Inspection on 06/07/05 for Quince House

This inspection was carried out on 6th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 01/06/06

Quince House 12/10/05

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 Hemel Hertfordshire HP2 5DZ Lead Inspector Marian Byrne Unannounced 6 July 2005 th & 7th 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 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 Stationary 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 I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Quince House Address 77 Adeyfield Road, Hemel Hempstead, Hertfordshire, HP2 5DZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01442 248316 01582 840023 Complete Care Services Limited Angela Rankin Care Home, PC Care Home only 6 Category(ies) of LD Learning Disability (6) registration, with number of places Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection n/a Brief Description of the Service: Quince House is a six bedded house in Hemel Hempsead offering a home for up to six service users with a learning difficulty who may also exhibit challanging beheavour. It is situated close to Hemel Hempstead town centre. Hemel Hempstead nestles between the M25 and M1 motorways, offering easy access to London and the North. It also allows easy access to the Hertfordshire counry side. It was registered as a Care Home in September 2000. It is a domestic dwelling blending in well with the surrounding domestic housing. The home is on two storeys and does not have a lift. There is a large kitchen with a breakfast bar, a large dining room, and a sitting room. One bedroom is down stairs. There is off road parking in the front of the home. Quince House is part of Complete Care Services Ltd. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over two days the 6th and 7th July 2005. The visit on the 6th was in the afternoon to ensure the inspector met the service users and was able to observe the interaction between them and the staff and to observe how the home functioned when all the service users and the staff were present. An inspection of the environment was also carried out on the first day. The visit on the second day was carried out in the morning and concentrated on inspecting the paperwork. The inspection had both positive and negative aspects. The positive aspects pertained to the care of service users and the running of the home. The negative aspects pertained to the funding and the upkeep of the home. The inspector witnessed very good interaction between staff and service users. The home opened and admissions started in October 2004. The site visit carried out in July 2004 by the inspector who found a house in a very good decorative state. At this inspection the hallway carpet (biscuit coloured) was partly covered with a dark blue remnant of carpet nailed to the floor and also held in place with silver coloured masking tape. This looked very unsightly. The carpet on the landing upstairs was badly stained and the carpet in a service users’ bedroom was also stained. The armchairs in the sitting room were very dirty, particularly on the arms. The television was broken. Some of the tiles on the kitchen floor were chipped. One service users’ room had what could be a large damp patch on the ceiling this also appeared to be blistered. The manager informed the inspector that her budget for food and house hold supplies is £25 per head of service users. This also includes food for staff usually three members for at least two meals per day. The inspector was present when the manager returned from shopping and observed that there was a large amount of ‘value’ products from a well known supermarket. The fee for service users is £1,650 per week. On one service users’ care plan there was a letter indicating that the proprietor had charged them for deliberate breakages in their room. The manager was not able to provide an investigation into how this conclusion had been drawn. The inspector could not find anywhere on the care plan or in any policy or procedures that this was the course of action the Registered Proprietors would automatically take. The service user has challenging behaviour and had been in the home approximately six weeks on the date the letter was written. The service users finance records shows that the money had been paid to the Registered Provider. This incident has been referred to Adult Protection for a full investigation. The inspector was concerned by some of the instruction to staff provided in folders in the home were contrary to good care practices for example ‘please note no items/goods of any description must be brought into the homes by any persons ie service users, their relatives, charities anyone, without first consulting the owners due to the past accumulation of unwanted useless clutter which costs time and money to dispose of seek permission first’. And another ‘it is better that the residents do not use expensive household equipment ie the vacuum, Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 6 dishwasher washing machine cloths dryer etc since they are very expensive and cannot be replaced as a regular event also the staff have to use the equipment reading the instructions carefully thank you the owners. And yet another it is preferred that any messy activities for the residents ie painting and pottery etc are done at the day centre where they have the most suitable facilities for them also the residents gets to go out if the home which is less boring for them. Other less specialised activities can be done in the house in the allocated agreed area for them ie sewing crayoning cooking etc There were several folders containing instructions to staff in a similar vein. They appear to promote the upkeep of the premises rather than the welfare of the service users. The funding of the home and the financial status of the Registered Provider will be further pursued. What the service does well: What has improved since the last inspection? What they could do better: The Registered Provider must display an understanding that he is providing a home for service user with learning disabilities who may have challenging behaviour. The home must be run for the benefit of the service users and not solely for the profit for the Registered Provider as they instructions to staff Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 7 could indicate. He must display a working knowledge of the Care Standard Act 2000 and support staff in carrying out their duties to service users, ensuring service users can live a dignified life within a caring and educational environment where they can learn life skills. 