CARE HOME ADULTS 18-65
Old Barn Close (4) Gawcott Bucks MK18 4JH Lead Inspector
Chris Schwarz 15
th Unannounced Inspection February 2006 10:00 Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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 Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Barn Close (4) Address Gawcott Bucks MK18 4JH 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) 01280 821006 Hightown Praetorian & Churches Housing Association Ms Dawn Mayhew Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Ms Mayhew is to have completed her NVQ Level 4 / Registered Managers Award by the 1st January 2007. 27 September 2005 Date of last inspection Brief Description of the Service: 4, Old Barn Close is situated in a quiet residential area of the village of Gawcott. This village is a short distance from the town of Buckingham, which has a variety of shops and other local amenities. Gawcott is served by infrequent local bus services, with more extensive transport accessible in Buckingham. The home is part of the Hightown Praetorian Housing Association. 4, Old Barn Close is a modern bungalow, which is home to 4 male service users with behavioural problems, learning and communication difficulties. The home has an enclosed garden, which provides service users with a safe external area in which they can walk unhindered and in safety. The garden contains swings for service users, and is planted with flowers and shrubs. Entry to, and exit from, the home, has to be facilitated by staff, and an alarm alerts staff if the door is opened at other times. All service users are accommodated in single bedrooms, which possess washbasins. A separate shower and bath are present in the home, as well as a kitchen, laundry, staff sleep over room, dining and lounge areas. All service users are registered with a general practitioner, and access to other healthcare professionals, such as community nurses and dieticians, is through direct contact by staff, or through GP referral. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit took place on a week day and lasted from 9.50 am until 1.50 pm. It comprised a tour of the premises, discussion with the registered manager and reading of some of the home’s required records. There was also opportunity for informal discussion with service users, all of who were at home, and staff. Most of the key inspection standards had been covered during an announced visit in September 2005. This visit was by way of follow up to the announced inspection and to assess the few remaining key standards. The manager was given under twenty four hours notice of this visit and co-operated fully with the inspection. Staff and service users are thanked for their hospitality and assistance with the inspection. What the service does well: What has improved since the last inspection?
A homely environment has been created for service users with enhancements made to improve communal spaces. Medication for disposal is being appropriately stored using printed envelopes supplied by the pharmacy. The manager has successfully been registered with the Commission. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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 Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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): EVIDENCE: None of the standards in this section were assessed on this occasion. There have not been any new admissions to the home since the last inspection. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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): 7 Arrangements are in place to enable service users, with assistance, to make decisions regarding their everyday lives. EVIDENCE: Service users were seen to have free access around the building and staff gently reminded anyone who wandered into another service user’s room that this was private space. An advocate from Aylesbury Vale Advocates has regular involvement at the home and facilitates monthly service user meetings. From minutes of these meetings, it was possible to see that staff have raised practice concerns on behalf of service users. Risk assessments/management plans are in place where service users present a likelihood of self harming, although there are concerns that staff are not consistently following these, described under standard 23. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 10 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): 13 There are opportunities for service users to be part of the local community, although there are restrictions on when this can take place. EVIDENCE: Minutes of service users’ meetings provided evidence of people having contact with family and friends and making use of community facilities such as swimming pools, eating out at cafes, going to Gateway club and attending multi-sensory and soft play sessions. Use is made of local supermarkets and shops in Buckingham, with service users accompanying staff for the food shopping. The home has its own vehicle although an arrangement to take one of the service users to and from his parental home five days a week places restrictions on use of the car and staff resources whilst this is being done. This impinges on available time that staff have in facilitating community presence for other service users, particularly in the afternoon and at weekends. A requirement is made to review this arrangement, to result in removal of this restriction.
Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 11 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): EVIDENCE: Standards 18, 19 and 21 were not assessed on this occasion. Standard 20 was reviewed only to check on a couple of matters and not in sufficient detail to score as met or otherwise. A requirement regarding appropriate disposal of drugs was being met. A medication fridge had not been obtained for the home yet and a requirement is made to attend to this. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 12 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): 23 Management of physical and verbal aggression needs to be better handled at the home, to ensure a safe and consistent approach to service users’ challenging behaviour. EVIDENCE: During the course of this visit, a service user was heard becoming increasingly agitated and the manager needed to intervene to instruct staff to administer “as required” medication. There was a risk assessment in place for the person’s challenging behaviour and this clearly showed steps to try and de-escalate situations, with reference to administration of “as required” medication if this was unsuccessful. A protocol was additionally in place for the medication and experienced and trained staff were on duty at the time of this incident. In discussion with the manager, it was evident that the staff team does not act consistently in managing this person’s behaviour and interventions which could be construed by the service user as rewards are occasionally given by some staff when they ought to be following the written procedures agreed with Manor House Hospital. Records of behavioural incidents were looked at for the service user referred to; no entries were made after 16th January this year. This did not tally with medication administration records which showed that there had been several more recent incidents. Staff must be vigilant in recording incidents and in sufficient detail to enable the manager or Manor House staff to be able to carry out an audit to establish any known triggers or contributing factors. Staff also need to be reminded of the importance of following instruction on managing challenging behaviour, to avoid injury to the service user, other service users and themselves.
Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 13 Records of violent incidents were additionally examined. Some of these occurrences should have been notified to the Commission, such as injury to another service user or staff member or where there is anything other than minor scratches or scrapes caused by self harming. Some work is needed with the use of these forms; staff had used the format for non-violent occurrences such as a service user chewing his own hand and clarity is needed with descriptions of injuries to ensure that they accurately reflect the situation. A form had not been completed following a note from a parent the previous week regarding a scratch and a bruise and this should be attended to. A referral has been made to the community team regarding a service user who masturbates in inappropriate places, including out in the community. This does not appear to be a new behaviour and it is therefore concerning that referral had not been made earlier, to preserve the person’s dignity. In summary, the management of challenging behaviour needs particular attention at the home. Protocols for managing individual service user’s behaviours are to be followed by staff and accurate records maintained to describe any episodes. Notification is to be made to the Commission, within 24 hours, where there is injury to another service user or member of staff or where the service user sustains significant injury to themselves or to property. Input should be provided for staff on completion of the home’s violent incident forms, to distinguish between accidents and violent episodes, and for accurate descriptions to be used to record injuries. The Commission would expect disciplinary proceedings be followed where any member of staff ignores an agreed strategy for managing challenging situations. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 14 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): 24 A homely environment has been created for service users with enhancements made to improve communal spaces. More work is needed to provide a safe and comfortable environment for both staff and service users. EVIDENCE: Since the last inspection, redecoration has taken place to areas identified as poorly maintained, other than the laundry. Plans are in place to attend to the laundry and to replace the lounge curtains. The standard is scored as nearly met until this is achieved. The bath/shower rooms, identified as needing refurbishment, looked bright and fresh on this occasion with stencilling work planned to provide homely touches. The office is minuscule, with some records needing to be stored in the hallway. A health and safety assessment needs to be carried out of the office and sleeping in environment, which provides a cluttered and restricted daytime working space and no comfort or relaxation to anyone sleeping in at night. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 15 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): 34 and 35 Thorough recruitment practices are in place, to protect service users from risk of harm. Improvement has been made to training, to ensure that service users are cared for by competent staff. A lack of certificated or other evidence in some cases prevents accurate training records being maintained. This could mean that some of the staff team are not up-to-date with practice. EVIDENCE: There were three fulltime support worker posts vacant at the home at the time of this inspection. Agency staff are being used to cover gaps with effort made to use a consistent group of workers. Records were in place to verify that the supplying agencies had undertaken appropriate recruitment checks of anyone sent to the home and the manager stipulated that she would not permit anyone new from the agency commence work without the necessary documentation. A new member of staff was in the process of receiving training in line with a requirement made at the last inspection. From a look at courses already completed and those booked, he was on target to complete all mandatory courses within six weeks of employment. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 16 Training records of other staff were looked at. There was evidence of improvement following a requirement at the last inspection regarding mandatory courses although in some instances a lack of certification or other form of evidence prevented verification. The manager said that the courses referred to had been provided by the provider organisation, some going back as far as six months ago. Without evidence, the standard cannot be scored as fully met and the requirement is therefore repeated. Input on Protection of Vulnerable Adults needs to be updated annually to ensure that staff knowledge of adult protection procedures and good practice is reinforced, and to provide them with opportunity to discuss difficult situations such as the management of challenging behaviour. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 17 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): 37, 39 and 42 The home has an experienced manager, providing consistency and leadership. Regular monitoring is undertaken by the provider to assess quality of care to service users. This needs to be supplemented with a quality audit of the service. There is due regard for health and safety at the home, to prevent accidental injury to staff, service users and visitors. EVIDENCE: The manager has been registered with the Commission and has commenced the Registered Managers Award, as required. Until this has been achieved, the standard cannot be scored as fully met, which is not a reflection on her abilities to lead the staff team at the home. Monitoring is undertaken regularly at the home by the provider and the manager confirmed that such visits are always unannounced. Reports of the visits were available at the home and are sent to the Commission regularly.
Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 18 The manager has been in post a year and could not recall any quality assurance exercise being undertaken by the provider. These needs to be carried out on an annual basis and a requirement is made to attend to this. A range of health and safety checks is undertaken at the home. The fire log showed that routine testing and maintenance is carried out, supplemented with regular drills. The last quarterly health and safety audit was undertaken in January this year, including a check of the first aid box. There was a gas safety certificate dated August 2005 and records to demonstrate that staff routinely check hot water temperatures. A water sample check for the presence of Legionella species was due to take place shortly. Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 1 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 3 x x x LIFESTYLES Standard No Score 11 x 12 x 13 2 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x 2 x 2 x x 3 x Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA13 Regulation 10(1) Timescale for action The regular transporting home 01/04/06 arrangement for one service user is to be reviewed, to result in removal of restrictions in accessing the community for others. A medication fridge is to be 01/04/06 obtained. A consistent approach is be 28/02/06 adopted to the management of challenging behaviour, following agreed protocols and procedures and backed up by accurate records. Notification is to be made to the 28/02/06 Commission, within 24 hours, where there is injury to another service user or member of staff as a result of a service user exhibiting challenging behaviour, or where the service user sustains significant injury to themselves or to property. All staff will receive training and 01/03/06 updates in mandatory training to include - fire safety, moving and
DS0000023095.V283718.R01.S.doc Version 5.1 Page 21 Requirement 2 3 YA20 YA23 13(2) 13(6) 4 YA23 37 5 YA35 18(1) Old Barn Close (4) handling, food hygiene. Previous timescales, the most recent 01/01/06, not met. 6 YA35 13(6) Protection of Vulnerable Adults 01/06/06 training is be updated and thereafter attended annually. A quality assurance audit is to be 01/06/06 undertaken, thereafter annually, and a copy of the report forwarded to the Commission. 7 YA39 24 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 YA24 Good Practice Recommendations It is strongly recommended that the organisation review the staff office / sleep-in room, with a view to an improvement of these facilities and the provision of secure storage for residents records that does not impinge on residents communal space. A health and safety assessment is to be undertaken of the office space and forwarded to the Commission. Input should be provided for staff on completion of violent incident forms to ensure that these are used effectively, including accurate descriptions of injuries sustained. 2 YA23 Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Old Barn Close (4) DS0000023095.V283718.R01.S.doc Version 5.1 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. 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!
