Inspection on 27/03/07 for The Cherries

This inspection was carried out on 27th March 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 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cherries 03/12/07

The Cherries 17/07/06

The Cherries 21/11/05

The Cherries 12/04/05

The Cherries 10/08/04

The Cherries 26/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Cherries Heath End Road Flackwell Heath High Wycombe Bucks HP10 9DY Lead Inspector Catherine Kane Unannounced Inspection 27th March 2007 2:30 The Cherries DS0000023062.V329465.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 The Cherries DS0000023062.V329465.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. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 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.V329465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2006 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 current range of fees from information provided by the registered manager in the pre inspection questionnaire outlines annual charges of £43,904.78 per person as part of a block contract. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 2.30pm on Tuesday, 27 March 2007. The inspector was in the service for almost four hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The manager was on duty at time of the inspection visit. Three members of staff were on duty for the morning shift and two staff members were on duty for the afternoon shift. The inspector spoke with all six residents. The inspector saw staff and residents prepare for their evening meal and saw how staff help residents look after and take their medicines. She also looked at residents care plans and other records kept in the home and made a tour of the part of premesis. The inspector would like to thank the manager and her staff team for their assistance with the inspection. She also thanks residents who shared their experience of this home. What the service does well: What has improved since the last inspection? Areas of the home have been redecorated, some new furniture and equipment has been purchased and the garden has been tidied up. More staff on duty on the early shift means that residents can get out and about more. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 6 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. The Cherries DS0000023062.V329465.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 The Cherries DS0000023062.V329465.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): Standard 1 and 2. Quality in this outcome area is good. The homes statement of purpose was not up to date. The admission procedure is good although not tested, as there have been no new admissions to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose document made available by the manager provided information on what a new resident could expect if they moved into this home. However, this needed to be reviewed and updated. There have been no new admissions to this home since the last inspection. At the time of this inspection the home had no vacancies. Generally, admissions would not made to the home until a full needs assessment has been undertaken. The home would then be able to confirm that they can meet the needs of the individual through the service they deliver. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is poor. The care planning system in place to provide staff with the information they need is adequate. The home’s system for assessing risk is satisfactory but risk assessments had not been kept updated or reviewed which potentially places residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were seen during the inspectors visit. The home continues to use a care planning system that incorporates two files; these hold personal details and relevant information that considered areas of the individual’s life including health, personal and social care needs. The inspector found this system confusing; files were bulky and there was often repeated information held elsewhere within the files. Information updated on one piece of information had not been updated on the same piece of information held elsewhere. This could be confusing for staff that need these documents to be accurate so that residents receive the correct care. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 10 Guidelines seen on the management of an individual’s behaviours explained what the individuals behaviour was but did not fully explain what staff were expected to do should an event occur. Records of recent review meetings that had taken place had been included within the residents’ care plans seen. The manager informed the inspector that the home was using a listening monitor to alert staff should one resident require assistance at night. There were no clear guidelines included in the resident’s care plan. The decision to start using this equipment, which could compromise residents’ privacy, dignity or restrict their freedom, had been made by the home. While the inspector understands the decision taken to put limitations may be in the best interest of the resident this must be done only though a full care planning process if the resident is not able to give their consent. This would involve the individuals who would be able to act on the resident’s behalf, for example, their relatives or advocate and other social care or healthcare professionals. Some limited progress has been made to update the risk assessments relating to the building. However, no progress has been made to update risk assessments in residents care plans since 2003; requirements have been made for the home to address this at the last two inspections. CSCI shall consider enforcement action to ensure this requirement is complied with. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. Opportunities for people who use this service to take part in a variety of interesting activities are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the inspector was in the home during the afternoon and early evening. She spent this time with all six residents and the staff on duty. Two the six residents had some limited communication skills, with the help of staff were able to tell the inspector about their experiences of the home and some things that were very important to them. Residents do not hold house meetings but have allocated one to one time with their key worker where issues relating to the daily running of the home can be raised. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 12 Many activities provided in house were based on what residents prefer to do in their leisure time; these included puzzles and games, music therapy and aromatherapy. Each resident has a programme of regular activities outside the home that include day services, clubs and shopping. The manager stated that since the last inspection an additional staff member on the early shift every day has increased opportunities for residents to get out and about much more. Notes seen in residents’ daily diaries confirmed that this happened. Some residents had already planned for their annual holiday accompanied by staff. One resident with the help of the manager told the inspector about how they are supported to maintain their relationships with their friends and family. This was very important for them. The inspector was in the home when the evening meal was being prepared and served. Residents were involved in the setting of the table and clearing up following the meal in the dining area. The meal on the evening of the inspection was freshly cooked pasta followed by dessert. Regular drinks and snacks are available. A varied menu is provided and residents special dietary needs are catered for. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is adequate. The personal and healthcare needs of residents are generally well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Essential information needed by staff to be able to provide personal and health care support was included in residents’ files. Staff help residents to look after their own medication and see they get to see their local GP and other community healthcare services when needed. The inspector saw how the home helped residents to access specialist healthcare support when this was needed. Residents’ medicines are kept in a locked medicines cabinet situated in the home’s downstairs office. However, the inspector saw that the medicines cabinet key was kept clearly visible and accessible for potential misuse. The home uses a pharmacist produced medication administration record (MAR). Records seen were neat and well maintained. Most residents medicines are supplied in pharmacist produced monitored dose system. Records were kept of staff assessed as competent to administer residents’ medicines. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 14 The manager has completed training on medicines through a local adult education college distance-learning course. During the inspection one member of staff confidently demonstrated how a residents’ medicines are looked after and how residents are helped to take their medicines. One resident has a prescribed rectal administrated medication. Procedures are currently in place should this medication be required. It would not be in the residents’ best interest to delay this treatment for an ambulance or paramedic to attend. The home should seek advice from the residents’ GP or other specialist healthcare professional and to put in place procedures for delegated staff who have been trained by the appropriate healthcare professional who must be satisfied that they are competent to carry out this specialist healthcare task. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. The home has a protection from abuse policy and the complaints procedure is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager declared that home has received three complaints in the last year and these were responded to following the homes complaints procedures. The Commission has received no information relating to complaints in the last year. A resident who spoke with the inspector was very clear about whom they needed to speak to if they wished to make a complaint. Staff have attended specific training on protecting vulnerable people from abuse and about local adult protection procedures. Staff who spoke with the inspector were clear about their responsibilities and were aware of the homes ‘whistle blowing’ policy. The Commission has received no information relating to adult protection issues since the last inspection. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 16 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): Standards 24 and 30. Quality in this outcome area is poor. The overall quality of furnishings and fittings in this home is good but the design of parts of the building and some major maintenance that is still required does not create a pleasant environment to live in. The home was tidy and generally clean at the time of the inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection some clear improvements had been made to the environment including some redecoration, new equipment in the kitchen, new dining room furniture and work has been done in the garden area. However, major maintenance is still needed to repair to a leak in the downstairs corridor and to upgrade and refurbish bathrooms. At the time of the visit the home was clean and tidy. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 17 One resident’s deteriorating mobility means they have great difficulty getting around the home due to its layout and, in particular, safely negotiating stairs. At the previous inspection a solution to enable this resident to continue living in their home had been agreed but it required extra funding to achieve this. The delay in addressing this issue is not acceptable and puts this resident at considerable risk. The manager stated that discussions to address these issues with the local authority, who is also the housing provider and funding authority, have begun. The home must ensure that all outstanding major maintenance of the building is carried out without delay and a suitable solution sought for the resident with changing mobility needs with urgency. