Inspection on 20/12/05 for The Firs And Hewlitt

This inspection was carried out on 20th December 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs And Hewlitt 30/08/07

The Firs And Hewlitt 06/06/06

The Firs And Hewlitt 26/08/05

The Firs And Hewlitt 09/12/04

The Firs And Hewlitt 10/08/04

The Firs And Hewlitt 07/02/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 The Firs And Hewlitt Woodside Road Abbots Langley Watford Hertfordshire WD5 0HT Lead Inspector Mrs Alison Butler Unannounced Inspection 20th December 2005 10:00 The Firs And Hewlitt DS0000019569.V272900.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 Firs And Hewlitt DS0000019569.V272900.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 Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Firs And Hewlitt Address Woodside Road Abbots Langley Watford Hertfordshire WD5 0HT 01923 681157 01923 681157/8 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) Life Opportunities Trust Mrs Rebecca Burrows Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (15), Physical disability (15), of places Physical disability over 65 years of age (15) The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th August 2005 Brief Description of the Service: The Firs and Hewlitt is a care home providing personal care and accommodation for fifteen adults with learning disabilities, some of whom also have a physical disability. Life Opportunities Trust (LOT) owns the home, which is a voluntary organisation. The home is located on the outskirts of Abbots Langley, a short walk from a shopping precinct that includes a surgery, pharmacist, convenience store and a restaurant. A little further away is the village of Abbots Langley, which has shops, pubs and a library. There is a local bus service to the towns of Watford, St Albans and Hemel Hempstead. The home was opened in 1993 and consists of two purpose built detached buildings that are accessed via a private drive. The Firs is a bungalow comprising a lounge, dinning room, kitchen, laundry room, seven bedrooms and two bathrooms, one with a shower and hoist and one small toilet. Hewlitt is a chalet style house, with a similar layout to the Firs, except that it has six bedrooms on the ground floor and two on the first floor, accessed by a stair lift. All the home’s bedrooms are single; none of the bedrooms have en-suite facilities. The home has a large, well maintained garden area. The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the second of the required inspections for the year. The inspection took part during the morning and was conducted with the deputy manager. The majority of this inspection was spent within Hewlitt talking with the residents, looking at care plans and records and following up on the previous requirements and recommendations. A short visit was conducted at the Firs. Where the standards remain the same the information has been carried forward. What the service does well: What has improved since the last inspection? What they could do better: A number of areas within the homes require decorating and bringing up to an acceptable standard. The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 6 The Service User Guide should be made into a user-friendly document and discussion took place during the inspection about the use of pictures (WIDGET). Resident’s contracts still require signing by residents and/or their representatives to ensure their rights are maintained and protected. Training in adult protection and medication has still to be carried out although the deputy confirmed it had been booked for early in the New Year. A quality assurance audit must be carried out to review the quality of the service provided at Firs & Hewlitt. A report must be made available to all interested parties and a copy forwarded to the Commission For Social Care Inspection. 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 Firs And Hewlitt DS0000019569.V272900.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 Firs And Hewlitt DS0000019569.V272900.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): 1&5 Information is available about the service, which enables prospective service users to make a choice about whether or not they may wish to live in the home. Unfortunately they are not yet in a user-friendly format. EVIDENCE: Copies of the Statement of Purpose and Service User Guide were shown to the inspector and these are to be forwarded to the Commission For Social Care Inspection. A discussion took place with the deputy about how they may wish to put them into a user-friendlier format for the residents. New contracts are to be issued and they are due to be signed with the residents and/or families during January 2006. The Firs And Hewlitt DS0000019569.V272900.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 Residents needs are reflected within their care plan, all but one has been reviewed and developed. EVIDENCE: All but 1 of the care plans showed the individual needs and goals and these had been reviewed. The individual whose plans are not fully up to date was admitted to the home in September and a lot of information was subsequently received and the deputy is in the process of disseminating and ensuring that only relevant information is contained within the care plan. All specific needs have had plans written following the last inspection. Plans have been drawn up with the involvement of the residents, families and other professionals as appropriate. Appropriate risk assessments were in place and a discussion took place as to the best place to keep them and it was suggested that they could think about cross-referencing them if they are to be kept in one place. It is recommended The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 10 that risks relating to individuals are reviewed every six months during their care planning reviews. All information within the home is handled with care and respect and locked away as appropriate. The Firs And Hewlitt DS0000019569.V272900.