Inspection on 17/01/08 for Hillgreen Care Limited

This is the latest available inspection report for this service, carried out on 17th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Hillgreen Care Limited 53 Myddleton Road London N22 8LZ Lead Inspector Brian Bowie Key Unannounced Inspection 17th January 2008 08:30 Hillgreen Care Limited DS0000070205.V355997.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 Hillgreen Care Limited DS0000070205.V355997.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. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillgreen Care Limited Address 53 Myddleton Road London N22 8LZ 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) 020 8365 7272 020 7365 7272 Hillgreen Care Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 5 First inspection of new home Date of last inspection Brief Description of the Service: 53 Myddleton Road is registered to care for five adults who have a learning disability. The home specialises in providing care for people who have a learning disability, autistic spectrum disorder and challenging behaviours. The home is situated near Wood Green in North London. There are local shops, cafes, churches, leisure centre and other community facilities within walking distance. It is close to local bus routes and underground stations. The house consists of five single bedrooms with en-suite toilets and hand basins, a lounge, dining room, kitchen, bath and shower facilities and a garden. Hillgreen Care Ltd also operates other similar care homes locally. The placement fee charged by the home ranges from £1,500-£1,650/week. Hillgreen Care makes available to residents, families and prospective residents information detailing the service provided by 53 Myddleton Road. Hillgreen Care intends to circulate inspection reports to families. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over one day and lasted 9.0 hours. The acting manager and service manager for Hillgreen Care were present throughout most of the inspection. The service manager for Hillgreen Care, acting manager and staff at the home assisted with the inspection and were interviewed. We saw 4 of the 5 people resident in the home at the time of the inspection. Some residents have difficulty communicating verbally. Throughout the inspection the way in which staff communicated with and supported residents was observed, as well as how residents got on with staff. A variety of records, including care plans, staff files and health & safety documents were looked at. In addition phone interviews were held with a social worker who has regular contact with the home and a parent of one of the residents. We were assisted with the inspection by an ‘Expert by Experience’ and his support worker. An Expert by Experience is a person who because of their shared experience of using services visits a service with an inspector to help them get a better picture of what it is like to live in or use the service. We would like to express our particular appreciation of the contribution made by the Expert by Experience, with the help of their support worker, with this inspection. The Expert by Experience provided a detailed report of their findings. We have drawn on their valuable comments and observations when producing this inspection report. The overall impression from this inspection is that 53 Myddleton Road provides a good standard of care to residents. Both staff and the management team are working hard to provide good support to a particularly challenging group of residents. What the service does well: Members of staff have got to know the residents very well and understand their individual needs and preferences. As a result residents with very specialised needs and some challenging behaviours have settled in quickly at 53 Myddleton Road in the 6 months the home has been opened. One resident said: Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 6 ‘I like it. It’s my home. There’s nice staff and nice clients. I like my room. I’ve got new friends at college.’ Each resident is seen and treated as an individual in their own right. This means each resident follows a different programme of activities during the week according to what they want to do. This is enabling the residents to build and develop a positive and individualised lifestyle. One relative said: ‘We’re very happy with the home. It seems to be very well organised. Our relative has settled well- I’m impressed.’ There is a committed team of staff at 53 Myddleton Road who work well together. Care plans for residents are detailed and set out clearly each resident’s needs. The staff have had a significant amount of training in working with adults with learning disabilities, including those with challenging behaviours. Consequently the residents get the benefit of living in a home where they feel understood and supported. Residents benefit by having specialist help when they need it. This includes support from local learning disability services as well as consultancy input that Hillgreen Care uses, particularly to help staff manage as well as possible the complex behaviours of the current group of residents. What has improved since the last inspection? What they could do better: From this inspection there are 3 areas the home has to improve. In order that the needs of residents are properly met at all times the home needs to achieve the following: Risk assessments in areas that affect the freedom of movement of individuals must be agreed in conjunction with residents as far as possible, relatives and relevant professionals and regularly reviewed so that a balance is achieved between safeguarding residents and not being unnecessarily restrictive. Regular health and safety checks of the premises must be made so that residents are properly protected at all times. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 7 Security procedures at 53 Myddleton Road must be in place that safeguard residents. These procedures need to take into account the individual needs of residents and comments from the local fire service. 