Inspection on 01/06/06 for Quince House

This inspection was carried out on 1st June 2006.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Quince House 13/05/10

Quince House 03/02/10

Quince House 01/12/09

Quince House 08/04/09

Quince House 01/05/07

Quince House 12/10/05

Quince House 06/07/05

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 Quince House 77 Adeyfield Road Hemel Hempstead Herts HP2 5DZ Lead Inspector Claire Farrier Key Unannounced Inspection 1 and 6th June 2006 9:05 st Quince House DS0000061600.V297947.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 Quince House DS0000061600.V297947.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. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quince House Address 77 Adeyfield Road Hemel Hempstead Herts HP2 5DZ 01442 248316 01582 840023 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) Complete Care Services Limited Angela Rankin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: Quince House is a care home providing personal care and accommodation for six younger adults with learning disabilities. It provides a specialist environment for people with ASD (autistic spectrum disorder) and associated challenging behaviour. The home was opened in September 2000. It is owned by Complete Care Services Limited. The home is located in a residential area of Hemel Hempstead. It is a two storey detached family house, indistinguishable from the neighbouring properties. All the community services are within easy reach. The home has its own vehicle and it is close to the town centre. All the home’s bedrooms are single, and five have en-suite facilities. One bedroom is on the ground floor, and would be accessible for any service user with mobility difficulties. The home has an enclosed garden, a patio area, lawn and flowerbeds. There is off street parking at the front of the house. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charge is £1650 per week. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two days, and including preparation time a total of 19 hours was allocated to it. The majority of time was spent talking to residents and staff, and discussions were held with the home’s manager. Some time was also spent in the office looking at records, care plans, risk assessments, complaints, staff training, and staff files, and the inspector made a tour of the premises. The staff and residents were very welcoming. Improvements have been made over the last year to establish provision of a good quality of care, but further improvements are needed to ensure that the needs of all the residents are fully met. What the service does well: The home provides a good quality of personal care and health care. There is good relationship between the staff and residents, and staff are aware of the residents’ individual needs and preferences and enable them to make appropriate choices and decisions about their lives in the home. Evidence was seen of the home’s commitment to equal opportunities, and the service is designed to meet each person’s individual needs. The residents were observed to be relaxed and happy, and two visiting relatives said that they have settled in very well and feel that Quince House is their home. There is a stable and experienced staff team, and they feel encouraged and supported by the manager. One member of staff said that Quince House is the best home they have worked in. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although the care plans contain comprehensive information on each person’s needs, in some cases it is not clear that the information is used in practice, in particular with regard to professional guidelines for communication. Although regular monthly weight checks are carried out, there was no indication that any significant change in weight is noted and acted on. On discussion with the staff, it seems likely that the bathroom scales that are used may not be suitable for the purpose, as they are not large enough for the residents to stand on safely without support, and they may not provide an accurate reading. The medication policy needs to be updated to address the systems for administration of medication that are currently used in the home. Recording of medication, and in particular PRN (when required) medications is inadequate and does not provide a sufficient safeguard against the risks of error. The laundry equipment and procedures for control of infection are inadequate for their purpose. The home has a separate laundry room, fitted with a domestic washing machine and tumble drier, and there are no facilities for sluicing soiled bed linen and clothing. Water temperatures are not monitored, and may be above the recommended level to prevent the risk of scalding. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 7 There is no formal system for quality assurance in the home. This needs to be fully developed, and to include both the views of residents and other stakeholders, and a system for analysing and utilising the results and reporting them back to the residents and to the Commission. Incident reports are completed appropriately, but no notifications of incidents that affect the welfare of the residents have been sent to CSCI. There was no evidence in one staff file of either a recent CRB (Criminal Record Bureau) check, or of a current work permit. 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. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has sufficient information on residents’ needs, including cultural needs, and access to appropriate services to enable their needs to be met, and appropriate information is available to enable prospective residents and their families to find out about the home before they move in. EVIDENCE: The mother of one resident was visiting the home and gave her views. She said that the social worker had made all arrangements for her son to move to Quince House, but she was happy with this as she felt that she knew nothing about residential services. She said that her son has settled in extremely well, and the staff are aware of all his needs. He prefers being at Quince House to his family home. The staff said that they have sufficient information to enable them to meet the residents’ needs, and they have the training that they need and good support from the manager, and other professionals. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 10 The home receives a full assessment of all the resident’s needs from the referring social worker before they are admitted to the home. One assessment contained a full list of the types of behaviours the person exhibited, with the effects and measures for management. The home completed its own assessment when the person had moved into Quince House, and the assessment plan contained information on all aspects of life and all personal care needs. The care plans contain information and procedures drawn from these assessments. Details of each person’s race, disability, gender, age, religion, and sexuality are also recorded, and any particular cultural needs are addressed in the care plan. There is a new format for the contract. This now contains details of the service provided and the terms and conditions, as well as the rights and responsibilities of the resident. It is well written in plain English, but it is not in a format that the residents of Quince House can understand. The Service Users Guide is also clearly written, and contains some photographs and clip art pictures. In contrast, the complaints form is simplified, with smiley faces and in a format that some of the residents may be able to understand. Consideration should be given to producing documents that are important for the residents in a more accessible format. This may include a form of augmented communication, such as widget symbols, but may also include photographs or video or tape recording, or individualised symbols or objects of reference where applicable for each resident. The Service Users Guide should contain all the information listed under Standard 1 of the National Minimum Standards, including details of the provider, and the qualifications and experience of the manager. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents’ care plans contain detailed information on all their personal care and health care needs, and comprehensive risk assessments related to each individual, which enable the staff to provide a good quality of care. However in some cases there is no indication that the staff are following guidelines for communication and behaviour management. EVIDENCE: Detailed case tracking was carried out through the files of four residents, which showed what care is provided for the residents and how it is recorded. The care plans have been revised and rewritten with input from social workers. They are clearly written, with good details of all the residents’ needs and procedures and guidelines for meeting those needs. Appropriate risk assessments are in place for each resident, and these are also clearly written, with good details of the risks involved and the measures needed to enable the residents to manage the risks safely. Some of the risk assessments are generic, and not necessarily appropriate for every resident, for example for falls in the home, eating poisonous plants, fire procedures, use of the kitchen. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 12 It may be appropriate to store these separately as they apply generally to possible risks for all residents. The individual risk assessments that remain in each person’s care plan would then be more prominent. Individual, specific risk assessments include the risks of blocking the toilet, aggressive behaviour, throwing objects and epilepsy. Although the care plans contain comprehensive information on each person’s needs, in some cases it is not clear that the information is used in practice. One person has guidelines for dealing with challenging behaviour. The care plan has a section on social interaction, which states “talk may escalate to challenging behaviour”. However there is no reference to the behaviour guidelines for clarification on how to manage this situation. Three residents have had assessments from a speech and language therapist. The resulting guidelines on aiding communication includes the use of objects of reference, but the care plans make no reference to this and have not been updated to include the therapist’s advice (see Personal and Healthcare Support). For one resident there is recording of incidents over three days, including “X was very agitated…. screaming and biting (them)self” and “X was a bit aggressive today, was spitting a lot”. The care plan states that the resident can show distress by these behaviours, and in includes the actions of “lead X away from the situation, offer comforting words”. The daily record did not show that these actions were followed, and the incidents were not recorded on ABC (antecedents, behaviour, consequences) monitoring charts. Apart from the care plan, the staff record daily events in three separate formats: daily recording, home skills and leisure activities. One member of staff said that on the activity record they write what the resident did, on the daily record if anything happened, and on home skills what the resident accomplished. If anything happens, an incident record is also completed. The member of staff felt that the system could work as a way of cross-referencing. However this double or triple recording seems to be an excessive exercise, and in several cases the same information was recorded on all three – “Went to Hargrave House”, with no further information. In most cases the daily record by itself is completed appropriately with details of personal care and activities, and relates to each resident’s care plan. Each resident’s benefits are paid directly into their individual bank accounts. There are good records for showing how their spending money is managed, with receipts for each purchase. Each resident has a small purse for any money they wish to take with them when they go out. Two residents have recently bought new bed linen and curtains for themselves. The receipts for this were seen and it was reported that the purchases were discussed in a staff meeting and with their key workers, with evidence that these items were their choice. The home has a Sharan seven seater vehicle. The residents make no financial contribution towards this, and all transport expenses are paid from the home’s petty cash account. However residents pay not only for their own holidays, but also the cost for the staff who accompany them (see Lifestyle). Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. They have good relationships with their families and with the local community. The menus offer a balanced and nutritious diet. EVIDENCE: All the residents were in the home on the first day of the inspection as it was the half term break from both college and day centre. Three of the residents attend college on two or three days a week, and two go to Jarmans day centre. There have been some problems of communication with the college in the past. These are mostly resolved, but other facilities are needed for one of the residents. There is a large board on the wall of the dining room with each person’s daily programme in Widget symbols. On the day of the inspection the activities displayed included 1-2-1 choice, cinema, club, and keep fit. On the day before the inspection all the residents had a day out to Thorpe Park theme park. The Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 14 manager has a small budget of £100 per week for all activities, outings and holidays. The home has a Sharan seven seater vehicle. The residents make no financial contribution towards this, and all transport expenses are paid from the home’s petty cash account. However residents pay for most of the activities outside of the home, and not only for their own holidays, but also the cost for the staff who accompany them. This year one resident is going to Euro Disney, and plans are being made for holidays abroad for the others. The proprietor pays the wages of the staff when they accompany the residents on holiday. It is surprising that the cost of a holiday was not included in the contract price as Quince House is a new home. Each person has an allocated housekeeping task each day, such as washing up, setting the table, cooking dinner. The staff encourage service users to get their own breakfast and to clear their dishes away at breakfast time, and they assist them to tidy their bedrooms. On the day of the inspection, the staff were seen preparing the evening meal without involving the residents. The resident who had “cooking dinner” on his programme was not involved in this activity. The weekly menu displayed in the kitchen shows a variety of nutritious meals. The home has a large fridge and freezers, and all the meals, including the Sunday roast dinner and all vegetables, are prepared from frozen food. The daily record for one resident indicated that on the previous day the evening meal was beefburger, vegetables and chicken noodles. Two visiting relatives were spoken to. They both said that they are made very welcome in the home. The residents are encouraged to maintain contact with their families, and most of them visit their families regularly. The mother of one resident said that they visits their family on most Sundays. They stay with them for one or two nights, but any longer than that, and they want to return “home” to Quince House. Another resident regularly speaks to their grandfather on the phone. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 15 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): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. The home has policies and procedures for the safe handling and administration of medication that protect service users’ interests. However measures must be put in place to ensure that the risks or errors are minimised. EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6). A good relationship was observed between the staff and the residents. They talk to the residents while they are assisting them, and they were seen to encourage one person to eat appropriately. The healthcare records seen included references to hospital visits, contact with GPs and other health professionals, appropriate monitoring of epilepsy and regular weight checks. Guidelines for managing challenging behaviour are in place for each resident. One resident has noticeably improved since they moved into the home. They are now walking independently, and no longer needs hospital treatment. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 16 Several residents need treatment for epilepsy, and may have seizures at any time. There are appropriate care plans for managing this, with clear protocols for the administration of rectal diazepam and when further action is needed. At night there is one waking night care worker, and one sleeping in, so that there are sufficient staff available to deal with any emergency. All the residents have communication difficulties, and most are either non-verbal, or almost nonverbal. The staff have had some training in the use of Makaton signing. Three residents have had assessments from a speech and language therapist. The resulting guidelines on aiding communication includes the use of objects of reference, but the care plans make no reference to this and have not been updated to include the therapist’s advice (See Individual Needs and Choices). Although regular monthly weight checks are carried out, there was no indication that any significant change in weight is noted and acted on. The record for one person showed a weight loss of 9lb in the last month, and for another an increase of 5lb. On discussion with the staff, it seems likely that the bathroom scales that are used may not be suitable for the purpose, as they are not large enough for the residents to stand on safely without support, and they may not provide an accurate reading. Medication is stored in a wooden cupboard on the landing. This does not meet the requirements for storing medication in a care home, but it was reported that the pharmacist that supplies medication to the home has said that it is satisfactory. None of the residents administer their own medication. The temperature of the cupboard is recorded, but on several occasions has been in excess of 25°C. Measures must be taken to ensure that medication is stored at below 25°C at all times as