Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Love Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: ï· Put the people who use social care first ï· Improve services and stamp out bad practice ï· Be an expert voice on social care ï· Practise what we preach in our own organisation Care Homes for Adults (18-65 years) Page 2 of 43 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF 01992700545 01992761735 ged.elliott@essexcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Essex County Council Name of registered manager (if applicable) Ms Geraldine Sonia Elliott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 6 1 0 care home 25 learning disability physical disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 25 persons) Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who also have a physical disability (not to exceed 6 persons) One named service user, over the age of 65 years, who requires care by reason of a learning disability The total number of service users accommodated in the home must not exceed 25 persons Date of last inspection 0 1 0 5 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 43 A bit about the care home Shernbroke is a purpose built home for people with a learning disability. The building is in keeping with the local community. There is a communal administration area and five separate houses/bungalows. Accommodation is arranged on a unitary basis, each house having domestic style facilities. Two of the houses are designed to meet the needs of people with a physical disability. The houses and grounds were seen to be generally well maintained, clean and tidy on the day of the inspection. The home is situated reasonably close to local shops and amenities. Care Homes for Adults (18-65 years) Page 5 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 43 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced key inspection. The visit took place over two days with one inspector and lasted a total of 14 hours, with all key standards inspected. We looked to see if there had been any changes to areas that we felt needed to be improved from our last visit to the home. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (AQAA). This is a document that is required by law, which is completed by the provider, detailing what they do well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was
Care Homes for Adults (18-65 years) Page 7 of 43 undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to this inspection surveys were forwarded from the Commission for Social Care Inspection to residents, residents next of kin, placing authorities, healthcare professionals and staff who work within the care home. At the time of writing this report we had received 4 completed resident surveys, 4 relatives surveys and 2 surveys from staff. Comments are highlighted within the main text of the report. The support team leaders and administrator assisted the inspector on the first day of inspection, whilst the manager and administrator assisted the inspector on the second day of inspection. Feedback on the inspection findings, were given as a summary at the end of the second day of inspection with the manager and service manager. The opportunity for
Care Homes for Adults (18-65 years) Page 8 of 43 discussion and/or clarification was given. As a result of concerns relating to inadequate and poor medication practices and procedures, an Immediate Requirement Notice was issued. What the care home does well Visitors to the home are made to feel welcome. Residents` comments relating to food are positive. Care Homes for Adults (18-65 years) Page 9 of 43 People living at Shernbroke seem to be happy and content. Residents and relative’s comments to illustrate this are recorded within the main text of the report. Several members of staff have been employed within the service for a long time. This is seen as positive as it provides residents with continuity and people they are familiar with. All areas of the home were observed to be clean, tidy and odour free. What has got better from the last inspection None of the requirements highlighted at the previous key inspection to the home have been addressed.
