Inspection on 24/11/05 for Robert Street (12)

This inspection was carried out on 24th November 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Robert Street (12) 24/01/07

Robert Street (12) 15/03/06

Robert Street (12) 03/03/05

Robert Street (12) 08/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Robert Street (12) 12 Robert Street Harrogate North Yorkshire HG1 1HP Lead Inspector Kate Shackleton Unannounced Inspection 24th November 2005 09:30 Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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 Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Robert Street (12) Address 12 Robert Street Harrogate North Yorkshire HG1 1HP 01423 541888 01423 541889 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) Henshaws Society for Blind People Miss Emma Claire Brook Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 5 service users with Learning Disabilities all of whom also have an additional Sensory Impairment 3rd March 2005 Date of last inspection Brief Description of the Service: Robert Street is a large terraced property occupying three floors. It provides accommodation in five single rooms, on the two upper floors, for adults under 65 years of age with a learning disability and visual impairment. Communal space is provided on the ground floor. Staff provide personal care, meals, laundry and a domestic service. Service users are encouraged to be involved in all aspects and activities of daily living. There is a small garden area to the rear of the premises. The home is close to the centre of Harrogate with easy access to all local facilities. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6:25 hour The focus was on a number of key standards together with those subject to requirements and recommendations made at the previous inspection. Some of the communal areas of the home were seen and a number of records were inspected. One service user, three support staff and the acting manager were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The registered provider (Henshaws) should inform the CSCI about the management arrangements for the home in the absence of the Registered manager. The acting manager will need good line management support to improve some aspects of service delivery. The manager should in discussions with service users and staff look at providing more nutritious meals. In considering this the cooking methods used and the money given to service users to purchase food needs to be taken into account.Staff may also benefit from advice or training from catering/health care professionals who know about healthy eating. The manager should put in place procedures and training for staff on a number of issues in order to safeguard service users from harm. The manager must make sure that the following concerns are put right without delay. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 6 The way in which service users are supported to self medicate needs to be made safer Staff fire training must be brought up to date. To prevent the risk of scalding, weekly checks on the hot water temperature need to be made and recorded. In addition to the above, work recommended by the fire authority to the basement ceiling must be done to make sure the home is safe. The records that provide evidence that staff are properly vetted before they start work so as to make sure that unsuitable people are not employed must be kept in the home available for inspection. 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. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users are given the opportunity to decide whether the home is suitable to meet their needs. EVIDENCE: The one service user spoken to said that she had been involved in making the decision to live at Robert St. The case file of the person most recently admitted to the home showed that an assessment from the referring authority had been provided. There was no evidence that staff in the home had completed an individual assessment. Staff said that there is a need for a settling in period before any assessment is made. Service users are admitted for a trial period to make sure that they feel comfortable living at the home and that the service can meet their needs. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users participate in decision-making and are supported to achieve independent lifestyles EVIDENCE: The one service user spoken to said that she is involved in decisions affecting her daily life. Staff were seen involving service users in making plans for the day In the majority of cases files examined showed that each person had a care plan which reflected their needs, aspirations and goals. The home operates a key worker scheme. The key worker works one to one with the service user to decide the service to be provided by staff to meet needs and achieve goals. Key workers are expected to do monthly evaluations of the plan. And record any changes to the plan in line with changing circumstances in the service users life. The Commissioning authority does a formal annual review. One service user did not have a care plan and the majority of monthly evaluations were not up to date. The registered manager is expected to do a monthly audit of the case file to make sure everything is up to date and action things that are not. This system of monitoring is not working well and has the potential to Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 10 allow gaps in service delivery, which could mean that changing needs are not recorded and therefore not met. The ethos of the home promotes independence and self-expression. Risk assessments are completed and any limitations on freedoms or choice are discussed with the service user and recorded. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15,16 and 17 Service users lead meaningful lives well integrated into the life of the local community. EVIDENCE: Case files and activity records seen showed that service users have the opportunity to live ordinary and meaningful lives in line with their abilities. A number of service users attend the provider’s arts and craft centre and one attends a further education evening class. Good use is made of the town’s recreational facilities and service users are supported to maintain appropriate relationships. Staff were seen providing support and guidance in a helpful and age appropriate manner. During this visit some of the service users were out at the centre. Others were in and out of the house engaged in everyday activities in the community. Service users decide the menus. A member of staff was seen doing this with two service users. The menus seen did not reflect nutritious wholesome food. There was little evidence of healthy fresh produce for example vegetables or salads or good sources of protein. Fresh fruit is available. Because service Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 12 users are expected to cook their own meals with some staff guidance all hot food is cooked in the microwave. This style of cooking significantly reduces the options for good “home cooked” food. Staff spoken to felt that this aspect of service delivery is poor and needs to improve. They felt challenged by balancing the rights of service users to choose what they eat with the need to provide a varied and nutritional diet. And because service users have some control over the money spent on food, they are given £20 each to buy food for their weekly tea- time meal and lunches when they are not at the centre. It was felt that this also restricted food choices. The home provides the majority of general provisions. Discussions were held about how staff could help service users to make good decisions about the food that they eat in the same way that they support service users to make safe decisions in other aspects of their lives. The one service user spoken to liked the food and particularly the fact that she could choose her own meal. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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 the following standard(s): 18,19 and 20 Service users receive support with personal and healthcare needs. EVIDENCE: Service user plans provide staff with the information they need to support service users in the way that they prefer. The service user spoken to was very satisfied with the care provided describing it as “ace”. All service users are registered with a GP and are able to access a range of other health care professionals as and when needed. A record of medical needs is kept. All of the service users who need to take medication self medicate. A risk assessment is done and safe storage is provided in their bedrooms. The pharmacy that supplies the medication provides training for staff. There is a safety issue with how the medicines are dispensed to service users. Medicines arrive in the home in their original containers. Staff then dispenses the medicine into weekly dossette boxes, which are given to service users to keep in their bedrooms. It is at this point that an error could occur and is therefore not acceptable. It is essential to minimise any possible drug administration errors by reducing the number of steps in the administration process. The best method of achieving this is to retain the medicines in their original containers bearing the pharmacist’s label. and administer directly to the service user (The Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 14 Royal Pharmaceutical Society of Great Britain publication The administration and control of medicines in care homes refers.) Advice was given to ask the pharmacist about the types of systems available to ensure safe administration for service users who self medicate. Proper records are kept on the receipt and disposal of medicines. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 15 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 Service users are protected from abuse and concerns are taken seriously and acted upon. EVIDENCE: There is a user-friendly complaints procedure. The records looked at showed that any concerns raised are dealt with quickly and seek to resolve the situation. The service user spoken to said that if she had any concerns she would talk to her key worker. Staff receive training in abuse awareness. Staff spoken to knew to pass on any suspicions or allegations of abuse to a manager. Policies and procedures are in place to safeguard service users from abuse. A situation found at the last inspection of the home whereby service users felt verbally abused by another service user has been resolved. In order to minimise the risk of financial abuse, sound accounting and recording systems are in place for all financial transactions completed on behalf of service users. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 16 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 Service users live in a clean comfortable environment. The ignoring of fire safety advice has the potential to place service users at risk. EVIDENCE: Robert Street is a three storey terraced house located within easy walking distance of the town centre. It was originally built as a private dwelling and was later converted into a care home. The house is decorated and furnished like any ordinary domestic household. A tour of the communal areas showed it to be clean bright and warm enough for service users. Bedrooms are located on the upper two floors together with adequate bathing and toileting facilities. Since the last inspection there has been some redecoration to the first floor bathroom and the hall stairs and landing. There remains an outstanding fire safety issue going back as far as August 2004. Following a fire safety officers visit a recommendation was made that work was needed to the basement ceiling to improve its capacity to contain a fire in this area. At the last inspection of the home by the Commission for Social Care Inspection (CSCI) in March 2005 a requirement was made that this work must be completed. The work has not been done. The registered provider is required to make adequate arrangements for the containment of a fire and must therefore get this work done without any further delay. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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 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): 33,34 and35 Service users needs are met by an enthusiastic staff group that works positively with service users. EVIDENCE: Staff were seen listening to service users and providing appropriate support. They seemed knowledgeable about service users individual needs and worked hard with them to achieve independent lifestyles. The home employs five support staff and a manager. Because the manager is absent from work, an acting manager is in post. He is undertaking National Vocational Qualification (NVQ) training level 4.One of the support staff is doing NVQ level 3 and two support staff are about to start NVQ level 2. It was not possible to make a judgement about the effectiveness of the recruitment process. The information about staff that has to be kept at the care home was not available for inspection. The acting manager thought it was kept elsewhere. Staff are recruited subject to a probationary period. There is a comprehensive staff-training programme. Records seen confirmed this. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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 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): The acting manager has an understanding of the areas in which the home needs to improve in order to ensure the health and safety of service users. EVIDENCE: The registered manager is absent from the home. The registered provider (Henshaws Society for blind people) has not notified the CSCI of this proposed absence. The acting manager has been in post for one week and is aware of some of the issues that need to be addressed. He is intending to meet with his line manager soon to discuss the management of the home. There is a quality assurance and monitoring system in place, which canvasses the views of service users. Copies of monthly reports completed by a manger from another service about the conduct of the home were seen. A Quality Assurance report completed by a senior manager was also seen. The registered provider provides a range of policies and procedures designed to promote and maintain the overall health and safety of service users and staff. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 19 Proper individual and environmental risk assessments are carried out. Staff spoken to confirm that they receive training in health and safety matters for example first aid, moving and handling, fire safety and food hygiene. All electrical appliances are checked annually to ensure that they remain fit for purpose. On the day of this inspection a water hygiene risk assessment was being done. The temperature of the hot water is supposed to be checked and recorded weekly to ensure the safe delivery of hot water and minimise the risk of scalding. There were no records available for November. Fire records examined showed that some staff last received fire training in January 05. North Yorkshire fire authority recommends that staff in care homes receive instruction at the following intervals; two periods of instruction in the first month of employment, six monthly for day staff and three monthly for night staff. The fire detection system was serviced in October 05. One member of staff spoken to did know when asked how to activate the fire alarm system and evacuate the building. Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 20 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 X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 1 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Robert Street (12) Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 1 X 3 X X 1 X DS0000007890.V264816.R01.S.doc Version 5.0 Page 21 Yes 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 2 Standard YA6 YA17 Regulation 15 16(2)(i) Requirement Every service user must have a service user plan Service users must be provided with adequate quantities of suitable wholesome and nutritious food, which is varied and properly prepared. Advice must be sought and acted upon from the dispensing pharmacist about a safer way of administering medicines for service users who self medicate The recommendations made in the fire officers report of August 2004 must be addressed and resolved (Previous timescale of 31/05/05 not met) A copy of each reference obtained for staff as part of the recruitment process must be kept in the care home. All of the other information required by this regulation must also be kept in the home. The registered provider must inform the Commission in writing about the absence of the registered manager providing information about: DS0000007890.V264816.R01.S.doc Timescale for action 14/12/05 07/12/05 3 YA20 13(2) 31/12/05 4 YA24 23 (4) 28/02/06 5 YA34 17(2) Schedule 4(6) 30/12/05 6 YA37 38 14/12/05 Robert Street (12) Version 5.0 Page 22 7 YA42 23(4)(d) •The expected length of the absence •The reason for the absence •The arrangements, which have been made for the running of the care home during the absence. •The name, address and qualifications of the person who will be responsible for the care home during the absence. Staff must receive fire training in 30/12/05 line with the recommended intervals set by North Yorkshire fire service. 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 42 Good Practice Recommendations Hot water temperatures are checked weekly and recorded in line with Henshaws procedures Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Robert Street (12) DS0000007890.V264816.R01.S.doc Version 5.0 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. 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