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 18 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): Standards 32, 34 and 35. Quality in this outcome area is adequate. This homes recruitment procedures and training for staff to do their jobs well is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visit the inspector spoke with three members of staff who were on duty. She spoke by telephone with one other member of staff the following day. The home has a core of well-established staff that understand residents’ needs and they relate well to. One staff member has left and two new members of staff has been recruited since the last inspection. There is low use of agency staff. Staff commented that morale is good. The inspector viewed two staff files selected at random. This organisation has an agreement with CSCI for it to hold centrally some specific staff recruitment documentation and maintain a signed checklist within the home. These checklists were seen during this visit and were in order. A senior CSCI manager visited to inspect staff records at the central HR office of this organisation in August 2006. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 19 General recommendations were made at that time and a review of recruitment procedures was being undertaken. The home keeps a record of training completed by staff; staff spoken with confirmed details of the training they have undertaken. From information provided by the registered manager in the pre inspection questionnaire no staff members have completed a relevant National Vocational Qualification (NVQ). The manager declared that only 3 of the 11 staff are currently undertaking NVQ programmes. This home has not achieved national targets of 50 staff with this qualification therefore it is an area needs to be developed further in order to meet National Minimum Standards where residents benefit from being supported by a well trained and qualified staff team. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is adequate. The manager has a good understanding of management areas in which the home needs to improve and needs to put plans in place to address this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced and is knowledgeable about working with people with learning disabilities. It is expected that the registered manager shall undertake further training qualifications at level 4 NVQ in both management and care. Therefore, this standard is rated as ‘standard almost met’ scored 2. Comments received from staff were complimentary about the manager and said they felt they were supported and listened to. A requirement was set at the last inspection for the registered provider to ensure that proprietors’ representative monthly visits take place and a report The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 21 produced. Only four reports have been produced in the last 12 months. The Commission no longer requires that a copy of this report is sent routinely to CSCI but a copy must be kept in the home and made available for inspection. An annual report completed by an area manager from a service user perspective is produced following the organisations “Big Respect” initiative. From this and another “Investors in Care” development meeting an action plan for the home is generated from this with timescales for the manager. However, other quality assurance, monitoring systems or annual audits that would provide the inspector with information to indicate how the home was performing and providing a good quality service were not available. The manager informed the inspector that MacIntyre Care has achieved an Investors in People award. The home has sound policies and procedures in line with current thinking and practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. The home works to a clear health and safety policy and checks take place to ensure the home meets relevant health and safety requirements and legislation. Records kept were good and are routinely completed. MacIntyre Care, who run this service, has financial and accounting systems subject to internal and external audits The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 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 2 X 2 X 2 X X 3 X The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 23 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. Standard YA7 Regulation Schedule 3 Requirement A record must be kept of decisions that have been made for residents and the reasons why these decisions have been made. Risk assessments are to be reviewed annually/or as needs change and the range of assessments broadened. (Previous two timescales of 31/08/06 and 01/06/06 not met.) The keys for the medicines cabinet must be kept securely. A protocol must be put in place regarding the administration of rectal diazepam. Staff must be assessed and deemed competent to carry out this procedure. Records of individual staff’s assessment and competency must be maintained to support this. (This requirement was only partially met.) The home must provide CSCI with written details of the outstanding major maintenance that requires attention and timescales for this work to be carried out. DS0000023062.V329465.R01.S.doc Timescale for action 15/06/07 2. YA9 13(4) 15/06/07 3. 4. YA20 YA20 13(2) 13(2) 30/04/07 15/06/07 5. YA24 23(2) 15/06/07 The Cherries Version 5.2 Page 24 6. YA24 23(2) 7. YA39 26 The home must provide CSCI with written details of how it intends to find a satisfactory solution to the accommodation needs for a resident with deteriorating mobility to enable them to continue living in their home and timescales for this to be achieved. Monthly monitoring visits must take place and copies of the reports made available at the home. (Previous timescale of 31/08/06 was not met) 15/06/07 15/06/07 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 Refer to Standard YA35 Good Practice Recommendations More staff should be supported to undertake NVQ qualifications. The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 The Cherries DS0000023062.V329465.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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