CARE HOME ADULTS 18-65
The Cherries Heath End Road Flackwell Heath High Wycombe Bucks HP10 9DY Lead Inspector
Chris Schwarz Unannounced Inspection 21st November & 15th December 2005 09:50 The Cherries DS0000023062.V264700.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 The Cherries DS0000023062.V264700.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. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Cherries Address Heath End Road Flackwell Heath High Wycombe Bucks HP10 9DY 01628 530657 01628 850474 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.macintyrecharity.org MacIntyre Care Miss Claire Samuels Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th April 2005 Brief Description of the Service: The Cherries is registered to provide accommodation for up to seven adults with learning disabilities. The provider, MacIntyre Care Services, has kept occupancy levels at six since a service user moved out a few years ago. The service user group is a stable one and individuals have a range of personal care needs. The home is close to the centre of Flackwell Heath where there are shops, pubs, banks, a library and community centre and transport links to nearby towns such as High Wycombe. The Cherries is built into the side of a hill which has resulted in a split-level style of accommodation. Bedrooms, bathrooms and the laundry are on a lower ground level with the lounge, kitchen and dining room on an upper ground level. The office and a training/resource room are in a separate building, linked to service users accommodation by a patio walkway. There are front, side and rear gardens with a parking area at the front of the building. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to the findings of two visits – an unannounced inspection on 21st November 2005 and subsequent follow-up visit to meet with the manager on 15th December 2005. The visits included a tour of the building, opportunities to meet with service users and staff, examination of some of the home’s required records and discussion with the registered manager. Total inspection time was just over five hours. What the service does well: What has improved since the last inspection? What they could do better:
Further evidence is needed to show how service users have been enabled to make decisions and involved in consultation processes. Risk assessments need to be reviewed and the range expanded, to ensure that independence is best promoted. Personal care practice needs to be improved to ensure that privacy and dignity are promoted and that service users are afforded respect at all times. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 6 An up-to-date complaints procedure is needed, to ensure that complainants know that they may additionally refer matters to the Commission. Training on adult protection is needed, to ensure that skills are updated. A risk assessment is needed to ensure that staff under 21 are appropriately trained and supported to be left alone at the home. Evidence of thorough recruitment checks is needed, to ensure that all necessary clearances have been obtained and that these are satisfactory. Window frames need to be repainted in some of the bedrooms, to improve appearance. Ways of improving light and ventilation in the bathrooms needs exploring, to make these areas more pleasant. Infection control measures need to be improved to guard against the risk of cross-infection. Practice evacuations need to be held at least every six months, to ensure that staff and service users are well rehearsed in the event of a fire. Aerosol containers need to be stored safely away from heat sources, to prevent risk of explosion. Out-of-date and unnecessary information in care plan folders should be archived to streamline them. Documentation within care plan folders should be signed and dated as a good practice. Advocacy involvement with service user meetings/consultation should be explored, to seek views. Guttering needs to be cleared of leaves and moss to improve drainage. 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 Cherries DS0000023062.V264700.R01.S.doc Version 5.0 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 The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards in this section were assessed on this occasion. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans are in place for each service user, to ensure that needs are recognised and can be met. Some service users can readily make decisions, although further evidence is needed to show that those with communication difficulties are consulted and their views actioned. Service users are enabled to take risks as part of daily living but assessments need to be reviewed and expanded to further promote independence. EVIDENCE: Care plans are in place for each person living at the home. There was evidence of formal reviews taking place recently and, in some, cases, maintenance of monthly summaries prepared by service users’ keyworkers. Information in files was extensive, with details that may be best archived as they do not relate directly to current care needs. Some of the documentation was unsigned and undated and risk assessments were largely in need of annual review to ensure that up-to-date assessments were available to staff. Folders showed that a broader range of assessments is needed to enable service users to be as independent as possible.
