Inspection on 25/01/07 for Sybden

This inspection was carried out on 25th January 2007.

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 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 09/07/2008.

CARE HOME ADULTS 18-65 Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY Lead Inspector Julia Bradshaw Unannounced Inspection 25th January 2007 10:00 Sybden DS0000019559.V328662.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.V328662.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.V328662.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 Nonye Otuonye Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th December 2006 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.V328662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 25th January 2007 and was the fourth visit to be carried out in this inspection year .The home currently has a temporary manager in post whilst the current manager is suspended. There has been an ongoing problem with providing adequate heating to the home. This was the third visit where the heating had been disfunctioning. This was a particular concern on this visit as the temperature was below freezing and the new boiler that had been fitted during the previous week had broken down. The manager had purchased some portable heaters but this was proving inadequate in maintaining a suitable le temperature. The staff have worked hard to improve the internal areas of the home and in particular the service users bedrooms, which all appeared homely, well decorated and reflected service users personal interest and hobbies. The temporary manager has been in post for a period of six months and has worked hard to implement some positive changes as well as improving some existing policies and procedures. There was an immediate requirement made as a result of this inspection in relation to the central heating. There were also requirements made in relation to medication and service user records. What the service does well: What has improved since the last inspection? There were some areas of the environment that had improved since the last key inspection was carried out and the manager stated that there are several areas of the home that are due to be improved during the coming months. The service user documentation has improved and staff are now reviewing service Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 6 user plans more regularly. Behavioural guidelines were in place and daily write-ups were being kept up to date. The home is now fully staffed which is providing consistency and therefore benefiting the service users. 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.V328662.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.V328662.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): 2,3,4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems in place for assessing service users needs – prior to admission. Risk assessments were in place but must be reviewed more regularly. EVIDENCE: Three service users plans were inspected on this occasion and documentation was provided in order to meet this standard. The home receives a preadmission Prospective Service Users are given a User Friendly Formatted Service User Guide and make visits to the home (including overnight/weekend stays) as part of the assessment and transition process. A plan and progress notes for a prospective Service User was seen. The CSCI has been given a copy of the Service User Guide. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 9 Contracts are with the Local Authority purchasing the service and Service Users have a copy of the Agreement on their individual files. However some of these contracts need updating and service users or their representatives must sing the contract and any amendments that occur. Sybden DS0000019559.V328662.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): 6,7,8,9. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users’ needs are detailed in their individual care plans that provide information to facilitate consistent care. There are currently inadequate systems in place in order for service users to ensure their views are established and they can contribute to the running of the home. The manager must ensure that ALL risk assessments are updated and reviewed regularly. EVIDENCE: Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 11 All service users have an individual care plan and an allocated key worker to support them in the home. Individual daily guidelines/diary notes for service users where observed within the home. All service users will be supported within the Person Centred Planning programme once completed. Within the home each service user is encouraged to partake in daily living tasks, where appropriate, for example help with washing up, laying the table and shopping. Staff can sometimes find this challenging with the service users who have been living in institutions for many years and can be reluctant to partake in self-help programmes. The home is adequately decorated and the service users are involved with the choices for decoration collectively. There was little evidence on the day of the inspection to confirm that the service users are supported and encouraged to contribute to the running of the home. Communication systems must be improved to ensure that all service users are enabled to contribute to the service in which they live. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 12 Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 13 Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 14 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 this service Personal development opportunities are encouraged for all service users ensuring interactions within the local community and responsibilities are recognised and supported. A wholesome diet is provided and enjoyed. EVIDENCE: Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 15 Four of the Service users attend various daycentres. The remaining service user stays at home during the day and is supported by care staff. Access to transport occurs with the use of the home’s onsite transport, with staff support. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. All service users have one day off per week in order to attend to their personal tasks including washing, cleaning their rooms and personal clothes shopping, this is usually combined with a trip out for lunch. The home also provides annual holidays for all its service users. All service users are encouraged and supported to maintain links to the local community. The home is close to Hemel Hempstead and although is situated within a small village setting and appears quite remote. Routines within the home promote and encourage service user independence. Menus within the home are offered on a flexible basis, with service users making choices over the meals daily. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 16 Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 17 Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 18 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. Personal care needs and health care needs are well supported with an individual approach acceptable/preferred by each Service User. Medication procedures are currently inadequate and not being followed EVIDENCE: The care plans inspected contained guidance to staff in how to manage personal care needs according to the Service Users preference. Likes and dislikes/preferences were recorded. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 19 In reading the progress notes I observed how health care and emotional needs were being met. Generally a Service User will attend the GP surgery for consultation but if the GP needs to be called out he will visit them in their own room and a member of the homes Care Staff Team will support the Service User. Appointments are recorded and outcomes of appointments are documented, which aids consistency in following up. None of the Service Users in the home are able to self-administer their own medication even with support. The inspector discussed with the manager how the medication in “non-blister packs” was checked and counted. It was discovered that staff were using an inappropriate method of counting out medication, which is both unsafe and could lead to inaccurate recording of this medication. A requirement has been made to reflect this concern. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 20 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 home must improve its communication methods There is a complaints procedure in place. EVIDENCE: The home has a written policy which complies with the requirements of this standard and which staff said they were aware of. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. The home has a written procedure in relation to Adult Protection and uses this in conjunction with the Hertfordshire Adult Protection policy, which was on display within the main office. The home also has a written whistle blowing policy in place .The home has a detailed policy in relation to service users monies which includes regular audits and the maintenance of receipts for all purchases. Each service user has a savings account. None of the service users are able to manager their own money. The inspector carried out a random check of three service users monies, which proved to reconcile with their individual ledgers. However there was a note in one service users tin from the previous manager that is still unresolved. This appears to involve one Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 21 service user lending monies. This is totally unacceptable and represents poor practice and must be resolved immediately. The manager must improve and develop the current systems of communications in order to ensure service users can make an informed choice. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 24 –30. Service users health and safety is currently compromised. The individual bedrooms have been tastefully decorated. Hot water temperatures were inadequate. EVIDENCE: The inspector arrived at the home on a cold and frosty morning to find that the heating had broken down and the only form of heating was some portable convector heaters. The home had received a new boiler the previous week but this had only been functioning for a few days. The home has a historic problem with heating the building and this was the third inspection where the heating was found to be ineffective. There was also a concern that the flue for the Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 23 boiler had been ill fitted and there was a risk of poisonous fumes entering the bathroom. The manager was made aware of this during the previous inspection and an immediate risk assessment was carried out. A notice had been place in the bathroom for the window to be kept shut due to these fumes. The inspector insisted that the flue must be re-fitted before the boiler was in operation again. The staff team have worked hard to improve the service users bedroom areas and all appeared to be clean, nicely decorated and personalised. The hot water temperatures were inadequate due to the boiler not working and the only access to hot water on the day of the inspection was one shower room. The manager must carry out an annual health and safety and COSHH audit and the finding s sent to the CSCI office, for the inspector’s attention. The manager must ensure the front door is secured at all times as on the day of the inspection the front door was open and the inspector was able to let themselves into the home. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 24 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): 32,33,34,35,36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate to provide the attention that the service users require and to achieve the aims of the home. Members of staff are provided with the training to support service users effectively and meet their needs. The home operates sound recruitment practices that protect the interests of service users. Staff receive individual supervision. EVIDENCE: Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 25 On the day of the inspection there were three staff on duty and the manager arrived at the home later that morning. Staffing levels are adequate for the current service user group. Training records were checked and the manager confirmed that all staff have received mandatory training. Currently one person is doing NVQ level 2. Three staff currently have NVQ level 2 and five staff are currently doing NVQ level 3 and one person already has NVQ level 3. The temporary manager has enrolled on NVQ level 4. The manager confirmed that all staff receive individual supervision on a six weekly basis. Some staff appraisals were completed in March 2006 and some staff will receive appraisals later this year. The commission has recently received a complaint from a staff member who is employed at the home, stating that there are several staff issues occurring within the home. The manager had also received this complaint, in writing .The inspector has asked the manager to investigate this complaint and send an investigation report to the CSCI office by the 31/1/07. The inspector feels that the home has suffered some difficult periods in the past year that have affected staff morale. Therefore it is recommended that the staff team should receive some external staff training in “team building”. The registered manager of the home is currently suspended and there is a temporary manager in post. This situation needs to be resolved as soon as possible in order for the staff team to benefit from a permanent and consistent management team. All new staff receives structured induction and foundation training Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 26 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): 37,38,39,40,42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Health and safety of service users, staff and visitors is currently compromised. The temporary manager has been in post since July 2006 and has worked hard to develop and improve the systems within the home. Self-monitoring systems are adequate. EVIDENCE: Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 27 The management approach of the home endeavours to create an open and positive atmosphere for both staff and service users. However the home has undergone some major changes within the staff team over the past six months and there are some historical issues relating to the staff make up and staff mix. This, on occasions, has created some difficult atmospheres within the home and this could create an unsettling atmosphere for its service users. The situation regarding the management team must be resolved as soon as possible in order to provide a settled and well-supported environment for both service users and staff. Adequate training is being provided to ensure all staff have the necessary underpinning knowledge to carry out their role effectively. The manager must carry out a complete health and safety and COSHH assessment. The situation regarding the mal functioning of the heating system on 25th January when the inspector arrived was unacceptable and compromised the health and safety of the service users. The general standard of the external environment is poor and the manager should endeavour to ensure that the upkeep of the home is maintained to an acceptable standard. All serious issues relating to the service users health and safety must be reported to the Commission as soon as it occurs. The manager must ensure that there is a comprehensive Quality Assurance system in place to ensure all aspects of the home are run effectively and safely. The management of service users monies is the responsibility of the manager and the issue relating to an outstanding amount of money of one service user “lending” another service user money is totally unacceptable and constitutes poor practice. The manager must resolve this situation immediately. Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 28 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 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 2 2 2 x 1 x Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? Sybden DS0000019559.V328662.R01.S.doc Version 5.2 Page 30 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 YA9 Regulation 13 (4) (c) Requirement Risk assessments must be reviewed and updated on a regular basis. (This Requirement was left following the previous inspection on 03/05/06. The manager must ensure that all medication procedures are strictly adhered to. In particular the counting of medication and maintaining a running record of PRN medication. The Manager must ensure that hot water temperatures are maintained within safe limits at all times. Timescale for action 26/01/07 2. YA20 13 (2) 26/01/07 3. YA24 13 (4)(c) 25/01/07 4. YA24 13 (2) (p) 5. YA35 18(c) (i) 6. YA39 12 (2) 7. YA41 17 (1) 8. Sybden YA42 13 (4) (c) The manager must rectify the 25/01/07 malfunctioning heating system immediately as this is putting the health and safety of service users at risk. The manager must arrange some 28/02/07 staff training to assist in the rebuilding of the staff team and to assist in improving the staff morale/self esteem. The manager must implement a 28/02/07 more effective system of communication in order for service users to make an informed choice about the service that they receive. The manager must ensure that 28/02/07 all the home’s policies and procedure are in place and ensure all staff adhere to these in relation to the safeguarding of service users. The manager must ensure that 25/01/07 the health and safety of service DS0000019559.V328662.R01.S.doc Version 5.2 Page 31 users are protected at all times. 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.V328662.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hertfordshire Area 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.V328662.R01.S.doc Version 5.2 Page 33 - 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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