Inspection on 06/06/06 for The Firs And Hewlitt

This inspection was carried out on 6th June 2006.

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 3 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 20/12/05

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 Jeffrey Orange Key Unannounced Inspection 6th June 2006 07:25 The Firs And Hewlitt DS0000019569.V299584.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 Firs And Hewlitt DS0000019569.V299584.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 Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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 hewlitt@lifeopportunitiestrust.co.uk tanners@lifeopportunitiestrust.co.ukwww.lifeopp ortunitiestru Life Opportunities Trust 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) 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.V299584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 20th December 2005 Brief Description of the Service: The Firs and Hewlitt is a home providing personal care and accommodation for fifteen adults with learning disabilities, some of whom also have a physical disability. The home is owned and managed by Life Opportunities Trust (LOT), which is a voluntary organisation. The Firs and Hewlitt 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 home has a Service User’s Guide and Statement Of Purpose, which sets out information about the home and the services offered for prospective service users. Current charges are £860 per week (as at 6/6/06). Additional charges are made for hairdressing, personal toiletries and newspapers. Copies of the previous inspection report by the Commission for Social Care Inspection (CSCI) are available in the home. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been drawn up following a site visit to the service that started early in the morning and continued through to mid-afternoon. This provided an opportunity to speak to service users, observe how their care was delivered and to speak to staff, including the management team. It was also possible to look at records and to tour the premises. This report also draws on any information received by the CSCI since the previous inspection in December 2005. What the service does well: What has improved since the last inspection? What they could do better: The environmental issues identified during the previous inspection are in the process of being addressed but have not yet been completed. There were some errors found in the administration of medication records and the standard of storage of materials that could potentially prove hazardous to service users was not satisfactory. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 6 The service is currently without the active participation of the registered manager and although the acting management team, with input from the LOT senior management team, are coping well, the home will nonetheless benefit from the having a consistent and effective registered manager active in post. 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.V299584.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 Firs And Hewlitt DS0000019569.V299584.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 245 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information is made available to prospective service users, which should, together with the opportunity that is provided for trial visits and overnight stays, mean that they are in a position to make an informed judgement about living in the home. EVIDENCE: Information was recently provided to the CSCI about trial visits that had been arranged for a prospective service user, who subsequently moved into the home. The home has reviewed its Statement of Purpose and Service user guide to make sure that it is in an appropriate format for service users to readily understand – it is understood that this work continues. A robust pre-admission process was seen to be in place which should prevent people whose care needs cannot be adequately met being admitted. The Firs And Hewlitt DS0000019569.V299584.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 679 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflect the needs of service users and how they are to be met. There is a robust process of review in place to identify when those needs change and service users are supported and encouraged to retain as independent a life as possible, within a risk assessment framework. EVIDENCE: Care plans were seen to be comprehensive and kept up to date. They had been reviewed to ensure that service users changing needs could continue to be appropriately met. Service users were seen to be being asked about the routines of the day in order to ascertain their wishes and preferences for example as to lunches and attendance at day centre. One service user went down to the local shops unaccompanied. He informed staff that he was going and his return was discretely monitored, this sensible, risk assessed approach, enabled him to exercise reasonable control in this area of his life. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 10 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 15 16 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported and enabled to take part in a range of activities that meet their need for social interaction and stimulation. Meals are provided for service users that reflect their own preferences and choice, whilst also providing a sound nutritional intake in line with expert guidance. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care plan and person centred planning documentation seen includes evidence of service users’ involvement in a wide range of social and day care activities. Service users went off to day centres during this visit and some were able to give details of where they were going and what they would do. Staff draw up the daily menus with input from service users, based upon their known and expressed preferences, care plans include advice from dieticians to assist in providing well-balanced and nutritious meals. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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 19 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care is provided to service users in line with their requirements and in the way that they want it to be given. The involvement of a range of health professionals enables the general and specific health needs of the home’s service users to be adequately met. Whilst the medication policies and procedure is essentially sound, there are occasions when the standard of recording is not satisfactory. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care plans include evidence of the active involvement of a range of healthcare professionals with service users. The standard of care seen was good and was being provided in a way that was based on an individual knowledge and understanding of the service user and their preferences. Medication records seen included a number of errors such as gaps in the administration charts and some totals of medication spot-checked did not agree with the records. The basic system in place and the home’s medication policies and procedure are however satisfactory and should, if followed, enable medication to be administered safely. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures, provided in a format that can be readily understood by service users, are in place to protect them from abuse, neglect and selfharm. EVIDENCE: The home follows the Hertfordshire County Council Adults at Risk procedure and staff receive training in adult abuse, what it is, how it might be recognised and the appropriate action to take if it is. Documentation seen contains records of occasions when meetings have been held under the above policy in order to discuss how service users may be best protected from potentially abusive situations. There are a regular service user meetings held in addition to key worker review meetings, which allow opportunity for service users to make their concerns, if any, known within the home. The service users are generally well able to make their views known and as they are involved outside of the home with a range of health and social care professionals, they have opportunities to do so. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment of the home is essentially satisfactory, there are however a number of what may be regarded as minor issues, which cumulatively detract from the overall appearance and feel of the home. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 16 EVIDENCE: There was a minor but noticeable problem with odour in Firs. Fire doors marked keep locked were not and bleach was found in an unlocked cupboard under one sink unit, both of which represent risks to the health and safety of service users. There are minor maintenance issues such as broken fascias in the Hewlitt kitchen, the blind for the front door at Firs and the plastic strip, put on to protect the corners of walls in Firs that still have the bar-codes visible on them which is unsightly, there are also areas of wall, where hand rails have been removed that require making-good. The bins containing cigarette butts outside the entrances to the home should be emptied more frequently as they do not present a very attractive “first impression” on entering the home. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment, training and supervision practice is adequate to offer protection to service users and to ensure that their care needs are met by staff with the necessary skills and training to do so appropriately and safely. The use of long-term agency staff has improved care continuity for service users, this will be further enhanced when adequate permanent staff are recruited to fill all vacancies. The home is currently lacking the day to day management and co-ordination input of the registered manager, which is having an effect on the monitoring of things such as medication, health and safety and food hygiene in the home. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 18 EVIDENCE: Staff files were seen, and documents, or confirmation about recruitment, were provided by the head office staff, contacted during this visit. Discussions were held with members of the acting management team, staff both permanent and long-term and the home’s training matrix was seen. The number and range of lapses in medication, health and safety, security and food hygiene practice suggests that, despite the efforts and commitment of the acting management team, assisted by the service development manager, the absence of the registered manager is nonetheless having a negative impact on the co-ordination and monitoring of the staff team. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite the efforts of the acting management team, assisted by the service development manager, the home is lacking the effective day-to-day input of the registered manager. This has resulted in a number of areas of practice that have not been adequately monitored. It is recognised however that the efforts of the acting management team have ensured that good care outcomes have been sustained for the homes’ service users, for which they deserve credit. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 20 EVIDENCE: The kitchen door to Firs was open and unattended at 7.30 am, making unsupervised access to the home possible. Fire doors, marked keep locked were left unlocked. There were gaps in medication records and medication totals did not agree in every case. There were failures in the control of substances hazardous to health. Not all jars of food had been dated on opening. The temperature records for meat did not appear to be complete and in Firs the fridge temperature had not always been recorded. Service users are involved in the planning and review process of the home and take part in the decision making process. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 3 5 3 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 1 2 3 X X 2 X The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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 YA20 Regulation 13(2) Requirement Any gaps in medication records must be identified at the earliest possible opportunity and appropriate action taken to ensure that service user’s health is not compromised as a result. Regular audits must be undertaken to ensure that the records of medication held on behalf of service users are accurate and up to date. A protocol must be included within the medication policy, for the management of the temperature of the medication cupboard. This has been brought forward from the previous inspection, as it has not yet been added to the home’s policy for the administration of medication. 2. YA24 23 (2) (d) The problem of odour in Firs must be addressed by use of an effective cleaning regime or if necessary replacement of floor coverings. 30/06/06 Timescale for action 06/06/06 The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 Page 23 3 YA42 13 (4) The security of the home must be reviewed and appropriate action taken in the light of that review to ensure that unauthorised access to the home is prevented. All materials covered by the control of substances hazardous to health regulations must be stored appropriately. Food hygiene practice in respect of food storage and the recording of temperatures of refrigerators and cooked meat prior to serving must be reviewed and action taken, in the light of that review to ensure that it fully complies with current good practice. 06/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA43 Good Practice Recommendations The registered provider should review the management structure of the home to ensure that the current registration as one service, with one registered manager, is still effective and appropriate. The Firs And Hewlitt DS0000019569.V299584.R01.S.doc Version 5.2 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.V299584.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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