Care Homes for Adults (18-65 years) Page 10 of 43 What the care home could do better Staffing levels and deployment of staff need to be improved and maintained so as to ensure residents safety and wellbeing. Staff recruitment procedures need to be improved to ensure that residents are safe. Further training and personal development is required for staff to ensure that they have the skills and competence to meet residents needs and to deliver good care. Staff working within the care home must receive regular staff supervision. Care Homes for Adults (18-65 years) Page 11 of 43 The social care needs of all residents must be actively encouraged, promoted and maintained. The routines of the home must not be dictated by staff and staff must ensure that individuals care needs are maintained. Further development is required to ensure that all care plans are person centred, that they clearly record peoples care needs and how these are to be met by support staff. Care Homes for Adults (18-65 years) Page 12 of 43 Additionally there are clear risk assessments, detailing the specific nature of the risk and how these are to be minimised. This will ensure that staff working within the care home are fully aware of the individual persons care needs and are able to deliver care in line with these requirements. Medication practices and procedures must be improved upon to ensure peoples safety and wellbeing. Issues were highlighted at the previous inspection and remain outstanding. The management team of the home must be proactive in addressing previous identified shortfalls and those that have been highlighted and/or repeated at this inspection. Care Homes for Adults (18-65 years) Page 13 of 43 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Michelle Love Commission for Social Care Inspection Capital Park, CPC1 Fulbourn Cambridge CB21 5XE 01223 771300
If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 14 of 43 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their care needs can be met. Evidence: The manager advised that the homes Statement of Purpose and Service Users Guide is currently being reviewed and updated to reflect the impending change of ethos within the service, following a formal agreement by Essex County Council cabinet at the end of October 2008 to review Learning Disability Residential Hostels reprovision within Essex for the future. The manager advised that an extensive consultation process has been undertaken with relatives and carers and some people who use the service, however it is recognised that this is an anxious time for both people who use the service, carers and staff members. There is a formal pre admission assessment format and procedure in place, so as to ensure that the management team/staff team are able to meet the prospective residents needs. The inspector was advised by the person in charge on the first day of inspection that no new people have been recently admitted to the service. At the previous key inspection pre admission assessments were deemed adequate in content
Care Homes for Adults (18-65 years) Page 16 of 43 Evidence: and detail. The AQAA details under the heading of our evidence to show that we do it well, individually paced transition into the home enables service user to settles well. This was confirmed by one person who has been living at the home for some considerable time. Two surveys returned to us from residents stated that they were given a choice as to where they wanted to live and recorded, I saw some other places but I likes this one and I wanted to come and live here. Staff surveys returned to us recorded they did not always receive up to date information from placing authorities (Com 5) about prospective residents, and not enough information with people brought to us for emergency stays. Care Homes for Adults (18-65 years) Page 17 of 43 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although residents are happy with the care provided, shortfalls in care planning and risk assessing were highlighted, which could potentially have an adverse affect on outcomes for residents and their wellbeing. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. It was evident from both observations and talking with staff that people living at Shernbroke have a range of complex and diverse care needs. As part of this inspection two care files were inspected. Care planning records were seen to be detailed and comprehensive, detailing individuals care needs and staff interventions required so as to enable staff to deliver care in line with the individual’s needs. Each file contained sufficient information relating to their personal, health, social and emotional care needs. Each document was noted to be well organised with information easy to access. A pen picture was evident within both care files and this was seen to be positive as it would provide a reasonable level of information to new
Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: staff/agency staff employed within the service. In addition to the above each file contained a personal planning book, recording important people involved within individual peoples lives, daily routines, hopes and dreams and personal preferences. Additionally there was a section entitled my goals, however evidence showed that this had not been updated for either person and there was no information to suggest that these had been met or attained. The AQAA details under the heading of what we do well, service users have individual support plans that provide clear information on how their needs are to be met. Some additional information is required to ensure that information is person centred and comprehensive. This refers specifically to one care plan making reference to the person using makaton signs so as to communicate effectively, however no list was available for staff as to what signs are recognised/utilised by the person on a regular basis. The care plan for both people case tracked recorded them as exhibiting aggressive and/or inappropriate behaviours on occasions. Although information recorded within the plan of care was noted to be detailed, some inconsistencies in recording were evident. This refers specifically to a behaviour monitoring chart being in place for only one person and this not corresponding in all instances with the record of when PRN (as and when required) medication was administered. Additionally the care plan for one person recorded they should be weighed monthly so as to monitor the persons fluctuating weight, however records showed that this was not being monitored regularly. Risk assessments were not devised for all areas of assessed risk pertaining to each person case tracked and some assessments were observed to lack clarity and sufficient information advising