Inspection on 11/12/08 for Penn House

This inspection was carried out on 11th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penn House 02/12/09

Penn House 19/12/07

Penn House 20/12/06

Penn House 11/01/06

Penn House 19/10/05

Penn House 09/11/04

Penn House 01/03/04

Penn House 01/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Penn House Chesham Lane The National Society For Epilepsy Chalfont St Peter Gerrards Cross Bucks SL9 ORJ 01494601435 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The National Society for Epilepsy Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 22 The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Date of last inspection Brief description of the care home Penn House is one of a number of homes situated on the Chalfont Centre for Epilepsy. The home is registered to provide residential care to for up to twenty two adults with a physical disability, including one relief bed. The home provides care and support to individuals with a range of personal care needs. The home is made up of five flats each with their own kitchen, sitting area and shower. Downstairs is wheelchair accessible. The Centre provides banking facilities, an internet cafe, a shop, a restaurant and various social and life skill opportunities.There is access to public transport and the Care Homes for Adults (18-65 years) Page 4 of 39 Brief description of the care home centre is accessible to Chalfont St Peter Village, which allows for access to the towns of Amersham, High Wycombe, Uxbridge and Slough. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on the 19/12/2007. This unannounced key inspection was conducted over the course of one day and covered all of the key National Minimum Standards for younger adults. Prior to the inspection, a detailed selfassessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection was facilitated by the team leader and consisted of discussion with the staff and service users, examination of some of the homes required records, Care Homes for Adults (18-65 years) Page 6 of 39 observation of practice and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. The requirements made at the previous inspection have been complied and this inspection has resulted in a number of requirements and recommendations to improve practice. What the care home does well: What has improved since the last inspection? What they could do better: A service user guide must be developed and made available to service users to enable them to have the required information on what the service offers. Service users to the home must be fully assessed with records of assessments in place to support this to ensure that the home can meet identified needs and have considered compatibility with other service users. Service users contracts should be completed in ink and signed off by staff as outlined on the contract to safeguard service users. Service user care plans must be developed to clearly and specifically outline care needs including service users ability to make choices and decisions. These must be kept up to date and reviewed to promote continuity of care. Service user plans must include up to date risk assessments which address all identified individual risks, including moving and handling. These must be kept up to date and reviewed to promote service users safety. Care Homes for Adults (18-65 years) Page 8 of 39 Restrictions imposed on individuals must be within an individual risk assessment framework so as not to impact on other service users. Service user files should be reorganised and made more accessible. Service user plans should accurately reflect the service users religion to promote their individual needs. Opportunities for leisure activities must be improved to enable service users to have access to a wide range of activities. Accurate records should be maintained to reflect the activities that have taken place. Opportunities must be made available to enable service users to develop their independence and take a more active role in the day-to-day running of the home. Service user plans should outline the support required with post and a risk assessment should be in place to indicate why an individual do not have a key to the front door of the home. This is to promote service users rights and responsibilities in their daily lives. The registered person must ensure that all events, which affect the well being of service users is reported to the Commission. The complaints procedure must be updated with the correct contact details of the Commission to ensure that service users are provided with the correct information. The organisation should consider making available to the home confirmation of recruitment checks and training for bank staff used at the home on a regular basis to safeguard service users. Staff must have the required mandatory and specialist training to enable them to meet service users needs in a safe and consistent way and to fulfill their roles. Training records should be reorganised, made more accessible and kept up to date to accurately reflect the training that has taken place. The organisation must ensure that a permanent manager is appointed and that the care staff vacancies are filled to promote service users health and welfare. The organisation should ensure that up to date policies and procedures are in place to safeguard service users and staff. Hazardous cleaning materials must be stored securely and in appropriate labeled containers to safeguard service users. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 39 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are not provided with the key information on the home, contracts are incomplete and evidence of formal assessments are not available which potentially could result in service users needs not being identified and met. Evidence: The home has a statement of purpose in place which was not accessible to service users. This document has been updated to reflect the changes within the service. The home does not have an up to date service users guide. The manager advised this is currently being reviewed and updated and will be made available to service users when updated. The home has an admissions policy in place, which was last updated and reviewed in July 2005. The statement of purpose outlines the arrangements for agreeing admission to the home, which indicates that an initial visit to the service user takes place followed by a four-week assessment period at the home. The completed Annual Quality Assessment document completed prior to the inspection indicates that the Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: home has an assessment tool in place to carry out assessments on prospective service users and ensure all assessments for long term care and respite care are well documented and comprehensive. The home has had three admissions in the previous twelve months. The files of those individuals were viewed. None of the files viewed indicated that a formal assessment of needs had taken place although review meeting minutes made reference to it. This must be addressed with evidence of a formal assessment taking place and included in service users files to ensure that the home can meet assessed needs and has considered compatibility with other service users. Service user plans included a contract. However the managers name and the fees being charged were written in pencil, which potentially could put service users at risk. The contract was dated and signed by the service user but not signed off by staff. This should be addressed. Care Homes for Adults (18-65 years) Page 13 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users plans and risk assessments must be developed and improved to indicate restrictions, service users involvement in decision-making and to ensure that service users needs are met in a safe and consistent way. Evidence: The completed Annual Quality Assessment document completed prior to the inspection indicates that comprehensive care plans are in place for every service user. Four service user plans were viewed at this inspection. Care plans showed evidence of being discussed and agreed with service users with two of the four care viewed being up to date and reviewed. All of the files viewed included an information sheet, significant dates and two of the files contained a pen picture of the individual. One of the care plans viewed was detailed and specific as to the care and support required with all aspects of the persons life. One of the care plans viewed was for a service user who transferred from another service on site in June 2008. The information within the care plan related to the previous home and had not been updated to reflect the move to Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: Penn house. This must be addressed as a priority to ensure that the care plan reflects current needs. The other two care plans viewed were found to lack specific detail in relation to the care being provided. One of those care plans viewed used abbreviations to describe medical conditions with no explanation as to what the abbreviations meant. One care plan made reference to a mental illness but it was not clear what the mental illness was and how it presents and should be managed. This care plan outlined behavior in relation to isolation and social skills needs but the action to address those needs contradicted each other. One care plan made reference to a behavior protocol, which was not included in the care plan and was not available in the home for reference. One care plan in relation to epilepsy made reference to the attached seizure description, which was not attached to the care plan and was not available in the home for reference. The shortfalls within the care plans must be addressed to ensure that service users needs are clearly addressed and consistently met. Care plans were found to be bulky with out of date information filed in the current care plan file. This made access to the files more difficult. Service user plans outlined service users religion. In one care plan viewed it indicated on the personal details information that the service users religion was Church of England, however within the care plan it indicated that the service user was a Roman Catholic. This must be clarified and the care plan updated to ensure that the service user is supported to practice their chosen religion. Care plans makes reference to communication needs but does not specifically outline the support required by the individuals in making choices and decisions. This must be developed on as part of the improvements to care plans. At the time of the inspection the home had no advocacy involvement but was aware of how to access advocates if this was required for individuals. During the inspection one service user requested to visit a friend that afternoon but this was denied by staff as there was a Christmas party on site that evening and they were advised they would get the opportunity to meet up with their friend then. During the inspection it was noted that three service users were having restricted access to their cigarettes. Individuals care plans and risk assessments made no reference to this, or why this practice was necessary. During the inspection one service user requested a packet of crisps, as they were not accessible to them as other service users were considered to be at risk of over eating such snacks. These practices must be addressed and managed appropriately within a risk assessment framework for each individual as opposed to impacting on all service users. Service users have monthly house meetings and the opportunity to contribute to Committee meetings on site. Minutes are maintained of house meetings. A completed survey received from one service user indicated that they were not always able to make their own choices and decisions as some staff think they know everything and know better than the individual. This individual did not give their name to enable this comment to be explored further. Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: Three of the four service user plans included risk assessments. However the majority of risk assessments were found to be general type risk assessments, which were in place for all service users as opposed to individual to address individual risks as outlined on the care plan. One of the care plans viewed included risks as identified at the previous home and was not updated to reflect the current risks. As outlined above one of the files viewed had no risk assessments in place. The majority of the risk assessments viewed were found to be overdue for review with some risk assessments last being reviewed in 2005. Three of the four care plans viewed had a moving and handling risk assessment in place, one of those was overdue for review. The fourth care plan had no evidence of a moving and handling assessment being carried out and therefore there was no moving and handling management plan in place to indicate any moving and handling needs. The registered person must ensure that risk assessments are put in place to address risks associated with individuals medical conditions, behaviors and all individual risks, including moving and handling. These must be kept up to date and reviewed. The home has a missing person policy, which was reviewed in May 2005 and was overdue for review since May 2007. Care Homes for Adults (18-65 years) Page 16 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for leisure activities need to be further developed with service users being supported to live a more independent lifestyle, which reflects their interests and abilities. Service users are provided with nourishing meals and supported to have contact with family, friends and the community. Evidence: At the time of the inspection some service users were involved in work placements on site and college placements. One of the work placements on site is due to close during the year and work is underway to find other suitable work placements. The home has developed a weekly timetable detailing service users activities, occupation, college commitments so all staff are aware of where service users should be during the week. The individual weekly activity programme included in the care plans was not updated for all individuals to reflect their current weekly programme. Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: Service users have some access to leisure activities, which includes swimming, shopping, meals out, and trips to the pantomime. The home has a reduced staff team and only two drivers which impacts on the frequency on which service users can participate in activities off site. Leisure activities out of the home has to be planned in advance to ensure that sufficient staff are available. Records of leisure activities are recorded in individuals daily logs so the amount of leisure activities that have taken place was not evidenced. Completed surveys received from service users and staff confirms that sufficient leisure activities are not provided due to staff shortages and lack of drivers. This must be addressed. Staff confirm that volunteers facilitate in house activities like board games, skittles and bingo but records are not maintained to evidence this. The Annual Quality Assurance document confirms that the service users of Penn house have access to the Rehabilitation department on site which offers training for work, personal development, cultural awareness, gardening, horticulture, service user empowerment which includes service users committees, faith and spirituality, advocacy, work experience which includes theoretical learning for example fire awareness and moving & handling, learning through play, communication, information technology training, volunteer support, epilepsy awareness, moving on and development of life skills, community presence, rebound therapy, hydrotherapy, occupational therapy and art therapy. They also offer complimentary therapies, which include massage, relaxation and visualisation, reflexology acupressure, Indian head massage and abdominal massage. Service users are supported to have an annual holiday and this year two holidays took place, one to Devon and one to France. Some service users choose not to go on holidays and instead are offered day trips out. Staff confirmed that service users are supported to maintain family links. Service user care plans outline key people involved in the service users life and visitors are welcome in the home. Staff support service users to visit their families and at the time of the inspection some service users were making plans for leave to their family over Christmas. Service user plans included some risk assessments to indicate that individuals are encouraged to promote their independence, however as outlined in standard 9 risk assessments were out of date and not specific to individuals. The care plans viewed made some reference to supporting with social skills but there was very little evidence of service users being encouraged to be actively involved in the running of the home or to develop their independence skills. This should be developed on to prepare service Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: users for the transition from Penn house to alternative accommodation. Staff confirmed that some service users have a key to the front door whilst others do not. Risk assessment should be put in place to indicate why individuals do not have a key to the front door of the home. Service users post is delivered to the home. Care plans do not outline if individuals require support with managing their post. This should be addressed. Service users have some restrictions imposed on them as outlined under standard 8. Requirements have been made to address this. Service users have access to three meals a day. Breakfast is prepared at the home with service users having access to cereals and toast. The lunch and main meal is delivered to the home from the central kitchen on site and served to service users by staff at the home. Service users are given a menu to choose their meal from and are supported by staff to complete this. The records seen indicate that service users have access to a variety of meals. Service users have access to snacks and drinks at the home, although as outlined under standard 8 there are some restrictions imposed on individuals in relation to the snacks they can access. This is to be addressed. The Annual Quality Assessment document confirms that the home is planning to self cater and a meeting is arranged for January with staff from another home who have implemented self catering to discuss the transition. The move to self-catering is positive and will promote service users independence and involvement in meals. The progress with this will be reviewed at the next key inspection. The home is divided into five units with a small kitchen area in each unit. This facility is ideal in promoting self catering for service users who are interested in this and who may in the future move into a more independent setting. Care Homes for Adults (18-65 years) Page 19 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are well met, promoting health and well being and ensuring that they receive