Inspection on 18/02/08 for REACH Vale Road Chesham

This inspection was carried out on 18th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 REACH Vale Road Chesham 17 Vale Road Chesham Buckingham HP5 3HH Lead Inspector Mike Murphy Unannounced Inspection 18th February 2008 10:00 REACH Vale Road Chesham DS0000071265.V357888.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 REACH Vale Road Chesham DS0000071265.V357888.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. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service REACH Vale Road Chesham Address 17 Vale Road Chesham Buckingham HP5 3HH 01753 888688 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) chesham@reach-disabilitycare.co.uk www.Reach-disabilitycare.co.uk REACH Limited Radka Zajicova Care Home 6 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: Learning disability (LD) - 6 (six) Physical disability (PD) - 2 (two) The maximum number of service users who can be accommodated is 6 (six) This was the first inspection of this new service 2. Date of last inspection Brief Description of the Service: Vale Road is a detached house which provides residential care to adults with learning disabilities. The home can accommodate six people. It is located in a residential area about one mile from the centre of Chesham. The nearest rail station is Chesham (London Underground Metropolitan Line). There are buses from Chesham to Amersham, Berkhamsted, High Wycombe and other areas. There is limited parking to the front of the house or in the street. The home has its own vehicle (a ‘people carrier’) for the people living and working there. There are six single rooms. Two bedrooms are on the ground floor, three bedrooms on the first floor and one bedroom on the second floor. None of the bedrooms have en-suite facilities. The bedrooms vary in size. The home does not have a lift. The home provides spacious and pleasant accommodation for residents. The shared accommodation comprises a living room, dining room, kitchen, bathrooms, shower and WC’s. There is a pleasant garden on two levels to the rear of the home. The ground floor accommodation and patio area of the garden is wheelchair accessible. Staff provide support to residents as needed. Residents are encouraged to participate in a range of activities, including shopping, outings to places of interest and entertainment, and, where required and available, training and educational courses aimed at developing individual skills. Fees at the time of this inspection were around £1578 per week. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1. This means the people who use this service experience adequate outcomes. This inspection, which was the first inspection of this new service, was carried out by one inspector in February 2008. The inspection process included consideration of documents provided by managers, a visit to the home, a tour of the home and grounds, examination of records, interaction with residents (including lunch), discussion with managers and staff, and examination of documents (including care plans). The home is a pleasant detached house. The interior is bright, colourful and spacious. It is well furnished and standards of cleanliness are high. The overall standard of accommodation is good. The registered manager describes the aims of the service as: (1) to support independence; (2) to enable residents to lead as normal a life as possible; (3) to support residents to be involved with the wider community; (4) to have opportunities for educational and social development; and, (5) to develop communication skills. These aims are achieved through the activities of daily living, participating in community activities (and not being segregated from that community), having access to education and training opportunities, and, receiving health and social care services as required. The home has made a very good start in its endeavours to meet these aims. REACH has good systems for assessing the needs of prospective residents. Individual support needs are set out in support plans. Plans include risk assessments. Staff support residents across a range of activities, both in and out of the home, and each residents’ quality of life is enhanced through this. The organisation’s arrangements for staff recruitment, training and development are good. Residents are protected by its procedures for staff recruitment and supervision and by its safeguarding adults policy and procedures. The home receives good support from senior managers and staff based at its head office in Gerrards Cross. The statement of purpose, service user guide, and information on the arrangements for dealing with complaints require amendment for the benefit of current and prospective residents and their families in this service. Overall however, on the basis of the evidence seen on this inspection, this home is providing a useful, valued and effective service in supporting its residents in everyday activities and in accessing amenities and services in the local community. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Review and update the home’s statement of purpose so that residents, their families and prospective referrers are aware of what this home offers and to ensure full compliance with Schedule 1. The service user’s guide should be amended and updated so that residents, their families and others involved with them (such as advocates) are aware of what this particular home offers and to ensure conformance to standard 1.2. References to the complaints procedure – and where necessary the procedure itself - should be amended to make it clear that it covers all complaints, that complainants can refer a complaint to CSCI at any stage, and that it is available in a format which may be more easily understood by residents. The medicines cupboard should be fixed to a wall to maintain the security of medicines in the home. All staff files should include evidence of conformance to Schedule 2 in the appointment of staff in order to ensure the protection of residents. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. REACH Vale Road Chesham DS0000071265.V357888.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 REACH Vale Road Chesham DS0000071265.V357888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are carefully assessed before admission to ensure the home can meet the person’s needs. The statement of purpose and service user’s guide both require updating since both currently fail to provide prospective and current residents, their families, advocates, and referrers with all the information required by the Regulations and standards. EVIDENCE: There is a statement of purpose dated November 2007. The documents sets out the aims and objectives of the home (on page two), the facilities provided (on page one), there is a reference to the organisation’s complaints policy which is a separate document and to its policies on maintaining the privacy and dignity of residents (on page three). The document should be updated since it refers to a ‘proposed’ manager (there is now a registered manager in post) and includes reference to ‘Issues of compatibility with Upton Court Road’s present resident group…’ (on page one). REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 10 The service users guide is a single page document which has not been written for this particular service. It is written in general terms for all REACH homes and falls short of fully meeting the criteria outlined in standard 1.2. Referrals to the service are made to the organisation’s head office in Gerrards Cross. Referrals from local authorities will include a care manager’s assessment of the person’s needs. The referral information is considered by the operations director. Where the referral is progressed arrangements are made for the operations director and care services manager to carry out an assessment of the person’s needs. This includes meeting the prospective resident and his or her family or current carers, acquiring further information if required, and writing up the detail of the assessment. A decision is then made on whether the organisation should offer a place to the person and on which home is likely to be able to meet the person’s needs. The manager of the home becomes involved at this stage. Arrangements are made for the prospective resident to visit the home, view its facilities and meet residents and staff. If all parties are in agreement arrangements for a trial admission are then made. The detail of the process may vary according to individual circumstances but in most cases it involves the person spending an increasing amount of time in the home and getting to know staff and residents. A review is usually held at six weeks and at three months. The ‘contract’ is a three page document entitled ‘Service User Plan and Licence Agreement’. It is noted that in relation to complaints the document includes the sentence ‘We will ensure that your complaint is fully investigated. If after that you are still dissatisfied you may write to the local Commission for Social Care Inspection’. This is at variance with standard 22.3. There is no ‘local’ Commission. CSCI is a national organisation. The word ‘office’ may have been omitted in this sentence. This document should now give details for the CSCI South East Regional Contact Team in Maidstone, Kent and the CSCI customer service helpline. REACH Vale Road Chesham DS0000071265.V357888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each resident. Care plans include details of resident’s preferences and a range of risk assessments. Care plans aim to ensure that residents needs are met, that independence is supported, risk is minimised, and that care is provided in accordance with the person’s wishes. EVIDENCE: Four documents inform the care to be provided to each resident: (1) the care plan, (2) the information file, (3) the health passport, and, (4) the personal diary. A full care plan was in place for two of the three people resident at the time of this inspection. The care plan for the third person who moved in December REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 12 2007 was still being developed. It was expected that it would be completed by the time the resident had lived in the home for three months. The completed care plans include comprehensive information on the person. This includes basic information (including key contacts), communication, notes on how the resident expressed him or her self and how staff should respond, people and things that are important to the person, a pen picture, diary for the week, things the person likes and dislikes, what a special day, evening or weekend might consist of, and a summary of problems and of the support required. Care plans are reviewed weekly by the person’s key worker. More comprehensive reviews had been held at six weeks after the person’s admission. Care guidelines were thorough. They covered such matters as the support required in (among others): bathing, oral hygiene, mobility, meal times, dressing, wheelchair, when at the swimming pool, and challenging behaviour. Notes are written in diaries three times a day and were very comprehensive. The staff were observed to work collaboratively with residents. Residents were supported in making decisions on day to day matters and the relationship between residents and staff was good. Activities were suggested or residents reminded of an appointment. All three residents had significant problems in verbal communication but staff appeared to have acquired a good understanding of residents needs and how these were communicated. Risk assessment processes are thorough and cover a wide range of activities. The include: hot food and drink, preparing meals and washing up, when in a wheelchair, getting and out of the home people carrier, choking (when eating), epileptic seizures (a listening device is in use when the resident is in their own room at night), and falls. The home has good systems for safeguarding confidential information. Staff are required to conform to REACH policy in respect of confidential information. REACH Vale Road Chesham DS0000071265.V357888.