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Inspection on 03/05/06 for Shernbroke

Also see our care home review for Shernbroke for more information

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service continues to provide accommodation that is homely and maintained to a good standard. Staff appeared to have a good understanding and knowledge of the needs of service users, and were seen and heard interacting with service users in a positive way. Many of the service users residing at the home have complex needs both in terms of their learning disabilities and healthcare needs. Verbal communication for most was very limited, however observation of service users, and interactions between them and the staff supporting them, gave the impression that the service users were comfortable and at ease within their environments. The relative of the service user spoken to during the course of the inspection spoke of being generally happy with the overall performance of the home, although they expressed some concerns about the staffing levels which they felt were not adequate, and also about the continued usage of agency staff which, although they recognised had reduced considerably, still left them with some concerns.

What has improved since the last inspection?

The manager and staff spoken with reported that the use of agency staff had dropped significantly since the previous inspection and that continuity of care to service users was now much improved.Access to formal supervision of staff was reported to be much improved, with all the staff spoken to indicating that they were receiving formal supervision every six to eight weeks. Evidence was provided that indicated that the home`s safe working practices are now meeting with requirements.

What the care home could do better:

The home needs to further explore ways in which to enhance opportunities for service users to maximise their opportunities for personal development and pursue a range of appropriate leisure pursuits. Staff were of the view that the staffing levels of the home do not support this development. The registered person needs to ensure that all records required under regulation are obtained and maintained in respect of recruitment of staff.