medication in a safe and consistent manner. Evidence: Service user plans make reference to support with aspects of personal care, however in three out of the four care plans viewed this was not detailed and specific. Two of the service user plans viewed included a moving and handling management plan. Personal support is provided in private. Times for getting up are flexible at the weekends as some service users have a weekly programme of activities to attend to during the week. Staff confirmed that service users choose their own clothes and hairstyle but care plans did not evidence that service users make those choices. Service users have access to specialist support from Health Professional and records of appointments with professionals evidence this. Service users have access to general nursing care and Psychiatric input. The Annual Quality Assurance document confirms that all individual service users have a keyworker and service users work with their keyworkers to produce and agree a care plan. Records seen evidences that service users have a Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: nominated key worker however due to the number of staff vacancies at the home staff are acting as a keyworker to a high number of service users which makes this role difficult to fulfill. Service user plans viewed did not outline individuals preferred routines. One of the four care plans made reference to that individuals likes and dislikes. The Annual Quality Assurance document confirms that the service users have access to an on-site neurologist, psychologist, psychiatrist, epilepsy specialist nurses, physiotherapists and occupational therapists. There is a first line nurse on call 24 hours a day. Records of appointments are maintained to evidence this and service users care plans outline individual healthcare needs. Service users have access to a General Practitioner, dentist, chiropodist and opticians as required and the Annual Quality Assurance document confirms that the service users can make alternative arrangements with regard to dental, chiropody and General Practitioner arrangements if they wish to do so. It is not clear how service users are made aware of this. At the time of the inspection eleven service users were self-medicating. Care plans viewed indicated if individuals were self-medicating and at what stage of selfmedicating they were at. Only permanent staff administer medication and at the time of the inspection this was the responsibility of four staff. The night staff member is not trained to administer medication and in an emergency they would call on the first line nurse on site to administer medication required at night. The home has individual medication records with a photograph, which includes a General Practitioner prescription medication administration record and a Consultant medication administration record. The records viewed showed no gaps in administration of medication. All medication administered is prescribed including homely remedies. Permanent staff on duty are responsible for ordering, receiving and returning medication and records are maintained to evidence this. Staff on duty confirmed that new staff are trained, observed and signed off as competent prior to getting involved in medication administration. The newest staff member to the home was not on duty and records of medication assessments for that individual were not available to evidence this. Three of the four staff involved in medication administration have up to date medication training with the fourth staff member scheduled to go on medication update training in January 2009. None of the staff are trained to administer emergency rectal medication but are trained to administer emergency oral medication. Service users records include a seizure description sheet and a protocol for administration of their as required emergency medication. A medication management incident report is completed for all medication errors, however not all medication errors have been reported to the Commission as required under Regulation 37. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: Completed surveys received from service users confirmed that they were happy with the care provided. Care Homes for Adults (18-65 years) Page 22 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and training in relation to complaints and safeguarding is not up to date which potentially put service users at risk. Evidence: The Organisation has a complaints procedure in place, which was reviewed in May 2005 and is overdue for review. As part of the review the policy needs to be updated with the Commissions change of contact details. The complaints procedure is displayed on the notice board but this needs updating to reflect the correct contact details of the Commission. The Annual Quality Assurance Assessment document outlines that the home has one complaint in the last twelve months. A log is maintained to record complaints and their outcomes. The Commission has received one complaint from an ex staff member during the period under review. It was felt not appropriate for the Commission to get involved in staff issues and the complainant was advised of this. Completed surveys received from service users and service users spoken with confirmed that they know how to make a complaint and were satisfied that issues raised would be addressed. The Annual Quality assurance document confirms that a complaints audit has been implemented by the Director of Services and this is monitored quarterly. The Organisation has a vulnerable adults and whistle blowing policy in place. The whistle blowing policy was reviewed and updated in March 2008. The abuse policy was Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: last updated in March 2004. The home has had no safeguarding of vulnerable adults referrals in the previous twelve months. Staff on duty were clear of their responsibility to report bad practice and abuse. Two of the four permanent staff have up to date safeguarding of vulnerable adults training with one staff member due to go on this training the week following the inspection. The home is relying on bank staff to cover the vacancies but records of bank staff training was not maintained at the home to evidence that they had up to date safe guarding training. Records are kept of incidents and accidents involving service users and staff. Copies of all incidents, accidents and