one that this happens sometimes. All felt that they were kept up to date. Most relatives stated that staff support service users in the way that they would wish them to. Surveys were also received from staff members. These raised concerns regarding poor staffing levels, and some issues regarding the quality of food. One staff member stated that ‘there have been shifts when it is possible for service users to enjoy only a very basic quality of their day to day needs being met due to not enough staff’. During the course of the inspection the menus, and food stocks were examined. Clear information had been provided regarding service users individual dietary needs. There were ample stocks, and only four of the tins were ‘value’ products. There were also fresh vegetables available. A record Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 16 is maintained of all meals taken. Service users are given the choice to eat alone or with others. Staff demonstrated a good knowledge of each service users dietary needs. Service users are provided with appropriate adaptations to promote their independence. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are provided with appropriate support to meet their personal care needs. Service users have been provided with assistance to access health care services and specialist advice has been sought as required. Appropriate action has not been taken where service users have lost weight. The lack of security of some medicines places people resident in the home at risk of harm. EVIDENCE: Within the Annual Quality Assurance Assessment the Registered Manager has stated that the home ‘provides service users with the personal support they require in their preferred way, meet the physical and health needs of the service user’. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 18 Each service user room has en suite bathing facilities. Three service users have bath chairs. Service users appeared well presented. Staff have consideration to each service users individual tastes and preferences. One survey received from a relative stated that ‘personal care is excellent’. Care plans included evidence of service users receiving support to attend routine health appointments, and referrals being made to specialist services when required. An appropriate pressure risk assessment had been completed for one service user who had been identified as being at risk of pressure damage. Records for a further service user contained detailed information regarding their medical condition. There were appropriate guidelines in place regarding service users epilepsy needs. Individual seizure records were maintained in service users’ plans. For one service user weight records evidenced that they weight had decreased from 9st in May, to 8 st 12lb in June and 8st 9lb in July. Their care records did not evidence the actions being taken to address this weight loss, and there were no further weight records for this service user. For another service user weekly weight records had not been maintained. For a further service user the care plans stated that their weight can be unstable and that nutritional supplements are available. Weight records evidenced that their weight had decreased from 8st 6lb in July to 8st 2lb by August 2007, There were no further weight records for this service user. The care plan did not evidence the actions being taken to address this need. Medication Administration Records (MARS) were examined. These contained a photograph of the service user, and information regarding any allergies. A clear procedure is followed when medication enters and leaves the home. There was one hand transcribed entry on the medication record that had not been supported by a date or staff signature. There were a number of further hand transcribed entries where only one staff signature was recorded. It is recommended that all amendments to medication records are checked and signed by a second staff member to reduce the risk of human error. Whilst most medicines were found to be stored securely we found that all staff could access some medicines. We also found that some people would only take their medicines in particular ways. Whilst the members of staff on duty at the time of the inspection were able to tell us how they gave the medicines there was no record made of how this decision had been reached. This may mean that if unfamiliar carers were on duty the person may not receive their medicines, as although they could indicate not to take the medicine they would not be able to instruct the carer how they would take the medicine. We found that all staff administering medicines by specialised techniques had received appropriate training. However we were not able to find evidence that all members of staff administering one particular medicine had received training on how to give it or been assessed as competent to carry out the task. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has taken appropriate action in response to complaints raised. The home must ensure that staff are aware of the whistle blowing policy. EVIDENCE: The home has complaints procedure. This includes details of external agencies that may be contacted. The procedure states that ‘if you are not happy’ you may contact CSCI. This must be amended to state that CSCI may be contacted at any stage. Service users are provided with an accessible version of the complaints procedure and with ‘help’ cards. Within the surveys received relatives confirmed that they would know how to raise a complaint. There have been two complaints received since the last inspection. The home has taken appropriate action to address the issues raised. The home has a whistle blowing policy. Most staff spoken with during the inspection were not aware of the whistle blowing policy or that they may report concerns to external agencies. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Huish House provides a comfortable and homely environment. Appropriate adaptations have been provided to meet the individual and collective needs of service users residing at the home. Generally the home has been decorated and maintained to a high standard, however some work must be undertaken to ensure the health and safety of service users. EVIDENCE: Huish House is a large house situated in a semi-rural setting on the outskirts of Langport with views of the countryside to the rear of the property. The home is surrounded by a large garden, which includes a patio area with a pond. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 21 The home has twelve single rooms, five of which are on the ground floor and seven on the first floor. Three bedrooms are accessible for wheelchair users. All rooms have en-suite facilities. Bedrooms are adapted and personalised according to individual needs and tastes. Social areas include a large lounge and balcony area, two dining rooms, sensory room, training kitchen and main kitchen. Since the last inspection kitchen worktops have been replaced, and the gardener has re-started work at the home. Within the Annual Quality Assurance Assessment the Registered Manager has stated that ‘We provide an accessible homely clean hygienic safe well maintained and comfortable environment to meet individual service users needs and current legislation’. During a tour of the premises it was noted that the wallpaper has started to come off the ceiling in one service users room. The carpet has begun to ridge within a further service users room, and this may pose a trip hazard to this service user who has poor mobility. Unguarded hot pipes were also noted in the sensory room that may pose a risk of scalding to vulnerable service users. The home has been decorated and furnished to a high standard. Appropriate adaptations have been provided to meet service users needs. The home has a laundry with commercial style washing machine and dryer. Appropriate hand washing facilities have been provided. The paintwork by the washing machine and hand basin has started to flake off making this area difficult to clean. The home had been maintained to a high standard of cleanliness. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. On some occasions the level of staffing has impacted the range of activities available to service users. Staff have not been provided with appropriate updates in moving and handling training to enable them to safely undertake their roles. Service users may be at risk through failure to operate a robust recruitment procedure. EVIDENCE: Within the Annual Quality Assurance Assessment the Registered Manager advised that actions had been taken to address staff shortages, and in-house training was now available for many courses through the EL Box (laptop computer). Prior to the inspection surveys were received from staff members and relatives. Within the surveys received from staff members a number of concerns were raised regarding low staffing levels, and the impact this had Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 23 on the provision of activities for service users. The surveys completed by relatives similar comments were received in addition to concerns about the high level of staff turnover and the implications this may have for their relatives who have complex needs. Staff also provided positive feedback regarding the care provided and including comments that there was a ‘first class staff team’. Staff spoken with during the inspection confirmed that staffing levels and the quality of food had improved. Some staff stated that they would benefit from further opportunities to undertake training. Staff stated that they received regular supervision and staff meetings. Staff demonstrated a good knowledge of service users individual needs. On the day of the inspection there were eight staff on duty during the morning, six during the afternoon, and one sleepover and two waking staff scheduled to cover the night duty. Staff training records were examined, and it was found that only two out of twenty three staff had received updated training in moving and handling. This is of serious concern as there are two service users at the home requiring assistance with a hoist and three service users using a bath chair. Further service users require support when walking. The lack of manual handling training may place service users and staff at risk of injury. Training records evidenced that a further four staff needed updated training in food hygiene, and four in first aid. Only five staff were recorded as having attended Protection of Vulnerable Adults training, however the Registered Manager advised that further staff had completed this, but were