Inspection on 02/08/06 for Sewells (6a)

This inspection was carried out on 2nd August 2006.

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

Other inspections for this house

Sewells (6a) 14/05/07

Sewells (6a) 01/12/05

Sewells (6a) 30/08/05

Sewells (6a) 21/01/05

Sewells (6a) 10/08/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Sewells (6a) 6a Sewells Welwyn Garden City Hertfordshire AL8 7AQ Lead Inspector June Humphreys Key Unannounced Inspection 2nd August 2006 10:00 Sewells (6a) DS0000019519.V306602.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 Sewells (6a) DS0000019519.V306602.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. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sewells (6a) Address 6a Sewells Welwyn Garden City Hertfordshire AL8 7AQ 01707 395 187 01707 321 344 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) tanners@lifeopportunitiestrust.co.ukwww.lifeopp ortunitiestru Life Opportunities Trust Ms Ruth Shannon Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7), Physical disability (7) of places Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: 6a Sewell is a purpose-built modern style bungalow that was designed to accommodate seven adults with learning and physical disabilities. It is located at the end of a cul-de-sac on a housing estate in Welwyn Garden City. All bedrooms are offered for single occupancy and the home is equipped with appropriate adaptations and equipment to enable staff to meet the needs of the service users. The aim of the home is to enable service users to play a part in the day-to-day running of the home, ensuring that they have an input into how they live their lives. Particular regard is paid to the privacy of individuals, integration into the community and ensuring that service users have a wide range of activities, experiences and relationships available to them. The fee range (top up) is currently between £1,133.99 to £1,164.50 per week. This can be seen as approximate cost as it is based on individual assessed need. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced key inspection completed on 2nd August 2006.Evidence gathered during the inspection included: • Observation of interaction between staff and service users, • Individual interviews with three service users, and two support workers • A detailed discussion with the deputy manager • A look at relevant documentation maintained in the home. • Paper evidence received by the CSCI from the service since the last inspection on the 1st December 2005. The home has a temporary change in the services management team for a period of three months. The CSCI will be notified of any further changes. This was generally a positive inspection, and all the standards from the previous inspection were met. Several new requirements were made in relation to the environment. What the service does well: • Service users are being involved in the process of planning and delivery of their care and are encouraged to fully participate in decisions that affect their lives. There is a genuine attempt to put the service user at the heart of the decision making process both in the home, and the personal choices they make; staff efforts are commendable. The service users enjoy a healthy diet, offering a range of different foods. Mealtimes are unhurried and sociable. The menu is planned with service users, taking into consideration individual likes and dislikes. Health action plans are being completed with all service users, which clearly details all aspects of the persons health needs. The format is user friendly, and encourages the person to be involved. • • Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 6 • Robust procedures are in place to ensure that service users are protected from abuse and harm. A service user had made one complaint since the last inspection. This had been fully investigated. The staff team working at ‘Sewell’s’ is a small group of staff that appear to work well together. There was a good atmosphere between staff and service users on the day of inspection. • What has improved since the last inspection? What they could do better: 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. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 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 Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 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): 1,2 and 5 Sufficient information about the aims of the home, and the service to be provided is available to prospective and current service users. The assessment information is comprehensive, and provided in a format that enables service users to understand and participate in the assessment. Each service user has a statement of terms and conditions, which forms part of their individual contract. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The current statement of purpose and service user’s guide was looked at as part of the inspection. It contained the required information and is available to the service users at all times. The manager usually updates the document each year as part of the services business plan. The service ensures that detailed assessments are carried out with new service users prior to their admission to the home, and this extends to a trial period staying within the home. The trial period ensures that the home can meet the service users individual needs, and also enables and empowers the service user to make an active choice about if this the right home for them. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 9 Each service user is issued with a contract of tenancy that outlines the residency agreement between the home and the service user. Two contracts were looked at on the day of inspection. The contracts seen contained all the required detail and information to ensure that service users right and needs are protected and empowered. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 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 the following standard(s): 6,7 and 9 Service users changing needs are identified within a named file but the information is not stored in an easily accessible format. Service users are being involved in the process of planning and delivery of their care and are encouraged to fully participate in decisions that affect their lives. Activities that pose a possible risk are effectively managed through the risk management process. The quality in this outcome group is adequate (continued work is required in relation to the care plan format); this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Four care plans were looked at as part of the inspection process. Whilst the individual files held a range of significant information, the detail (of which some information was out of date) made reading a lengthily process. Time was spent discussing a possible format, which includes the most important information that is needed for staff to support individuals on a day-to-day Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 11 basis. The remainder of information, although important should be separated from the main care plan. The staff are clearly committed to providing a high standard of service having started to complete health action plans, as well as person centred plans. All activities are risk assessed for each service user and copies of the risk assessments were seen on the individuals’ files as part of this inspection. Staff clearly work extensively to try to meet individual service users requests; a trip on the London Eye was happening as part of someone’s Birthday. Another person had travelled to Dundee by aeroplane. This is a genuine attempt to put the service user at the heart of the decision making process both in the home, and the personal choices they make; staff efforts are commendable. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 12 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 are encouraged to participate in a range of different activities both within the home and the community. The key worker system allows for individualised programmes ensuring service users maintain their own sense of purpose and identity. The service users enjoy a healthy diet, offering a range of different foods. Mealtimes are unhurried and social able. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The menu is planned with service users, taking into consideration individual likes and dislikes. The home has a four-week rolling seasonal menu, which appeared well balanced. Records are maintained of food consumed to ensure service user approval. Feedback from service user interviews again reinforced that choice is offered. One service user stated that the food was ‘always nice’, and a second option being made available. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 13 Service users take part in a wide variety of activities that they discuss and negotiate with staff. Most of them attend a day centre for part of the week. This provides them with the opportunity to socialise with friends that they have known for sometime. Two people have one to one support in the home, and a minibus is available for staff to take people out. Two of the service users interviewed both expressed concern about the day centre they attend closing. Both were aware that this was for a limited period of time but had not been advised of where they might go, or for how long. One person talked about going to college and appeared to have insight into why it had not previously worked i.e. ‘my behaviour was a problem’ The staff within the home agreed to assist service users in finding out what the plan is with regard to the future day care arrangements. Staff encourage and support service users to maintain family relationships, and the contact person, and frequency of visits was available on each persons file. A service user spoke of how important it was for his sister to visit and staff appeared aware of the importance of this. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 14 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 Assessment and reviews are completed, and changes to care documented. The service involves outside agencies in meeting the health care needs of service users and has good examples of effective working. The temperature for the storage of medication was not known and could not be verified. Surplus medication should cease to be stored inappropriately. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Health action plans are being completed with all service users, which clearly details all aspects of the persons health needs. The format is user friendly, and encourages the person to be involved. The service has access to a range of input from specialists such as community nurses, consultants as well as more routine dentists and G.P’S. All appointments are recorded with any necessary actions. Day to day administration and storage of medication was checked and found to be satisfactory. However a range of surplus medication is stored in a locked cupboard in the laundry room. The conditions in this room are dry and humid. Two types of medication were identified that need to be stored below a certain temperature to be effective. Lactulose should be stored below 20 degrees Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 15 centigrade, and Amitriptyline below 25 degrees. This cupboard should no longer be used for the storage of medication. The necessity to keep such a large amount of surplus medication in the house is unnecessary. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 16 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 The complaints procedure is sufficient and adequate in order for the service users to feel that their individual views are listened to. Robust policies, procedures and training are in place to ensure service users are protected and safe. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A comprehensive complaints procedure is in place. A record is maintained of complaints made, detailing actions and outcomes as necessary. A service user had made one complaint since the last inspection. This had been fully investigated and when the person was interviewed they declined to speak about it saying that they felt it had been resolved. Robust procedures are in place to ensure that service users are protected from abuse and harm. The Hertfordshire adult protection procedure was on display in the office, and regular training, and updates were routinely offered. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 17 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): 24,25,29 and 30 The home is adequately maintained and furnished providing a homely, comfortable environment for service users to live. However two requirements were made at this inspection. Shared spaces, compliment individual spaces with service users being involved in the maintance and decoration within the home. Bedrooms were personalised and individual in appearance. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The building is well-designed, accessible, and equipped with suitable aids and adaptations. Bathrooms and toilets are sufficient for the number of service users, but the lino flooring requires replacement in one of the bathrooms. The service users bedrooms overall were personalised and individualised in their décor. Two service users interviewed were clearly delighted with the involvement and choice they had been given in redecorating their rooms. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 18 However this was not the case in one identified bedroom where on the day of inspection the smell of urine was quite unpleasant. The deputy manager was made aware of this and has agreed to take action. The outside garden area has improved since the last inspection, and provides a nice place to sit and socialise. There was concern raised in relation to an area directly outside of the home where a vast quanitity of cigarette butts were found to be in there hundreds. It is unclear if this is part of the homes premises, but the service must demonstrate that there is a plan to rectified the situation. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,and 35 The policies and procedures relating to recruitment meet the requirements of the national minimum standards, and care homes regulations. Staffing levels within the unit are sufficient to meet service users’ needs. Staff has appropriate skills and experience to respond to individual needs. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Whilst the policy and procedures relating to recruitment meet the national minimum standards, the inspector was unable to access personnel records. This has been the case over several inspections and is of concern. The service must demonstrate that the necessary C.R.B checks and references checks are adhered to prior to employment of new staff. The rotas seen demonstrated that adequate numbers of competent staff are provided at all times to meet service users needs. Agency workers are rarely Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 20 required to work in the home, with staff employed usually remaining for a considerable amount of time. The staff team working at ‘Sewell’s’ is a small group of staff that appear to work well together. Supervision records showed that a system of all staff receiving one to one sessions was in place. The frequency between meetings was variable upon need. Due to the changes in management structure it is important that the current management of the service places supervision and regular team meetings high on the agenda to ensure the high level of consistency and cohesiveness in the staff team continues. Two members of staff spoken with said they were very well supported both by senior staff and the current acting manager. A relatively new member of staff discussed the induction process in the home has informative, and felt that the overall support provided was very good. The training planner was seen at this inspection and provided a satisfactory profile of training for staff. Staff had been provided with the opportunity to complete N.V.Q 2/3 and most staff were either qualified or in the process of completing their award. One member of staff was now involved in assessing staff. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 The current management structure is adequate but must be kept under review, and the CSCI notified of any changes. The home actively seeks the views of service users, and other involved people in order to ensure that a good quality of care is provided. The service users living in the home are generally safeguarded by the current practices in place with regard to health and safety. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 22 The standard of care offered within the home is good; both in the delivery of care, and the recording of information. As previously stated care plans have improved but further work is required both with regard to consistency, and the process of reviewing information. On the day of inspection the CSCI had not been advised that there was currently a acting manager of the service. This has since been rectified. At present the acting manager has worked at the home for a considerable time and has been able to allow this transition to be smooth. However the deputy manager involved in the inspection process is also not based at the home for more then a few shifts per week. Another member of staff is acting up into a senior role, but she is relatively inexperienced. Service users did appear to be aware of the changes in management and when asked said they were happy with the changes and seem to be aware of what was happening. Whilst it is appreciated that cover has been put in place there is some concern that this may not be adequate over a lengthily period. The service must advise the CSCI of any further changes. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Timescale for action 31/10/06 2. 3. 4. YA20 YA30 13 (2) 16(2)(k) 16 (2)(c) YA24 The registered person must ensure that all service users have a current and up to date Care plan which is an easy reference point for staff. Surplus medication should not be 31/08/06 kept, or stored in the laundry room. The manager must ensure that 31/08/06 the offensive odour in the room identified to her is eradicated. Lino flooring requires 30/09/06 replacement in one of the bathroom. 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 YA37 Good Practice Recommendations The CSCI should be notified of any further changes in relation to the management structure. (Registered manager) DS0000019519.V306602.R01.S.doc Version 5.2 Page 25 Sewells (6a) 2. YA30 A plan is required to rectify the storing of used cigarette butts directly outside of the back door of the home. Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Office 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 Sewells (6a) DS0000019519.V306602.R01.S.doc Version 5.2 Page 27 - 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!