as to how the risk was to be minimised by support staff. For example one care file made reference to the person having limited communication, at risk of their weight fluctuating and some allergies. No risk assessment was devised for any of these areas, detailing the specific nature of the risk, how this impacts on the person and how the risk is to be minimised. Daily care records were in general poorly completed as they provided insufficient information relating to staffs interventions and limited information as to how people spent their day. Comments such as gone out with 1-1, rash on the neck, keep on banging their head and refusing other foods and was looking unwell were recorded, with little else noted. Also some terminology used by staff was noted to be inappropriate with no clear meaning e.g. looked manic and bad today. Staff interactions with residents were throughout the first day of inspection observed to be inconsistent. The best interactions were noted to be from regular/permanent members of staff, whilst other staff members were noted to sit and watch people and not to engage with individuals unless prompted by another person. A resident spoken with, confirmed that they are provided with sufficient support from staff and are enabled and empowered to retain their skills and abilities. Relatives surveys returned to us recorded mixed comments relating to whether or not people felt their member of family were receiving appropriate care. These included, I believe that [name of resident] needs in general are not being met by this care home and usually my
Care Homes for Adults (18-65 years) Page 19 of 43 Evidence: relatives needs are met. Care Homes for Adults (18-65 years) Page 20 of 43 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in the activities programme at the home, means that some residents do not have their social care needs met. Evidence: Within each care file case tracked, a weekly activity programme had been devised. Records showed that people have access to adult education classes (music and movement/drama), sensory, listening to music, personal shopping, walks, multi-choice activities, cooking, arts and crafts etc, however this is very dependent on sufficient levels of staff being on duty, staffs willingness to enable people living at Shernbroke to participate in activities and there being a driver available who is willing to support people within the local community. From talking with senior members of staff and from inspection of staff/house meeting minutes, it is evident that some people have been denied the opportunity to participate within a leisure/social programme. This has resulted in people not going swimming or attending college. Evidence of actual activities undertaken by individual residents were limited and poorly completed.
Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: Surveys returned to us from residents recorded, I like to go to college during the week and in the evenings I do colouring, knitting and watching television. I go to church once a month and relax at the weekend and sometimes I go to the pictures at the weekend and sometimes go to the pub. It is clear that the routines of the home are and have been run for the benefit of staff and not for the benefit of the people living at Shernbroke. One staff meeting minutes recorded, staff are refusing to do things that are asked of them e.g. wont go swimming, cant do sleep-ins or the duty officer role, attend appointments etc and only one person takes [name of resident] swimming, if and when they are off then swimming doesnt happen. One member of staff spoken with commented that the above resident loves swimming and its a shame that they dont go regularly. It is of concern that issues as detailed above have also been highlighted at previous inspections to the home and there was no evidence to demonstrate that this has been reviewed by the manager or the registered provider to address the shortfalls and to ensure that the social care needs of individual people are met and maintained. The manager also advised that staff have not been willing to accompany people living at the care home to have a holiday. The manager stated that all but 2 people have had an annual holiday, however staff from within another service supported residents. The AQAA details under the heading of what we do well, support service users to access shops, leisure centres, restaurants, church, social clubs etc and support individuals to choose and develop interests both within and outside of the home. This does not concur with the inspectors findings. One relative survey confirmed the above by stating, to the best of my knowledge staff seem to be of the idea that [name of relative] should fit in with their ideas instead of fitting their work in with [name of relative] needs. One person was able to confirm that they access the local community independently and have the freedom to pursue their personal interests and hobbies. There is an open visiting policy and procedure in place at Shernbroke, whereby people at the home can have visitors at any reasonable time. Visitors spoken with confirmed that they are made to feel welcome. Comments in relation to food were noted to be positive and included, the food is lovely and the food is great. Those people who live within the bungalow have their meals prepared within the main kitchen, whilst others have their meals prepared within each of the houses. Care Homes for Adults (18-65 years) Page 22 of 43 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst systems are in place to ensure that people living at the care home have access to a range of healthcare provision, they cannot always be assured that staff will be willing to support them. Current medication practices and procedures in the home are unsafe and do not safeguard people so as to ensure their wellbeing, health and safety. Evidence: On inspection of care plans, records showed that the healthcare needs of individual people are adequately recorded. Records showed that people have access to a range of healthcare professionals and services, including GP, Consultant Psychiatrist, District Nurse services, Chiropodist etc as and when required, however further development is required to ensure that records of healthcare appointments include outcomes from visits and any follow up action to be taken. The manager advised that an investigation is being undertaken with one staff member as they refused to support a resident who was in hospital and alternative arrangements had to be made for another member of staff from within another service to provide this support. Additionally there have been issues with another member of staff who ignored a resident who was incontinent whilst they used their mobile phone.
Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: The majority of medication is managed through a monitored dosage system (blister pack). Medication was noted to be stored securely within each house. Although medication within each of the houses was noted to be held securely, within the main administration building, medication was noted to be stored on the floor of the ‘sleeping in room’. The door was left open throughout the first day of inspection and provided easy access to staff, people who live at Shernbroke and members of the public. This is unacceptable and could result in other people helping themselves to the medicines available and residents having access to the medication and possibly overdosing with serious consequences. Where medication requires cold storage, fridge temperatures were not recorded. The support team manager was advised that the failure to store medicines at the proper temperature could result in residents receiving a treatment that is ineffective. Additionally, discrepancies were noted whereby the records of medication and actual medication available did not tally. For example one person was noted to be prescribed Epilim Chrono 200mg Tablets, once daily. Records showed that between 8/9/08 and 25/9/08 (18 days) inclusive, 17 doses of the above medication were signed as having been given with one omission of signature. Assuming 18 tablets had been administered out of 28 tablets received, this should have left a balance of 10 tablets, however further evidence revealed a stock balance of only 6 tablets (discrepancy of 4). The support team manager was able to verify the above, but unable to provide an explanation as to the discrepancy. This was not an isolated case and other similar discrepancies were noted. There was no record of some medicines having been given to the resident when they were due, as the entries on the MAR chart had been left blank and not signed by staff. It was of concern that one persons MAR record recorded omissions for one medication for a consecutive period of 4 days. When discussed with the manager as to the rationale, the manager stated that the medication had not been administered as staff had forgotten to take the medication with them, on the residents holiday. This is unacceptable as it confirms that the resident did not receive their prescribed medication. Handwritten MAR records did not always include the quantity of medication received, who by and the date commenced. The MAR record for one resident did not record all of their medications. This refers specifically to the person’s Zopiclone being missed off the MAR record (8/9/08 onwards) following an instruction from the GP to alter this medication to PRN (as and when required). Records show that for some people a PRN (as and when required medication) administration record had been devised, however discrepancies were noted whereby staff were not always recording when PRN medication had been administered and the rationale. The manager advised that medication audits have been devised and implemented since the end of August 2008. Records show that few discrepancies have been picked up by staff in relation to the above issues. The AQAA details under the heading of our evidence to show that we do it well, service user plan identifying health needs and action plan, medication administration records; staff training documentation. It also states under the heading of how we have improved in the last 12 months, closer monitoring of the medication workbook training and development of additional training to this to meet individual service users need. The above statements do not concur
Care Homes for Adults (18-65 years) Page 24 of 43 Evidence: with the inspectors findings. A Regulation 37 notification was forwarded to us in August 2008, advising that a resident had been administered another residents medication. Although the notification showed that staff had contacted the individuals GP/NHS Direct for advice and information, there was no evidence to show what action had been taken with the staff responsible e.g. additional training and/or competency assessment. The support team leader advised that all staff who administer medication have completed a medication workbook. There was no evidence to support this statement on either day of the inspection and from inspection of staffs training records there was no evidence to show that staff have undertaken regular competency assessments. The record of when training updates are due showed that the medication work book is undertaken as a one off with no further update planned. This is seen as inadequate and in light of the above variances, consideration should be given to ensuring that training for staff is more frequent. As a result of the above areas of concern, an Immediate Requirement Notice was issued. Care Homes for Adults (18-65 years) Page 25 of 43 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate corporate complaints procedure and system for logging complaints and guidelines for staff in relation to safeguarding. People cannot be