Inspection on 23/06/05 for Shrewsbury House

This inspection was carried out on 23rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shrewsbury House 07/01/08

Shrewsbury House 09/01/07

Shrewsbury House 12/01/06

Shrewsbury House 25/01/05

Shrewsbury House 10/06/04

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Insight - Eastchurch

Southfields

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33 St John`s Church Road

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

CARE HOME ADULTS 18-65 Shrewsbury House Battlebridge Road Merstham Surrey RH1 3LT Lead Inspector Cathy Clarke Announced 23 June 2005 10:00 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 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 Stationary 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. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Shrewsbury House Address Battlebridge Road Merstham Surrey RH1 3LT 01737 215135 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashcroft Care Services Limited 21 Gatwick Metro Centre, Balcombe Road, Horley, Surrey, RH6 9GA To be confirmed Care Home (CRH) 5 Category(ies) of Learning disability (LD) 5 registration, with number of places Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The age/age range of the persons to be accommodated will be: 18-65 YEARS Date of last inspection 25 January 2005 Brief Description of the Service: Shrewsbury House is an attractive five bedroomed detached residence located in Merstham village. Three bedrooms are situated on the ground floor within close proximity to bathroom and toilet facilities. Communal areas on the gound floor include a spacious television room, a well equipped kitchen and combined dining area. Separate utility facilities are situated in the conservatory. Upstairs there are a futher tow bedrooms, a second bathroom with separate shower and an office. Accommodation is domestic in scale and character. Local shops and community facilities are within walking distance of the home. Redhill town is accessible by public transport and provides a larger shopping centre and leisure amenities. . Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 5 and half hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. Cathy Clarke, carried out this inspection Mr Alan Bitsios Manager and Miss Laura Connor Deputy Manager were present as the representatives for the establishment. As part of Laura’s personal development she assisted with the inspection process, taking the lead from the services point of view. A full tour of the premises took place and documents inspected included care plans, menu plans, staff records, policies and procedures and service users financial records and petty cash. Four service users were spoken to during the inspection. This was a positive inspection. The inspector would like to thank the staff and service users for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? The manager has applied to the Commission for Social Care Inspection to register as the registered manager. New furniture has been ordered for the lounge, which will be more comfortable for service users and their visitors. Furniture is to be received for the garden free of charge as part of the deal for ordering the sofas. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 6 The grab rail in the bathroom downstairs has been moved by the occupational therapist. This has enabled one of the service users to be able to have a bath with assistance. The Activities building to the rear of the property has been demolished following condemnation by the fire service and this area is now used for parking. 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. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 standard(s) 1,2,5 Information relating to the service is available for prospective service users in the form of a service user guide. Prospective service users are assessed prior to admission and a trial period is offered. EVIDENCE: There is a comprehensive statement of purpose and service user guide in place. A key member of management staff has changed her name and this needs to be amended in both of these documents. The service user guide is in pictorial format. Prospective service users are visited prior to moving into the house and a three-month trial period is offered, which is followed by a review. Files sampled during the inspection confirmed that assessment and reviews had taken place for service users prior to admission and after moving in. The service has contracts for each service user from the local authority. Please see requirements section of this report. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 standard(s) 6,7,9 There is a proactive approach to promoting the independence and life skills of the service users through careful care planning and risk assessment. EVIDENCE: Service user records sampled during the inspection included comprehensive care plans outlining the goals and achievements that individuals had made. There was evidence of assessment and reviews and risk assessments were in place. Regular health checks are conducted including general practitioner health checks, chiropody, dental treatment, monitoring of body weight and opticians appointments. Monthly reports are recorded for each of the service users and a six monthly review with their key worker. One of the service users was asleep for most of the morning and likes to get up and have his breakfast mid morning. Staff are very aware of the daily routines of service users. Another service user was feeling quite anxious during the inspection and he was given time and space to calm down. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 standard(s) 12,13,15,16, Service users have opportunities for personal development, to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. EVIDENCE: Service users are supported to take part in activities in the local community, and the service is actively trying to find a job for one of the service users. Service users spoken to during the inspection confirmed that they like to go to college, day centres, the pub, day trips, meals out, swimming, boot sales, trampolining and to visit a local farm shop. The home organises regular barbecues and invites family along during the summer months. One of the service users was looking forward to going to Ireland with staff to visit his sister. Telephone, letter and visits maintain family links. One of the service users has a wide circle of friends. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 11 Holidays are organised individually tailored to the needs of service users and group holidays are not taken. One of the service users attends an outreach centre on a Thursday. There is a full programme of activities for service users. Staff support service users to prepare for annual events such as birthday celebrations, which can cause some anxiety. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18,19,20 Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies and procedures are in place for the administration and management of medication. EVIDENCE: Service users are assisted with personal care where required and one of the service users is now able to bath with assistance since the removal of a grab rail in the bathroom. During the inspection one of the service users was receiving one to one support with his emotional needs from a behavioural assistant who visits him once per week. Staff are very aware of both the physical and emotional state of the service users health. Regular health checks are made including GP visits, chiropody, dental appointments, monitoring of weight and optical assessments. One of the service users was feeling anxious during the inspection and it was felt that he should be given some space and therefore his room was not inspected. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 13 One of the service users self medicates and he informs the staff when he has taken his medication, staff complete the medication record chart and personal medication book, which indicates self-medicating. Most of his medication is stored in the medication cabinet within the office. He has a medication cabinet in his room. Staff have received training in medication and have signed to say that they have read and understood the medication policies and procedures. One of the staff was questioned during the inspection on his knowledge of the procedures to follow in the case of a medication error. He informed the inspector that he would report the error immediately to the on call manager, house manager staff members and GP and would complete a regulation 37 notice and send to the Commission for Social Care Inspection. All Medication administration records were completed correctly. Each service users photograph is in the medication file and the medication procedures. There is a book containing records of all medication received into the service and returned to the pharmacy. There are no controlled drugs and blister packs are used for all service users bar one. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 standard(s) 22,23 All required policies and procedures are in place to ensure that service users views will be listened to and acted upon. Policies are in place to protect service users from abuse and neglect. EVIDENCE: The complaints procedure needs to include details of the Commission for Social Care Inspection and be comparative to the service user guide. There have been no complaints since the last inspection. There has been one vulnerable adult investigation since the last inspection and this has been investigated and closed following a Senior Strategy meeting with the local authority. Please see requirements section of this report. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,28,30 The location and layout of the home is suitable for it’s stated purpose. It is accessible, safe and well maintained. The home was found to meet service users’ individual and collective needs in a comfortable and homely way. EVIDENCE: The house was found to be generally tidy with no mal odours. The sofa’s in the lounge are to be replaced and are on order. This was identified as a need during a recent regulation 26 visit. As part of the order the home is to receive some garden furniture free of charge. Service user bedrooms are decorated and furnished according to their preferred choice. One of the service users showed the inspector his fish, budgerigars and cockatiels that he keeps as pets in his bedroom. He looks after them very well, cleaning the cages and tanks regularly. Risk assessments have been conducted for keeping such pets. One of the service users spoken to during the inspection informed the inspector that he is responsible for ensuring his room is tidy. He likes music and showed the inspector his CD collection. His room was a little untidy but he said that he was going to do it later on as he was feeling a little anxious today. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 16 The decoration in the quiet room on the ground floor looks tired and the chairs in this room were marked. The garden is well kept and has suitable furniture for social occasions and sitting with visitors. The activities unit, which was at the end of the garden has been demolished following condemnation by the fire service and the area is now used to park the homes transport vehicles and staff cars. The kitchen was clean and tidy and fridge and freezer temperatures were checked. The freezer was within required limits however the fridge temperature recorded the previous evening was high. Temperatures were checked on the day of inspection and found to be within limits for both appliances. Staff informed the inspector that they thought the fridge had been open for too long before the temperature was recorded on the evening in question. Meat has been probed and temperatures recorded. The last recorded date being the 15/6/05. When questioned regarding temperatures since this date the manager informed the inspector that meat had been casseroled. The COSHH cupboard in the kitchen is kept locked and a list of cleaning materials is kept on the door of the cupboard. The laundry room was clean and tidy and linen folded neatly. Please see requirements section of this report. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,35,36 Interactions observed between staff and service users evidenced a high degree of respect and skill in working with the individual service users at the home. Recruitment practices are to be improved, providing evidence for inspection of all necessary employment checks. Staff files must be available for inspection for all staff working in the home. EVIDENCE: Job descriptions and induction programmes seen during inspection for the newest members of staff. The induction programme is monitored by the manager and when complete is signed off. Recruitment files inspected revealed that one file had only one reference received from a previous employer. Member of staff is on a student visa but this was not on file for inspection. Two other staff files inspected contained all of the relevant documentation and identification required. The personnel officer from head office brought criminal record bureau disclosures to the home for inspection. One of the disclosures has been returned to the Criminal Records Bureau on the 16th May 2005 because the form had been incorrectly completed. Another application form has been completed for a long-standing member of staff who does not