CARE HOME ADULTS 18-65
Sycamores 33 Dymoke Road Hornchurch Essex RM11 1AA Lead Inspector
Ms Rhona Crosse Unannounced Inspection 13th December 2005 10:00 Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sycamores Address 33 Dymoke Road Hornchurch Essex RM11 1AA 01708 726933 01708 707370 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) Mr Michael Joseph Prior Mrs Harjinder Kaur Prior Mrs Harjinder Kaur Prior Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th October 2005 Brief Description of the Service: Sycamores is in a residential area of Hornchurch and is within walking distance of Romford market town. The home offers 24 hour care for 5 adults with learning disabilities. All accommodation is in single bedrooms one bedroom has an en-suite facility. 2 bedrooms are on the ground floor and 3 are on the first floor. The home is not suitable for anyone who uses a wheelchair as the corridors are narrow and there is no passenger lift to the first floor. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced therefore the home did not know the inspector was coming. The inspector arrived at approximately 10.00am. The manager was not at the home as she was involved in a review of one of the service users. The home was appropriately staffed. The ‘core’ standards were inspected over the 2 inspection visits, therefore not all of the standards were inspected. The inspector spoke with service users and looked at care plans, risk assessments, daily records, medication records and staff files as part of the inspection process. The building was also inspected. The house is very homely and there is always a good atmosphere. The home was decorated for Christmas. One service user is to go to visit relatives for Christmas, the manager/proprietor will be taking the service user ½ way on the journey to the west country to meet up with the relatives. The inspector spoke with the service users who were at home. A recent holiday to Turkey (2 weeks) was spoken about. All of the service users appeared to have had an enjoyable time and spoke about a new hotel they had seen this year and that they would like to go to the new hotel next year for a holiday. Some of the requirements set at the last inspection have not been achieved. The handyman left and the home are advertising for another handyman. The home have been given extra time to comply with the re decoration of the hallway and landing and the replacement of the stair, hall and landing carpets. The manager is to confirm in writing to the Commission by the 28 February that this work has been completed. Training in the protection of vulnerable adults that was to take place was over subscribed. A new date has to be booked. The manager must ensure that this training takes place and confirm in writing the booked dates and the staff who are booked to attend the training. Care plans are being reviewed and were in the process of having changes made to them. These care plans were not at the home. The manager had to go to her own house to get these documents. All information relating to service users must be kept at the home and be available for inspection at any time. Whilst the service users are well cared for, the paperwork of the home is not always up to date. This must be addressed to ensure the well being of all service users. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The care plans were in the process of being reviewed and updated. These were not at the home, the manager had to go to her own home to retrieve them. All documentation must be held at the service users home and be available for inspection at any time. The care plan must show the skills and set goals to be achieved as part of the reviewing process to enable the home to be able to evidence the good work that is taking place. As none of this is recorded. Although personal development is taking place and the confidence and abilities of service users are apparent to the inspector, this is only measurable as the same inspector has visited the home over a period of time. The documentation of the home must evidence the work that they are doing to achieve standard 11 as a standard that can be met.
Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 7 As the original timescales given and agreed by the manager/ proprietor have not been complied with, further new timescales have been given. The manager/proprietor must meet the new timescales or the Commission may take formal action against the home to ensure compliance. Although medication practice is normally good, at this inspection it was observed that medication (Sodium Valporate) that had come into the home was not counted and carried forward onto the new medication administration sheet, therefore for this medication a clear audit trail could not be shown. All medication coming into the home that is not dispensed from the pharmacy in a monitored dosage system must have the amount of medication received into the home recorded, the start date of the medication recorded and if any medication is left at the end of the month this must be counted and recorded and carried forward onto the next medication administration sheet each month. This is to ensure that all medication is administered as prescribed. Decoration of the downstairs en-suite has not taken place, nor has the decoration of the hallway stairs and landing. The manager stated that this was due to the handyman leaving. The home has advertised for a replacement handyman. However this work needs to be completed by 28 February 2006 and arrangements must be put into place to achieve this, irrespective of whether the home is able to employ a handyman. The stairs, hallway and landing carpet must also be replaced on the completion of the decorating by the 28 February 2006. 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. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 8 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 Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 9 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): These standards were not inspected at this inspection. The home has no vacancies. These standards will be inspected again when any new service user is admitted. EVIDENCE: Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 This standard is not being well managed. Work that is taking place to review the current care plans has not been achieved within the timescale given and agreed with the manager/proprietor at the last inspection. Standard 6 could be met once this work is completed. EVIDENCE: The care plans for all the service users are being reviewed and updated. This was an unmet requirement from the last inspection. Extra time has been given for this to be achieved. However these care plans with goal settings must be completed by the new timescale to ensure the welfare of the service users. Any further failure to meet the new timescale may result in formal action being taken against the home by the Commission. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 the following standard(s): 11 and 17 Although personal development is taking place and the confidence and abilities of service users are apparent to the inspector, this is only measurable as the same inspector has visited the home over a period of time. The documentation of the home must evidence the work that they are doing to achieve standard 11 as a standard that can be met. EVIDENCE: Standard 11 is not met and the timescale at the last inspection that the home were given and agreed was achievable has not been complied with. The manager/proprietor must provide documentation that can show a measurable increase in the skills and personal development of the service users accommodated. Extensive discussions have taken place during the inspection process to advise the manager of the way forward. Extra time has been given for this to be achieved. However the home must comply with this requirement within the new timescale or formal action may be taken against the home.
Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 12 Meals and menus were inspected along with the food stocks held. The main meal for the evening of the inspection was roast lamb. Service users said that they liked this meal. The menus were varied and from discussion with service users these took into consideration their likes and dislikes. Fresh fruit was seen to be available on the dining table. Service users said ‘we get enough food here’ ‘I like the food’ ‘I like roast dinners’, ‘I like sausages best’. ‘I am eating too much, look at me I’ll have to slow down’. ‘Yes we get a choice of food and we go out to eat as well, ‘we all went out for a birthday meal the other week to Liberty Bell in Romford, it’s nice there’. Meal choices were recorded and any change to the menu was also recorded. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 the following standard(s): 19 This standard is now met with documentation to support the health care needs of service users. EVIDENCE: At the last inspection records were poorly completed in relation to health care needs and some information relating to Consultants visits and GP visits was incomplete. Since the last inspection there has been an improvement in the recording and information about health needs was now observed to be well documented. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 the following standard(s): 23 It was a requirement at the last inspection that all staff attend training in the protection of vulnerable adults. This training was oversubscribed and the staff have not been able to attend this training. This standard cannot be met until all staff have attended this training. EVIDENCE: Staff are given policies and procedures about dealing with suspected abuse and this also forms part of their induction training. The training for staff in the protection of vulnerable adults must be achieved. The manager/proprietor may need to look for alternative trainers if staff cannot be given a place for this training within the timescale set. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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 the following standard(s): 24, 25, 26, 27 28 and 30 The majority of the home is well maintained, however the areas that require attention must be dealt with to ensure the ongoing safety and comfort of service users. EVIDENCE: The home is well maintained in general and has a good standard of decoration. Communal areas are well furnished and decorated. The kitchen is well maintained. All bedrooms are single occupancy and furnished with the individual choices of service users. Bedrooms are decorated to the choice of service users and are full of personal possessions. The en-suite of the downstairs bedroom requires decorating. The entrance hall, stairs and landing on the first floor require decorating. The carpet to these areas requires replacing as it is worn and will become a trip hazard. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 16 These are both unmet requirements from the last inspection. A new timescale has been given for these to be achieved. The home must ensure that this work is undertaken and confirm in writing that this has been achieved by the new timescale given or the Commission may take formal action against the home. The home is not suitable for anyone who has a physical disability as there is no passenger lift and corridors are very narrow. The garden is well maintained. Pruning of shrubs and trees that has taken place has accumulated and needs to be removed from the garden. Also electrical wiring and old light fitting also need to be removed from the garden. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 34 and 35 Recruitment and employment procedures need to be more thorough to protect the vulnerable service users. Staff must be provided with appropriate training as not all have attended statutory training, this reflects on the staff’s abilities to deal with situations that may arise. Other core standards in this section were met at the last inspection and were therefore not inspected at this inspection. EVIDENCE: The home has a stable staff group this is seen as beneficial as it enhances the lives of service users as all staff have a good knowledge of the needs and aspirations of the service users. A random selection of staff files were inspected. From observation it was noted that the majority of files held the appropriate documentation. However gaps in employment records on the application form are not always being addressed. References were not looked at in enough detail as the application forms did not always identify how the staff member was known to the person providing the reference. An induction programme for one staff member was not in the staff members file. The home must ensure that all employment documentation is held as required by legislation.
Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 18 Although there is a mix of skills within the staff group not all staff have attended statutory basic food hygiene training, lifting and handling training or basic first aid. Staff should also attend training in how to deal with challenging behaviour. This must be addressed to ensure that staff deal appropriately with any situation that may arise. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 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): 42 Fire drills are not being recorded. This places the home at risk of formal action being taken against them. All other health and safety matters were well organised and certificates and records were in place. These were inspected at the last inspection and were recorded in that report. EVIDENCE: A fire drill took place on the day of the inspection. All service users left the building and made their way to the ‘collection’ point. One service user has to be assisted to leave the building by staff. The service users and staff evacuated the building quickly. However it was of concern that the home could not evidence from fire records that the required amount of drills set by the Fire authority (4 per year) had taken place. The home must ensure that 4 drills are undertaken and a record is Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 20 kept of each drill. Further failure to achieve this will result in formal action being taken against the home. Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x X Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 3 N/a 3 LIFESTYLES Standard No Score 11 1 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Sycamores Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000027873.V274626.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(1) & (2) Requirement Care plans must be updated to reflect the changing needs of service users. Have a programme in place and a system of recording goals to be achieved and skills maintained and a system to enable service users to reach their potential. Records must evidence the work the home is undertaking. All staff must have training in the protection of vulnerable adults. Decorate the hallway landing and stairs. Remove the garden pruning and old electrical wires and lighting from the garden. Replace the carpet in the hallway stairs and landing. Decorate the en-suite of the downstairs bedroom. Ensure all staff have the
DS0000027873.V274626.R01.S.doc Timescale for action 28/02/06 2 YA11 12(1)(b) 28/02/06 3 4 5 YA23 YA24 YA24 13(6) 23(2)(d) 23(2)(o) 30/03/06 28/02/06 28/02/06 6 7 8 YA24 YA27 YA34 16(2)(c) 23(2)(d) 19 28/02/06 28/02/06 28/02/06
Page 23 Sycamores Version 5.0 9 YA35 10 11 12 YA35 YA35 YA42 appropriate employment documentation and that any gaps in employment are discussed at interview. 18(1ci)1013(4c)13(5) All staff must have training in basic food hygiene, basic first and lifting and handling, 18(1)(c)(i) All staff must have training in dealing with challenging behaviour. 18(1)(c)(i) All staff must have training in Epilepsy (due to recent admission). 17(2)(14) & 23(4)(e) Ensure that 4 fire drills a year take place and a record is kept of each drill. 30/03/05 30/03/06 30/03/06 28/02/06 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 Sycamores DS0000027873.V274626.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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