assured that staff, working within the care home have the skill and knowledge to deal with their challenging and/or inappropriate behaviours. Evidence: There is a corporate complaints policy and procedure in place and this is readily available for people to access. On inspection of the complaint log, this showed that since the last key inspection the management team of the home have received 2 complaints relating to poor care practices. Records evidenced the specific nature of the complaint, details of any investigation (where appropriate) and action to be taken. Surveys returned to us from residents who are able to verbalise their needs/express their wishes confirmed that they knew how to make a complaint and included, If Im not happy I will tell the staff and they will help me and There is someone always around who I can speak to. Additionally some people felt that staff listened to them and acted upon what they said/wanted. Comments were recorded and these included, If the telly is too loud I ask them to turn it down and If I want something they try to help me. Since the last key inspection there have been no safeguarding referrals. Staff spoken with demonstrated a basic understanding and awareness of safeguarding procedures and advised that should an issue arise, information would be passed to the person in
Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: charge of the shift and/or the manager. On inspection of a random sample of staff training records, these showed that not all people working within the care home have received safeguarding training and in some cases this has not been updated since 2004. One member of staff is being investigated for alleged poor care practices. There are some people in Shernbroke who exhibit inappropriate/aggressive behaviours from time to time, yet not all staff have received training on how to deal with the above or have updated training. The supervision record for one person in March 2008 detailed they had requested training in relating to challenging behaviour, however there was no evidence to show this has been provided. Care Homes for Adults (18-65 years) Page 27 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well maintained and comfortable environment. Evidence: At the time of the inspection, 1 house and 1 bungalow were in the process of being refurbished. The inspector was advised that 15 residents are currently accommodated in 2 houses and 1 bungalow. A partial tour of the premises was undertaken during the first day of inspection. Each house/bungalow was observed to be pleasantly decorated and refurbished. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. Each of the home environments were noted to be clean and odour free. For those people who require specialist equipment, items were noted to be readily available e.g. special care beds, hoist trackers, shower trolleys etc. No health and safety issues were highlighted on the day of inspection. A maintenance person is available at Shernbroke 3 days a week, however these hours are flexible and can be utilised at other times e.g. weekends/evenings. A random sample of safety and maintenance certificates showed that the majority of equipment in the home have been serviced and remain in date until their next examination. On inspection of the gas certificate this showed that this was out of date and had not been
Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: reinspected. Following the inspection, a gas inspection was undertaken and a copy of the certificate forwarded to us. Care Homes for Adults (18-65 years) Page 29 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing/staff deployment restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Shortfalls in training means that residents are not fully safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. Evidence: The support team leader on the first day of inspection confirmed that staffing levels for each house are 3 staff between 07.00 a.m. and 09.30 a.m., 16.00 p.m. and 22.00 p.m. and 1 waking night between 21.45 p.m. and 07.15 a.m. each day (House 1), 1 member of staff between 07.00 a.m. and 08.30 a.m., 16.00 p.m. and 22.00 p.m. each day (House 2) and 3 staff between 07.00 a.m. and 09.30 a.m., 1 staff member between 09.30 a.m. and 16.00 p.m., 3 staff between 16.00 p.m. and 22.00 p.m. and 1 waking night between 21.45 p.m. and 07.15 a.m. each day (Bungalow). In addition to the above a support team leader sleeps-in and provides cover for the whole service. On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above have not always been maintained. We have not received any Regulation 37 notifications advising us of the staffing shortfalls and measures undertaken to deploy staff to the home. On the day of the inspection the shift was observed to be short of one member of care staff throughout the day. The staff rosters showed a high usage of