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): 12, 13 & 17 Residents are able to choose which activities to take part in the local community. A healthy diet is offered. EVIDENCE: The residents spoken to during the inspection appeared happy with their lives at the home and staff were very kind. Each resident has a daily programme in place detailing what they are to be doing and when. The rotas for staff are flexible to support the residents to access the local community. A number of staff have completed the mini bus test allowing them to take residents out in the home’s transport. Staff bring in information of events that take place in the community. It may be worth the home getting a local paper delivered to keep up to date with what’s on. The menu for the week is discussed at the weekly residents meeting, occasionally this may change and this is recorded but although residents may have something different they are not recording this. It is recommended that the information is placed at the bottom on the menu record so it can be The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 12 monitored as appropriate. A menu in pictorial form is due to be introduced very soon. Staff and residents were observed to interact well with each other and show mutual respect. The Firs And Hewlitt DS0000019569.V272900.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): 18, 19 & 20 All personal and health care support is well maintained within the home, ensuring individual needs and choices and preferences are met at all times. Policies and procedures are in place to ensure they have their medication administered appropriately. EVIDENCE: All care plans promote individual needs, choices and preferences, and staff adopt a person centred and holistic approach to their needs. Assessments and reviews are carried out with the exception of one individual whose care plans need reviewing and old information should be archived. There is a designated key worker system in place to support the provision of consistency within the home. This has been made extremely difficult for staff in maintaining the care plans due to staff shortages. The staff must be commended for their hard work. Medication was inspected and the paracetamol for an individual resident was unable to be reconciled. The deputy must carry out an investigation to find the error. The temperature of the medication cabinet is recorded although no written information is available for staff on what to do if the temperature is The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 14 above 25°C. The deputy confirmed that it is covered during their medication training during their induction. Appropriate coding is now in place and the date is recorded on opening of liquids and non-dosetted medication. The deputy was unaware that medication is to be maintained for seven days following death in case of a coroner’s inquest. It is recommended that this is included in the procedure to follow in the event of death. The deputy confirmed that medication training has been booked for early in the new year. The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Views of the residents are listened to and acted on although this is not always recorded. Policies and procedures are in place to protect residents from abuse, neglect and self-harm. EVIDENCE: The home has a copy of the Hertfordshire County Council Adults at Risk Procedure, which staff are aware of. Training has been booked and will be completed by the end of January 2006. The manager had been proactive in a arranging a strategy meeting to protect a resident. This led to new protocols being put in place with involvement from the resident, family, staff and other professionals to provide safe systems of work. A resident had recently raised an issue, which had been dealt with following discussion with the individual although no formal record was found to show it had been dealt with appropriately. The manager should ensure that a record is made of the action taken and outcome. One resident has an advocate through the local day centre, referrals have been made for other residents, but unfortunately there is no one available at present. The inspector recommended that as some of the residents are elderly they may like to try Age Concern. Residents are able to raise concerns through a variety of ways, residents meetings, key worker review meetings or requesting to talk to the manager. A simplified version of the complaints procedure is given to each resident. The inspector made a suggestion that they may like to put a letter together stating The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 16 that they have an issue and would like to discuss it, the resident would then only need to sign it. It could then be place with a pre paid envelope and posted to the relevant person, e.g. the Manager. Behaviour management guidelines are being put in place for an individual resident to ensure consistency in the management of them. There has been training over the past year in behaviour management and non-crisis intervention. Following recent thefts from the home in which the police have been involved, new procedures have been put in place and only permanent staff hold the keys. The Firs And Hewlitt DS0000019569.V272900.