8 recommendations are made to highlight ways in which practice can be further improved at the home. Care plans and records relating to residents should reflect more a person-centred approach to supporting people so that residents’ individual wishes are better responded to. It is recommended that staff at the home become more informed about the work being done with their residents at college and other projects so that they can talk more with residents about these activities and provide opportunities in the home to build on skills such as cooking or gardening. It is recommended that a wider variety of activities is available to residents so that their needs in this area can be better met. It is recommended that staff have specific training in the area of personal and sexual relationship for young adults with learning disabilities. Staff should enable residents, and those acting on their behalf, to communicate further their concerns so that they can be recorded in the complaint book to provide evidence that these issues are then taken up and sorted out. Staff should discuss with residents and families how to make 53 Myddleton Road more homely in appearance. Staff should actively involve residents in developing the garden as an attractive area in a way that develops their skills and interest in this area. All care staff should have further training in person-centred planning so that the home responds even more to the needs and wishes of the residents. These areas for improving the service were discussed and agreed with the acting manager and service manager. 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. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 8 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 Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 9 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving into the home can be confident that their needs will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met. EVIDENCE: The files for 3 of the residents were looked at and indicated that before they moved in a full assessment had been received from Social Services. A care plan had then been drawn up by the home showing how these needs were to be met. Given their challenging behaviours and communication difficulties residents gave the impression of feeling settled and supported at the home. Annual review meetings with Social Services indicated that residents are appropriately placed and their needs are being met. Residents spoken to said they liked living at 53 Myddleton Road. Observation throughout the inspection showed that residents are appropriately placed at 53 Myddleton Road. This indicates that the home is careful to ensure that it is able to meet the needs of new residents and does not admit people Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 10 whose needs it is unable to meet. A college tutor had commented at a placement review about one of the residents: ‘We’re so pleased with how this individual is doing. They are settled, happy and redeveloping their confidence. This has to be down to the great attitude and care from all the staff at the home.’ Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 11 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): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provided detailed information so that the needs of residents are met. Staff at 53 Myddleton Road are good at finding ways for residents to make as many decisions for themselves as possible. As a result residents are helped to make choices for themselves. Residents are protected by risk assessments that are comprehensive and indicate clearly how risks to the safety of residents are reduced. However residents do not have the protection of risk assessments in relation to their freedom of movement that have been discussed and agreed with all relevant parties. EVIDENCE: Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 12 ‘I like it. It’s my home. There’s nice staff and nice clients. I like my room. I’ve got new friends at college.’ This was the view of one of the residents interviewed. Throughout the inspection residents were observed in their daily routines and their contact with staff. Residents were clearly relaxed with staff and looked to them for support and guidance. Residents are enjoying being in a place that is able to give them time and space so that they can find a way of living with other people which is difficult for each of them. The records for 3 residents were looked at and indicated that for each one there was a current plan of care. Each care plan set out the needs of the resident and how they are to be met by the home. These plans have strategies in place to enable staff to deal with the residents’ challenging behaviours. As a result of staff becoming more aware of person-centred planning in relation to adults with learning disabilities the home is getting better at responding to the needs and wishes of residents. It is recommended that care plans and records relating to residents reflect more a person-centred approach to supporting people. The service users’ independence is being promoted by staff at 53 Myddleton Road who offer them choice in choosing activities they enjoy and assisting them to develop in all aspects of their daily living skills. Throughout the inspection members of staff offered choices to residents. People made choices about when they got up in the morning and when they had their meals. All plans recognise potential risks to residents and the risks that they may pose to others. The plans outline how these risks can be minimised, for example ensuring adequate staffing at particular times of the day. The plans also highlight what things might anger or agitate each resident and how these can be avoided or managed. As a result residents feel more relaxed and settled in the home so that there are fewer incidents of challenging behaviour. Staff interviews indicated that members of staff understand how to support residents. They do this in line with guidelines that have been developed in conjunction with the consultant psychologist who advises staff on how best to manage the challenging behaviours presented by the residents. The home is achieving a good standard in this area that is enabling people with complex needs to manage well in a small group living situation. On the morning of the inspection a resident managed to get out of the building unsupervised and had to be brought back by a member of staff. As a result of a similar previous incident with this individual the front door was being kept locked in order to safeguard this resident. On this occasion the door had not been left locked as required. Staff must ensure that there are satisfactory security arrangements regarding the premises in place at all times so that residents are protected. Further action to be taken by the home is detailed in Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 13 the section of the report relating to management and safety in the home. The home must ensure that risk assessments in areas that affect the freedom of movement of individuals are agreed in conjunction with residents as far as possible, relatives and relevant professionals and regularly reviewed so that a balance is achieved between safeguarding residents and not being unnecessarily restrictive. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 14 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): 12,13,15,16,17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is good at enabling residents to get out so that they lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community and the range of leisure activities available. Staff support residents so that they benefit from the close contact they have with friends and family. Residents benefit by having staff who respect their rights and encourage them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 15 Each resident has an activities programme and is encouraged to develop interests. Feedback from staff and examination of records confirmed that residents take part in a variety of activities, including college classes. One resident was attending a catering course and another one was attending a gardening project. The ‘Expert’ felt if the support workers knew more about the college activities this could be built on in their work with residents at home. It is recommended that staff at the home become more informed about the work being done with their residents at college and other projects so that they can talk more with residents about these activities and provide opportunities in the home to build on skills such as cooking or gardening. Cultural needs are identified in care plans and responded to. Meals provided reflect the differing ethnic backgrounds of the residents. Staff spoken to were aware of the cultural backgrounds of residents and took this into account when supporting them. Feedback from residents and staff showed that residents get out and about in their local community, including going shopping and on outings. An activities organiser helps to find suitable activities for residents. The ‘Expert’ felt the weekly activity plan could be improved as bowling or the cinema seemed to be the main activities on offer. The acting manager had identified this as an area for the home to improve upon. It is recommended that a wider variety of activities is available to residents so that their needs in this area can be better met. ‘Thanks for looking after our relative and being such lovely people.’ This was the comment from parents of one of the residents. Residents in most cases are having regular contact with their families. The staff team keeps in touch with families. Care plans note the residents’ needs in relation to personal and sexual relationships. Given that 4 of the residents are around 18 years in age it is important that staff are able to support residents effectively in this area. It is recommended that staff have specific training in the area of personal and sexual relationship for young adults with learning disabilities. Observation throughout the inspection indicated that staff treat residents with respect and are patient when persuading residents to do something or to change their behaviour. This was helping individuals who in some cases had high anxiety levels to feel more secure and relaxed in the home. If a resident wanted to be on their own in their bedroom this too was respected. Residents interviewed said that they enjoyed mealtimes and get a choice about what they eat. The ‘Expert’ was pleased residents had input into the food menu and drinks, snacks and fresh fruit was available between meals. The Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 16 menus seen showed that residents get a variety of food, with cultural preferences responded to, and with a suitable range of healthy food. Where a resident is overweight a plan is in place to encourage healthy eating. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 17 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): 18,19,20 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are good at supporting residents so that residents feel more at home and relaxed at 53 Myddleton Road . Staff are good at supporting residents so that their physical and emotional health needs are met. The residents are protected by effective arrangements regarding medication in the home. EVIDENCE: ‘It is nice here. I like my keyworker- she’s nice. ‘ Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 18 This was the comment of one of the residents about their life at 53 Myddleton Road. The care plans are detailed and set out clearly how staff should respond to the individual needs and wishes of residents, with guidelines about dealing with any challenging behaviours. As a result individuals with challenging behaviours and high anxiety levels feel more relaxed which in turn enables them to have improved relationships both with other residents and with staff. A keyworker system is in place so that each resident has a member of staff who has special responsibilities towards them, including reviewing their needs monthly, helping them to look after their bedroom and buying any clothing needed. Interviews with staff showed that staff had a good knowledge of residents’ needs, interests and preferences. ‘Both residents have settled in very well. Theyr’e both happy and calmer at 53 Myddleton Road. Staff involve them in reviews.’ This was the view of a social worker who had placed two people at 53 Myddleton Road. The social worker also commented on the positive effect of the input from the behavioural therapist employed by Hillgreen Care on helping staff to manage the challenging behaviours of residents. They also added: ‘Hillgreen Care is good at communicating with the learning disability team on how the residents are getting on.’ Health needs are responded to with evidence seen of referrals made to other relevant professionals. The local psychiatrist sees the residents to assess their wellbeing and decide if changes in medication are needed. Daily records are kept of when residents have had baths, showers, hair washing, shaving, nail care to ensure these personal care needs are met. Medication arrangements were gone through with the acting manager and were satisfactory. The records relating to the administration of medication to residents were seen and indicated that a detailed and accurate record is being kept. All staff have had guidance about the home’s procedures regarding medication. The home uses a monitored dosage system that helps to reduce the likelihood of mistakes being made in medication arrangements. Some residents have medication which can be administered as needed to reduce the individual’s level of agitation and/or challenging behaviours. Guidelines to staff about the usage of this ‘prn’ medication were in place. A member of staff has designated responsibility for overseeing medication arrangements and has had appropriate training for this task. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 19 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): 22,23 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home deals well with complaints so that residents and relatives feel confident their complaints and concerns will be listened to and acted on. The residents are protected by adult protection procedures that make sure that they are safe and secure whilst at 53 Myddleton Road. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints. The complaint record showed that no complaints had been made since the home opened. During the inspection residents were seen approaching staff and letting them know by their behaviour and/or body language if they were worried or unhappy about something. Staff responded quickly to residents and tried to resolve issues sooner rather than later. As a result of staff acting on concerns residents are helped to keep as calm and relaxed as possible, despite having high anxiety levels. It is recommended that staff enable residents, and those acting on their behalf, to communicate further their concerns and that these are recorded in the complaint book to provide evidence that these issues are then taken up and sorted out. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 20 A comments book is kept so that families and professionals can make observations on the care provided. Comments in the book from both families and professionals were positive, with one comment being: ‘We’re so pleased with how our relative is doing. They’re settled, happy and redeveloping their confidence.’ Staff have attended training courses on how to protect vulnerable adults from abuse and know what to do if they think a resident has been the victim of any form of abuse. Regular in-house sessions are held to remind staff of their responsibilities in this area. The London Borough of Haringey’s adult protection procedure is displayed on the notice board. Incidents are recorded using a what happened before/during/after format to assist with understanding better the reasons for the incident so that staff can work with residents in a way that minimises incidents, such as arguments between residents. There had not been any adult protection allegations since the home opened. As a result residents are protected by the arrangements in place in the home in relation to safeguarding adults. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 21 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): 24.30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at 53 Myddleton Road benefit from living in a small home where staff can pay attention to their individual needs and wishes. However residents do not have the full protection of regular health and safety checks being made of the premises. Residents enjoy a hygienic and clean living environment that adds to their quality of life. EVIDENCE: ‘The ‘Expert’ was pleased with the full co-operation of all the staff at the home. They liked the layout of the rooms and each resident has their own en-suite bathroom with a shower or bath.’ Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 22 The home is attractively furnished and decorated and is comfortable for the residents. ‘The ‘Expert’ liked the decor of the home but felt it was cold as all the rooms have wooden floors with no carpets or rugs.’ The house still feels like a new home with further work needed to make it more homely and reflect more the individual preferences and tastes of the people living there. It is recommended that discussions are held with residents and families to find ways of making 53 Myddleton Road more homely. ‘The ‘Expert’ felt the garden was bare with no furniture and very few flowers, as a resident had expressed an interest in gardening, it was suggested they could start their own area with support from their keyworker.’ It is recommended that residents are actively involved in developing the garden as an attractive area in a way that develops their skills and interest in this area. Residents’ bedrooms had been personalised with photos and posters, as well as having televisions and music players. In order to ensure the premises are kept safe regular health & safety checks must by made. The acting manager acknowledged these regular checks were not in place. The acting manager must ensure regular health and safety checks of the premises are made so that residents are properly protected at all times. Following the inspection a proforma for carrying out these checks was provided with a commitment to making regular checks. Throughout the inspection the home was seen to be clean and hygienic. Interviews with staff confirmed they understood about the importance of maintaining good standards of hygiene in the home and were taking appropriate action to ensure this was achieved. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 23 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): 32,34,35 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a committed, skilled and experienced team of staff. As a result residents’ needs are met. Residents are protected by the home’s recruitment procedures for new staff and by there being in place a staff rota that is always accurate and up to date. Staff have the relevant skills and training. As a result residents are supported effectively and enjoy as good a quality of life at 53 Myddleton Road as possible. EVIDENCE: ‘The staff provide very good and skilled support.’ This was the comment of a professional who has regular contact with the home. Feedback from relatives was also positive. Throughout the inspection Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 24 staff were seen to take time in listening to and responding to the needs and wishes of residents. Staff supported one resident to go out and attend college which they clearly enjoyed doing. Most members of staff have either achieved the NVQ Level 2 in care or are currently working towards this. Staff interviews showed that staff have built a good knowledge of each resident’s needs and wishes and how to support them in a way that develops their confidence and skills as far as possible. Consequently residents are being skilfully supported which is contributing to decreases in incidents of challenging behaviours. Staff files were looked at and contained the information needed to make sure that all new staff in the home have had the appropriate checks made, including obtaining written references and satisfactory CRB disclosures. As a result residents are protected by the procedures Hillgreen Care has in place when recruiting staff. New members of staff have a planned and thorough induction into the roles and responsibilities of being a care worker. The staff team has attended a range of relevant courses, including Safeguarding Adults, epilepsy, medication, challenging behaviours, and working with people with communication difficulties. This is in addition to training in essential areas such as first aid, food hygiene and health and safety. As a result staff are more effective in how they support residents, for example by giving residents choices whenever possible. Staff interviews indicated that they have some knowledge of personcentred planning, with elements of this approach in place in the home and some training provided. Given the importance of this approach in working with people with learning disabilities it is recommended that all care staff have further training in person-centred planning so that the home responds even more to the needs and wishes of the residents. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 25 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): 37,39,42 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well run home. Members of staff respond to and act on comments and suggestions from residents about how the home is run. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times. Residents do not have the full protection of security procedures in the home that have been discussed and agreed with all key parties. EVIDENCE: Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 26 ‘We’re so pleased with how our relative is doing………This has to be down to the great attitude and care from all the staff here.’ This was the comment of relatives of one of the residents and reflected the positive feedback received about the home from families and professionals. Care practice at 53 Myddleton Road in relation to supporting residents is of a good standard with priority given to meeting the needs of residents. Hillgreen Care has further strengthened the level of expertise in the home by buying in consultancy support in the areas of psychology and psychiatry so that the residents get the benefit of prompt and specialised support services. The registered manager left the home in October 2007. A senio, has acted as manager since then, with additional support from the service manager. This senior is being put forward by Hillgreen Care to CSCI to be the new registered manager. This person has achieved NVQ 3 in caring for people and is being enrolled to do the NVQ 4 registered manager’s award. The service manager for Hillgreen Care visits 53 Myddleton Road monthly and reports on how the home is running and areas to be improved. Written and verbal feedback from relatives about the home was positive. Service user meetings are held regularly so that residents can contributes their ideas on the running of the home. Hillgreen Care had completed the AQAA (Annual Quality Assurance Audit) that provides detailed information about the running of the services and areas needing improvement. Hillgreen Care intends to publish a report, once the home has been open a year, on the quality of service provided at 53 Myddleton Road that incorporates the comment and views of all parties involved with the home, including residents, relatives and professionals. A range of records was looked at, including health and safety and fire safety. In general these records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. Hillgreen has a procedure in place to ensure repairs and maintenance items are followed up promptly. Given the risks of some residents getting out unsupervised and jeopardising their safety, the home must ensure that security procedures are in place that safeguard residents whilst not being unnecessarily restrictive. In order to achieve this the home must agree appropriate risk assessments and safety procedures for each resident with relevant parties, including residents themselves as far as possible, families and professionals. Hillgreen Care must then develop appropriate security procedures at 53 Myddleton Road that have taken into account comments from the local fire service. Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 27 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 2 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 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 28 First inspection 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 YA9 Regulation 13 (4) (c) Timescale for action Risk assessments in areas that 29/02/08 affect the freedom of movement of individuals must be agreed in conjunction with residents as far as possible, relatives and relevant professionals and regularly reviewed so that a balance is achieved between safeguarding residents and not being unnecessarily restrictive. Regular health and safety checks 08/02/08 of the premises must be made so that residents are properly protected at all times. Security procedures at 53 08/02/08 Myddleton Road must be in place that safeguard residents. These procedures need to take into account the individual needs of residents and comments from the local fire service. Requirement 2 YA24 13 (4) (a) &(c) 13 (4) (a) &(c) 23 (4) (b) 3 YA42 Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 29 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 YA6 Good Practice Recommendations Care plans and records relating to residents should reflect more a person-centred approach to supporting people so that the wishes of residents can be better responded to. Staff at the home should become more informed about the work being done with their residents at college and other projects so that they can talk more with residents about these activities and provide opportunities in the home to build on skills such as cooking or gardening. A wider variety of activities should be available to residents so that their needs in this area can be better met. Staff should have specific training in the area of personal and sexual relationship for young adults with learning disabilities. Staff should enable residents, and those acting on their behalf, to communicate further their concerns so that they can be recorded in the complaint book to provide evidence that these issues are then taken up and sorted out. Staff should discuss with residents and families how to make 53 Myddleton Road more homely in appearance. Staff should actively involve residents in developing the garden as an attractive area in a way that develops their skills and interest in this area. All care staff should have further training in personcentred planning so that the home responds even more to the needs and wishes of the residents. 2 YA12 3 YA12 4 YA15 5 YA22 6 YA24 7 YA24 8 YA35 Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Hillgreen Care Limited DS0000070205.V355997.R01.S.doc Version 5.2 Page 31 - 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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