Care Homes for Adults (18-65 years) Page 30 of 43 Evidence: agency staff were being used regularly at Shernbroke, however there are several members of staff who have worked at the care home for a number of years. The inspector was advised that the high usage of agency staff is as a result of uncertainty surrounding the future of the service and a recruitment freeze being enforced by Essex County Council. Regulation 26 visits to the home recorded, Rotas are difficult at times, its impossible to cover some shifts and staff morale low due to staff shortages. Relatives surveys forwarded to us confirmed the above and recorded, the care is okay, it would be nice if there was not so many agency staff as they do not know the residents as well and there should be less reliance on the use of agency staff and making all efforts to recruit more full time staff. Staff surveys returned to us also made reference to insufficient staff being on duty on occasions. The AQAA details under the heading of what we do well, staff retention is good with many staff working at the home 8 years. Under the heading of barriers to improvement this records, remaining positive whilst waiting for decisions and outcomes to be agreed. To develop the use of a bank of relief staff, and retain the same agency staff where possible to ensure consistency, to highlight the impact of lack of resources to senior managers. The last Regulation 26 visit report (28/3/2008) included It has been difficult in the past year or so, hearing the news on the future has had a real effect on morale and attitude of some staff. This was also highlighted in June 2007, however there is little evidence to show what the registered provider/management team of the home has done to rectify the above and to improve staff morale. Residents spoken with were generally positive about individual staff members and commented, Yes, the staff are very nice and I like some of the staff. The staff files for 2 people were examined and included records for those people newly employed since the last key inspection. The majority of records as required by regulation were available, however gaps were noted in relation to no evidence of a Criminal Record Bureau (CRB) check and/or POVA 1st for either person and no written references for one person. We recognise that one person left the homes employment in April 2008 and returned to Shernbroke in July 2008, however all records as required by regulation are required. No record of induction was evident for either person. A random sample of staff files were looked at in relation to training records. Evidence showed gaps for some people in both core subject areas (food hygiene, fire safety awareness, health and safety etc) and those conditions specifically associated with the needs of people who have a learning/physical disability. Staff surveys returned to us recorded that they felt that insufficient training was provided within the service. One survey recorded, With profoundly handicapped people with complex needs, you need a lot of trained staff. You need more than just 3 large books to read through. From discussions with the manager they advised that for some members of staff there has been an unwillingness and reluctance to attend training sessions. The AQAA details under the heading of what we could do better, improve on staff recruitment and training once staffing restructure completed. The document also details under the heading of recruitment checks that all people who have worked in the home in the past 12 months have had satisfactory pre-employment checks. This did not fully concur with the inspectors findings. Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: On inspection of a random sample of supervision records for staff, evidence showed that not all staff have received regular formal supervision in line with National Minimum Standards recommendations. The AQAA details that the percentage of permanent staff with an NVQ Level 2 or above qualification exceeds 50 . Care Homes for Adults (18-65 years) Page 32 of 43 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live in a well run home or have their best interests considered. Evidence: On the first day of inspection, the manager was not present and the site visit was conducted with the assistance of an administrator and 2 support team leaders throughout the day. The manager was available on the second day of the site visit. Following discussions with the manager, it is evident they have vast experience with working with both children and adults who have a learning disability and have worked in Social Care over the past 30 years. The manager has been at Shernbroke for the past 5 years and is currently providing support to both Shernbroke and another service. The manager is a qualified social worker, has attained a Diploma in Applied Management Studies, has achieved the Assessors Award and has an NVQ Level 4 in Management. The manager advised that the ethos of the home was previously a home for life, however this has now changed to reflect that the service is to prepare people for moving to alternative accommodation over the next 5 years and to enable people to live independently with an appropriate care package or within a smaller environment.