safeguarding of vulnerable adults referrals are sent to the Organisations Health and Safety department and the number of incidences are analysed centrally. This is reported back to the Health and Safety Committee and any necessary action agreed to prevent reoccurrence. The completed Annual Quality assurance document indicates that staff attend mandatory challenging behavior training to ensure that service users who present with this type of behavior are treated safely and appropriately.The training records viewed evidenced that none of the staff team have challenging behavior training even though some care plans indicated that individuals can be aggressive. This must be addressed to promote staff and service users safety. Service user plans made reference to support required with finances. Service users accounts are held centrally with service users being able to access this money when required. The home keeps a record of service users money in and out with receipts obtained for expenditure. Staff sign to confirm any transactions with service users and only the shift leader have the key to access the money. At the previous inspection there was some discrepancy in service users money and a requirement was made that the registered manager must ensure that effective systems are in place for the safekeeping of residents monies. Staff at the home look after money for five service users. All five finance records and money were checked and found to be correct. This requirement has been complied with. Care Homes for Adults (18-65 years) Page 24 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean, homely and adequately maintained, with some improvements made to communal areas to promote a positive environment for service users. Evidence: The home is a detached house situated in the grounds of the Chalfont Centre. Peter. The house has been divided into five flats, each of between three and six bedrooms. There are four flats on the ground floor and one on the first floor. Each flat comprises single bedrooms, kitchenette, lounge, shower, toilet and storage area. The home does not have a lift. The ground floor is accessible to a wheelchair user. The home has a bathroom with chairlift for service users who require support. At the time of the inspection the home was decorated for Christmas. Bedrooms vary in size but were found to be clean, personalised and suitably furnished. There is a spacious and well equipped kitchen from which meals are served. The dining room is sufficient in size for the current number of service users. The individual kitchens and sitting areas seem to get limited use. Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: At the previous inspection it was noted that the shower rooms were considered to be particularly unwelcoming, cold, dusty, poorly equipped, and in need of refurbishment. Since that inspection aspects of the environment have been improved with the main corridor recarpeted and four of the five shower rooms have had new flooring and have been painted. During the tour of the home it was noted that one of the showers did not have a curtain, which is required to promote privacy. Three of the kitchenettes have had the kitchen cupboards repaired and have been painted. The home is scheduled to close in 2011 and whilst the environment is not ideal it is currently adequate in providing a comfortable and homely environment for service users. The home has a housekeeper. On the day of inspection most areas of the home were clean and tidy although the majority of microwaves were found to have a build up of food and were in need of a clean. Completed surveys received from service users confirm that they think the home is usually fresh and clean and they feel having a housekeeper has helped this. Care Homes for Adults (18-65 years) Page 26 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are suitably recruited with formal inductions and supervisions taking place, however the home has a high number of staff vacancies and staff do not have the required training to support them in their roles, which potentially put service users at risk. Evidence: Staff on duty during the inspection were found to be accessible to, approachable and comfortable with service users. The permanent staff team appear committed and interested despite being under pressure due to high number of care staff vacancies. The staff member who facilitated the inspection was confident in her role and was able to access the required records. Staff on duty felt they had the skills and training to do the job required. The training records indicate that some staff have attended specialist training. Four of the five staff have training in epilepsy, four staff have training in buccal midazolom administration, one staff member have training in autism awareness, dementia, mental capacity act and equality and diversity. This needs to be further developed to ensure that more staff have access to specialist training to enable them to fulfill their roles effectively. None of the staff training records viewed indicates that staff have had training in communication and in dealing with anticipated behaviors and challenging behaviors. The annual quality assurance document indicates that two Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: permanent carers have a National Vocational Qualification level 2 with no records of National Vocational Qualification maintained at the home for bank staff. At the time of the inspection the home had eight full time care vacancies with five staff having left employment in the past twelve months. Attempts were been made to recruit into those vacancies. The home was being staffed by five full time staff, which included the deputy manager, two team leaders, a carer and a night carer. The home has a full time housekeeper who is responsible for the cleaning of communal areas of the home. The rota indicates that four staff are on duty each daytime shift with two staff on duty on night. Extra staff are provided for specific activities. There is always a senior member of the permanent staff team on each daytime shift with the other three staff generally made up by bank workers. The home has a regular team of bank workers who work at the home to provide continuity of care for service users. However the high number of staff vacancies has impacted on the quality of service users plans and risk assessments and on staff training updates