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): 24, 25, 27 & 30 The home was cleaned to a good standard. Some areas of the home require additional work to give a more homely feel for the residents. EVIDENCE: Not all areas were fully inspected. (FIRS) The entrance and communal corridors have recently been decorated in consultation with the residents. The carpet requires replacing as it is badly stained and is looking worn. This would improve the overall feel to the entrance of the home. The main bathroom is need of a replacement radiator cover, which is rusting, and also the wooden shower chair that is looking very old and does not look pleasant for residents who have to use it. The lounge has recently been decorated but the carpet requires a steam clean or replacement again to improve the overall feel of the room. (HEWLITT) The communal corridors and entrance hall are in need of redecoration especially the paintwork that has been damaged by the general wear and tear. A resident was happy to show the inspector their bedroom, it was found to be in need of redecoration as the paintwork was flaking especially around the sink area. It had been personalised with lots of items, which they were very proud of and happy to discuss with the inspector. The garden area was well maintained. There were a number of items such as an old bed, vacumn cleaner and suitcase which were waiting to be disposed of. The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 35 Competent and qualified staff support the residents, although more permanent staff would be a benefit. The permanent staff are well trained ensuring the residents needs are met. EVIDENCE: The inspector was unable to access the staff records as the manager was unavailable during this inspection and therefore was unable to inspect standard 34. Staff were very clear of their responsibilities and roles. Each member of staff is provided with the General Social Care Council (GSCC) Code of Practice. The home continue to have recruitment issues although they have employed 3fixed term contracts with an agency giving consistency to the residents. One permanent member of staff began their employment in November 2005. The deputy stated that further interviews were taking place early in January 2006 to recruit for the vacancies. A training matrix has been introduced to enable to see at a glance if there are any shortfalls in the training. The Firs And Hewlitt DS0000019569.V272900.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): 37, 38, 39, 40, 41 & 42 The home is well managed. The health, safety and welfare of residents, visitors and staff is promoted through a series of checks and risk assessments. A quality assurance report is still to be implemented to ensure self-monitoring and review is in place. EVIDENCE: Interaction observed during the inspection was seen to be supportive and encouraging. The residents and staff are well supported and the home has a relaxed atmosphere. There is a vast range of policies and procedures in place. Staff are requested to read and sign these. All records with the exception of the staff records were available for inspection. The records are securely stored and well kept. The deputy was unable to confirm if a quality assurance report had been completed although it appeared questionnaires had been completed. The manager must arrange for a quality audit to take place and a report written The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 20 and made available to interested parties and a copy forwarded to the Commission For Social Care Inspection. The manager must remember to ensure that Commission For Social Care Inspection are informed under regulation 37 any incident that adversely affects the well being of a resident. The majority of the residents files have been sorted and old information archived with the exception of one and this is to be complete by the end of January 2006 The Firs And Hewlitt DS0000019569.V272900.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 3 X X X 2 Standard No 22 23 Score 2 3 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 2 X 2 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Firs And Hewlitt Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 3 X DS0000019569.V272900.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 YA20 Regulation 13(2) Requirement The manager must investigate the incorrect administration of medication and complete a report on the findings. A protocol must be implemented and recorded within the medication policy for the management of the temperature of the medication cupboard. This (HEWLITT) The manager should ensure the paintwork, which has been damaged by general wear and tear is brought up to an acceptable standard. (FIRS) The carpet in the entrance hall and corridors must be replaced (HEWLITT)The manager must ensure the individual residents bedroom identified during the inspection is decorated and brought up to an acceptable standard (FIRS) The manager must arrange for the replacement of the rusty radiator cover. The shower seat must be DS0000019569.V272900.R01.S.doc Timescale for action 31/12/05 has been brought forward from the previous inspection 2 YA24 23 (2) (d) 31/03/06 3 YA25 23 (2) (d) 31/03/06 4 YA27 23 (2) (d) 31/03/06 The Firs And Hewlitt Version 5.0 Page 23 replaced. 5 YA39 24 The manager must carry out a 31/03/06 quality assurance audit to establish the quality of care provided. A report must be made available to all interested parties and a copy forwarded to the Commission For Social Care Inspection. 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 Refer to Standard YA5 YA20 Good Practice Recommendations The residents and/or their representatives should sign the new contracts. This has been brought forward from the The manager should include in the medication policy and the procedure to follow in the event of a resident’s death that medication should be retained for 7 days in case of a coroners inquest. The manager should ensure that the training is carried out and all staff attend. The manager should record all concerns and niggles made and record any investigation, action and outcome. The manager should ensure that all files contain only current information all other information should be archived. This has been brought forward from the previous inspection previous inspection 3 4 YA22 YA41 The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. Extracts may not be used or reproduced without the express permission of CSCI The Firs And Hewlitt DS0000019569.V272900.R01.S.doc Version 5.0 Page 25 - 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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