The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 10 Some examples were observed of service users making decisions, such as one person making a drink and another going out to buy a newspaper and cigarettes. The home does not hold service user meetings due to communication difficulties but the manager advised that efforts are being made to introduce a tool which can be used on a one-to-one basis to ascertain service user views. Advice was given to additionally see whether advocacy services in the area could help with this. The Cherries DS0000023062.V264700.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): EVIDENCE: None of the standards in this section were assessed on this occasion. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The delivery of personal care needs improvement at the home, to ensure that service users are afforded privacy, dignity and respect at all times. EVIDENCE: A member of staff was heard referring to service users as “honey” and “good girl” on several occasions. Assisting a service user to the toilet, a staff member called to her colleague in front of others to bring a set of clean clothes and a pad and at one stage left the service user in the toilet unaccompanied, resulting in the service user coming into a communal area of the home with her bottom revealed. There were further issues regarding infection control, which are detailed under the final section of the report under standard 42. This occurrence reflected particularly poor personal care practice at the cost of the service user’s privacy and dignity. During the second visit, no such occurrences were observed and staff were encouraging a male service user to have a shave to maintain his appearance. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 An up-to-date complaints procedure is required at the home, to ensure that service users and their representatives know who they can share concerns with. Effective adult protection and whistle blowing/public disclosure procedures are in place which need to be supplemented with Protection of Vulnerable Adults training, to best reduce the risk of harm to service users. EVIDENCE: An old complaints procedure was in place at the home, dated 2001. The manager had been given a new policies and procedures folder but the revised complaints policy had been removed. A requirement is made for a copy of the most up-to-date version to be in the home, which should mention the Commission for Social Care Inspection as an additional recipient for complaints. The log book showed that the most recent complaint was received in 2004 and appeared to be resolved. Procedures on Protection of Vulnerable Adults and whistle blowing/public disclosure were in place and available within the office. Staff cover these elements initially as part of induction and a signature sheet showed that staff had recently be appraised of the whistle blowing procedure. Training is needed for staff on adult protection to refresh knowledge. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 14 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 Improvements have been made to the environment, to ensure that service users have a safe, comfortable and well maintained place to live, but further work is needed. EVIDENCE: Various property-related issues were raised during the inspection in April this year. Attention has been given to the garden and further work is planned to improve the rear and sides of the premises. Window frames were in better condition this time with little evidence of mould growth/staining from previous mould growth. Some of the bedroom windows are in fact now looking in need of sanding down and re-glossing. The guttering was clogged with old leaves and moss and needs to be cleared. The hallway, stairwell and dining room are to be redecorated as well as the bathrooms. The schedule of works also contains plans to find ways of improving ventilation and light in the bathrooms, to bring the bathrooms up to standard. Plans for the next financial year include replacing sofas and redecoration of some bedrooms. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 15 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): 32, 33, 34 and 35 Measures are in place to ensure that service users are cared for by competent, qualified and effective staff, to meet care needs and provide continuity of care. The provider’s procedures for inducting new managers are not sufficiently structured to ensure and prove that they receive all necessary information. This could put service users’ well-being at risk from ineffective management. Induction of other staff is more effective, ensuring that care needs can best be met. There is insufficient evidence at the home to demonstrate robust recruitment, which could mean that service users are at risk of harm from the vetting procedures. EVIDENCE: Rotas showed that appropriate levels of staff are covering the home to meet current care needs. The home was fully staffed with use of agency staff only to cover periods of sickness; this is a significant achievement for the home. Minutes showed that regular staff meetings take place and various matters are raised. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 16 During the first visit to the home, a member of staff under the age of 21 was alone whilst her colleague took a service user out. There was no risk assessment in place to ensure that she had the necessary induction and backup support and training for emergency situations and this will need to be attended to. Recruitment files of the four most recently employed staff did not provide evidence of the full range of schedule 2 checks being undertaken, as original documentation is located at the provider’s central offices in Milton Keynes. Some copies of checks were available, with references and applications available in each file examined. A structured induction had not been provided for the manager, although she has attended a range of training courses and is aware that an induction package is being developed within the organisation. Induction of other staff was more effective, with verbal confirmation of undertaking a personal development portfolio, initial training and shadowing experienced staff. Written induction sheets for two agency staff were additionally seen. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 17 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 There are ineffective health and safety measures in place, which could place service users, staff and visitors at risk of harm. EVIDENCE: A member of staff was observed on the first day of the inspection leaving a toilet where she had assisted a service user, still wearing protective gloves and carrying a bag of soiled clothes and wet wipes. These were taken into the kitchen where the wet wipes were placed on a shelf and the gloves disposed of in the kitchen bin, increasing the risk of cross-infection along the way. An aerosol container was removed by the inspector from the window ledge in the staff toilet, where the container was heating in the sun. This hazard has been raised at the home before. The fire log showed that most fire safety checks are being undertaken on a regular basis and a fire-based risk assessment had been drawn up this year. Records of practice drills showed a gap of ten months in between the most recent and previous drill.
The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 18 Cleaning products were not observed to be accessible to service users on this occasion, which had been an issue in April 2005. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 19 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 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 3 1 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Cherries Score 1 x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x DS0000023062.V264700.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA9 YA18 Regulation 13(4) 12(4)a 10(1) 22(7) Timescale for action Risk assessments are to be 01/06/06 reviewed annually and the range of assessments broadened. Personal care must be carried 15/12/05 out with due regard for service users’ privacy and dignity and convey respect. An up-to-date complaints 15/01/06 procedure is to be made available at the home, referring to CSCI as an additional recipient of complaints Protection of Vulnerable Adults 01/04/06 training is to be undertaken by all staff working at the home. Window frames must be kept in 01/09/06 good condition, repainting where necessary. Previous timescale of 30/06/05 not met. There must be evidence of 15/12/05 thorough recruitment practices, in line with schedule 2, prior to staff starting work at the home. Previous timescale of 12/04/05 not met. Ways of improving light and 01/09/06 ventilation in the bathrooms must be explored. Previous timescale of 12/04/05 not met.
DS0000023062.V264700.R01.S.doc Version 5.0 Page 21 Requirement 3 YA22 4 5 YA23 YA24 13(6) 23(2d) 6 YA34 19(1) 7 YA27 23(2)p The Cherries 8 9 10 YA42 YA42 YA42 13(3) 23(4) 13(4) Proper infection control 15/12/05 measures are to be implemented at the home. Practice fire evacuations are to 15/12/05 take place at least every six months. Aerosol containers are to be 15/12/05 stored safely, away from heat sources. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA6 YA6 YA7 YA24 YA33 Good Practice Recommendations Out-of-date and unnecessary information in care plan folders should be archived. Documentation within care plan folders should be signed and dated. Advocacy involvement with service user meetings/consultation should be explored. Guttering should be cleared of leaves and moss. A risk assessment is to be prepared regarding the member of staff under 21 being left alone on duty. The Cherries DS0000023062.V264700.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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