temperatures above this may reduce the effectiveness of the medication stored. Most medications are supplied in individual blister packs, and recorded appropriately on MAR (medicines administration record) charts. Some medications are supplied in the original packaging, either because they are not suitable for the blister pack system, eg Epilin, or because they are PRN (when required) eg paracetamol and ibuprofen. These are not recorded on the MAR charts appropriately. It is not possible to carry out an accurate audit of the medication, as there is no indication on the MAR chart or on the box of when each box was started. One resident has Epilin in two separate strengths, with different amounts of each morning and evening. Two care workers sign for each dose administered, but as a safeguard to ensure that the correct dosage is given each time the number of each strength given should be written on the MAR chart with the signature. PRN medications are not recorded on the MAR chart as they are not supplied each month. The home should ask the pharmacist to supply a MAR chart with all of each person’s prescribed medications printed on it. For medications not supplied in blister packs, the number remaining at the end of each month should be brought forward onto the new MAR chart, in order to ensure that an accurate audit can be carried out. It was reported that Lloyds pharmacist carries out audits, but there was no evidence of this. An effective system of audit must be put in place, to ensure that the risks of error in administration are minimised. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 17 Several residents have a prescription for rectal diazepam for use in case of a seizure. It was reported that two diazepam suppositories for each person are kept in the car, so that they are available for use when they are out. This does not provide a secure system for storing the medication, and for ensuring that the stocks held are correct. One person has PRN Loperimide. It was reported that it is given to them when they goes out, but there is no indication on the MAR chart, the package, or in the care plan of why and when this should be administered. On the box and on the MAR chart the instruction is “As directed. Do not take more than 8 in 24 hours.” On the GP contact sheet it is recorded that the GP prescribed this medication “for the persons legs”, but there is no protocol and no information on the reason for giving the medication and the number to be given each time. The medication policy needs to be updated. It was written for the use of Nomad boxes, but medication is now supplied in blister packs so it is out of date. It has no procedure for administering the medications mentioned above that are not supplied in blister packs, or for administering PRN medications. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 18 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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are encouraged and enabled to make their views and concerns known. Policies and procedures are in place to ensure that service users are protected from abuse and neglect. EVIDENCE: The home has a complaints procedure that contains the required information and a simplified version in Widget format is included in the service user’s guide. No complaints have been received since the last inspection. The visiting relatives spoken to said that they have no complaints, and that any concerns are dealt with as they arise. The home has adequate policies concerning adult protection and whistle blowing. They do not refer directly to the Hertfordshire inter-agency guidelines, but the procedures are sound. The procedures file contains adult protection protocols for Bedfordshire and Luton, but not for Hertfordshire. As Hertfordshires’ procedures may differ they should obtain a copy for reference. All staff have had training in the prevention of abuse, and it was reported that there is an annual update, but some of the staff spoken with were not aware of the procedures for reporting any allegations of abuse. One resident has recently disclosed a possible abuse (not concerning the home’s staff); this was reported and dealt with appropriately and effectively, with the involvement of Hertfordshire Social Services and other agencies. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness. However the laundry equipment and procedures for control of infection are inadequate for their purpose. EVIDENCE: The building is an ordinary detached house, furnished and decorated in domestic styles that produce a homely, comfortable environment that allows the residents to relax and feel very much at home. The residents all have their own rooms, arranged and decorated to reflect their particular interests and tastes. Five of the six bedrooms have en-suite shower rooms, and there is a communal bathroom with a Jacuzzi bath. The lounge, dining room and kitchen are domestic in style and are comfortably furnished and well equipped. The home has an enclosed garden a patio area, lawn and flowerbeds. The home appeared to be clean and generally well maintained. The top of one dining table was loose, and could be a safety hazard if anyone leans on it. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 20 The home has a separate laundry room, fitted with a domestic washing machine and tumble drier. These are not adequate for the purpose of a care home. There are no facilities for sluicing soiled bed linen and clothing, and these items are currently rinsed by hand in the sink in the laundry room before being washed in the washing machine. Appropriate facilities for sluicing must be installed, and one option would be professional washing machine with a sluice cycle. The home’s infection control policy states, “The germs in most soiled and fouled linen is unlikely to cause infection in healthy staff provided that care is taken and protective gloves/aprons are worn.” This is not a sufficient guard against the spread of infection. Soiled items must not be handled more than is necessary, and equipment such as soluble red bags, placed directly into a washing machine with a sluice cycle, would assist with this. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed by experienced support workers who are appropriately trained to meet the needs of the residents. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. Evidence was seen of a thorough recruitment procedure that ensures that residents are protected by staff that are fit to work in a care home. All the required information on staff must be kept in the home. EVIDENCE: The staffing rotas show that there are four or five support workers on duty throughout the day, and one during the night, with a second support worker sleeping in case of emergencies. There are eight permanent staff in addition to the manager, and regular bank workers make up the staffing complement so that there is no need to use agency staff. The staffing levels are sufficient to meet the needs of the residents, and on the day of the inspection they spent time taking residents out, playing football in the garden. The high level of staff to residents should also be sufficient to ensure that the residents are involved in tasks in the home, such as cooking, but little evidence was seen during the inspection that this is happening. The visiting relatives said that the staff are Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 22 very good and helpful, and they were observed to have a good relationship with the residents. The staff have access to the Hertfordshire social services training programme. The induction programme takes place over three weeks, during which time the new member of staff does not work alone. Mandatory training includes fire safety, emergency first aid, health and safety, equal ops, policies and procedures, food hygiene, infection control. It is the intention that all staff should complete the mandatory training within three months of starting work in the home. No one should work alone in the home before they have completed basic health and safety and moving and handling training. Training is also available to meet the special needs the residents have such as epilepsy, learning disability awareness, administration of rectal diazepam and Makaton. Four of the support staff, 50 of the total, have either completed NVQ2 or NVQ3 qualifications. It is intended that the remaining members of staff should also take the qualifications, but there has been some difficulty in finding assessors to support them. The staff spoken to confirmed that they have ready access to relevant training opportunities. The manager confirmed that she is working towards providing supervision for each staff member six times a year, but by the end of June, which will be six months, each person will have had only two sessions of supervision. The staff files of two members of staff were inspected. They contained all the required information to show that they are fit to work in the home. However one person has transferred to Quince House from another Complete Care Services home, and there was no evidence in this file of either a recent CRB (Criminal Record Bureau) check, or of a current work permit. When a member of staff transfers from another home, it is recommended that the previous manager should provide a current reference, and all information must be in the home for all people who are employed there. Staff photographs are displayed on a board in the entrance hall, so that it is clearly seen who is in the house and who is out with residents. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 23 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, 38, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. Evidence was seen of the home’s commitment to equal opportunities, and the service is designed to meet each person’s individual needs. An effective quality assurance system is needed, to ensure that views of the residents and their families underpin all self-monitoring, review and development of the home. EVIDENCE: The manager communicates a clear sense of direction and leadership, and she is available to both staff and residents when they wish to speak to her. Evidence was seen of the home’s commitment to equal opportunities. Details of each person’s race, disability, gender, age, religion, and sexuality are recorded, and any particular cultural needs are addressed in the care plan. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 24 The manager has completed NVQ level 4 in care, and she is studying for a degree in care that includes the Registered Managers Award. She has worked in care settings for the whole of her career, and she had nine years experience of management before being appointed to Quince House when it opened. One member of staff said that she is a good manager, and Quince House is the best home they have worked in. The manager has formal support from the proprietor. The conflict between the instructions of the manager and proprietor that were noted in the first inspection of the home in July 2005 have resolved somewhat, and the manager is now fully in charge of the home. However the proprietor is not sufficiently experienced and qualified to provide adequate professional support for the manager. The managers of all the Complete Care Services homes support each other informally, and may benefit from a more formal system of professional support. It is suggested that this could include carrying out the monthly monitoring visits of each other’s homes that are required by Regulation 26. There is no formal system for quality assurance in the home. Questionnaires were sent to all the residents last year. It was reported that the questionnaire is in a widget format, which most of the residents can understand. However there was no analysis of the results of the questionnaires. A monitoring form has been developed to audit each resident’s needs, care plans and activities. These activities could form a basis for an efficient self-monitoring quality assurance system. This needs to be fully developed, and to include both the views of residents and other stakeholders, and a system for analysing and utilising the results and reporting them back to the residents and to the Commission. The proprietor carries out regular monitoring visits to the home. As mentioned above, these may be