awaiting the certificates. Recruitment files were examined for three staff members who had recently been employed at the home. For one staff member there was a record of an application form being completed, two references being received, and an enhanced CRB disclosure being completed. However there was no proof of identity or record of induction training. For the second staff member there was a record of an application form being completed, only one reference being received, and an enhanced CRB disclosure being completed. An induction record had been completed for this staff member. For the third staff member there was record of an application form being completed, only one reference, and an enhanced CRB disclosure being completed. There was no record of induction training for this staff member. Voyage Ltd. has recently begun holding recruitment records centrally at the Head Office, with information sheets being held for each staff member within the individual homes. However the information sheets for these staff members had not been completed in full. There was no record of applicants’ qualifications or experience. There was no evidence that the references Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 24 received were satisfactory and for two staff members only one reference had been recorded. These matters will be discussed with the Provider Relationship Manager for Voyage Ltd. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not effectively managed. Service users may be put at risk by failure of the home to test equipment regularly and provide staff with appropriate updates in fire safety training. EVIDENCE: The Registered Manager is Lisa Richards. She has many years experience of providing care to service users who had a learning disability. Ms Richards has recently completed the Management Development program provided by the company and is working towards the Registered Managers Award. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 26 Comments received within the staff surveys stated that staff did not feel able to raise issues of concern. Further comments stated that staff felt that there was a breakdown in communication between the manager and staff, that staff did not feel supported and that there was low morale within the staff team. These matters were discussed with the Registered Manager during the inspection and with a Regional Manager at Voyage Ltd following the visit to the home. The Registered Provider has recently appointed a Regional Quality Assurance Manager. The majority of service users at the home are not able to provide verbal communication regarding their satisfaction with the service, however their views are sought, and regular reviews held with relatives and Social Workers. Regulation 26 visits are conducted on a monthly basis by the Registered Provider. Records relating to the visit conducted on 6/8/07 state ‘Has the service training record been completed and updated ad do staff personnel files contain relevant certificates? YES, and Does the training record show that the service meets the requirements of CSCI / Supporting People ? YES. Training records seen during the inspection did not reflect this judgement. The home has appropriate policies and procedures in place. The home displays appropriate Employers liability insurance. The Registration certificate is currently displayed in the office. This should be moved so that it is visible to all visitors to the home. Fire safety records were examined and it was found that the last record of the fire system being tested was 17/9/07. Four staff had not received updated fire safety training, including a newly appointed member of staff for whom there is no record of fire safety training. An Immediate requirement was made that the fire system must be tested weekly and an appropriate record maintained and staff must receive regular updates in fire safety training and appropriate training must be provided for newly appointed staff. The company policy states that staff must receive two fire drills each year, however for twelve staff there was no record of fire drills being undertaken within the last year. Fire extinguishers, torches and emergency lighting had been checked weekly and were last recorded on 17/9/07. The fire risk assessment completed and reviewed 26/2/07. The fire system was serviced on 24/8/07. Detailed health and safety audits had been completed on a weekly basis. The hoist had been serviced on 3/9/07 and the lift serviced on 11/5/07. One bath chair was being replaced. Gas and portable appliance testing was up to date. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 27 Hot water temperatures for three en suite bathrooms had been recorded as too hot, in addition to the hand basin in sensory room, and downstairs toilet. The Registered Manager advised that maintenance had been advised of this, but no action had yet been taken. Due to the dependency levels of the service users, this must be followed up as a matter of urgency. Some gaps were noted within kitchen cleaning records and one freezer was recorded as being –33 C. This exceeds the normal levels for freezer temperatures. An inspection was completed by the Environmental Health Officer on 8/8/06. An outcome of this was that hazard analysis must be completed in accordance with the HACCUP guidance. This had not been addressed. Accidents had been recorded and audited on a monthly basis. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 4 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 2 33 2 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 1 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 1 1 2 3 X 1 X Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 (2b) Requirement The manager must ensure that the service user’s care plans are reviewed regularly. Care records must include a staff signature. 2. YA9 13 (4) [c] Risk assessments must be appropriately maintained regarding the use of bed rails. The Registered Manager must review use of the Communication Book and whiteboard in the office to ensure that the storage of personal information complies with the Data Protection Act 1998. Service users must be provided with regular opportunities to participate in activities both within home and local community. 30/11/07 Timescale for action 30/11/07 3. YA10 17 (1) [b] 30/11/07 4. YA14 16 (2)) [m[ 30/11/07 5. YA19 17 & Sch 3 (3) [m] Appropriate plans must be 30/11/07 developed where service users have lost weight, or are at risk of weight loss. Nutritional plans DS0000039967.V352877.R01.S.doc Version 5.2 Page 30 Huish House must be reviewed regularly. 6. YA20 13(2) The storage of all medicines must be safe and secure. Immediate Requirement Issued There must be a record in each individual care file to detail how their medicines are to be given. Immediate Requirement Issued Staff must be made aware of the whistle blowing policy. The Registered person must take action to address the following issues: • Carpet that has begun to ridge in one service users room wall paper that has started to come away from the ceiling in a further service users room. unguarded hot pipes in the sensory room 29/01/08 18/10/07 7. YA20 13(2) 25/10/07 8. 9. YA23 YA24 13 (6) 13(4) [a] & 23(2) [d] 29/01/08 21/12/07 • • 10. YA30 13 (3) The paintwork within the laundry must be repaired to ensure that this area remains easy to clean. Newly appointed staff must be provided with Induction training. There must be sufficient staff on duty at all times to ensure that the home is able to meet service users’ personal and social care needs. 11. 12. YA32 YA33 18 (1) [c] (I) 18 (1) [a] 30/11/07 30/11/07 13. YA34 19 (4) [b] Two satisfactory references must 30/11/07 be obtained prior to a member of staff commencing employment DS0000039967.V352877.R01.S.doc Version 5.2 Page 31 Huish House at the home. Appropriate records must be maintained of staff members’ qualifications and experience. 14. YA35 13 (5) All staff working at the home must receive updated training in moving and handling Immediate Requirement Issued. 15. YA37 24 (1) [a & b] The Registered Manager must establish appropriate systems to review and improve the quality of care provided at the home. 29/01/08 21/12/07 16. YA38 21 (2) The Registered Manager must 21/12/07 establish appropriate systems for staff members to raise concerns. During Regulation 26 visits the 30/11/07 Registered Provider must review the standard of care provided, with particular regard to the staff training. Appropriate action must be taken to address: • hot water outlet temperatures that exceed recommended limits. Gaps in kitchen cleaning records 29/01/08 30/11/07 17. YA39 26 ( 4) 18. YA42 13 (4) [c] • 19. YA42 13 (4) [c] Hazard analysis must be completed with regard to food preparation in accordance with the requirements issued by the Environmental Health Officer on 8/8/06. The fire system must be tested weekly and an appropriate record maintained. DS0000039967.V352877.R01.S.doc 20. YA42 23 (4) [c] 18/10/07 Huish House Version 5.2 Page 32 Immediate Requirement Issued. 21. YA42 23 (4) [d] Staff must receive regular updates in fire safety training and appropriate training must be provided for newly appointed staff. Immediate Requirement Issued. 30/11/07 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. Refer to Standard YA5 Good Practice Recommendations It is recommended that the written contract include a summary of the complaints procedure. It is recommended that the manager consider implementing a more detailed finance record to include two staff signatures on all transactions. It is recommended that more consideration be given to ensure staff engage with all service users as fully as possible. Further training in specialised communication skills could be provided in this area. It is recommended that there is a clear process to update service user files with current medicines following a review. It is recommended all hand written entries on medication records are checked and signed by a second staff member to reduce the risk of human error. The complaints procedure should be updated to state that CSCI may be contacted at any stage. It is recommended that all staff are provided with DS0000039967.V352877.R01.S.doc Version 5.2 Page 33 YA7 3. YA11 4. YA20 5. YA20 6. 7. YA22 YA35 Huish House Protection of Vulnerable Adult training, medication training and further increase the level of NVQ trained staff. 8. YA41 The registration certificate should be displayed in a conspicuous place. Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Huish House DS0000039967.V352877.R01.S.doc Version 5.2 Page 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!