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 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 this service. Residents lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that residents experience a range of social, leisure and other activities and are involved with the local community. Residents are provided with a varied diet. EVIDENCE: Staff support residents with the aim of enabling each person to maintain and develop social and independent living skills as far as possible. The three people resident at the time of this inspection were relatively young. On the first day of this inspection all residents and staff were going out together to a school function (because of this the inspection visit was postponed to the following week). REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 14 One resident was still at school. The registered manager had initiated a discussion with Amersham College regarding residents’ attendance on courses in cooking, gardening and other practical subjects. Staff and residents regularly went shopping in Chesham, Amersham and Hemel Hempstead. Residents now used the local swimming pool, library and other amenities of Chesham. One resident used a local barber, a short distance from the home. Relations with neighbours were said to be good. Residents had been to a show at the local theatre. They had visited Whipsnade Zoo and a light railway in Ruislip. They also made regular use of the local park and local cafes. Residents will be having a holiday in a cottage in Somerset later in the year. The holiday is funded in part by REACH and in part by the residents. In addition, it is expected that other half day or full day outings will take place over the course of the year. Staff and residents appeared to pursue an interesting range of activities and made frequent use of the home’s people carrier. All residents are in contact with their families and meet them at least once a month. Residents are also supported in maintaining other relationships – such as with old school friends. The daily routine is flexible but all residents tend to be up by 9:00 am. They may spend time in the morning pursuing their own interests or tasks in the home, may go out with staff or participate in a planned activity. Lunch is around 12:30. The afternoon routine is again a time for individual or group activity; inside or out of the home, planned or spontaneous. Dinner is around 6:00 or 7:00 pm. Meals are planned with residents. Breakfast consists of Cereal, Fruit Juice, Toast with Jam or Marmalade and Tea or Coffee. On some days breakfast includes ham, pate, cheese spread, croissant, or a muffin. Lunch is a light meal and samples from the menu included: Greek Meatballs in Tomato Sauce followed by Fruit; Toasted Crumpets with Cheese and Tomato Salad followed by Yoghurt; and, Mortadella Pasta Salad with Chopped Tomatoes followed by Ice Cream. Dinner is a two course meal and samples from the menu included: Chicken and Mushroom Casserole followed by Eton Mess; Goulash with Potatoes followed by Yoghurt; and, Grilled Tuna Steak with Cannellini Beans and Cucumber Salad followed by Fruit. A roast meat based dish is often served on Sundays. Given that this is a new service it might be helpful at this early stage to obtain the opinion of a dietician on the nutritional value of the menus - although it is important to state that no concerns were raised on this inspection. The menus are varied and contemporary and appear nutritious. The one suggestion made on the day of the visit was to consider increasing the range of fish, in particular fresh fish. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 15 Lunch was taken with residents and staff – the main course being a range of quiches and salad – and was a pleasant shared experience. Staff assisted residents as required. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents as required. Arrangements for liaising with health and other support services in the community are good. Arrangements for the control and administration of medicines are satisfactory. Together, these aim to ensure that residents healthcare needs are met. EVIDENCE: Staff provide support to residents as needed. As mentioned elsewhere in this report, observation of practice during the course of the inspection visit showed that the relationship between staff and residents in the home is good, that staff appeared to have a good understanding of residents needs, and provided appropriate guidance and support to residents when needed. Technical aids in the forms of wheelchairs and a bath lift were provided to assist residents. The service manager said that other aids would be provided if the assessment indicated a need. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 17 Residents in this service had complex healthcare needs. The detail of those are set out in care plans and related documents. Evidence of liaison with local NHS services was seen in examining care planning documentation. All residents are registered with the Watermeadows GP practice in Chesham. Optician services were accessed through a high street chain in the town. NHS dentistry is available in a practice in Amersham. All residents are in contact with the community learning disability team based at Manor House in Aylesbury. Medicines are prescribed by the residents GP. Medicines are dispensed by a pharmacy attached to the surgery and collected by staff. Most medicines are supplied in NOMAD (a monitored dosage system) containers. Medicines are stored in a metal medicines cupboard in the office. At the time of the inspection visit the medicines cupboard had not yet been affixed to the wall. It is important that this matter is addressed by the registered manager. A refrigerator had been obtained for the appropriate storage of external preparations where prescribed. The organisation has a policy governing staff practice in the administration of medicines. Training is in-house – a combination of an introduction to the subject on induction, interactive CD based training under the guidance