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 I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,5. The Statement of Purpose and Service Users’ Guide offer a guide to the facilities offered by the home, some of the policies and procedures of the home are contrary to those stated in those documents. Service users are offered a trial period and may visit the home prior to moving in. EVIDENCE: The Home has a Statement of Purpose and Service Users Guide. These outline what services are offered to the service users and what the service users can expect from the service. The instruction to staff do not support the spirit of the Statement of Purpose and Service Users’ Guide as they appear to promote the upkeep of the premises rather than the welfare of the service users. One service user who lived locally with her family took several months before she finally moved in full time. The service user and her family had full support from the Registered Manager and her staff. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10. Service users have care plans and risk assessments. Where possible they are consulted on the day-to-day running of the home. They live as independent life as is possible. Data is stored appropriately. EVIDENCE: All service users have a care plan with risk assessment covering all aspects of their lives at Quince House. As the home is new, information is still being amassed on all the service users. The care plans contain information from all associated bodies in Health and Social Services. The care plans need to contain the information on how service users are assisted to live their lives on a dayto-day basis in a more easily assessable format. On the first day of the inspection all the service users were out. One was at College, one was collecting a new car and doing the shopping with the Registered manager and the remaining three were out with two members of staff for a walk in the park. The home has started to hold service users meetings these need to be held more frequently and to become part of everyday life at Quince House. All information relating to service users was held in locked cupboards. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17, Staff endeavour to ensure that service users have opportunities for personal development and activities. The local amenities are used. The instructions to staff by the Registered Proprietor on the running of the home do not all support the service users rights. The inspector was concerned about the restrictions on the household budget. EVIDENCE: Three of the service users attend college in St. Albans one has been refused a college place and staff are endeavouring to secure another place for her. One service users had recently moved into the home and is still settling in. Service users use the local amenities. On the second day of the inspection the service users were using the local bowling alley. Service users pay for all their activities outside the home. Plans are in place to ensure all service users have a holiday or if it is their choice a series of ‘days out’ instead. There are no restrictions on visiting the home. All service users have a record of ‘tasks’ on their care plans these include simple household task such as setting and clearing the table and assisting with washing or making tea. During the inspection one service users made herself and the inspector several cups of Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 12 tea. As already stated in this report the budget for food and household provisions is £125 per week to provide food and household supplies for five service users and the three staff on duty during the day . If the service users chose to have a ‘take-away’ meal they meet this cost them selves despite the fact that their contract says that their fee of £1650 per week will cover meals. The staff at Quince House have worked hard to ensure the service users retain family contacts. One service user who moved from another County to be closer to her family is now able with support able to invite her family to visit her in the home and to start to build relationships with them. This was not possible initially. Staff have no optian but to buy long life milk as the refrigeration facilities are not sufficient to store fresh milk. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Service users personal and healthcare support is met. Service users do not administer their own medication. EVIDENCE: Service users decide the time they rise and go to bed. Their care needs are met in their own rooms. They decide what clothes to wear. Each has their own routine in the mornings and cannot be rushed. Some of the service users who have difficulty communicating indicate their wish to go to bed by taking a member of staff’s hand and lead them to their bedroom. All service users are registered with a GP who specialises in treating people with a learning disability. Service users are referred to health professionals as appropriate. No service users self medicate. The administration of medication is recorded and stored appropriately. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 14 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 standard(s) Where possible service users have their views listened to. Service users are not fully protected from abuse. They are protected from self harm and neglect. EVIDENCE: The home has a Complaint policy and a Whistle Blowing Policy. The home received four complaints they were investigated within the home’s Complaints Procedure. The Whistle Blowing Policy must contain information on who staff and service users may contact outside the Company if they have concerns regarding the welfare of a service users. This should include the Commission for Social Care Inspection and Social Services. One service user had to pay £121.03 to the Registered Provider regarding an allegation that she wilfully destroyed a chest of drawers in her room. The Registered Manager when asked could not supply the inspector with details of the investigation on how this conclusion was arrived at. A letter was written directly to the service user who has learning difficulties demanding the payment. There was no evidence on file that she understood the significance of the letter. Her care plan did not indicate that she would deliberately break furniture. The Statement of Purpose, Service Users Guide and the Service Users’ contract do not indicate that if a service user breaks furniture that they must replace it. A referral has been made regarding this to the Adult Protection Team in Social Services for a full investigation. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 15 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 standard(s) 24,25,26,27,28,30. Some of the floor covering and the furniture were soiled and stained. The home meets the space requirements. Furniture and fittings were of poor quality. Service users have access to local amenities. EVIDENCE: The hallway carpet is of a biscuit colour and on the days of the inspection it was partly covered with a dark blue carpet remnant. This was nailed down and the edges were covered with silver masking tape. This gave the home a very neglected appearance. When asked why this was the Registered manager said that the carpet underneath was badly stained. The carpet on the upstairs landing was badly stained also as was one service users’ bedroom carpet. When asked by the inspector how the carpets were kept clean the Registered manager informed the inspector that the home had no carpet cleaner that staff had to get on their knees and scrub the carpet. The furniture in the sitting room especially the arm chairs were very badly soiled. The television had a break on the top corner. One bedroom had, what appeared to be a damp patch on the ceiling this was also blistered. Not all bedrooms had bed linen that covered the whole bed, this gave an appearance of neglect. The chest of Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 16 drawers in one room would not close. One service user had bought an additional wardrobe as the one provided was not sufficient. The floor in the kitchen had chips out of the tiles. The office space is not suitable to meet the needs of a member of staff sleeping over. This must be addressed. The home was odour free and apart from the furniture was clean and fresh. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) ,34,35. In the main staff are recruited appropriately. There was no training programme in place. EVIDENCE: The Registered manager does not have an identified training budget and was therefore unable to produce a training plan for the year. Training completed by staff included moving and handling, medication in house, no staff had completed Hertfordshire Social Services Department administration of medication, fire safety, food hygiene had been completed by one member of staff, two member of staff had completed specialist training in autism and challenging behaviour. The Registered manager must when recruiting ensure that Criminal Records Bureau checks are completed for all staff prior to them commencing their employment with Quince House. All other employment checks were in order. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42,43. There is conflict between the roles of the Registered Provider and the Registered Manager. Service users do not benefit from this. Service Users rights are not protected by the conflict between the instructions to staff and Policies and Procedures of the home. EVIDENCE: As indicated in this report there is conflict between the home’s files on instructions to staff and policies and procedures and at times these instructions work in direct contradiction to the Care Standard Act 2000. These instructions are provided by the Registered Provider who is the line manager of the Registered Manager. The Registered Manager has a direct legal responsibility to the Commission for Social Care Inspection to ensure the welfare of the service users in the home she manages. This conflict must be resolved. The Registered Provider must have a working knowledge of the Care Standards Act 2000 if he is going to involve himself in the day to day running of the home. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 3 N/A 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 1 Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Quince House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 x 1 x x x I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement The Registered Must ensure that the detail in care plans is readily accessible to all staff and service users. The Registered Provider must provide sufficient funds to ensure the service users have access to good quality food and that all their meals are provided and paid for. The Registered Provider must ensure that there is sufficient refrigration and freezer space to ensure service users have choices regarding what dairy products they use. The Registered Provider and the Registered manager must ensure that all service users in their care are protected from all types of abuse. The Registered manager must ensure all staff have a knowledge of Hertfordshire s Social Services Protection of Vulnerable Adults policy. The Registered Provider must ensure that the furniture particularly the dining room table and chairs - in the home is of good quality, is clean and of a robust nature to ensure the Timescale for action Henceforth and ongoing Henceforth and ongoing 2. 17 16(2)(i) 3. 23 13 (6) Henceforth and ongoing 4. 24, 26 & 30 16 (2) (c) 31/07/05 Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 21 5. 38 12(5)(a) 6. 40 12(1)(a) 7. 35 13(4)(c ) 8. 24 23(3)(b) 9. 43 25(2)(a) safety of service users and to ensure they live in a domestic homely atmosphere. Carpets must be restored to an acceptable level of cleanliness and any floor coverings must be domestic in nature and pleasing to the eye. The Registered Provider must ensure that he understands and respects the Role of the Registered Manager and support her in ensuring the health and safety and welfare of all those people who use the house. The Registered Provider and the Registered Manager must ensure the policies and proceedure are adhered to and that they meet the requirements of The Care Standard Act 2005. Instructions to staff must not comprimise these. The Registered Provider must ensure that the Registered Manager has an identified budget specifically for the training of staff. The Registered Provider must ensure appropriate arrangements are made for staff who sleep over. The Registered Provider must ensure that the Commisson has access to the annual accounts, (certified by an accountant) of Complete Care Services Ltd. Hencefoth and ongoing Henceforth and ongoing Henceforth and ongoing 31/08/05 31/07/05 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. Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 22 Refer to Standard Good Practice Recommendations Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Quince House I52 S61600 Quince House V236315 060705 stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!