Inspection on 02/06/06 for Sybden

This inspection was carried out on 2nd June 2006.

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 8 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 16/08/05

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 Julia Bradshaw Key Unannounced Inspection 2nd & 9th June 2006 10:00 Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 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 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) Turning Point Southern Area Office Nonye Otuonye Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Sybden is a residential home for six service users, who have a learning disability whose needs may require a high level of guidance and support. Prospective Service Users vacancy who are looking for a suitable placement, are supported to make a choice by regular visits, exploring options, and assessment of suitability of the home and that they are compatible with the current group of service users. Sybden is a single storey country house, situated in the small, rather idyllic, village of Great Gaddesden, which is approximately 5 miles from Hemel Hempstead town centre. The home has been extended and sits amidst extensive gardens. The location is relatively remote and rural. There are a few shops, for basic requirements, services and community resources but these are limited. The home does have its own transport, which provides access to local towns, just a few miles away. There is a bus route close by. The fee range for this home was not available at the time of the inspection. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection took place over two separate days, 2nd June and a follow up visit on 9th June. The manager was off duty for the main part of the inspection but a list of the outstanding information required to complete the inspection process was left on the 2nd June to be sent to the CSCI office the following day. Unfortunately this information was still unavailable on the second visit and this is reflected in the body of this report. The staff on duty appeared relaxed and well informed of the needs of the service users who were at home on the day. There were some issues relating to the environment that were identified during the first day of the inspection and requirements have been made to rectify these issues. What the service does well: What has improved since the last inspection? What they could do better: The manager and staff must ensure that risk assessments are updated regularly and whenever the needs of the service user change. Several risk assessments were either not dated or were more than a year old. The manager must ensure that all health and safety procedures are adhered to within the home, this includes keeping areas that present as a risk to service users. One service user who is at risk of falling on a regular basis has been given a “makeshift chair” to use, which must be replaced with a more appropriate one. Some areas of the home were in need of redecoration and repair. On the day of the inspection there was no heating. The member of staff spoken to stated that this had been reported a week ago but was still outstanding. One room was covered in faeces, the curtains had been pulled down and the bath panel in the main bathroom was damaged and in need of replacing. Emergency pull cords in individual bedrooms must be in easy access of all service users; some pull cords had been tied up and out of reach of people. On the day of the inspection neither the fridge/freezer temperature records were available, staffing records and regulation 26 documentation was unavailable. The Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 6 manager was asked to supply these to the area office within two days of the inspection being carried out. However these records were not provided within the agreed time and therefore a further visit was carried out on the 9th June to obtain these records. Unfortunately the manager has still failed to provide both the regulation 26 documentation and staff training records. 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 DS0000019559.V293029.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Generally there is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Risk assessments were out of date. EVIDENCE: Care records of 3 service users were inspected and there was evidence of pre admission assessment of needs being carried out in each case. The home receives a copy of the pre admission assessment of needs of prospective service users for those who are funded by the Social Services and discharge letters from hospital, where applicable. The manager or a senior member of staff would carry out the home’s own pre admission assessment of needs of any referred service user. The home has a detailed assessment system in place. Staff members were observed to be interacting well with service users; demonstrating good skills and knowledge to meet the specific care needs of the respective clients’ group. However one service user is currently being reassessed as the manager and staff consider his physical needs and vulnerability are unsuitable for the home and that his needs cannot be fully met. Care plans were examined and a detailed assessment process was seen Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 9 to be in place to ensure that only those people whose care needs could be appropriately met were admitted. Also the current care plans could be further developed and improved by ensuring that individual risk assessments are updated regularly and behavioural guidelines are maintained within the care plan, where applicable. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 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): 6,7,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The standard of care planning is adequate and service users have access to appropriate community healthcare services. Risk assessments require updating. Service users information is being stored appropriately. EVIDENCE: Service users looked well cared for, and were treated sensitively. Care plans must be reviewed regularly and signed by the service users representative. Some care plans inspected were incomplete and contained out of date risk assessments. Also the manager must ensure that individual risks are identified and the necessary risk assessment carried out. (Risk of choking) There were some “listening devices” within the home, which if being used, would require a consent form to be completed. However, on the second visit to the home, the manager stated that these were not currently in use. The manager and staff should endeavour to produce service user information in a more “service user Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 11 friendly” format, as the majority of people currently living at the home communicate through non-verbal systems of communication. All service users information is handled and stored appropriately within the main office and confidentiality is maintained. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 12 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): 11,12,13,14,16,17. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home supports all service users to maintain family, representative and community links as they wish, thus empowering and encouraging service users to maintain, respect, dignity and personal autonomy over choices in their lives, where possible. Wholesome, adequate, varied meals are provided within the home presenting a well-balanced nutritious diet for all service users supporting them to maintain a healthy life. EVIDENCE: Activities are offered within the home by care staff during the evenings and weekends as well as service users accessing local day care provision. Service user meetings do occur within the home, although these do not appear to be held regularly. The minutes contained within the office were for February and April. If further support and or advice is required in order to ensure freedom of Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 13 choice for the service users the home should seek specialist advocacy services in the best interest of the service user. Some relatives and friends visit the home and some service users go home for weekend visits. The home endeavours to provide a variety of activities appropriate to the needs and interests of each individual service users. The home has its own “on-site” transport and summer holidays are offered to all service users. Holidays carried out last year included a self-catering cottage in Devon and a trip to Euro Disney. The home appears to provide adequate and wholesome meals. A four-week menu is used and the fridge on the day of the inspection contained adequate food supplies. However the manager and staff must ensure all food stored in the fridge displays a date of opening in order to maintain food hygiene standards and fridge and freezer temperatures are recorded daily. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 14 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. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Physical and emotional needs are currently compromised. The standard of care planning is good and residents have access to appropriate community healthcare services. EVIDENCE: The care plans seen on the day of the Inspection appeared both detailed and comprehensive and identified all areas of individual need, including health care and personal needs. Care plans are reviewed on a monthly basis. All healthcare visits are recorded within the care plan folder but on separate documentation. Medication was not inspected on this occasion. Training records in relation to the administration of medication were unable to be inspected as the manager was off duty and training records were unable to located on the day of the inspection by the staff on duty. There was a mal odour coming from one of the service users bedrooms. On investigation by the Inspector it was discovered that faeces had been smeared over the bedding and the walls of the room. This was pointed out to a member of staff at the time but the room remained unattended and dirty for the remaining time that the inspection was being carried out. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The staff on duty were unable to confirm if they had received any recent Adult Protection Training and the training records were unavailable on the day of the Inspection to evidence that training had been provided. Staff appeared to have little understanding in relation to Adult Protection and the whistle blowing procedure. Although the manager was asked to send this information immediately – the training records for the home remain unavailable for Inspection. The complaints procedure must be provided in a format that the service users are able to understand and interpret in order to ensure their needs and wishes are being heard and responded to. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Sybden provides a pleasant environment for residents and is maintained to a adequate standard. Resident’s rooms were personalised. Infection control standards were inadequate. The overall standard in terms of safety is adequate with one issue that requires attention. Specialist equipment is inadequate. EVIDENCE: Care staff do not maintain health and safety or infection control standards within the home. One bedroom was discovered by the inspector to be covered in faeces and this was not responded to during the whole of inspection process despite being pointed out as soon as it was discovered. Infection control standards must be maintained at all times within the home. Training records in Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 17 relation to both infection control and health and safety were unable to be evidenced on both the day of the inspection or since, as the manager has not provided the training records. Service users bedrooms have been personalised and with a variety of their own furniture where possible and are maintained to an adequate standard. The bath panel in the bathroom requires replacing as the current one is damaged and in poor condition. The chair currently used for one service user who physical needs are compromised has been given a chair that is both unsafe and in a state of disrepair. At the time of the inspection the central heating had been broken for one week. The care staff on duty stated that it would be fixed the end of the day. The second visit to the home on the 9th June confirmed that the system was now fully operational. The manager must ensure that all service users are able to access the emergency call system. During this inspection several emergency call cords were seen to be tied up and out of reach of service users. It was positive to hear that three bedrooms had been re-decorated since the last inspection had taken place. The home was not clean and hygienic on the day of the inspection. The manager must ensure all health and safety standards and infection control standards are maintained at all times in order to protect both service users and staff from unnecessary risk. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 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, 35 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service EVIDENCE: These standards have been difficult to assess on this inspection, as the training records remain unavailable for inspection. The manager has been asked twice to provide these but to date these still have not been received by the Commission. However all staff on duty appeared to be competent and have a good understanding of each service users needs. Discussions with staff on duty revealed that communication between staff members and the managers had improved and that staff felt that the forum in which to raise and discuss issues have been improved since the last inspection. Staff meetings are held although there were a couple of week’s where the minutes were missing. The manager should endeavour to ensure these meetings are held regularly and minutes taken and available for all staff to comment and sign. The permanent member of staff spoken to stated that they do receive supervision at least six times per year. It was not possible to inspect staff files as the manager was off duty. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service The service users can confident that their views underpin the self-monitoring review and development by the home. The health and safety of service users is currently compromised. EVIDENCE: The home has various systems in place to ensure that service user’s choices are respected, within their abilities and understanding. The care planning system in place provides an opportunity to share and discuss each person personal goals and aspirations with the relevant key worker and outside professionals. Records and documentation are audited by the organisation. Policies and procedures were in place for the protection of service users but unfortunately staff records were not. Therefore the manager is unable to evidence that service users are fully protected. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 20 There were several areas within the home at the time of the inspection that caused concern for the health and safety of the service users – these included faeces in one of the bedrooms that was left unattended to, risk assessments that had not been updated, emergency pull cords were out of reach of service users, the central heating system had been out of order for a week, the bathroom was in a state of dis-repair and one service user whose mobility is poor has been provided with an unsafe and damaged chair to use. Regulation 26 records were incomplete. The last record on file was March 2006. Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 3 32 x 33 x 34 x 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 x x 3 x 3 x x 1 2 Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 Standard YA9 YA18 Regulation 13 (4) (C) 16 (2) (K) Requirement Risk assessments must be reviewed and updated on a regular basis. The physical needs of service users must be respected at all times. – Faeces smeared in one bedroom was left unattendedthis is unacceptable. Staff training records were unavailable and therefore inadequate evidence was available to ensure that vulnerable service users are that staff are provided with the necessary training to carry out their role effectively. Standards of infection control are currently inadequate. The bathroom is in need of repair. Specialist equipment must be provided, where necessary in order to meet the service users individual needs. The central heating system must be repaired Regulation 26 visits must be carried out on a monthly basis and evidence of these visits must be held within the home. DS0000019559.V293029.R01.S.doc Timescale for action 03/06/06 02/06/06 3 YA35 4 (1) (c) 03/06/06 4 5 6 YA42 YA27 YA29 16 (2) (j) 23 (2) (B) 13 (4) (a) 02/06/06 09/06/06 18/06/06 7 8 YA24 YA41 23 (2) (p) 26 (4) 03/06/06 09/06/06 Sybden Version 5.1 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 Sybden DS0000019559.V293029.R01.S.doc Version 5.1 Page 24 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 © 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 DS0000019559.V293029.R01.S.doc Version 5.1 Page 25 - 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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