more effective if carried out by other managers within the company. All staff records and residents’ records are stored securely to preserve confidentiality. The staff files do not contain all the required information as listed in the Regulations and Schedules (see Standard 34). Health and safety records are completed appropriately and evidence was seen of a health and safety audit, although the last audit was carried out in October 2005. The fire drill log confirms that each member of staff takes part in at least one fire drill a year. Incident reports are completed appropriately, but no notifications of incidents that affect the welfare of the residents have been sent to CSCI. Two should have been sent, concerning the allegation of abuse (see Concerns, Complaints and Protection), and concerning a resident’s admittance to hospital following two seizures. There is no record of water temperatures. In the communal bathroom the water in the bath was cold, and in the washbasin it measured 48°C on the home’s thermometer. The temperature of all baths and showers must be monitored regularly and regulated to ensure that it does not exceed the recommended level of 43°C to protect service users from acidental scalding. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 25 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 2 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 2 2 X Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2)(c) Requirement Although the care plans contain comprehensive information on each person’s needs, in some cases it is not clear that the information is used in practice. Care plans must be updated when necessary to ensure that they contain all the information that the staff need to meet the residents’ needs. In particular, details of procedures for communication and for behaviour management must be included in the care plans and followed by the staff. There was no evidence seen that action is taken on recorded changes in weight. Measures must be put in place to ensure that the weight of residents is recorded accurately, including appropriate equipment for the residents’ use. Appropriate actions must be taken following a recording of abnormal weight change, and the actions and results must be recorded in the care plan. Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 27 Timescale for action 31/07/06 2. YA19 12(1)(a) 30/09/06 3. YA20 13(2) The temperature of the cupboard used for storing medication was recorded as over 25°C on several occasions. The temperature of the medication cupboard must be regulated to below 25ºC. The method of recording the medication that is administered does not enable an accurate audit to be carried out. Emergency supplies of rectal diazepam are kept in the home’s vehicle. All medication must be stored, administered and recorded in accordance with the Royal Pharmaceutical Society guidelines. The medication policy must be updated to provide procedures for medication supplied in blister packs, and for PRN and other medications. The top of one dining table was loose, and could be a safety hazard if anyone leans on it. The registered person must ensure that the premises and furniture are maintained in a good state of repair. There are no facilities for sluicing soiled bed linen and clothing, and the home’s infection control policy is inadequate. Appropriate facilities for sluicing must be installed in the home. The procedures for control of infection must ensure that there is no risk to residents or staff. 30/09/06 4. YA20 13(2) 30/09/06 5. YA20 13(2) 30/09/06 6. YA24 23(2)(b) 30/08/06 7. YA30 13(3) 30/09/06 Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 28 8. YA34 YA41 17(2), 19(1)(b) There was no evidence of a CRB check or of a current work permit in the home for one member of staff. 31/07/06 9. YA39 24 10. YA42 13(4) (a) & (c) All the required information on staff as listed in Schedule 2 and Schedule 4.6 must be kept in the home, including confirmation of CRB checks, work permits, and appropriate references. A system for monitoring the 30/10/06 quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. In the communal bathroom the 31/07/06 water in the bath was cold, and in the washbasin it measured 48°C on the home’s thermometer. The temperature of all baths and showers must be monitored regularly and regulated to ensure that it does not exceed the recommended level of 43°C. Incident reports are completed appropriately, but no notifications of appropriate incidents have been sent to CSCI. The registered manager must ensure that notifications of all events that affect the welfare of residents, as listed under Regulation 37(1), are sent to the Commission without delay. 11. YA42 37 31/07/06 Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations The Service Users Guide should be amended to ensure that it contains all the information listed in Standard 1. In particular, it should provide details of the provider, and the qualifications and experience of the manager. It is recommended that the staff and service users should explore imaginative ways to make the service users’ guide and contract more accessible to the service users. It is recommended that the cost of a holiday should be included in the contract price. The home has adequate policies concerning adult protection, but they do not refer directly to the Hertfordshire inter-agency guidelines. The HCC guidelines for protection of vulnerable adults should be kept in the home, and the home’s procedure should be updated to be in line with the HCC guidelines. The registered manager should ensure that each member of staff has formal supervision at least six times a year. The managers of all the Complete Care Services homes support each other informally, and may benefit from a more formal system of professional support. This could include carrying out the monthly monitoring visits of each other’s homes that are required by Regulation 26. 2. 3. 4. YA1 YA14 YA23 5. 6. YA36 YA37 Quince House DS0000061600.V297947.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire Al7 3BQ 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. 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