Inspection on 06/03/07 for Juniper House

This inspection was carried out on 6th March 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 no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Juniper House 16/09/08

Juniper House 25/07/07

Juniper House 19/01/06

Juniper House 14/07/05

Juniper House 11/02/05

Juniper House 20/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Juniper House 159 Strathmore Avenue Luton LU1 3QR Lead Inspector Alan Buttery Key Unannounced Inspection 6th March 2007 10:30 Juniper House DS0000015013.V335986.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 Juniper House DS0000015013.V335986.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. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Juniper House Address 159 Strathmore Avenue Luton LU1 3QR 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) 01582 419923 Mrs Audrey Greer Mrs Audrey Greer Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Juniper House is a small home for three service users with learning disabilities. The home was owned and managed by Mrs Audrey Greer. A small staff team are employed and work closely with service users. The home is situated in a residential of Luton, close to shops and other amenities. The building is a detached house with four single bedrooms. The ground floor has a lounge, dining room and the kitchen with washing machine. An enclosed garden with a patio was accessed from the kitchen. The home charges between £600 and £700 per week for the care, depending on the individual needs of the service user. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, and during this inspection all of the key National Minimum standards for younger adults were assessed. The Proprietor/manager was working on the day of the inspection together with one member of staff and assisted the inspector with the information required. During this inspection documentation was read, a tour of the home was undertaken and a service user was spoken to. Nine requirements have been made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Although offering a very personal service to the three service users living in the home, a number of areas requiring improvement were noted, including recruitment practice, staff training, supervision, care planning and risk assessment. These are highlighted at the end of this report as requirements, and must be addressed within the timescales quoted. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 6 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. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good quality information is gathered prior to anyone moving to the home so that the person moving in can be confident the service can meet his or her needs. EVIDENCE: Since the last inspection, a new service user has moved into the home, and the process followed was discussed with the proprietor of the home. The initial referral came from the local authority and the proprietor then met with the individual’s care manager and service user. In addition information was gathered from the service users advocate and from other health professionals involved in the case. Consequently a very detailed profile was established which enabled the service to provisionally offer a place subject to funding and transition work. The transition period was kept short to avoid unsettling either the prospective new admission or the two service users in the home, but involved a number of visits, which were successful enabling the service user to move into the home last December. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 9 Evidence of this process was seen on the service users individual file. Throughout the process the small staff team were aware of the progress, and able to add their own thoughts, particularly relating to the trial visits arranged. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care plans are not updated or reviewed and this means that staff will not be aware of how to meet peoples needs EVIDENCE: Being a very small service, run on a domestic scale, both the proprietor and staff team are aware of their limitations, and are unable to accommodate any service user with either high dependency or challenging needs. The assessment process followed ensures that service users in the home can confidently expect their varying needs to be met, and met in a manner appropriate to them individually. The proprietor advised that each of the service users has the support of an advocate who is able to discuss care issues with them, and who is involved in care planning. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 11 However, in spite of this, care plans seen during the inspection were poor, and not reviewed as often as necessary. This was discussed with the manager who accepted that they needed to do some extensive care plan work, and that new care plans were needed for all three-service users. The filing system and service users files were extremely cumbersome, and did not offer easy access to information, and these should be revised, ensuring then that staff can follow agreed plans. Although some risk assessments were available, they were very basic, no assessment of risk around the environment had been done and there was no evidence that the risk assessments had been reviewed. With the cumbersome files mentioned above, it was extremely difficult to find any relevant information. For example, the kitchen was kept locked because of issues with one of the service users, but no guidelines, planning or risk assessments were found. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 15, 16 and 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 encouraged to make good use of community facilities. EVIDENCE: In spite of the earlier comments around the lack of care planning and risk assessments, the service does offer a particularly good level of service user involvement, and felt very homely, a fact reinforced by the service user in the home on the day of the inspection. A variety of day and evening activities take place, some structured day services as well as varied social and leisure activities. Two of the service users attend local college courses and day services, and at other times undertake a variety of everyday domestic tasks with support, including housework and cooking. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 13 The service users will often have lunch out on a Saturday, and go to local pubs and restaurants, shopping and for visits to local amenities. Service users often walk to the shops with staff on a Sunday to buy a newspaper or go for a coffee. There is a local disco once a month and annual holidays and day trips are planned. The home has cable television, and the service users often rent DVD’s from a local shop to watch. Monthly residents meetings are held and during these meetings service users are able to talk about the home and any changes they would like to make. As well as helping prepare meals, service users are involved in planning menus and shopping Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 14 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): Standards 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is no evidence of individual involvement in health support, although people using the service appear happy with the support they receive. EVIDENCE: Although offering a high level of individual knowledge and attention to service users, there was little to evidence how service users healthcare needs are attended to, in a way in which they are happy. Clearly healthcare needs, both physical and emotional are met, with good support from local professionals, for example daily visits to give two service users with diabetes their insulin injections, but there needs to be a better and clearer record of the support required and how it should be given. Medication records were examined which were in order, and relevant training is given to staff. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although policies are in place, training in adult protection matters has not been provided, potentially placing people who use the service at risk EVIDENCE: The home has both a complaints and adult protection policy and in the past year has had no complaints or adult protection issues to deal with. However at the time of the inspection, the proprietor reported that she was the only member of staff to have had POVA training. This must be arranged for all staff members urgently. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is domestic in scale and clean and tidy offering a homely setting for people living there EVIDENCE: The service is run from a 4 bed roomed detached house in a suburban part of Luton, and very well suited to its use. It is very homely, and run like any domestic home, although of course subject to regulations. The home is well decorated, and each service user has been able to help with the colour schemes both in their own room and in communal areas. On the day of the inspection, the home was clean and tidy, and there were no unpleasant odours present. However there were no risk assessments available for the home, which must be done. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 17 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): 32, 34, 35 and 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Recruitment processes are not followed placing people who use the service at risk EVIDENCE: A staff team of three at present plus the proprietor, with the occasional use of agency staff, supports the three service users in the home. A satisfactory recruitment policy is in place, but evidence on files examined did not show that the policy was being followed. One file for an employee who had recently rejoined the home after a two year gap had only one reference and no CRB check. It was agreed that a verbal reference and immediate CRB check would be done, although the proprietor said that some one from the CSCI had agreed that the employee could rejoin. Although there was some evidence that training is planned over the next few months the staff files examined failed to show any training since July 2005, and infrequent supervision. Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 18 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): Standards 37, 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although procedures are in place, inadequate training and risk assessments place users at risk EVIDENCE: In spite of poor record keeping and care planning, and several other administrative issues, it was clear during the inspection that the home is run very much with the service users interests at heart. They are actively involved in all areas of their lives, enjoying a varied social calendar and taking an active role in the running of their home. Health and safety issues must be addressed, in particular risk assessment and staff training to avoid the need for enforcement action to be considered Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 19 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 2 X Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 YA6 Standard Regulation 15(1) Requirement Individual care plans must be available and reviewed to ensure all staff are aware of how to meet service users needs. Risk assessments must be completed to ensure the safety of service users both inside and outside the home. Individual plans must demonstrate the involvement of people who live in the home to ensure their individual preferences are recognised A detailed record must be available to show how individual healthcare needs are met All staff must have adult protection training to ensure people who use the service are not at risk All staff must be suitably trained to meet the needs of people using the service A detailed recruitment process must be followed with the necessary checks to ensure people using the service are properly protected All staff must be appropriately supervised DS0000015013.V335986.R01.S.doc Timescale for action 30/06/07 2 YA9 13(4)(b) 30/06/07 3 YA18 15(1) 30/06/07 4 5 YA19 YA23 12(1)(a) 13(6) 30/06/07 31/07/07 6 7 YA32 YA34 18(c)(i) 17(1)(a) 31/07/08 30/06/07 8 YA36 18(2) 30/06/07 Juniper House Version 5.2 Page 21 9 YA42 13(4)(a) Risk assessments and training must be in place to ensure the health and safety of staff and service users. 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Juniper House DS0000015013.V335986.R01.S.doc Version 5.2 Page 23 - 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. 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