Inspection on 21/04/08 for Sybden

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sybden 17/04/09

Sybden 23/04/07

Sybden 25/01/07

Sybden 02/06/06

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 28/09/2008.

CARE HOME ADULTS 18-65 Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY Lead Inspector Marian Byrne Unannounced Inspection 21st April 2008 10:00 Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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.V362907.R01.S.doc Version 5.2 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.V362907.R01.S.doc Version 5.2 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) www.turning-point.co.uk Turning Point Southern Area Office Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd April 2007 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 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. Information regarding the service is available in the Statement of Purpose and the Service User Guide. These and a copy of the last inspection report are freely available on request. The range of fees for Sybden are between £900 and £1200. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The information in this report is based on an unannounced visit to the home by one regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as ‘we’. We have also reviewed the information we have received about this service between inspections, the last inspection was carried out on the 23rd April 2007. What the service does well: The staff team work to improve to ensure the residents have a high quality of life. The staff continue to adjust well to the major changes within the staff team and have worked hard to ensure that the service provided to the people living at Sybden is consistent and professional. The service users have both complex needs and severe challenging behaviour needs which requires the manager and staff team to be both professional and consistent in their approach with them. Staff were observed to be calm, relaxed and caring when offering care and support to the residents. The environment provides a homely domestic setting in which the service users can live safely and lead lifestyles that suit them. In particular, the bedrooms are decorated and furnished to reflect the taste of the residents. The communal areas of the home were domestic and were clean and fresh on the day of the inspection. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that an assessment will be completed to ensure that the home can meet people’s individual needs. However the Statement of Purpose of the home does not contain any detail on how issues of equality and diversity will be met. EVIDENCE: A Statement of Purpose and a Service User’s Guide are in place that contains some of the required information about the service provided. It does not state how equality and diversity issues will be met in caring for the residents. An example of this was one resident though born in England was of Afro Caribbean heritage. There was no exploration of what his cultural needs were or how they were to be met. The assessment paperwork does seek to identify the resident’s sexuality. There was no further exploration of how the resident’s sexuality is expressed in their daily lives. The residents are also asked if they have ever been a ‘sex worker’. There is no explanation as to why this question is asked. No other occupation questions are asked. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 9 Three service users’ care plans were inspected on this occasion there was not sufficient information relating to the service users’ needs, wants and wishes to ensure staff delivered person centred care. Staff have started to re-write care plans in a more person centred way. If the new lay out of the care plans are followed in full there should be enough information to deliver person centred care. The Manager assured us that this piece of work would be prioritised. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the people who live at Sybden need wider opportunities made available to them so they can exercise more choice over their lives. EVIDENCE: As already stated equality and diversity issues are not explored therefore it is not possible to say if they are being met. The home has four resident at present. Two have no day care provision. The manager is pursuing this and is attempting to get more day care provision. The day to day running of the home resolves around taking service users to day care and back. This breaks the day in a way that makes it difficult to arrange any meaningful activities for the service users who do not have day care provision, as the day shift changes at 14.00 hours with a handover at 13.45. By the time staff return from transporting service users to the day centres it can be 11.00 leaving 1 hour 45 minutes for outing etc. This restricts Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 11 the arrangement of activities/outings for the service users who have least time away from the home. One the day of the inspection the home was locked and the gate was open, this prevented the service users in the home form having safe freedom of movement within the grounds of the home. There is a residents meeting every Saturday morning. Staff are now trained in Macaton and this has improved communication between staff and service users. The home had recently arranged a holiday for one resident in France. This was very successful and the resident enjoyed it very much. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the residents have a good lifestyle other have a restricted lifestyle as they are not able to meet with people outside the home on a regular basis. Residents are provided with freshly cooked nutritionally balanced meals which support their health needs and what they like. EVIDENCE: Service users who have no day care and the provision are limited to contact with other residents, staff and visitors to the home. They are further restricted from free access to the grounds of the home through the lack of adequate security with the gate to the home. (see later in this report – environment). All service users are encouraged to assist in their personal tasks including washing, cleaning their rooms and personal clothes shopping, this is usually Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 13 combined with a trip out for lunch. The service took one resident to France recently for a holiday. This proved to be very successful. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the people living at Sybden are supported to maintain their health and achieve an good standard of personal care that reflects their individual needs and maintains their dignity. They can be confident that medication records are always maintained to a satisfactory level to ensure people are protected at all times. EVIDENCE: Some of the people who live at Sybden are well supported and are able to articulate their likes and dislikes. There are only four people living at the home and staff know their needs, however because issues relating to equality and diversity have not been explored it is not possible to state that all the people living in the home have their needs met. As already stated the care plans do not give sufficient information to establish if person centred care is given. The admission papers ask about the person’s heritage, this is recorded as a tick in the appropriate box and was not explored into the provision of care. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Sybden can be confident that there are systems in place to respond to problems reported by staff or outside agencies. The lack of security at the entrance to the home could compromise their safety. EVIDENCE: A written policy is in place which complies with the requirements of this standard and which staff said they were aware of. A record is maintained of complaints made detailing actions and outcomes as necessary. A written procedure in relation to Safeguarding adults is in place and this is used in conjunction with the Hertfordshire County Council Safeguarding Adults policy, which was on display within the main office. There is also a written whistle blowing policy in place. There was evidence that complaints were taken seriously and were investigated and responded to in depth. The protection of the service users remains compromised though the lack of security at the front gate. On the day of the inspection the inspector drove in to the grounds of the home. Since the last inspection and electronic alarm has been installed at the gate to alert the staff of someone entering or leaving the home. On entering the grounds of the home we could not gain access to the home via the front door and had to go to the back door. This indicates that the alarm was not working or that staff do not take any notice of it. An immediate Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 16 requirement was left with a limited time scale to ensure that this gate is made secure. This issue was raised at the last inspection. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 17 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. 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. The people at Sybden live in a modern, domestic style environment, which is well maintained and decorated and furnished to allow each person to have their own personal space, which reflects their individual personality. However they are prevented from having free access to the grounds through lack of security at the gate. EVIDENCE: A tour of the home indicated that it was clean and fresh. All bedrooms are decorated to reflect the taste of the residents. At the last inspection a sensor has been fitted to the gate of the home in order to assist with the monitoring and security of the service users. However a discussion with the manager resulted in the agreement that further systems to improve security should be implemented. The current security could compromise service users safety, as there is little to prevent service users Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 18 wandering out onto the road, which adjoins the home. The security that has been added since the last inspection is a chain to be put in place when the gate is closed. There are no signs asking staff and visitors to ensure the gate is closed and chained and as already stated the gate was open when we arrived. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Sybden can be assured that staff are recruited appropriately, that security and identity checks have been carried out, and that they have undergone mandatory training. EVIDENCE: Three staff records were inspected and they all contained the required security and identity checks including Criminal Records Bureau checks and two references. Training is ongoing with all staff taking part. Training records were checked and the manager confirmed that all staff have received mandatory training. The manager confirmed that all staff receives individual supervision on a six weekly basis. The manager has worked hard to improve and develop staff morale within the home. Staff spoken with confirmed that the morale is better and that it is a nice place to work. All new staff receives structured induction and foundation training Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Sybden can be confident that the manager will endeavour to meet their healthcare needs. The safety of the residents could be compromised by the lack of security outside the home. EVIDENCE: A new manager has been appointed and has been in post since July 2007. The manager is still working to change the home and in particular the care plans of the service users. We found that the staff felt that the current manager is supportive. The manager has introduced Macaton training to improve the communication between staff and residents. Staff stated that they found this useful. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 21 The safety of the residents could be compromised through the lack of security of the gates to the grounds. This has been raised earlier in the report and in the previous report (23/04/07). The lack of security also restricts the freedom of movement of the residents as they are reliant on staff to keep them safe in the grounds and therefore the availability of staff to accompany them. The paperwork relating to assessing the prospective residents asks questions that does not respect the dignity of the person i.e. asking them if they have been a ‘sex worker’, no other question of occupation is asked. The Manager was unable to give a reason why this question was asked of the residents living in Sybdens. There was no indication that the residents understood the question or if they had it explained to them. The lack of information on diversity and equality means that the staff of the home have no way of knowing if they are meeting the needs of the residents. The manager informed us that the introduction of person centred care plans is underway and these will be inspected at the next inspection. A requirement was left at the last inspection that require all policies and procedures affecting and involving service users must be produced in a format that is understood by the people that use the service this had not been met. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 22 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 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 X 2 X X 2 X Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 23 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 YA24 Regulation 13(4)(a) Requirement The security and safety of the front entrance to the home must be improved in order to prevent service users from wandering out onto the road that adjoins the home. Timescale for action 19/05/08 2. YA1 YA7 3. YA1 4. YA2 AN IMMEDIATE REQUIREMENT WAS ISSUED ON THIS. 12(2)16(2)(J) All policies and procedures 30/06/08 affecting and involving service (M)(n)24(3) users must be produced in a format that is understood by the people that use the service. 4 The admission paperwork 19/05/08 must be reviewed to ensure the dignity of the residents and prospective residents is promoted by not asking inappropriate questions i.e. relating to working in the sex industry. 4 The diversity of the residents 19/05/08 must be respected by ensuring that a resident’s heritage is explored and care plans drawn up appropriately. Sybden DS0000019559.V362907.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations Sybden DS0000019559.V362907.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V362907.R01.S.doc Version 5.2 Page 26 - 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. 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