Care Homes for Adults (18-65 years) Page 33 of 43 Evidence: The manager advised that consultation with carers and staff have taken place over the past 4-5 months, including public meetings and a DVD has been provided showing other similar schemes. Limited consultation has taken place with people who use the service as it is recognised that this may raise anxieties. It is evident from this inspection that little progress has been made to address previous identified shortfalls. Further development is required to ensure that care planning/risk assessing processes and procedures are improved, that staff deployment/staffing levels are appropriate to meet the needs of people living at Shernbroke, training for core areas and those conditions associated for the needs of people who have a learning/physical disability are provided for all staff so as to ensure that they have the competence and skill to provide care to residents and robust recruitment procedures need to be adhered to in line with regulatory requirements. Additionally the management team of the home must ensure that all residents are provided with an appropriate programme of social activities both in house and within the local community, that the home is run in the best interests of the people who reside at Shernbroke and not for the benefit of staff. The existing poor arrangements for medication practices and procedures must be addressed as a matter of urgency in order to safeguard peoples health and wellbeing. The management team of the home must demonstrate a proactive approach to addressing and sustaining good practice within the care home, so as to ensure peoples safety, wellbeing and positive outcomes. We must feel assured that issues highlighted above will be addressed and improved upon. The manager recognised that the juggling of two services has been demanding and that ultimately this has resulted in Shernbroke not having the best management support over recent months and the service not functioning as it should. However, the manager advised that not all issues/areas of concern have been brought to her attention by members of her senior team and she is aware of deficits in relation to communication within the care home/staff team which have hampered any progress. The manager advised that she receives regular support from her service manager and that she feels supported. The manager currently receives bi-monthly supervisions however there was little evidence to support this statement. The manager supervises the support team leaders, however she recognises that these have not been conducted regularly. This was confirmed by 2 support team leaders spoken with during the first day of inspection. There was evidence to show that staff meetings and house meetings are held at Shernbroke. Records show that at one full staff meeting this year, no one attended and handovers for staff from shift to shift are not always taking place. The manager advised that Regulation 26 visits are conducted by the registered provider to the care home, however the last record available was dated 28/3/2008. The last quality assurance survey was completed for the period 2006-2007. Questionnaires for residents were observed to be in both written and pictorial format. Positive comments were noted from relatives and included, my [name of resident] seems very happy and well cared for, staff are friendly and helpful, good atmosphere
Care Homes for Adults (18-65 years) Page 34 of 43 Evidence: and making sure my [name of resident) has their favourite room when they come to stay and happy with the care given. Staff surveys recorded issues relating to too much paperwork, too high usage of agency staff, minimal supervision/supervision cancelled, staff shortages and no transport to take residents out. A health and safety policy and procedure was observed within the home. Accident records were completed and included all necessary information. Care Homes for Adults (18-65 years) Page 35 of 43 Are there any outstanding requirements from the last inspection? Yes √ No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No 1 Standard 6 Regulation 15 Requirement Timescale for action All care plans must be kept 15/06/2007 under regular review. The National Minimum Care Standards provides guidance on what is appropriate. This is a repeat requirement from the last inspection. The timescale to meet this requirement was 30/06/06. 2 17 16 The home must maintain a form of record to demonstrate that residents are provided with food and drink which are in adequate quantities, suitable, wholesome, nutritious and varied. 31/05/2007 3 20 13 Current medication practices 31/05/2007 must be reviewed to ensure that all practices are in line with legislation and current guidance. Details of the shortfalls are within the report. Care Homes for Adults (18-65 years) Page 36 of 43 4 35 18 Suitable, qualified, trained, 31/05/2007 experienced and competent staff must be on duty at all times and in sufficient numbers to meet the assessed needs of residents. The home must conduct itself in accordance with its Statement of Purpose and its philosophy of care. This is in relation to: 1 -Adequate staff on duty to meet the assessed social, recreational and activity needs of residents. Provision must be made for residents to go out into the community if they choose or wish to. Because of assessed risk, this may mean two staff per resident. The views, rights and interests of all residents need to be addressed with regard to this issue. This matter was raised at the last inspection and remains outstanding. Residents should not be admitted unless the home can meet care needs. 