Inspection on 05/10/05 for Sycamores

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamores 02/11/07

Sycamores 29/07/06

Sycamores 13/12/05

Sycamores 01/03/05

Sycamores 20/12/04

Sycamores 12/12/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Sycamores 33 Dymoke Road Hornchurch Essex RM11 1AA Lead Inspector Ms Rhona Crosse Unannounced Inspection 5 October 2005 13:30 Sycamores DS0000027873.V255187.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.V255187.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.V255187.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.V255187.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 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.V255187.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 so the home did not know the inspector was coming. The inspector arrived at approximately 13.30, lunch had just finished. There was adequate staff at the home to meet the needs of service users. The inspector spoke with service users and inspected the premises and documentation, including care plans, risk assessments, health care records and records relating to health and safety. There were no relatives visiting at the time of inspection. It is evident from entering the home that there is a ‘family’ atmosphere within the home. The 5 service users who live there get on well with each other and there is a stable staff group. The inspector has seen the abilities and confidence of four of the service users increase since they have lived at the home. A new service user came to live at the home in March 2005. The home is not evidencing the changes in abilities through goal setting and skills maintenance programmes. This should be documented to show the good work that is taking place. Care plans (although thorough) are not being updated this must be addressed. Medication is well managed. Health care needs are dealt with appropriately although recording of this needs to be more thorough. The repairs to the bedroom wall that were required due to a problem with the damp course have now been addressed. The wall needs to be decorated as does the en-suite in of this bedroom. The entrance hallway landing and stairs and upstairs corridor must be decorated and the carpet replaced as the décor is shabby and the carpet is worn through in places. This spoils the look of the home as the rest of the home is well furnished and maintained. A 2 week holiday abroad is booked and service users were very excited about this, wanting to go out to buy new clothes for their holiday. One service user had already got his case out to pack. Previous holidays to the same area have been very successful. Local amenities are used by the service users and activities are provided. Whilst the majority of health and safety checks were taking place and certificates and records supported this, there was no recording of any fire frills taking place in 2005. This is poor practice and must be rectified with a fire drill taking place and the home ensuring that 4 drills a year take place thereafter. Sycamores DS0000027873.V255187.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 updating of care plans and the setting of goals and skill maintenance plans must be addressed. This will enable the home to evidence the good work it achieves, (an example of this is one service user who has an anxiety of going out of the house requesting to go out with the proprietor/manager). Some recording requires more attention (to give more detail of why a service user has attended a hospital appointment). The entrance hall stairs and landing requires decorating and a new carpet fitted. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 7 The wall in the downstairs bedroom that has been repaired requires decorating. The en-suite of this room also require decorating. There is no record of any fire drill taking place for the year of 2005. This is poor practice a fire drill must take place as soon as possible and a record must be kept. There after a further 3 drill must take place before the end of 2005. 4 fire drills must take place within any one year and a record kept. 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.V255187.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.V255187.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): Standards 2, 3 and 4 were inspected. Standard 3 and 4 are well managed. However no written assessment for a new admittance could be provided by the home at the time of inspection. Therefore the home cannot evidence how they assessed the needs of the new service users or that they carried out a robust assessment. This standards was not well managed. EVIDENCE: There has been a new admission since the last inspection. The service user’s file was inspected. Although there was an assessment provided by the local authority, the homes own written assessment could not be provided at the time of the inspection. The home must always carryout a written assessment prior to any new admission to ensure that the home can meet the needs of the service user. In discussion with the manager she stated that she had visited the service user in his previous accommodation and he had visited Sycamores several times and stayed over night to see if the home was suitable to him and could meet his needs. This was confirmed by the service user when the inspector spoke with him. Sycamores DS0000027873.V255187.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): Standards 6,7 8 and 9. Although there are comprehensive care plans for all service users these must be updated to show the changes that have occurred. Once this is achieved this standard will be well managed. EVIDENCE: From the inspection of care plans it was established that the care plans are not being updated. This must be addressed. The manager stated she was in the process of updating the current information on computer, however these were not available for the inspector to see. One service user who has epilepsy had a care plan that did not reflect his current needs. This identified rectal diazepam was prescribed, this was to be administered if there were multiple seizures over a set period of time and if the seizures were prolonged. The service user is no longer prescribed this medication as there have been no seizures for many years. The care plan should reflect the change in needs. Service users have a say in how the home is operating by making choices about what they want to do, how their rooms are decorated and in general all aspects of daily life (although this is dependent on their abilities and their understanding). Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 11 Service users are supported to take risks. Where there is a risk identified, a risk assessment is written. Risk assessments were being updated for the two weeks holiday that is to take place. Service users are aware that there is information held about them and are aware of their own files and records. They may not be able to read the records or understand why they need to be kept. Staff speak to service users about their records and what is being written. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 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): Standards 11, 12, 13, 14 and 16. There are no recorded goals set for improving the abilities of service users or maintaining the skills that they already have. This must be addressed to show the work being undertaken by the home and to enable service users to reach their potential and have more fulfilling lives. EVIDENCE: The home was undertaking the recording of goals and skills maintenance. However this has not been recorded for some time and must be used to show the improvements in the abilities of service users and support the good work that is being carried out. It is very evident that service users have improved and have built on their confidence when you speak to them (this is only evident as the inspector has visited the home over a period of years) anyone visiting for the first time would not identify the changes that have occurred. Therefore the home must evidence the work they are doing. One example of good practice is assisting a service user to get over the anxiety of going out of the house to activities in the community. Steps forward have been made with this service user asking Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 13 on one occasion to go out with the manager. This is a real breakthrough for this service user and should be recorded as part of goals set to be achieved. Service users are encouraged to join in local activities in the community. One service user who has been recently admitted has continued to go to a farm (out of the borough) to work there. However this farm is now closed and the home are looking for similar work for the service user. There is a record of activities that service users take part in. All have opportunity plans. Activities that have taken place recently are a trip to Little Holland on the 2/7/05, a barbecue on the 9/7/05, afternoon tea and cakes at a local café on the 13/7/05 that the service users enjoy going to. A trip to Lakeside shopping and lunch out took place on the 20/7/05. Lunch in a local pub took place on the 29/9/05 as a special treat for one of the service users birthday. Daily activities such a Church on Sunday and a Saturday club and Monday club also take place. Service users are encouraged to enjoy their own individual hobbies as well as taking part in shopping for the home. All service user bedrooms have a lock and it was observed that some use this facility whilst others choose not to. Service users are able to use their bedrooms during the day to have time on their own and this was observed during the inspection. Service users help with the daily life of the home and participate as far as their abilities allow with household tasks. One service user was observed helping staff to take the washing from the line. Another service user made tea. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 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): Standards 18, 19, 20 and 21 The standards inspected showed that most areas are well managed taking into consideration the needs and wishes of service users. Greater care needs to be taken with documentation to enable the home to show why service users have attended a hospital appointment or seen a Consultant. EVIDENCE: There is a mix of age and gender within the staff group. This aids service users to have same gender care if they wished. However none have shown a preference to this. The home has policies and procedures for the administration of medication. Medication practice was observed to be good with documentation appropriately completed. Service users health care needs were well met with GP visits, optician and chiropodist appointments made when necessary. Documentation did not always state what an appointment was for therefore anyone tracking the health of a service user could not always establish the care being provided. The documentation needs to be more informative and state exactly what the appointment is for and the outcome once known. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 15 Service users information at the time of death is being recorded to ensure the home knows the wishes of the service user and relatives at this time. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 16 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): Standards 22 and 23. EVIDENCE: The home has policies and procedures for dealing with suspected abuse. Staff are aware of their responsibilities of reporting any suspected abuse. However not all staff have received training in the protection of vulnerable adults. The home must provide this training for all staff. From observation of service users and staff it was evident that service users felt able to speak to the staff (in particular the manager) about anything that they were concerned about. One service user said “Jinder will sort things out”. The home has a complaints procedure and this identifies the address and telephone number of the Commission. The home has a policy and procedure for dealing with complaints. There have been no complaints made to the home since the last inspection. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27 and 30. The home is in general in good repair however some areas require attention to being the home to the required standard, improving the facilities for 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. One service user newly admitted to the home is choosing the décor he would like for his new bedroom. One doorframe around an upstairs bedroom door is cracked and requires making good. 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. The wall that was repaired in the downstairs bedroom (due to damp) requires decorating as does the en-suite in this bedroom. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 18 The laundry room was clean and well organised. The bathroom has a bath and separate shower. A further W.C. is located the first floor. The home was free from odours. The home is unsuitable for anyone who is physically disabled therefore the home does not provide any aids and adaptations. The garden is accessible from the rear of the home and is well laid out with mature trees and shrubs. A paved seating area is provided and this is well used in the summer months. Tree and shrub pruning and clearing of flower beds had been taking place, this rubbish needs to be removed or shredded. Electrical wire and lamps changed by the electrician were also staked on this pruning, this also needs to be removed. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 36. Standards 34 and 35 will be inspected at further inspections. Standards 31 and 36 are well met. This assists in keeping care standards to an acceptable level ensuring the needs of service users are being met by the staff. Standard 36 is used to identify good practice that staff are carrying out and also highlights were improvements that need to be made. EVIDENCE: Staff are clear about the duties they are to perform when they come on duty and work well as a team. Written formal staff supervision is taking place. Most staff have received more than one formal supervision session (2 have received 5 sessions, 3 have received 4 sessions and one staff member has received 3 sessions of formal supervision). The home is aware that all staff must have 6 supervision sessions within one rolling year. Staff training is taking place. 10 staff have either taken or are at present undertaking NVQ level 2 training. Training in mediation administration and recording took place in June 2005. The manager is waiting for a date for staff to attend food hygiene training, manual handling training and health and safety training. Staff have not had training in the protection of vulnerable adult. The manager must ensure that this training is provided. Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42. Standards 37 and 39 will be inspected at the next inspection. All the safety checks were in place and appropriate apart from the recording of fire drills. No fire drills were recorded as taking place for the year of 2005. The home must address this with urgency, (4 fire drills should take place within one year) and a record kept of these drills. This places service users at risk and is very poor practice. EVIDENCE: The fire extinguishers received their annual inspection on 13/7/05. Fire alarms are being tested weekly and a record is kept. The fire alarm was last serviced on 3/9/05. The record of fire drills did not record a drill taking place in 2005. This is poor practice. A minimum of 4 drills a year should take place, the home must rectify this urgently to ensure all staff are aware of what they should do in the event of a fire to protect the service users. The emergency lighting was serviced on the 13/9/05. The Gas safety certificate was dated 25/4/05. The 5 year electrical safety certificate was dated the 11/8/05. The annual portable appliance test was carried out on the 13/6/05. The annual Legionella test was carried out on the water system on the 8/7/05. Sycamores DS0000027873.V255187.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 2 3 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 N/a 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X X X 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sycamores Score 3 2 3 3 Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000027873.V255187.R01.S.doc Version 5.0 Page 22 yes 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 YA2 Regulation 14(1) Requirement Timescale for action 30/10/05 2 3 YA6 YA11 4 YA19 5 6 7 YA23 YA24 YA24 No service user should be admitted to the home without the home carrying out a written assessment of the service users needs. 15(1) & (2) Care plans must be updated to reflect the changing needs of service users. 12(1)(b) Have a programme in place and a system of recording goals to be achieved and skills maintained, to enable service users to reach their potential and the home evidence the work they are undertaking. 17(1)(a)(k) Records must make clear reference to why a visit to a GP, Consultant or hospital appointment is made and any results once known. 13(6) All staff must have training in the protection of vulnerable adults 23(2)(d) The entrance hallway, stairs and landing must be decorated. 16(2)(c) The carpet to the entrance hallway, stairs and landing must be replaced as this is worn and a trip hazard. 30/12/05 12/12/05 12/12/05 30/12/05 12/12/05 12/12/05 Sycamores DS0000027873.V255187.R01.S.doc Version 5.0 Page 23 8 9 10 YA24 YA24 YA42 23(2)(d) 23(2)(d) 23(4)(e) Decorate the downstairs bedroom where the wall has been repaired. Decorate the en-suite of the downstairs bedroom. Carry out a fire drill, keeping a record and ensure thereafter that 4 drill within one year take place and a record is kept of each drill. 12/12/05 12/12/05 30/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sycamores DS0000027873.V255187.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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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