Inspection on 27/02/07 for Nicholas House

This inspection was carried out on 27th February 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nicholas House 06/02/09

Nicholas House 07/02/06

Nicholas House 12/09/05

Nicholas House 09/12/04

Nicholas House 09/07/04

Nicholas House 01/03/04

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 Nicholas House Cairns Close St Albans Hertfordshire AL4 OEY Lead Inspector Hazel Wynn Key Unannounced Inspection 27th February 2007 10:00 Nicholas House DS0000019482.V313754.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 Nicholas House DS0000019482.V313754.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. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nicholas House Address Cairns Close St Albans Hertfordshire AL4 OEY 01727 839909 01727 858742 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) www.Adepta.org.uk Adepta Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Nicholas House, provided by PentaHact, is a residential care home for seven younger adults with autism, severe learning disabilities and challenging behaviour. It is situated in a residential area, about two miles away from the town of St Albans. There are ample parking facilities nearby. The three-storey building is part of the former Hill End Hospital complex. The external appearance of this Edwardian building blends in well with surrounding properties. It has been completely renovated internally to accommodate the assessed needs of the residents. There are six bedrooms, mainly on the first and second floors. The first floor has two bedrooms, a lounge with adjoining dining room, a domestic-scale kitchen, a Jacuzzi bathroom and toilet and a separate toilet. The office/sleep-in room is also on this floor. The second floor consists of four bedrooms, a bathroom and a separate toilet. The ground floor has a one-bedroom flat for a service user, a sensory room, a recreation room and the utility room. There is a large garden to the back of the building. It has a summerhouse, garden swings and garden furniture. The garden overlooks Highfield Park. The statement of purpose, service user guide and previous CSCI inspection reports are available at the mangers office at Nicholas House (a copy of the residents guide will be provided to prospective residents by the home) CSCI inspection reports are also available on the CSCI web site. The fee range is currently £1816.84 per week to £1854.16 £1,200 additional care = £2033.09 per week. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the afternoon and early evening of 28th February 2006. The assistant manager and operations manager were present. The home is registered for 7 residents; one service user is currently awaiting funding agreements in order to move from the home in order to meet their changed needs. The registered manager has resigned and interviews to fill this post are scheduled to take part in March 2007. One of the assistant managers is currently acting as home manager. The inspection began with meeting staff on duty and most of the residents. This was followed by a tour of the premises excluding the flat on the ground floor; where a service user did not want the intrusion. The care plans and other documents were examined. One service user needs to be constantly supervised and monitored by a member of staff. The other residents contributed to the inspection. Feedback was given at the end of the inspection to the assistant manager. What the service does well: What has improved since the last inspection? What they could do better: The home will be in a stronger position to meet it’s objectives fully when a current service user has moved to a more appropriate service (due to changed Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 6 need). Currently, the home is only able to contain the service user who’s needs it has identified cannot be met at the home; despite attempts by the home to support the service user towards resettlement, the situation has dragged on for longer than is desirable due to funding arrangements not yet being agreed. It is understood that the home is doing all that it can to bring a conclusion to this situation but it is recommended that an update regarding progress in obtaining funding is sought. The registered manager has resigned and the post is vacant; interviews have been set for March 2007. A requirement is made for the registration of a successful applicant to the post of manager. 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. Nicholas House DS0000019482.V313754.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 Nicholas House DS0000019482.V313754.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 were assessed. A comprehensive assessment is carried out prior to the admission of a service user, prior to the admission of a service user and a trial period is arranged. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Service User Guide and a copy of the written contract of agreement are provided to each service user. A trial period is designed individually for each service user wishing to be placed in the home. The home has identified that it cannot meet the changed needs of a service user who is awaiting funding agreements to be finalised in order for them to move to an alternative placement. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 were assessed. Residents have the assurance that their assessed and changing needs are recorded and acknowledged through an individual plan of care and this includes decision making. Individual risk assessments are in place to support residents towards their potential independence level. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans examined reflected that the assessed and changing needs of the residents re tracked and met. One service user’s needs can no longer be fully met and the home is doing all that it can to transfer the service user to an alternative identified placement and is awaiting funding arrangements to be finalised, which is taking longer than is desirable in the interests of this service user and other residents residing at the home. The care plans are reviewed monthly and reveal that the residents require daily one-to-one supervision and Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 10 guidance. Individual risk assessments were in place to ensure appropriate support is in place to support residents to enjoy as independent a lifestyle and progress as is possible for each service user. Observations were made of how staff support residents to make decisions on a day-to-day basis. A key worker is assigned to each service user who becomes accountable for the meeting of all needs and to flag up any deficit or change. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12. 13, 15, 16 and 17 were assessed. An activity programme is designed and planned to suit individual needs and interests and choice. The residents’ activities include them in the use of community resources and their personal relationships are respected with support given to maintain contact with family. The residents’ rights are respected and programmes are in place to support them towards their responsibilities as a citizen. The menu reflects the provision of a healthy diet and there are comfortable dining arrangements. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans looked at during this inspection showed that a programme of leisure and structured activity is in place for each service user. The residents attend the PentaHact Day Care Centre in Brickets Wood as part of their Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 12 structured daily activity programme; appropriate transport is provided. Leisure activities are arranged to suit the individual needs and preferences of the residents and these include frequent activities in the community. One of the residents requires one to one supervision at all times and staff arrange activities to suit their needs with the appropriate high level of support. The home has a recreation room equipped with indoor games, including a pool table and a computer system with Internet access and some computer games. One of the residents gave some good feedback about his experience of the home (see the summary section of What the home does well). A dietician provides advice in meeting the individual nutritional needs of residents and the menu reflected healthy choices and variety. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Personal support is provided in accordance with individual preferences and needs. The home meets the physical and emotional needs of residents and takes action as appropriate. Medication is managed in accordance with guidance and legislation. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence was gained from the records and from discussions with staff that health needs and behavioural concerns are referred to the appropriate health care professional. One service user’s health and emotional needs have been reviewed and an alternative placement has been identified to meet changed need; in the meantime the situation for this service user is one of safe containment and the home struggles to provide for their needs but it is clear that they are managing and staff are monitoring him closely. The staff explained how they minimise any disruption to the lives of the other residents living in the home and there was certainly a relaxed atmosphere in the home throughout the inspection process. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 14 Evidence of training shows that staff who administer the medication, have received the necessary training to do so. There were no gaps in the medication administration record and the medication system was being well managed. Nicholas House DS0000019482.V313754.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were assessed. A robust Complaints’ Policy and Procedure is in place at the home and these are available to residents and others. The staff are well versed in safeguarding adults. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint had been received and fully investigated; the complaint had been partially upheld and substantiated. Safeguarding Adults training has been provided to staff in the interest of protecting residents from abuse and self-harm. A copy of the Hertfordshire Adult Protection Procedure is in place at the home; it is easily accessible for staff and this is used as part of induction for new staff. Nicholas House DS0000019482.V313754.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 were assessed. All areas of the main part of the home were and comfortable and pleasant. The home is maintained in a clean and safe manner. It is not possible to upgrade the flat occupied by one of the residents for well-established reasons. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The main parts of the home where six of the residents are residing was comfortably furnished and observed to be clean and hygienic. Residents own rooms reflected their needs and preferences. The inspector was unable to enter the flat were one of the residents who has very complex needs is currently residing whilst awaiting transfer to a more appropriate placement in line with his changed needs. The service user was very agitated and would not accept my visit. Staff explained that the condition of the flat is less than ideal but the service user will not tolerate any alteration and becomes very stressed with refurbishments and immediately commences to change the area back to its previous condition. The professional team Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 17 (including the social worker and health care professionals) are fully aware of the situation and an alternative placement has been identified but funding arrangements were not yet in place, at the time of this inspection. It is recommended that an update regarding the progress of obtaining funding be sought. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34 and 35 were assessed Staff roles and responsibilities are clearly defined; policies, procedures, training and guidance is in place to support staff to manage their role. The home has an effective and competent staff team, and it is adequately staffed to meet the needs of the residents. Robust recruitment procedures are in place in line with guidance to provide safeguards for the residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A rolling training programme, for all staff, is in place at the home, ensuring that staff have the necessary skills to provide care for the residents. From observation and discussions with staff it was ascertained that they are very experienced in this field of care. Staff explained the induction process, which is designed to take as long as necessary with shadowing until the staff member feels confident and they are assessed as competent to take on the role and responsibilities assigned. The residents are assigned a key worker from the staff team. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 19 Robust recruitment practices are adhered to with the necessary references, Criminal Bureau Record checks and Protection of Vulnerable Adult register checks being carried out. The full application form with employment history and induction evidence is maintained in the staff members file. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 were assessed. A vacancy exists for the post of registered manager; arrangements are in place to ensure the home is well run. The residents’ views influence the way in which the home is run. Systems are in place to ensure that the health, safety and welfare of residents are promoted and protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The operations manager explained that interviews for the post of manager are being held during the month after this inspection (in March 2007). A requirement has been made that the successful applicant will make application for registration by June 15th 2007. In the meantime, the assistant manager and the operations manager are providing management support to the home; the assistant manager has been employed at the home for several years. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 21 Reliable quality monitoring systems are in place with records maintained in a folder in the office; systems include the views of the residents and the developments in the home are in response to the residents’ needs and any views they express (or the views of others involved on their behalf). Fire safety checks are maintained and a record is kept and was up to date. Evidence was also seen of other environmental safety checks and contractors certificates (i.e. gas and electrical safety checks). It was observed that control of substances hazardous to health is maintained. Risk assessments both individual and general are carried out and kept reviewed in order to maintain a safe environment and to support residents to enjoy further independence to their fullest potential. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 22 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 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 3 X 1 X 3 X X 3 X Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 23 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. Standard YA37 Regulation 8 Requirement The home must have a registered manager in post. (It was explained during the inspection that interviews would take place within one month; the successful applicant must then apply to register within the given timeframe). Timescale for action 15/06/07 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 Refer to Standard YA19 & YA24 Good Practice Recommendations The home should continue to seek an update in progress regarding the finalising of funding in order to resettle one of the residents as possible in the placement that has been identified to meet his changed needs. Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nicholas House DS0000019482.V313754.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!