of the care services manager, and supervised practice by the registered manager. References on medicines available to staff include the use of internet sites and a copy of the most recent guidance on medicines in social care published by the Royal Pharmaceutical of Great Britain. The home would be advised to also obtain a copy of an authoritative non-technical text (such as that published by the BMA in 2007) and to download CSCI guidance. Medicines Administration Records (‘MAR’ charts) include a photograph of the resident, the MAR chart, relevant correspondence (such as from a GP or hospital) and relevant information on some medicines. The MAR charts examined had been completed appropriately. The organisation’s policy and practice on homely remedies aims to ensure that the use of such medicines is well controlled. Homely remedies are administered on the authority of the resident’s GP and a copy of the relevant letter is included in the residents section of the MAR folder. Good practice. The organisation has a policy to guide staff should a person in one of its residential services require terminal care. Managers acknowledged that this was a sensitive subject, especially in a new service with younger residents, and the service manager said that practice to date was to gradually begin a conversation with families once a person had settled in to a home and when it felt appropriate to do so. It was felt rather too early to approach this subject at Chesham Vale. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 18 REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a good framework of policy, reporting arrangements and staff training with regard to safeguarding adults. These aim to protect residents from abuse. Weaknesses in references to complaints processes in documents may lead to residents’ complaints not being appropriately reported or recorded. EVIDENCE: The home is subject to the policies and procedures of REACH. A reference to the organisation’s policy on complaints is included in page two of the statement of purpose (SOP). The final paragraph of the SOP states that the document ‘should be used in conjunction with…..our Complaints Policy..’. The penultimate paragraph of the single page service user’s guide says that ‘Service users have access to the Complaints Book and can be given support to complete an entry if they so wish. REACH also offers a fuller Complaints Procedure, which includes contact details for the local offices of the Commission for Social Care Inspection and the Local Government Ombudsman’. The Service User Plan and Licence Agreement says ‘If you have any complaints about the services provided, you should contact the Home Manager. If this REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 20 complaint is sufficiently serious you should follow the complaints procedure. A copy of which is always available. We will ensure that your complaint is fully investigated. If after that you are still dissatisfied you may write to the local Commission for Social Care Inspection’. There is a bureaucratic tone to the above which seems out of keeping with the ethos of this service. Paragraph 14 of Schedule 1 of the Regulations states that the statement of purpose should include ‘The arrangements for dealing with complaints’. In this home the reader is referred to another document. Standard 1.2 says that ‘The service user’s guide sets out clear and accessible information for service users including….A copy of the complaints procedure..’. The paragraph on complaints in the current service user’s guide is clear but brief and refers the reader to another document. Standard 22.3 says that the complaints procedure should include information ‘…for referring a complaint to the NCSC (now CSCI) at any stage…’. The reference on this point in the home’s licence agreement is inaccurate. The licence agreement also appears to distinguish between complaints which are dealt with by the home manager and those considered ‘sufficiently serious’ to warrant the use of the ‘complaints procedure’. The procedure should cover all complaints. The complaints procedure is available in WIDGIT form. It is not currently available in any other format. CSCI has not received any complaints about this service since it opened. The home has good arrangements in place for safeguarding vulnerable adults. Staff receive training on the subject at induction and as part of the ongoing training programme. The organisation’s procedures for pre-employment checks on staff are thorough. The home has copies of relevant documents including the local joint agency policy and procedure dated April 2007. The registered manager had also obtained copies of a Department of Health leaflet on safeguarding adults with a learning disability. The organisation has good arrangements in place for liaising with local statutory organisations on safeguarding adults. There appears to be an open culture in thes home and relevant information is readily accessible to staff in the office. At the time of this inspection the home was not in touch with an advocacy organisation. Senior managers may be able to advise based on their experience of services provided elsewhere in Buckinghamshire but some organisations may have reduced in size and scope in recent years. The relevant department of the local authority may also be able to provide information on the current position in the area. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, pleasant and well-maintained environment which provides residents with a comfortable and safe place to live. EVIDENCE: The home is a pleasant and quite spacious house located in a residential area, about one mile or so from Chesham town centre. The nearest rail station is Chesham (London Underground Metropolitan Line), there are regular bus services between Chesham and other towns (some routes travel via the Chesham to Berkhamsted road a few minutes walk from the home), and parking is convenient, either at the front of the house or in the street. The house is a detached, older style, three-storey property. There is a paved, partly enclosed area to the front which provides limited space for parking. There is a garden on two levels at the rear of the house. Access to the garden REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 22 to the side of the house is controlled by a lockable gate. Entry to the home is controlled by staff. The ground floor accommodation is comprised of the entrance hall, dining room, lounge, kitchen, laundry, two bedrooms, office and WC. Stairs lead to the first floor where there are three bedrooms, bathroom and WC. A further set of stairs lead to the top floor where there is one bedroom and access to the attic. The house is equipped and furnished to a good standard and has a pleasant ambience. The dining room was said to be the centre of the home. It is a pleasant, spacious and well lit room with wooden flooring, light wood dining table and chairs, two contrasting dark armchairs, and light coloured walls on which contemporary prints hang. Flowers and fruit add colour (the fruit providing nutrition too of course). A small stereo allows music when required. Access to the garden is through the dining room. The lounge is well decorated. It is furnished with sofas, a coffee table, a TV and DVD/Video (which also plays CDs). There are two bedrooms on the ground floor. The kitchen is well equipped. It has a gas cooker, microwave, sinks, fridge/freezer, dishwasher, and electronic insectocutor. There was sufficient storage in the fitted wall mounted and base storage units. One work surface is lower than others to facilitate use by a wheelchair user. The kitchen was well organised, tidy and clean, although some products in the fridge had not been labelled with date of opening. A small room on the ground floor houses a washing machine, tumble dryer and sink. Bedrooms vary in size. None have en-suite facilities but all have a hand basin. Bedrooms are well decorated in neutral colours and well furnished. Residents had personalised their rooms according to their own tastes and interests. There are sufficient baths (X3), a shower (X1) and WCs (X4) for current needs. One bathroom has an electrically controlled chairlift. The service manager said that other aids would be provided according to the needs of a resident. The ground floor is accessible by wheelchair. The garden is on two levels. Access to the upper level is via a set of steps. The garden was still under construction at the time of this inspection. The lower level is a paved patio area which will provide a pleasant place to sit, have barbeques or other events in good weather. The upper area will include an area of lawn, flower beds, shrubs and perhaps a small area for growing vegetables and herbs when it is completed. Access to the side of the house is controlled by a lockable gate. Standards of housekeeping and hygiene are very good. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 24, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of people living in the home. EVIDENCE: As mentioned elsewhere in this report staff were observed to be attentive to the needs of residents and supportive in their responses. Many of the residents have difficulties in verbal communication and staff endeavoured to establish an understanding of residents needs across a range of interactions observed during the course of the inspection visit. Staff were accessible and approachable at all times. Three staff had started NVQ training with ‘Affinity’ training. Current staffing levels are two care staff in the morning, two in the afternoon and evening, and one waking plus one sleeping at night. These figure may include the manager. The majority of staff are female, there is currently one male member who is attached to the organisation’s relief pool of staff. Staffing REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 24 levels at present are sufficient to enable staff to meet residents needs. On the day of the inspection visit, each resident pursued their own interests in the morning. The residents, staff, managers and the inspector then had lunch together. Residents went out with staff in the afternoon. The pace of life seemed to suit the residents and they each appeared to have their needs met over the course of the day. The home is supported in the recruitment of new staff by personnel staff based at the organisation’s head office in Gerrards Cross. The records of five staff were examined. Applicants are required to complete an application form. All had done so. An enhanced CRB certificate should be obtained for all staff. One was on file in four out of five cases. The manager explained that in the case of the fifth person, the CRB certificate was probably on file in the home in which they had previously worked – also run by REACH. Because staff had worked at the other home before Chesham opened this explanation was accepted on this occasion. However, in such circumstances managers should place a letter on the Chesham file giving the essential details of the certificate (name of the person, date of disclosure, level of disclosure, including POCA check (if requested), including POVA check, Disclosure reference number). For staff starting work before the CRB certificate was received, a POVA First check had been carried out. References and information on health status had been obtained as required. Two of the five files had a recent photograph. One had a photocopy of a photograph. The manager undertook to obtain recent photos for all staff. It is noted that files also include an equal opportunities monitoring form. A good practice. The storage of CRB disclosures was discussed with the care services manager. CSCI guidance on this matter is set out in section 3.11 of its guidance to providers issued in January 2007. This includes reference to inspection. Conformance to this guidance should both protect the confidentiality of individuals and deal with the concerns of senior managers expressed at this inspection, that inspectors at future inspections will insist on examining disclosures received before the previous inspection. A schedule of training attended by staff to date was made available for this inspection - so too was a copy of an organisation wide report on training carried out in 2007. Recent training for staff in the home covered ‘POVA’, ‘Infection Control’, ‘Medication’, ‘Moving & Handling’, ‘Health & Safety’, and ‘Fire Safety’. Training in food hygiene was scheduled for March 2007. The care services manager said that options for developing staff training and development were being considered and that external bodies (such as SECAS – a Skills for Care advisory service) are involved as appropriate. The organisation’s three-month induction is said to meet most of the Skills for Care induction standards. Training in ‘Equality and Diversity’ was also in place. New staff have a six month probation period. Personal supervision is well established in REACH and takes place monthly. All staff have an annual appraisal. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to the quality of the service is providing good care outcomes for residents. Arrangements for health and safety are thorough and aim to maintain a safe environment for residents, staff and visitors. EVIDENCE: The registered manager has worked with REACH since March 2005, at care support worker and senior care support worker level. The manager has acquired NVQ3 in care and at the time of this inspection was pursuing both NVQ4 in care and the Registered Managers Award (RMA). Over the course of REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 26 2007 the manager, apart from NVQ training, had also attended training on the Mental Capacity Act 2005, Breast Awareness, Epilepsy, and had undertaken a training needs analysis. The aims of the service, as seen by the manager, are clear. They are: (1) to support independence, (2) enable residents to lead as normal a life as possible, (3) to support residents to be involved with the wider community, (4) to have opportunities for educational and social development, and, (5) to develop communication skills. These aims are to be achieved through the activities of daily living (both inside and out of the home), participating in community activities (and not being segregated from the community), attending college and having access to training opportunities, and, receiving health and social care services as required. The home will be required to participate in REACH’s quality assurance activities. These include: an annual survey of stakeholders, monthly staff and resident meetings, monthly Regulation 26 visits by senior managers, regular reviews of resident’s progress, and the formulation of an annual development plan. Polices and procedures are formulated and agreed by managers and the home has a copy of a policy folder which is accessible to all in the home. Standards of record keeping are good and facilities for the storage and security of records are satisfactory. The manager is aware of the need to conform to Freedom of Information legislation. Arrangements for health and safety are generally satisfactory. A policy governs staff practice and the organisation has engaged external consultants to ensure that policy and practice is up to date. The home has been thoroughly refurbished and adapted for its current use. All electrical and gas appliances are new. The security of the building is maintained by physical measures (fencing and doors) and staff control of people entering and leaving. Arrangements for fire safety appear satisfactory. The kitchen had been inspected by an environ health officer and an email sent after the visit was seen. Staff are due to attend food safety training in March 2007. Staff need to ensure that food opened in the refrigerator is labelled with date of opening. Lines of accountability within the home and to the wider organisation are clear. The organisation has an established cycle of business planning which this new home will fit into. REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 27 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 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 3 3 3 3 3 REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 28 N/A 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 YA1 Regulation Schedule 1 5 Requirement The registered manager must review and update the home’s statement of purpose and ensure that it complies with Schedule 1 The registered manager must review and update the home’s service user’s guide so that it is specific to this service and complies with the Regulations. The registered manager must ensure that the arrangements for the storage of medicines are secure. The registered manager must make it clear in all relevant documents that the complaints procedure covers all complaints, informs complainants that they can refer a complaint to CSCI at any stage, and ensure that it is available in a format which may be more easily understood by residents. The registered manager must ensure that personnel files retained in the home include evidence of compliance to the Regulations in the recruitment of staff. Timescale for action 30/05/08 2 YA1 31/05/08 3 YA20 13 (2) 30/04/08 4 YA22 22 31/05/08 5 YA34 Schedule 2 30/04/08 REACH Vale Road Chesham DS0000071265.V357888.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 2 Refer to Standard YA17 YA20 Good Practice Recommendations The registered manager should seek the opinion of a dietician on the nutritional value of the home’s menus. The registered manager should obtain a copy of the CSCI guidance on medicines in care homes and consider obtaining an authoritative general text on medicines for reference by staff and residents. The registered manager should obtain contact details on one or more local advocacy organisations with skills and experience relevant to the needs of residents. 3 YA22 REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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 REACH Vale Road Chesham DS0000071265.V357888.R01.S.doc Version 5.2 Page 31 - 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. 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