and activities for service users. Regular team meetings take place and staff on duty felt supported in their roles whilst acknowledging the staff shortages meant that they were unable to keep on top of paperwork, attend training and improve the range of activities on offer for service users. The recruitment of staff is managed centrally with a checklist maintained at the home to confirm what recruitment checks have been carried out for individuals. This was not available for bank staff as they are managed centrally. This was not yet available at the home for the newest staff member either. The checklist seen confirmed that staff are recruited in line with standard 34 and Regulation 17. It is recommended that a checklist of recruitment be maintained at the home for bank staff that are used regularly and frequently, as is the case for Penn house. The Annual Quality Assurance document confirms that new staff undergo induction training in line with skills for care. The induction record for the newest staff member to the home was not available to confirm this, as this individual was not on duty. All new staff complete all mandatory training during their induction and prior to being placed on shift. The home has no record of induction into the home for bank staff. The training records indicate that staff have limited specialist training with all mandatory training updates overdue for the night staff carer. This must be addressed as a priority. Moving and handling, fire safety and food hygiene updates training was overdue for three of the staff with only one staff member having all of the required up to date mandatory training. The housekeeper does not have specific health and safety or COSHH awareness training, which is reflected in the practice of unsafe storage and decanting of cleaning fluids. This must be addressed. The training records were found to be disorganised with training records not kept up to date to reflect training that had Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: taken place or to highlight when updates were due. This should be addressed. There was no records of training for bank staff used at the home on a regular basis. This information is collated centrally. The organisation should consider making this available to homes where bank staff work on a regular basis to ensure that the manager is aware of what training those individuals have and have an awareness of when updates are due to promote service users safety. Staff on duty confirmed that they receive regular supervision and feel supported in their roles. Records are maintained to evidence that supervision takes place. The Annual Quality Assurance document indicates that an area for improvement is to improve the quality of supervision notes. The deputy manager and team leaders are responsible for supervising staff with the manager supervising the deputy manager. The training records indicate that the deputy manager and one of the team leaders have not got supervision training to assist them in this role. This must be addressed. Completed surveys received from staff confirm that they are properly recruited, inducted, trained, supported and supervised in their roles. Feedback from one bank worker confirms that that individual does not receive formal supervision even though they work regular shifts at the home. However this individual felt supported. Completed surveys received from service users confirm that they feel staff listen and treat them well. Care Homes for Adults (18-65 years) Page 29 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home currently has an experienced manager, with changes being made by her to improve practice however some aspects of practice and monitoring of standards of care must be improved to safeguard service users. Evidence: The current manager is managing two services and is spending two to three days a week at the home whilst being available on site at the other home if required on the other days. She is registered with the Commission as the manager of the other home. She has obtained a National Vocational Qualification level 4 in care and has completed the registered managers award training. She was in the process of applying with the Commission as the registered manager of this service but has recently had a change to her job role, which has resulted in this application not being progressed. Staff feel she is supportive, approachable and has provided them with guidance to improve aspects of practice. An Annual Quality Assurance Assessment document was completed by the manager prior to the inspection and information from this has been incorporated into the report. The manager has been proactive in improving the environment and in Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: setting boundaries for individuals to promote staff and service users safety. The home has a high number of staff vacancies which impacts on the day to day running of the service including the development of care plans, risk assessments, training, activities and in progression of the service. One requirement was made at the previous inspection which has been complied with. This inspection has resulted in a number of requirements to improve practice and the standard of care. The organisation must now consider how this service will be managed to ensure that requirements are complied with. The manager confirmed that no formal annual quality assurance audit tool is in use by the Organisation.However there is a system in place to audit aspects of care including accidents, incidents, seizures, safe guarding referrals, and complaints for the whole organisation as well as a health and safety audit of the service. The home has monthly Regulation 26 visits with copies of the reports maintained. The Regulation 26 visits tend to focus on the environment, discussion with staff and service users but not at records required for Regulation. The Organisation has the required policies and procedures in place but as outlined in the report the majority of policies viewed are due for review and updating. This should be addressed to ensure that staff practice is in line with current legislation and requirements. All staff have not got up to date mandatory training as outlined under standard 35. During the inspection it was noted that dishwasher tablets, rinse aid, scale away and dishwasher salt which was decanted from its original packing and in a jug