2 -The competencies of staff must be assessed to ensure that regulatory records are maintained to the required standard. Care Homes for Adults (18-65 years) Page 37 of 43 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No 1 Standard 20 Regulation 13 Description Timescale for action Medication practices and 27/10/2008 procedures within the care home do not protect individuals health and safety and wellbeing. So as to ensure that people receive their prescribed medication, that systems in the home are safe for peoples safety and wellbeing. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No 1 Standard 6 Regulation 15 Description Care plans must clearly identify individual residents care needs and how these are to be met by staff. Timescale for action 27/10/2008 This will enable staff to deliver care in line with peoples care needs. 2 9 13 Risk assessments must be devised for all areas of assessed risk. 27/10/2008 Care Homes for Adults (18-65 years) Page 38 of 43 This will enable staff to minimise any risks for residents and to ensure where possible, their health and safety. 3 14 16 All people living in the care 27/10/2008 home, must have staff willing to support them so as their social care needs can be met. This will enable people to enjoy an active social life and to not become bored. 4 19 12 People living at the care 27/10/2008 home must have their health and welfare needs met at all times. Residents will not have their healthcare needs met and this potentially places them at risk. 5 20 18 All staff who administer 01/12/2008 medication to residents must be appropriaetly trained. This will ensure that staff are competent and have the skills to carry out the task safely. 6 20 13 Medication is not left 27/10/2008 unattended and medication easily accessible to residents and others. This will ensure that unnecessary risks to residents’ health and wellbeing is averted.
Care Homes for Adults (18-65 years) Page 39 of 43 7 20 13 Residents must be protected 27/10/2008 from harm by having their medication administered safely and in accordance with the prescribers instructions. This will ensure peoples health and safety and that they get their medication. 8 20 17 When medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. 27/10/2008 This will ensure that staff have all necessary and upa to date information. 9 23 18 Staff must be appropriately trained in relation to dealing with residents challenging and/or inappropriate behaviours. 01/01/2009 This will ensure that residents are safeguarded and that staff have the skill and competency to deal with issues effectively. 10 33 18 Sufficient staff must be on duty at all times, and the deployment of staff must be appropriate to meet the needs of residents. 27/10/2008 This will ensure that residents have their care needs met and their health, safety and wellbeing are maintained. Care Homes for Adults (18-65 years) Page 40 of 43 11 34 19 Ensure that robust 01/01/2009 recruitment procedures are adopted at all times for the safety and wellbeing of residents and that all records as required by regulation are sought. This will ensure that people living at the care home feel assured that staff looking after them are recruited appropriately for their safety and wellbeing. 12 35 18 Staff must receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of people who have a learning and/or physical disability and includes core areas. 01/01/2009 This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. 13 36 18 Staff must receive regular supervision. 27/10/2008 So that staff feel supported and residents know that staff are appropriately managed. 14 38 10 The care home must be managed effectively. 27/10/2008 So as to ensure that the home is run in the best interests of the people who live at Shernbroke. Care Homes for Adults (18-65 years) Page 41 of 43 15 39 24 A more up to date system for 01/01/2009 seeking the views of residents, their representatives and other interested parties must be undertaken. This will ensure that the service continues to evaluate the quality of the service provided at Shernbroke. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No 1 Refer to Standard 1 Good Practice Recommendations A copy of the Statement of Purpose and Service Users Guide should be forwarded to the Commisison for Social Care Inspection once reviewed and updated. Daily care records should be informative and reflective of how people spoend their day and staffs interventions. The care home should be run for the benefit of the people living at the care home and not for the benefit of staff. Routines within the home should not in the main be task orientated. It is recommended that those people who administer medication to residents, undertake regular assessments to assess their continued competency. 2 3 6 14 4 20 Care Homes for Adults (18-65 years) Page 42 of 43 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 43 of 43 - 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!