CARE HOME ADULTS 18-65 Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF Lead Inspector Neal Cranmer Key Unannounced Inspection 3rd May 2006 09:30 Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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 Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Shernbroke Address 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF 01992 700545 01992 761735 ged.elliott@essexcc.gov.uk www.essexcc.gov.uk Essex County Council 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) Ms Geraldine Sonia Elliott Care Home 25 Category(ies) of Learning disability (25), Learning disability over registration, with number 65 years of age (1), Physical disability (6) of places Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 30th September 2005 3. 4. Date of last inspection Brief Description of the Service: Shernbroke is a purpose built home for people with a learning disability. The building is in keeping with the local community. 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 fee ranges for the home are between £245.40 -£4,454.24 per month. The information regarding the fee range was taken from information provided in the pre inspection questionnaire submitted on the 27/01/06, which also indicated that additional charges are made for: chiropody, hairdressing, aromatherapy and massage sessions. 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. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced inspection to Shernbroke, which took place on the 3rd May 2006, the first inspection at the home for the year 2006/2007. The fieldwork visit to the home was carried out between the hours of 09:30 and 16:00. Service users, a relative of a service user and staff were spoken with and records and files were sampled. A total of fourteen key standards were inspected, of which ten were met, one was partially met, and with the remaining two being major shortfalls. A tour of the home was undertaken. Each house visited was well maintained and decorated to a good standard; one house had been recently redecorated. What the service does well: What has improved since the last inspection? The manager and staff spoken with reported that the use of agency staff had dropped significantly since the previous inspection and that continuity of care to service users was now much improved. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 6 Access to formal supervision of staff was reported to be much improved, with all the staff spoken to indicating that they were receiving formal supervision every six to eight weeks. Evidence was provided that indicated that the home’s safe working practices are now meeting with requirements. 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. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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 Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): 2. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home has in place a process by which to determine the home’s ability to meet the needs of service users. EVIDENCE: The pre inspection questionnaire provided indicated that the home continues to have in place an admission and referrals policy and procedure, and that no changes had been made to this since the previous inspection. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. Service users’ needs are clearly reflected in their individual plans of care and are reviewed as needs change. Service users are supported wherever possible, and to the best of their individual abilities, to make decisions about their lives. Files sampled evidenced that factors that pose a risk to service users are assessed and kept under review. EVIDENCE: Four service users’ care plans were sampled. Each was developed from a Care Management Assessment or the home’s own pre-admission assessments. Each service user is allocated a key worker. Of the four care plans seen two contained evidence that they were being kept under review, the other two did not evidence that they had been reviewed. Daily records in respect of the care plans were well maintained. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 10 All the service users residing at the home have complex needs, with their abilities to make decisions about their every day lives being limited. However, staff were seen interacting with them in a way aimed at trying to include and involve. During the course of the inspection the inspector was, at short notice, invited to attend a home meeting at which two service users were in attendance, although their input into the meeting was limited due to their complex needs. Sampling of the care plans evidenced that risks pertaining to service users are assessed at the point of their admission to the home. The pre-inspection questionnaire submitted evidenced that the home has in place a policy/ procedure for responding to missing person incidents. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): 11 and 14. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to the service. Opportunities for service users in respect of their individual personal development are limited. Access to leisure pursuits within the home are reasonable, however opportunities to pursue pursuits in the wider community are very limited. EVIDENCE: Discussion with staff evidenced that opportunities for service users’ personal development are limited. Whilst it is recognised that the complex needs of the service user group make this a challenging area to address, staff were of the view that staffing levels play a large part in impeding this standard being met. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 12 Whilst there was evidence of in-house leisure activities being available to service users throughout the day and evening, opportunities for service users to pursue leisure pursuits in the community were reportedly poor and very limited. Once again staff cited staffing levels of the home as being the major factor in being able to improve in this area. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): 19. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users’ physical, emotional and health care needs are well met, with complications being referred promptly. EVIDENCE: Sampling of care plans evidenced that all service users are registered with a local General Practitioner. Health care records pertaining to service users were detailed and concise. Discussion with the registered manager and staff, as well as sampling of records, evidenced that staff had received training specifically related to health care needs of service users. Care plans evidenced that service users’ health care needs are closely monitored, with any identified complications being referred to the relevant specialisms promptly. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 14 Discussion with the registered manager confirmed that visits from health care professionals take place in the privacy of the service user’s own room. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): The key standards for this section were not inspected at this inspection, however all were met in full at the inspection of 30th September 2005. The pre inspection questionnaire provided indicated that whilst complaints had been received by the home since the previous inspection, evidence provided showed that these had been appropriately investigated and responded to, to the satisfaction of the complainants. EVIDENCE: Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): The key standards for this section were not inspected at this inspection, however all were met in full at the inspection of 30th September 2005. Tour of the premises on the day of the inspection evidenced that the home was a homely and comfortable environment that was designed to meet the needs of the service users. EVIDENCE: During the inspection a tour of the premises was made. All houses visited were well presented and decorated; evidence was seen of service users’ personal possessions, e.g. family photographs, televisions/videos, ornaments and items of other personal effects. One of the houses visited had recently been redecorated with some involvement of a relative of one of the service users who had wished to assist, and with whom the inspector had spoken at the previous inspection. On the day of the inspection all areas of the home visited were clean and hygienic and free of any foul or unpleasant odours Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 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): 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. Some further development is required to ensure that the home’s recruitment processes are robust. Service users are supported by a team of staff who are well trained and competent. Service users are supported by a team of staff who are well supervised and supported. EVIDENCE: Four staff files were sampled in respect of the home’s recruitment practices, three of which contained all the documentary evidence required under Regulation 19, Schedule 2 of the Care Homes Regulations. The third file sampled did not contain any evidence of any references. This is an important factor in the home’s recruitment practice and is important in ensuring that appropriate people are employed, and is one way in which to minimise potential risks to service users. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 18 Staff spoken with during the course of the inspection confirmed that access to training was good, with the following being cited as having been undertaken since the previous inspection: • • • • Adult Protection Medication administration Managing and dealing with conflict Manual handling. Staff files sampled contained documentary evidence pertaining to staff training undertaken, which confirmed the above. Discussion with the registered manager and four members of the care team evidenced that access to formal supervision was good, with staff being supervised every six to eight weekly. All spoke of access to informal supervision being good. The registered manager supports the Support Team managers who then support the care staff. The home holds regular team meetings, for which minutes are maintained. One of these meetings was witnessed taking place at the time of the inspection, and service users were in attendance. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 19 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, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Service users are supported by a team of staff who are managed by a manager who is experienced and competent. The home has in place a mechanism for reviewing and keeping under review the quality of its service provision, which is based upon the views of a range of interested stakeholders. The home’s safe working practices ensure that service users’ health and welfare are promoted and protected. EVIDENCE: The registered manager is qualified at N.V.Q level 4 in management and has significant previous experience of working and managing in the care sector. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 20 The registered manager has overall responsibility for the running of the home. Staff spoke of the manager providing a clear sense of leadership and direction, and of their managing the home in an open and transparent manner. There was good evidence of the manager providing strategies to enable service users and staff to voice their concerns in respect of the service. The home has in place a mechanism for reviewing and keeping under review the quality of its service provision, which includes seeking the views of service users, staff and other interested stakeholders. Action plans in respect of requirements from inspections are generally progressed within the agreed timescales. The pre-inspection questionnaire provided evidenced that policies and procedures are kept under review. The home’s safe working practices were inspected at the previous inspection, at which one requirement was made; this requirement has since been addressed. Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 21 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 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 3 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 1 12 X 13 X 14 1 15 X 16 X 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 X x 3 3 3 x x 3 x Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 22 NO 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 YA11YA14 Regulation 15 (2b) 16 (n) Requirement The registered person must ensure that service users’ plans are kept under review. The registered person must make provision for service users to have the opportunity to take part in meaningful activities. The registered person must ensure that no staff are employed in the home without having first obtained the required documentary evidence required under Schedule 2 of the Care Homes Regulations. Timescale for action 30/06/06 30/06/06 3. YA34 19, Schedule 2. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Shernbroke DS0000030743.V290116.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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