Inspection on 16/08/05 for Sybden

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sybden 17/04/09

Sybden 21/04/08

Sybden 23/04/07

Sybden 25/01/07

Sybden 02/06/06

Sybden 05/05/05

Sybden 07/01/05

Sybden 28/06/04

Sybden 16/10/01

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY Lead Inspector Hazel Wynn Unannounced 16 August 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. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Sybden Address Pipers Hill Great Gaddesden Hertfordshire HP1 3BY 01442 269986 01442 217646 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) Turning Point Southern Area Office Nonye Otuonye Care Home 6 Category(ies) of LD Learning Disability - 6 registration, with number of places Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 5 May 2005 Brief Description of the Service: Sybden is a residential care home for people who have a learning disability and whose needs may require a high level of guidance and support. Prospective service users, where there is a vacancy, are supported throughout a long transition period to frequently visit the home, stay over and try out the home prior to making a decision that the home can meet their needs and is suitable for them. During the transition the home also continues with its own assessment to ensure that the service can meet the assessed needs and there is compatability between the prospective service user and the current service users. The accommodation at Sybden comprises a single storey country house situated in the idyllic village of Great Gaddesden approximately five miles from Hemel Hempstead Town Centre. The house is set in large gardens; it is relatively remote and rural with just a few shops nearby. There are some limited resources and services close by. The home does have its own mini bus and there is a bus service which stops nearby. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 16th August 2005 during the afternoon/early evening. The planned inspection date was brought forward following an anonymous letter received by the CSCI. The evidence available (including records, discussion with staff on duty and face to face meetings with serviced users) dispelled some of the matters mentioned in the letter; other matters needed a more lengthy examination and would best be carried out by the manager and area manager of Sybden with the outcomes report to be forwarded to the CSCI. The staff on duty appeared relaxed and content and stated that they were happy in their role and with the support they were given. Service users appeared well cared for and the environment was well maintained. The house was fresh, clean and tidy and the records examined were well maintained and securely stored. What the service does well: The service provides for the assessed needs of the service users; in particular individual communication tools have been developed to support service users with choice and self-determination as well as communicating their needs/desires. The service users accommodated at Sybden have very complex needs and in order to be able to support them to participate in person centred care planning, user-friendly formatted documents have been developed for use. Staff training is provided leading to possible qualifications in care provision. All incidents are recorded and outcomes are stated. Prospective service users are supported well in order that they are able to be as involved as possible in making a choice about where to live and a long transition period is implemented following a satisfactory initial assessment. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Sybden I52 s19559 sybden v246450 160805 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 Sybden I52 s19559 sybden v246450 160805 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 - 5 Service users are supported to make an appropriate choice about where to live and their needs and wishes are fully assessed. Prospective service users “testdrive” the home on several occasions prior to moving in as part of the assessment process. Service users are provided with a copy of the terms and conditions of residency. EVIDENCE: Each service users file contains a copy of the Service User Guide, which is informative about the services provided at Sybden. A full assessment is undertaken commencing at the referral stage and continuing throughout the trial period and then regularly reviewed. Two files were looked at during this inspection. The assessments involve a variety of professionals to ensure that the home closely matches the individual’s need and is an appropriate choice. The names of professionals involved are recorded on various documents of assessment and review stored in the service user’s file. A user-friendly copy of the terms and conditions of residency is maintained on the service user’s file. Sybden I52 s19559 sybden v246450 160805 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 - 10 It is necessary for others to advocate on behalf of the service users to ensure that the assessed needs and personal goals are reflected in the care plan. The service users receive assistance to make decisions about their lives. Staff respond to the indications made by service users with regard to all aspects of life in the home. Risk management is in place to support service users to reach their potential in achieving as independent lifestyle as possible. Service users can be assured that information about them is appropriately handled and that their confidences are kept. EVIDENCE: The service users have very complex needs associated with profound learning disabilities; to overcome this a team of professionals advocate on their behalf in drawing up their care plan and reviewing the same and their names are listed on the planning and review minutes stored in the files seen at this inspection. Changes in the care plan indicate that these are in response to improving the way in which care is delivered and activities are provided. The records show that if a service user has not responded well to a particular activity either the approach is altered or an alternative is tried. The care plans show that the service users participate in various activities, structured and leisure, and that risk assessments have been carried out with clear instructions Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 10 to staff to maximise the development potential towards further independence of the individual. Information about service users is stored securely in the office and policies and procedures concerning confidentiality are in place. Confidentiality training is provided to staff as part of the induction process and is included in the training planner. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 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 standard(s) 11 - 17 Personal development opportunities are provided and these are age, peer and culturally appropriate, taking place both in the home, at day centres and in the community. Serviced users frequent the local community and are well known by other villagers. Relationships with family and friends are supported. Service users’ rights are respected and responsibilities recognised in their daily lives. Healthy diets are enjoyed at flexible mealtimes to suit. EVIDENCE: The care plans and progress notes seen provided evidence that personal development opportunities are planned in and provided. The type of activities provided appeared from the evidence to be age, peer and culturally appropriate and took place in a variety of settings including the local community and further a field during day trips and holidays. The service users are known to the local villagers as most have them have lived at Sybden for several years using the local resources as part of their care plan implementation. The care plans and progress notes provided evidence that relationships with family and friends are fostered and supported. The care plans and risk assessment seen provide guidance in how care is to be implemented by care staff and there are policies, procedures and training in Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 12 place to safeguard service users’ rights and responsibilities. The menus seen reflected a varied and wholesome diet and the arrangements for serving meals were seen to be satisfactory. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 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 standard(s) 18 -20 Service users receive personal support according to their individual need and preference. Physical and emotional needs appear to be met. It is not appropriate for service users to manage their own medication needs. EVIDENCE: The care plans seen provide clear guidance to staff for the meeting of personal needs in a manner preferred by service users to meet their individual needs. The care plans and progress notes provided evidence that physical and emotional needs are met. The service users accommodated at Sybden are not yet able to manage their own medication. Medication was appropriately stored and managed with accurate recording when seen at this inspection. Training is provided to staff administering medication and this is evidenced on the training files. Sybden I52 s19559 sybden v246450 160805 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 The policies and procedures in place and the training provided support service users’ rights to have their views listened to and acted on and to provide protection from abuse. The CSCI regulation inspector reserves the right not to be entirely satisfied until an investigation resulting from an anonymous communication has been completed. EVIDENCE: The care plans seen had been reviewed on a regular basis and changes appeared to be in response to supporting service users to dictate changes beneficial to them as an individual. The Hertfordshire County Council guidelines for the Protection of Vulnerable Adults were seen to be accessible in the home and form part of the induction process for all new staff. Abuse awareness training is given and the registered manager stated that she believes she provides an open door policy for whistle blowing to ensure the ongoing protection of the service users residing at Sybden. An anonymous letter was received that raised concerns that there may be issues concerning covert abuse of service users; the findings of this inspection process were inconclusive and the organisation is continuing an investigation; the judgement of the inspector was that this was a satisfactory arrangement in which to progress this matter. Sybden I52 s19559 sybden v246450 160805 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 and 30 Service users rooms are homely, comfortable and safe. The home is kept clean and hygienic. EVIDENCE: The inspector looked at three service users’ bedrooms, which were comfortable with personal possessions promoting ownership of their individual space. The bedrooms were personalised to reflect the personality and needs of the owner. The inspector observed the home to be clean and hygienic whilst be comfortable and homely. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 16 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 -35 Staff are clear about their roles and responsibilities. A competent and qualified staff team supports the service users. The team appear effective although there are some issues yet to be uncovered. Service users are protected through robust recruitment policies and practices. Service users individual and joint needs are met by appropriately trained staff. Staff receive formal supervision but it is not possible to make a reliable judgement regarding the support of all staff because at least one member of the team has made an allegation anonymously that staff complaints are ignored. At this inspection we were unable to prove or disprove that the allegation was conclusive and the organisation are continuing the investigation and will report their findings to the CSCI for further consideration. EVIDENCE: Each member of staff has a job description, which clearly defines the role and responsibilities of the role held by the employee; copies of these were seen on the staff files inspected at previous inspections. This inspection was brought forward following receipt by the CSCI of an anonymous letter stating that it was written by a member of staff on behalf of themselves and other colleagues. The letter states that members of staff have raised concerns regarding related staff covering shifts, staff members children accompanying them on service users’ holidays and at the expense of service Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 17 users, staff preparing and eating better quality food than is prepared and served for service users and that staff are working up to 80 hours per week at the home. The letter went on to state that incidents including bruising found on service users bodies were not recorded. The writer of the letter alleges that approaches to the management go unheeded. In looking at records and talking to staff we were unable to prove or disprove any of these allegations and further investigation is required. The accident/incident records had been regularly entered and did not contain entries, which raised our concern, and the service users at home looked well cared for and content. The organisation will continue to investigate the allegations and provide the CSCI with the report of outcomes of the investigation for further consideration. The registered manager stated that she believes that she encourages an open door policy to support staff to air their views, raise concerns or to whistle blow and that she has not been approached. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 18 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) 39 and 42 The service users can be confident that their views underpin all self-monitoring review and development by the home. The health safety and welfare of the service users are promoted and protected. EVIDENCE: The care planning process and reviews are included: the service user, professionals from the health and social care bodies, relatives (where appropriate) and the key worker (the care staff member employed by the home to monitor and ensure the care plan is in response to meeting needs and aspirations). The records we saw were detailed and listed those taking part in reviews. All records are audited by the organisation and form part of the selfmonitoring audit/quality review system in place at the home and it is from these as well as from other audits that developments are decided; in this way the service users views underpin the self-monitoring review and developments undertaken by the home. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 19 Policies, procedures and staff training are in place to support the protection of service users with respect to their health, safety and welfare and the organisation and registered manager have responded appropriately in carrying forward an investigation prompted by an anonymous letter to the CSCI; claims made in the anonymous letter were neither proved nor disproved at this inspection despite the perusal of records, face to face meeting with service users and discussion with staff on duty. The organisation will proffer its outcome of investigation report to the CSCI for further consideration. Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 20 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 1 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sybden Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 21 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 YA23 & YA 38 Regulation 12(5) Requirement The registered manager must ensure that the strategies in place for enabling staff, service users and other stakeholders to voice concerns and to affect the way in which the service is delivered is sufficient. Timescale for action 16.09.05 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. Refer to Standard Good Practice Recommendations Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ 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 Sybden I52 s19559 sybden v246450 160805 stage 4.doc Version 1.40 Page 23 - 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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