CARE HOME ADULTS 18-65
Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF Lead Inspector
Neal Cranmer Unannounced Inspection 30th September 2005 09:30 Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 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 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) Essex County Council 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.V254022.R01.S.doc Version 5.0 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 14th April 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 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.V254022.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day in September 2005, lasting 5.0 hours. One service user was spoken with during the course of the inspection. It proved very difficult to speak to more due to the complex needs of the service user group, however those seen appeared happy, relaxed and at ease in their environments. The duty officer, registered manager and four members of staff were spoken with. Tour of the premises included observation of service users’ rooms, bathing and toilet facilities, as well as access to communal areas and gardens. As well as discussion with service users and staff, time was spent sampling a range of documentary evidence. Twenty one of the forty three standards were inspected, of these eighteen were meet, two were minor shortfalls with the remaining one being a major shortfall. What the service does well: What has improved since the last inspection?
Since the previous inspection the home is now maintaining records of all activities in which service users partake. The home now maintains activity plans as part of service users’ plans of care. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 6 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.V254022.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Service users are admitted to the home only following the completion of a pre-admission needs assessment. EVIDENCE: Three service users’ files were sampled and were seen to contain evidence of needs assessments having been completed by representatives from the home. The assessments included: • • • • Family/social contact Assessment and management of risks Physical/mental health needs Preferred method of communication. The information from the needs assessment is then used to develop and formulate the service user’s plan of care. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No outcomes were inspected from this section on this occasion. EVIDENCE: Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 10 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, 12, 13, 15, 16 and 17. Service users are supported to fulfil opportunities for personal development. Staff support service users to partake in age appropriate activities and are supported to the best of their abilities to participate in community-based activities. Service users are supported by the care team to maintain links with their families and friends. Service users’ rights were seen to be respected by staff in all interactions witnessed. Meals provided by the home were generally described as being good, although mention was made of meals occasionally arriving warm rather than hot. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 11 EVIDENCE: The care plans sampled were seen to contain evidence of service users partaking in daily activities within the home. The records indicated the nature of the activity, who had been involved with the service user during the activity, and the service user’s response. The plans sampled evidenced that activity plans are now in place for service users and that they are being followed by staff. On the day of the inspection a number of service users were out attending the local resource centre. Discussion with staff informed service users accessing the following community based activities: • • • • • • • Membership of the local snooker club Visits to the local ten pin bowling club Visits to local public houses Use of local restaurants Shopping outings Visits to local markets Visits to local garden nurseries. The home has minimal access to transport, this being limited to one wheelchair accessible minibus. The manager spoke of staff supporting service users to access community based activities during the evening. This statement was supplemented in discussion with a service user and member of staff, both of whom spoke of visiting the ten pin bowling club in the evening. The manager spoke of service users being registered to vote, although many chose not to. The home has an open door policy on the receiving of visitors; the manager spoke of service users being free to choose where to receive their visitors. The home provides a quiet area that can be accessed to receive visitors. Service users have unrestricted access to the grounds, dependent upon their individual needs. Staff were witnessed interacting with service users in a number of varying settings. Meals at the home are provided from the main kitchen area. Service users spoken with spoke of the meals being nice, although it was stated that on occasions they do not arrive hot enough; staff mentioned that each home has facilities to warm meals up. Meals are provided three times daily, at least one of which is cooked. Staff confirmed that records of food consumed by service users are maintained.
Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 12 One service user spoke of preparing snacks and of recently having been supported to cook a birthday cake. Each house has a small kitchen area which is equipped to enable light snacks to be prepared. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20. Service users are supported in a manner that preserves their privacy and dignity. The home’s procedures regarding the dispensing of medication to service users at the time of the inspection were deemed to be sound. EVIDENCE: Personal support to service users was seen to be provided in private and every effort was made to ensure that service users’ privacy and dignity was respected. A range of technical aids and adaptations were seen to be available to enable service users maximise their independence. On the day of the inspection one house’s medication practices were checked. All staff who administer medication do so only following completion of the Essex County Council’s medication workbook. The home does not dispense any medication that falls within the controlled drugs category. The home has recently commenced a process of dual signatories following a recent event involving medication. Evidence was seen on one service user’s file of a consent form.
Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 14 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 home’s Complaints and Adult Protection Procedures were robust in terms of protecting service users from the risks of harm or abuse. EVIDENCE: The home’s Complaints Procedure is available in pictorial format and was seen to include the contact details for The Commission for Social Care Inspection and timescales for responding to complaints received. The home also maintains a log for the recording of complaints received. At the time of the inspection no complaints had been received in respect of the service. The home follows the Essex County Council’s Guidelines for responding to allegations of abuse. In this respect the home’s procedure was deemed to be robust. Reference was seen to the Public Disclosure Act of 1998. Discussion with a member of staff recently appointed evidenced that they had an awareness of adult protection and that they were to receive training in this area. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 15 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, 26, 29 and 30. Service users live in an environment that is homely, comfortable and safe. Service users’ bedrooms were seen to be equipped appropriately to enable service users to maximise their independence to the best of their individual abilities. The home is well equipped with specialist aids and adaptations to enable service users to maximise their independence. All the houses visited on the day of the inspection were found to be clean and tidy and free from any unpleasant odours. EVIDENCE: The premises were deemed to be fit for their stated purpose, being safe and accessible, and generally in a state of sound repair. Furnishings and fittings were seen to be of a good quality and, apart from the bathroom areas, were of a domestic nature. The premises on the day of the inspection were generally comfortable, bright and cheery, and clear of any unpleasant odours.
Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 16 Service users’ bedrooms visited were furnished so as to meet the individual needs of service users; evidence was seen of service users having their personal possessions around them. All the houses visited were seen to have a wide range of aids and adaptations available to enable service users maximise their independence, e.g. • • • • • Overhead tracking Hi-lo beds Call systems Hand grab rails Hi-lo baths. Each house has its own laundry room situated away from areas where food preparation takes place. Sluicing facilities were seen to be available as were hand-washing facilities. On the day of the inspection no evidence was noted of there being any foul or unpleasant odours about the home. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 and 36. Although staffing levels appeared adequate to meet the basic needs of service users, evidence suggested that staffing requires further review, either in terms of the levels available, or how the resources are being allocated, to ensure that service users’ needs are met beyond just basic need. The home’s recruitment practices were evidenced to be robust; staff files sampled were seen to be in compliance with regulatory requirements. The registered person must ensure that a mechanism is put in place to ensure that all staff receive formal supervision to enable them to carry out their roles effectively. EVIDENCE: Discussion with staff indicated that they felt staffing levels at the home were adequate to meet the basic needs of service users, although they could be improved to further facilitate opportunities for service users to maximise their access into community based activities. The manager spoke of having reviewed staffing levels recently using the recommended guidance. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 18 The home has no staff under the age of 18, and no member of staff is left in charge of the home under the age of 21. The home employs a number of staff on substantive contracts, with the remainder being made up of relief staff employed by Shernbroke on an as required basis. Discussion with the registered manager indicated that the home has a fairly high level of staff sickness. Three staff files were sampled pertaining to the home’s recruitment practices. All the documentary evidence required under Schedule 2 of the Care Homes Regulations was seen to be in place. Discussion with staff indicated that formal supervision was variable; one substantive post holder spoke of receiving formal supervision monthly, whilst a relief staff member spoke of never having received any formal supervision. All staff spoke of access to informal supervision being good. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 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): 41 and 42. Records pertaining to service users required under regulation were seen to be held on file. The health and safety of service users were seen to be promoted and protected by the home. EVIDENCE: Records required by regulation in respect of service users were seen to be in order. The following safety certificates were seen in respect of the home safe working practices and were seen to be in order: • • • Gas safety certificate Hoist inspection report Fire service certificate Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 20 The electrical installation certificate indicated that the report was unsatisfactory; reference was also made to arranging for the defects identified to be put right. Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 x x 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 3 x 1 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Shernbroke Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 2 x DS0000030743.V254022.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA33 Regulation 18(1b) 18 (2) Requirement Timescale for action 31/12/05 2 YA36 18 (2) 3 YA42 23 (2b) The registered person must ensure that staff employed at the home provide care in such a way that continuity of care is provided (this relates specifically to the use of relief staff). The registered person must 31/12/05 ensure that all staff working at the home receive formal supervision to enable them to carry out their roles effectively. The registered person must 31/12/05 ensure that all areas of the home are in a state of safe repair (this relates specifically to the need to ensure that the areas of concern addressed in the electrical installation certificate are addressed). Shernbroke DS0000030743.V254022.R01.S.doc Version 5.0 Page 23 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.V254022.R01.S.doc Version 5.0 Page 24 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
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