CARE HOME ADULTS 18-65
Vicarage Road (62) 62 Vicarage Road Buntingford Hertfordshire SG9 9BA Lead Inspector
Patricia Rogan Unannounced Inspection 6th August 2007 3:00 Vicarage Road (62) DS0000019603.V348588.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 Vicarage Road (62) DS0000019603.V348588.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. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Vicarage Road (62) Address 62 Vicarage Road Buntingford Hertfordshire SG9 9BA 01763 273191 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.grantahousing.org.uk Granta Housing Society Limited Manager post vacant Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Vicarage Road is part of Granta Housing Association Ltd. The home is situated at the end of a cul-de-sac in a quiet residential area of Buntingford and within walking distance of the town centre. The ground floor consists of a lounge with dining area, a kitchen with breakfast area, a utility room, one single bedroom and a W.C. The first floor comprises three single bedrooms, bathroom and toilet. There is a small office that is also used as the staff sleeping-in room. To the front is a large driveway to the home where the homes vehicle is parked and a small well tended garden. There is a larger garden to the rear of the property. The home is registered for 4 service users with a learning disability including those over 65 years of age. Vicarage Road was first registered 2nd September 1993 under the Registered Homes Act 1984. The fees at the time of this inspection range from £931 to £1007 per week. Fees are calculated according to the assessed care and support needs of people who use the service. The Statement of Purpose and Service Users Guide is available in various formats and provides additional information about the home for referring professionals and prospective clients. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included a visit to the home and one to one meetings with people who use the service and members of staff. Some family members and health and social care professionals were asked for their views via postal questionnaires and telephone discussions. The manager completed a comprehensive quality assurance document which covers many aspects of the way that care and support is provided in accordance with the National Minimum Standards. What the service does well: What has improved since the last inspection?
The majority of the requirements and recommendations made after the previous inspection have been met. There is to be an introduction of care plans which cover every aspect of how care and support is to be provided and the format uses Widget symbols to ensure that the information is easily understood by people with communication or reading difficulty. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 6 Photographs of each resident and member of staff are available for easy identification. Medication administration meets requirements and the procedure for people managing their own medication is good. There is evidence to show that residents or their representatives, where relevant, have been fully involved in the decisions regarding contributing their Mobility Allowance towards the upkeep of the minibus, which is used by the residents. 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. Vicarage Road (62) DS0000019603.V348588.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 Vicarage Road (62) DS0000019603.V348588.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place for ensuring that any prospective resident of this home would have a full assessment of personal care and social support needs. EVIDENCE: There has not been a new resident for some time but an inspection of one file showed that there had been a carefully recorded and in depth assessment prior to the decision to invite the prospective resident to spend time in the home. The file also had the views of the resident and family members following a visit and an overnight stay in the home and further evidenced that residents were helped with making the decision to move into the home. Vicarage Road (62) DS0000019603.V348588.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): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are individualised and reflect the changing needs of residents. Several methods are used to ensure residents choices are recorded and implemented. Risk assessments are appropriate and relevant without unnecessarily curtailing how each person wishes to live their lives. EVIDENCE: The care plans reflect the individual needs of the residents and as needs and abilities have changed, this has been recorded. Each resident has been included in the decision-making and this is shown by the comments recorded in the file and by signatures made where appropriate. The case files and daily record sheets show that the residents are regarded as individuals and they are helped to be as independent as possible. New care plans which will be even more helpful to residents, have been prepared and will be completed using Widget symbols for those people who have communication difficulty. Vicarage Road (62) DS0000019603.V348588.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have access a wide variety of activities in the local community and with their peers and with family and friends. Residents rights are respected. Meals are nutritious, seasonal and plentiful. EVIDENCE: Discussion with the people who use this service and an inspection of the records of activities that they have attended, shows that all the residents experience an interesting and stimulating lifestyle. One resident said, They are good here, they make sure I have a good life. Staff took the residents to a seaside holiday camp for a week and all the residents were keen to show the photographs of this holiday. Some residents go to day centres or college and visits to families and friends are encouraged. Shopping for food involves the residents and they are also helped to develop cooking skills by assisting with menu choices and preparing the meals and drinks.
Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 11 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): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care is individualised and reflects the needs and abilities of the resident. Access to health and social care professionals is always available. Medication administration policy and procedures, including how people can manage their own medication is stringently adhered to. EVIDENCE: People who use the service are encouraged to be as independent as possible by developing the confidence and skills to live as they choose. When assistance is needed, this is provided discretely and respectfully. This good practice was seen during the inspection when a member of staff waiting outside the bathroom while a resident took a shower and did not enter the bathroom until she was asked to do so by the resident. How personal support is to be provided was recorded in the care plan and when there was a change to this, the care plan was amended. Any input by a health or social care professional was recorded and if advice was given, this too was recorded and relayed to the staff on duty. One resident is helped to self -medicate and given support to store it safely and securely.
Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 12 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): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A positive response from people who use the service and from people who know how this service is managed showed a confidence that poor practice would not be tolerated. There is a good system in place for responding to allegations of abuse or concerns about the well being of residents. EVIDENCE: People who use this service were relaxed with the staff on duty and they said they would be prepared to tell the manager or a member of staff they felt comfortable with if they were unhappy with any aspect of their lives. In addition to this, residents are enabled to attend larger meetings where their opinions about the service and how the organisation is run can be shared. The majority of the staff have known the residents for several years and changes to demeanour or body language would be noticed and the person would be supported in expressing any concerns. There are regular residents meetings and one to one chats with residents and there are frequent reminders that it is important to speak of anything that concerns them. A record of concerns and how these are addressed to resolve matters are also recorded. All staff have training in safeguarding adults and have signed a whistle blowing policy, which stresses the expectation that any suspicion or allegation of poor or unprofessional practice must always be reported. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 13 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): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained to a high standard and is pleasant, clean and homely. EVIDENCE: The appearance of the home is that of a large domestic house and the decorations and furnishings are in good repair. All areas of the home that were seen were clean and hygienic and in good decorative order. The residents help with some domestic chores, such as doing personal laundry and tidying their own, personalised bedrooms. The kitchen is large, clean and spacious and there are plans to refurbish this. One resident was pleased a dishwasher is going to be included when the kitchen was changed. The garden is well maintained and there is wheelchair access via a ramp. A large patio with improved seating is going to be created for the residents to enjoy. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 14 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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training and qualifications are relevant to their roles and needs of the service. Sleep-in staff work a twenty-four hour shift and it is not recorded whether the views of the staff who do this have been taken into account. Recruitment vetting procedures are stringently carried out. EVIDENCE: There is a training programme that is designed to ensure that competent and skilled staff have the ability to support and enable the residents to enjoy a safe and interesting lifestyle. One person who completed a questionnaire said she felt that the training courses helped her to feel more confident. Staff are enabled to study for the NVQ (National Vocational Qualification). Sleep-in staff work a twenty-four hour shift but it is unclear why the rota cannot be changed to enable these staff to go home after the sleep in or to start work the evening before the sleep-in. This was noted at the previous inspection a year ago and for this reason, the requirement remains in place. Recruitment procedures are strictly followed and monitored by the organisations human resources staff.
Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 15 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): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is professional and qualified and ensures that the people who use the service live in a safe, well run home. People who use the service are involved in decisions made about how the service is run. EVIDENCE: The manager was described by a care professional as, Dedicated to the welfare of the residents. She sets high standards for the staff and is keen to develop their knowledge and skills. She has an open-door policy, which gives residents and staff confidence to express their views. During the visit to the service and by reading the comprehensive annual quality assurance document, her commitment to the health, safety and welfare of the residents and staff was clear. She has a good relationship with families and when working others Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 16 involved in the service, she represents the organisation in a professional, responsible manner. An application for registered manager is being made. Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 17 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 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 3 25 x 26 x 27 x 28 x 29 x 30 3 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 3 x 3 x 3 x x 2 x Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 18 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 YA33 Regulation 18(1)(a) Requirement The staffing rotas show that many staff work very long hours and long shifts. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations and to meet the needs of the residents. Timescale for action 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Vicarage Road (62) DS0000019603.V348588.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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