was left in an unlocked cupboard under the sink. Alongside this was a bowl of water. It was not clear what if any solution was added to the bowl. This is unsafe practice that puts service users at risk and must be addressed as a priority to safeguard service users. The staff member concerned has not attended specific health and safety or COSHH training and this practice indicates that this is necessary. An internal health and safety audit was carried out in November 2008. This was a comprehensive and detailed audit with recommendations made to improve aspects of health and safety. Some of those recommendations had been acted on with the others being addressed. A sample of health and safety records were viewed. An up to fire risk assessment was in place. Fire records indicate that fire exit inspections and weekly fire point tests take place. A fire drill was carried out on the 11 th November with a false alarm being recorded on the 30 th November. The records indicated that a full evacuation did not take place on that date and the alarms were reset by staff. The manager must ensure that response to the fire alarm and resetting of alarms is in line with the organisation policy and procedure. Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: The fire drill records viewed does not indicate the service users or staff in the home at the time of the drill. The manager advised that there was a fire booklet where this should be recorded and it does include that detail. This should be used to record future fire drills. The home has records in place to confirm servicing of gas, fixed lighting, portable appliances, fire and moving and handling equipment. Records are in place to evidence health and safety checks of bedrooms as well as weekly water temperature checks. Care Homes for Adults (18-65 years) Page 32 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered person must ensure that an up to date service users guide is in place and made available to service users. To ensure that service users are provided with the key information. 30/01/2009 2 2 14 The registered person must ensure that service users to the home are assessed with records of assessments in place to support this. To ensure that prospective service users needs are identified and met. 30/01/2009 3 6 15 The registered person must 28/02/2009 ensure that service user care plans are developed which clearly and specifically outline care needs including their ability to make choices and decisions. Care Homes for Adults (18-65 years) Page 34 of 39 To ensure that service users needs are met in a safe and consistent way 4 7 12 The registered person must ensure that restrictions imposed on individuals are within an individual risk assessment framework that does not impact on other service users. To safeguard service users 5 9 13 The registered person must 28/02/2009 ensure that up to date risk assessments are in place to address all identified individual risks, including moving and handling. These must be kept up to date and reviewed. To promote service users safety 6 13 16 The registered provider must ensure that opportunities are made available to enable service users to access a range of leisure activities. To promote social engagement. 7 16 12 The registered person must 30/03/2009 ensure that opportunities are made available to enable service users to develop their independence and take a more active role in the day to day running of the home. To promote independence. 28/02/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 35 of 39 8 20 37 The registered person must 30/01/2009 ensure that all events, which affect the well being of service users is reported to the Commission. As required under Regulation 37. 9 22 22 The complaints procedure 28/02/2009 must be updated with the correct contact details of the Commission. To safeguard service users. 10 35 18 The registered person must 28/02/2009 ensure that all staff have access to a range of specialist training to support them in their roles including challenging behavior training. To promote staff and service users safety. 11 35 13 The registered person must 28/02/2009 ensure that the housekeeper attends health and safety training and COSHH training to support her in her role. To promote service users safety. 12 35 18 The registered person must 28/02/2009 ensure that all staff including night staff have up to date safeguarding of vulnerable adults training, and all other mandatory training as required. To promote service users safety. Care Homes for Adults (18-65 years) Page 36 of 39 13 36 18 Supervision training must be 30/03/2009 made available to staff undertaking supervision. To ensure that staff are trained to fulfil their role. 14 37 8 The registered person must consider how this service will be managed to ensure that requirements are complied with to improve practice. To ensure that the service is effectively managed and monitored to benefit service users. 28/02/2009 15 42 13 The registered person must ensure that all substances hazardous to health is stored securely and in appropriate labeled containers. To promote service users safety 30/01/2009 16 42 13 The registered person must ensure that response to the fire alarm and resetting of the fire alarm is in line with the organisations policy and procedure. To promote service users safety. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 5 Service users contract should be completed in ink and Page 37 of 39 Care Homes for Adults (18-65 years) signed off by staff as outlined on the contract. 2 3 4 5 6 6 13 16 Service user files should be reorganised and made, more accessible. Service user plans should accurately reflect the service users religion. Accessible records should be maintained to evidence that leisure activities takes place. Service user plans should outline support required with post and a risk assessment should be in place to indicate why an individual do not have a key to the front door of the home. The organisation should consider making available to the home confirmation of recruitment checks and training for bank staff used at the home on a regular basis. Training records should be reorganised, made more accessible and kept up to date. Relevant policies and procedures should be updated and reviewed to safeguard service users. 6 34 7 8 35 40 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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