CARE HOME ADULTS 18-65
Sherwood Court The Common Hatfield Hertfordshire AL10 ONX Lead Inspector
Yoke-Lan Jackson Unannounced Inspection 7th October 2005 10:30 Sherwood Court DS0000019524.V256890.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 Sherwood Court DS0000019524.V256890.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. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sherwood Court Address The Common Hatfield Hertfordshire AL10 ONX 01707 262 405 01707 259 563 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) Caretech Community Service Limited Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8), of places Physical disability over 65 years of age (8) Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th April 2005 Brief Description of the Service: Sherwood Court is a residential care home for eight service users with learning and physical disabilities. The Provider is CareTech Community Service Limited. The building, a bungalow, is situated in the town of Hatfield. It is within walking distance of the supermarket, local shops, and public transport. There is a small parking area in the front of the building. The communal areas are limited to the lounge and a dinning room. The fitted kitchen is of average size. The bedrooms are situated to one side of the building. The shared assisted bathrooms and toilet facilities are nearby. There is a laundry room next to the office. The lounge overlooked a small courtyard that has a patio with garden furniture and plants. All the rooms, corridors and the patio are accessible to wheelchairs. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection report resulted from a number of monitoring visits (unannounced) that were conducted on 01/06/05, 07/10/05 (and 08/10/05). Previous inspections have revealed that the standard of services has been inconsistent. Following the inspection and the monitoring visit dated 01/06/05, the Statutory Requirements regarding the storage of medication and issues regarding environmental safety were met. However, the unannounced monitoring visit dated 07/10/05 revealed that the standard of services at Sherwood Court has not been positively maintained. Following the monitoring visit dated 01/06/05, the Provider, Caretech, had assured The Commission (CSCI) that all the care needs of a prospective service user will be met and that all staff will be adequately trained prior to their admission. The inspection visit dated 07/10/05 revealed that this was not the case. Three Statutory Requirement Notices have been served since the inspection dated 07/10/2005. In view of their learning and physical disabilities, all the 8 service users were unable to give their feedback. On the day of the inspection, 4 of the 8 service users were unwell. (Please see below details of the inspection report). What the service does well:
The individual staff members spoken with were keen and committed to caring and supporting the individual service users in their care to the best of their knowledge and ability. It was noted that the staff themselves are not confident that they can meet the needs of a service user who was recently admitted to Sherwood Court. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There was no written Service User’s Care Plan for a recent admission. The management should prepare a written care plan as to how the service user’s needs in respect of his health and welfare are to be met. (A Statutory Notice has been served to the Responsible Individual). One of the St Vincent Spinal Jackets for a service user was damaged when staff put it in the washing machine and it was not replaced. The jacket is required to ensure comfort and optimal postural alignment for one service user and the lack of a second jacket can result in cleanliness issues and create problems with hygiene for the service user. (A Statutory Notice has been served to the Responsible Individual). On the day of the inspection it was found that not all the staff were appropriately trained to care for one service user who was recently admitted to the home; that some staff had not received training in moving and handling; that different staff employed different methods to move the service user; that staff used a range of ways of using the brackets that are inserted under a service user’s mattress to support and maintain posture and comfort; that staff used a range of techniques to reposition the service user when she slips down the bed and the matrix wheelchair. Failure to maintain an appropriate posture could result in the service user choking on regurgitated food and phlegm. Staff stated that they are not familiar with the use of a gastronomy tube (A Statutory Notice has been served to the Responsible Individual). The staffing level is inadequate for the current group of service users. Management must ensure that at all times there are sufficient suitably qualified and experienced staff to attend to the health and welfare of the service users. The staffing arrangements need urgent review if the standard of care and services are to be maintained. It was noted that staff seemed further concern that they are unable to spend more time with the other 7 service users because of the high care demands and the close supervision needed for the new admission. (Please see Statutory Requirements). Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 7 The care home’s Central Heating System was not working on the day of the inspection. There was no alternative form of heating in place for at least 2 weeks (since 01/10/2005) when the system failed. The Commission has not been informed in accordance with Regulation 37 of the Care Homes Regulations 2001. (Please see Statutory Requirements). A bed that was unsuitable for one service user, continued to be used since the last inspection (14/04/05) and has not been replaced although the home manager has repeatedly requested one from the provider. The service user and staff continue to be exposed to the risk of physical injury. (Please see Statutory Requirements). The premises, externally and internally, have not been maintained and kept clean and tidy in a consistent way. The external grounds must be free from safety hazards. They must be accessible to the service users and wheelchair users at all times. Members of staff need to be more aware of hazards to health and safety. On the last inspection, dated 14/04/05, it was recommended that all staff attend further courses in Health and Safety and that the care home employ a part-time gardener. It is now recommended that the care home employ a full-time cleaner. (Please see Standard 19 and Statutory Requirements). Some medicines were found stored in a wooden cupboard in the Laundry Room, which means that they are exposed to unsafe temperature fluctuations. The management must ensure that all medicines in the home are handled and stored in accordance with the Medicines Act 1968 and the Guideline from the Royal Pharmaceutical Society and the Requirements of the Misuse of Drugs Act 1971. (Please see Statutory Requirements. A similar requirement was made after the last inspection dated 14/04/05). 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. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 8 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 Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 9 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, 3, 4. The assessment process undertaken by the management team prior to the admission of a prospective service user is inadequate and incomplete. There was no Service User’s Plan for the recent admission. Not all the staff have the skills and experience to care for the needs of a recent admission. EVIDENCE: There is evidence that the management team had not undertaken a thorough assessment process prior to the admission of a prospective service user with complex physical and learning disabilities. The inspection dated 07/10/2005 revealed that the management had not prepared a written Service User’s Plan for the recent admission. The case file revealed that the plan of care was the same plan of care that was formulated by the service user’s formal placement. There was no evidence of monitoring by a physiotherapist to ensure the service’s comfort and well being. There was no evidence that her dietary intake was being monitored and there was no record of regular maintenance of equipment for size and fit to ensure comfort and best postural alignment. (A Statutory Requirement Notice has since been issued to the Registered Provider). Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 10. The members of staff assisted the service users in all aspects of life in the care home. All personal information is kept safe in accordance with the Data Protection Act 1998. Not all the service users have their individual care plan developed or updated. EVIDENCE: In this care home, all the service users have severe learning and physical disabilities. They are unable to participate in the day to day running of the home. However, opportunities and choices are given in the course of the daily living routine. One service user spends most of her time on the floor and she is given access to all communal rooms. There was no service user plan for a recent admission. All the personal files are kept locked in the office. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15, 16, 17. The service users are encouraged to maintain family links. Staff support the service users to participate in activities in the community. However the recreational and social needs of some of the service users are not always met. Service users are offered a choice of menu. Mealtime is unhurried. EVIDENCE: The activity programme was recently revised. However, the recreational needs and the daily routine of some of the service users have been negatively affected since the recent admission of a service user. The service users who normally would have been up had to retire an hour earlier at night and missed out on their social interaction with the night staff. There were only 2 night staff on duty by 9.30 pm. No additional staff were deployed to assist during peak periods, including the late evening. On the day of the inspection there were no activities arranged for the service uses. Staff said they just have not got the time to get involved with activities as the personal care needs take up most of their time.
Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 12 It is recommended that the service provider engages an activity co-ordinator. Three of the service users will be away on 10 October 2005 for a week’s planned holiday to Scotland, accompanied by staff members. In the afternoon, one service user was visited by her family. Members of staff take turns to prepare the meal. A number of service users were referred to the dietician recently and the menu were revised accordingly. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. The service users are not always given the emotional and social care and support in the way they prefer and require. The management does not always ensure that the healthcare needs of the service users are fully met. Management has not provided an adequate staffing level to ensure that all the service users are cared for appropriately. Medicines are not handled and stored in accordance with legislation. EVIDENCE: On the day of the inspection, the home was managed by 1 senior carer, 2 bank staff and 1 agency worker. Four of the eight service users were unwell. All the service users were in the high need category. By 10.30 am, two of the service users were waiting for the staff to attend to their personal care needs. Both require two carers in attendance. There were periods when the service users in the lounge were left unsupervised. The Commission (CSCI) were assured prior to her admission that adequate staffing level will be maintained. This was found not to be the case. The General Practitioner was called to attend to two of the service users whose condition had not improved by the afternoon. The senior carer was advised to
Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 14 increase the staffing level. Additional agency staff were arranged by late afternoon to cover the weekend following the inspector’s visit. The area manager was contacted the same day to approve this arrangement. The staffing arrangements need urgent review if the standard of care and services are to be maintained. The care needs of a recently admitted service user are not fully met. There was no evidence that appropriate exercise was given to replace the hydrotherapy that she regularly received prior to her admission to Sherwood Court. There was no evidence that her dietary needs were being monitored appropriately and there was no record of regular maintenance of equipment size and fit to ensure comfort and best postural alignment. One of the two St Vincent jackets was damaged when staff put it in the washing machine. It was not replaced. The service user is required to wear the jacket at all times. The remaining jacket appeared soiled and unhygienic. There was no evidence of monitoring of her condition by a physiotherapist to ensure the service user’s comfort and well being were being maintained. (Please see Statutory Requirements). Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not inspected on this occasion. Please see Inspection report dated 14 April 2005. EVIDENCE: Please see Inspection Report dated 14 April 2005. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28. 29, 30. The home does not currently provide a safe, clean and comfortable environment for the service users. The premises have not been kept tidy in a consistent way. There are hazards to safety externally and within the premises. There is poor hygiene practice in the home. EVIDENCE: The external grounds have not been maintained in a consistent way. A disused bed remained dumped in the back garden and has been there for over two months. The old garden furniture has not been replaced. A wooden plank and several long plastic poles were found on the floor in the dining room and these presented hazards to safety of service users and staff. In one of the corridors leading to the bedrooms there was a large metal scale that was placed in a hazardous position. The home has one service user who spends most of her time moving about on the floor as she is unable to walk. A bed, which was unsuitable for one service user, continues to be used since the last inspection (14/04/05) and has not been replaced although the home manager has repeated requisitioned one from the provider. The service user and staff continue to be exposed to the risk of physical injury that may result from the use of the existing bed.
Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 17 (In the last inspection, dated 14/04/05, it was recommended that all staff attend further courses in Health and Safety; that the home employs a parttime gardener). It is now recommended that the care home employ a full time cleaner. The bedroom examined was untidy and unhygienic. The table for the Gastronomy (PEG) Equipments were stained with droplets of foodstuff. Three boxes of gastronomy tubes, a plastic bag of gastronomy tubes and the service user’s clothing were found on the floor in the bedroom. (See Statutory Requirements and Recommendations). Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 18 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): 31, 32, 33, 35. The staffing level was inadequate. Service users’ individual and joint needs are not met by appropriately trained staff. The staff roles and responsibilities need to be reviewed to ensure that all staff, including bank and agency staff, are able to participate in improving the care and services in Sherwood Court. EVIDENCE: All the service users have high care demands. One recent admission requires constant supervision. It was noted that agency and bank staff are not encouraged to participate in staff meetings and are not included in the staff training programme. The inspection revealed that some staff have not received appropriate training in moving and handling and were allocated to care for a service user with complex needs. Different staff employed different methods to move the same service user. The staff used a range of techniques to reposition the service user when she slips down the bed or her matrix wheelchair. This was witnessed in action on three occasions during the inspection dated 07/10/05. The failure to maintain the service user’s posture could result in choking on
Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 19 regurgitated food or phlegm. It was noted that staff are not familiar with the use of the gastronomy tube and the majority are not able to operate the PEG Feeding Equipment. Not all the staff have receive training in the care of visually impaired service users. The registered person is required to prepare a programme that will ensure that all staff (including bank and agency staff) that are required to care for the respective service user are appropriately trained and supported and to fully implement that plan in order to comply with Regulation 18 (1) (c) of the Care Homes Regulation 2001. A Statutory Requirement Notice has since been issued to the Registered Provider. (See Statutory Requirements and Recommendations). Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 20 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): These Standards were not inspected on this occasion. Please see Inspection Report dated 14 April 2005. EVIDENCE: (On the day of the inspection, the home manager was not present). Sherwood Court DS0000019524.V256890.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 1 1 2 x Standard No 22 23 Score X x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 x x 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 1 3 2 3 2 2 2 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 3 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score 2 2 2 X 1 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Sherwood Court Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000019524.V256890.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 YA2.1 2.4 2.5 2.7 Regulation 15 (1) 15 (2)(b) Timescale for action The registered person shall, after 31/10/05 consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met and to ensure that all her care needs are being met. The registered person shall keep the service user’s plan under review. The registered person must ensure that all medicines in the care home are handled in accordance with the Medicines Act 1968, Guideline from the Royal Pharmaceutical Society, the requirements of the Misused of Drug Act 1971. The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The external grounds must be consistently maintained.
Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 23 Requirement 2. YA20.1 20.1 20.6 13(2) 31/10/05 3. YA24.1 24.6 24.11 28.1 13 (4)(a) 23 (2)(o) 31/10/05 4. YA24.6 23 (2)(p) 5. YA29.8 23 (2)(c) 6. YA33.3 18 (1)(a) 7. YA35.3 35.6 35.7 18 (1)(c) (i)(ii) The home must provide adequate heating. The central heating system must be maintained in good working order. The equipment provided at the care home for use by the service user is maintained in good working order. The damaged St Vincent Spinal Jacket must be replaced. The registered person must ensure that at all times suitably qualified and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure that the persons employed to work at the care home receive: (i) training appropriate to the work they are to perform and (ii) suitable assistance, including time off, for the purposes of obtaining further qualifications appropriate to such work. A planned programme is required to ensure that all staff (including bank and agency staff) that are required to care for the service users are appropriately trained and supported and to fully implement that plan. 10/10/05 14/10/05 31/10/05 12/01/06 Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24.1 24.6 Good Practice Recommendations It is recommended that the care home employ a full time cleaner to ensure that the building is consistently kept hygienically clean and tidy. Sherwood Court DS0000019524.V256890.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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