possess a CRB Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 18 check. Discussion was held with the manager regarding risk assessments for individuals where formal checks have identified possible risks to service users. Two staff who work part time at the home have their files in other establishments and one member of staff is supervised by a senior manager and it was stated is not based at a house. One of the members of staff works one night per week at the home and is employed by another establishment and when the staff contacted this establishment the file was not available. Since the last inspection six staff have left the home. Two of these were internal transfers, one of these being promoted to manager. There are thirteen staff employed. Staff have received a range of training and development opportunities and the manager commenced NVQ Level 4 in October 2004. The deputy manager has completed three units of NVQ Level three. Two other staff are currently registered for levels three and four. One member of staff holds NVQ Level 2. The manager was unable to document the training records for three members of staff due to not having access to their staff records. Training has been provided on subjects such as challenging behaviour, autism, non-violent crisis intervention, report writing, bereavement, protection from abuse, report writing, health and safety, food hygiene and fire prevention. Manual handling training has been provided for staff and the course certificates are valid for a period of three years. It is advised and recommended that the service informs staff of any changes to practice that may arise in the period between training programmes. Supervision records were sampled and annual appraisal documentation. Appraisals use individual development and performance plans. Not all staff within the home are supervised by the manager, some are supervised by managers of other establishments within the group. It was felt that staff should be supervised in whichever establishment they are working in, whether that is part-time, bank or otherwise. Please see requirements and recommendations section of this report. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39,40,41,42 Service users benefit from the management approach at the home providing an open, positive and inclusive atmosphere. Procedures for administering service user finances must be followed at all times. EVIDENCE: The management approach of the home was open and inclusive and the manager encouraged the deputy manager to take the lead in the inspection process as part of her continuous professional development. Quality assurance questionnaires are given to service users and visitors to the home and regulation 26 visits are conducted monthly. Staff have access to up to date policies and procedures and these have been reviewed. Changes have been made to the smoking policy, referral and admission, racial harassment, hygiene and food safety. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 20 For those service users who have their money administered by the home the manager and deputy manager have written permission to use cash point cards on their behalf. One of the service users parents administers his money and they send money to Head Office and staff collect this as and when it is required. It is recommended that where the home is responsible for financial management of service users money that in all cases this is transferred into a savings account once it reaches an agreed amount. Cash held on behalf of service users was counted and in three out of the five accounts held these were found to be incorrect. One of the accounts had been accessed in the morning to pay for a holiday and the records were not amended at this time. Health and safety checks have been carried out. Fire evacuation procedures were carried out on the 13th June 2005. The fire alarms are tested on a regular basis. Staff training on health and safety procedures is up to date. A pat testing certificate for electrical appliances was issued in May 2005 and portable appliances were tested in the same month. Regulation 37 notices have been forwarded to the Commission for Social Care Inspection. Legionella tests have been carried out in December 2004 and found to be satisfactory. The accident and incident book is completed and stored appropriately. Please see requirements section of this report. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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 2 3 x x 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score 3 x x 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shrewsbury House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 3 3 1 3 x H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 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. Standard YA1 Regulation 6(a) Requirement The statement of purpose and service user guide is to include the change of name identified during inspection for one of the key managers in the organisation. The complaints policy is to be reviewed and details of the Commission for Social Care Inspection are to be included. The policy needs to compare with that of the service user guide. The quiet room downstairs must be redecorated and the chairs must be cleaned. Two written references must be obtained prior to employment of staff and criminal record bureau enhanced disclosures must be in place and correct at time of employment.. Recruitment and staff files must be made available for inspection and a copy kept in the home. Training records must be available for inspection for all staff employed at the home. Staff records must be maintained in the home in respect of each individual employed. Timescale for action 31/08/05 2. YA22 22(7) 30/09/05 3. 4. YA28 YA34 23 (d) 19 (1) (b) (6) schedule (2) 19 (1) (b) 5(d) 17(2) Schedule 4.6 17 (2) Schedule 4.6 30/11/05 31/08/05 5. 6. 7. YA34 YA35 YA41 YA36 YA41 31/08/05 31/08/05 31/08/05 Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 23 17 (3) (b) 8. YA41 17 (2) 17 (3) schedule 4 .9(a) Records accounting for service users income and expenditure for personal use within the home must be accurate, and up to date.. 31/08/05 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. 2. Refer to Standard YA35 YA36 Good Practice Recommendations It is recommended that staff are provided with up to date information on changes to manual handling practices as and when these occur. It is recommended that staff receive supervision in each establishment in which they work and supervision records be made available for inspection.. Shrewsbury House H58 S13789 Shrewsbury House V219174 230605 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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