Inspection on 01/11/05 for 1 & 2 The Hedgerows

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 & 2 The Hedgerows 16/05/07

1 & 2 The Hedgerows 09/06/05

1 & 2 The Hedgerows 08/10/04

1 & 2 The Hedgerows 01/07/04

1 & 2 The Hedgerows 25/03/04

Similar services:

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Southfields

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Dovedale Court

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1 & 2 The Hedgerows Station Road Staplehurst Kent TN12 0QQ Lead Inspector Marion Weller Unannounced Inspection 1st November 2005 01:30 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 1 & 2 The Hedgerows Address Station Road Staplehurst Kent TN12 0QQ 01580 893269 01580 893661 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) Kent County Council Mrs Susan Ann Pattenden Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users may also have a physical disability. The attainment of an appropriate management qualification by Susan Ann Pattenden by 2005. 9th June 2005 Date of last inspection Brief Description of the Service: The Hedgerows was originally the Police Station for Staplehurst. The Home is situated on the outskirts of the village of Staplehurst, which has a range of facilities including shops, library, medical centre, pubs and the village Community Centre. The nearest bus stop is on the main road, and there is a mainline railway station a short distance away. The Home offers respite care for short periods only. Service Users are required to attend day services, work experience and / or colleges from Monday to Friday. 24 - hour care is provided over the weekend / bank holiday periods. There are 5 single bedrooms, one of which is on the ground floor and is used by people with mobility difficulties. The Home does not offer services for wheelchair users requiring full care as there is not the equipment or facilities available to provide this. Limited parking is available to the front of the building and there is a large garden to the rear. Staff work a rota that includes one member of staff sleeping in at night. Support workers assist Service Users with meal preparation and domestic cleaning. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulatory Inspector Marion Weller carried out an unannounced inspection of The Hedgerows between 13.30 and 18.15. During that time staff on duty, the manager and service users spoke with the Inspector. The manager showed the inspector round the home. Three service users showed the inspector their bedrooms. The home was clean and well maintained. Additional information was obtained by looking at records together with some policy and procedure documents. Service user care plans and contracts were seen as well as staff files and staff duty rosters. The last inspection report together with progress and achievements made by the home since the last inspection were discussed. Some judgements about quality of life for residents were taken from conversations held with them in private and in public areas and observations. The atmosphere throughout was relaxed with service users interacting fully and enjoying being at The Hedgerows. The number of staff on duty was clearly meeting the individual and collective needs of those in residence. Comments made by service users included, “I love it at The Hedgerows and can’t wait to come each time” and “It’s really nice here, the staff understand me and are kind.” All staff were very helpful during the visit. What the service does well: Service users spoke positively of trial visits to the home before making a firm decision to stay. The arrangement of coming initially for tea and then staying overnight gave them practical experience of the home and a valuable opportunity to make an informed decision. Care plans were comprehensive and user friendly. They detailed the exact nature of presenting needs and how they were to be met by staff. Because of the short term nature of the services offered, a clear system was in place to ensure information held was reviewed and updated every time a service user returned to the home. Service users themselves helped to update information and knew they could record their choices and needs so that staff could give personal and consistent support. Staff were well supported through regular supervision and appraisal. They had access to a range of courses relevant to their work, which enhanced the quality of care provided. Service users benefited from a motivated and trained staff group who were committed to providing a good service. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,5. Prospective service users receive information and their needs are assessed prior to admission. They are further protected in residence by agreeing their own individual contract with the home. EVIDENCE: Clear procedures were being followed with regards to admissions into the home. The manager said emergency admissions to The Hedgerows were rare but if the situation occurred the home has written guidance for staff to follow within a comprehensive ‘risk assessment’ approach. The procedure identifies whether the homes resources could meet the needs of the person being referred and thus offers valuable safeguards to both parties. All service users routinely staying at the home have conducted initial tea and overnight stays, before deciding that they would like to stay on a regular basis. Service users spoken with evidenced this. Written evidence seen shows that care managers, service users themselves and family members all contribute to the provision of necessary and up to date information held by the home. Each service user has a contract between the home and themselves which they or a representative sign. The contracts were in widget format and gave good detail of the services to be provided. They clearly record who is responsible for 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 9 what. Service users evidenced their understanding and agreement with the contents of the document. . 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 10 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): 10 Service users know that information about them is handled appropriately, and that their confidences are kept. EVIDENCE: Staff had a good understanding of confidentiality issues and had received clear guidance within induction, training events and formal supervision. The home had a written policy with regards to confidentiality. Service users records were held securely and those seen maintained client confidentiality. Service users spoken with evidenced that they felt secure in the knowledge that staff would handle information about them appropriately and that their confidences were kept. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 Service users benefit from being supported in leading fulfilling lives inside and outside the home. EVIDENCE: The home understands the key role they play in providing opportunities for service users personal development. The manager discussed the importance of this and spoke about service users accessing a wide range of leisure, education or work activities during their stay, which frequently involved the local community. Important relationships are noted on care plans, respected and encouraged. The home would support a service user to attend church and routinely identifies and plans to meet service users spiritual and religious needs. The manager said transport to church would be provided, where possible. (The home has its own transport) Staff were seen in practice to encourage independence, and gave service users opportunities to make decisions and to accept responsibility for their actions. Service users evidenced in conversation that they felt valued and well supported. Their opinions as to daily routines and activities within the home are listened to and acted upon. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 12 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 21. Personal care needs are sensitively attended to in accordance with service users expressed wishes. Service users would benefit from improvements to facilities for dealing with medication storage. EVIDENCE: Care plans seen were comprehensive, in widget format and detailed the type and nature of support that individuals need in order to maintain optimum physical and emotional health. Staff on duty had a very good understanding of the preferred routines of each service user and delivered care in a way that individuals were comfortable with. The manager has recently revised the care plan format in line with a good practice recommendation made at the last inspection. Service users current medication details are now listed on the medication administration sheets upon admission and the detail accurately transcribed directly from the service users medication labels. The care plan continues to advise staff where the up to date information can be found. At the time of the visit, no service users were retaining their own medication. Medication was not inspected on this occasion. However, the manager spoke of her intention to expand upon written information and guidance available for 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 14 staff in relation to the administration of PRN medication to service users. The medication storage area was viewed. It was a small walk in cupboard that was also used for other items of stock. No working surfaces or hand washing facilities were directly available in the area. The manager said that medication administration is usually dealt with in the office or in service users rooms. It was discussed that the fridge currently used for the cold storage of medicines may not be suitable. It was seen to have no lock or temperature control device. As an aid to good practice, it was agreed with the manager that a Pharmacy Inspector would be consulted concerning the issues discussed. Discussion took place with the manager about the homes policy on dealing with ageing and death of service users who routinely stay at the home. It was clear that this situation had previously been handled in a sensitive and respectful manner in line with individual service users wishes. The home had written guidance, which informed and supported their practice. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The home has a clear and effective complaints system in place and service users are protected by robust adult protection policies and procedures. EVIDENCE: Service users were comfortable about raising concerns or complaints and knew exactly who to speak to. They said that staff would take their concerns seriously and would act on them. The complaints file was inspected. No new complaints had been received since the last inspection. The detail recorded in the complaints file was discussed with the manager and recommendations made to ensure the record are sufficiently clear and comprehensive. The manager said the Regulation 26 Visitor reviews complaints received by the home during routine visits. The home had up to date policies and procedures regarding the protection of vulnerable adults and appropriate regular training for staff. Staff evidenced a thorough understanding of the reporting process and whistle blowing procedures. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26,27,28,30. Service users benefit from staying in a safe and comfortable environment. EVIDENCE: The Hedgerows is a domestic style property, which is maintained and decorated, in a homely style. The entrance area was being improved on the day of the visit. The work was undertaken by the homes part time ‘handyman’. The ‘handyman’ had undertaken major refurbishment work in the rear garden earlier in the year. The completed project is lovely and has greatly enhanced the exterior grounds. Service users and staff said they were very pleased with the result. The two lounges were well equipped and the transformation of an old storage area into additional leisure space for service users means there is ample provision for people to be alone or to be in a group, as they may wish. The bathrooms and toilets afford privacy and were pleasant, clean and tidy. The well-equipped laundry was clean, as was the kitchen. The kitchen is very well organised and clearly shows where items of equipment and food can be found, promoting service users independence and confidence when accessing 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 17 the area. Bedrooms are quite large and were personalised to the level one would expect to meet a service users needs during a short stay. All are for single occupancy and have ample storage space, with a lockable cupboard. Staff were seen to follow good hygiene practices during the visit and had clear policy and procedure guidance for them to work to. No specialist equipment is needed. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 36. Service users benefit from being cared for by a cohesive and effective staff team who have a good understanding of their needs and receive regular supervision. EVIDENCE: A relatively small mixed gender staff team work at The Hedgerows. Staff spoken with were clear about their roles and responsibilities and knew what was expected of them. There was one staffing vacancy. The vacant roster hours were being covered by the use of permanent relief staff, familiar with the homes policies and procedures and known to the service users who routinely stay at the home. Service users spoke very highly of the staff. Evidence was seen that the ratio of care staff to service users is adjusted to meet the assessed needs of individuals staying at the home and is therefore regularly reviewed. The homes staff rosters were somewhat fragmented and not clearly explainable for inspection purposes. Information as to the working times of some staff employed by the home was shown elsewhere. It was discussed with the manager that the format of duty rosters be revised for clarity. Staff spoken with confirmed their own experience of a sound and thorough recruitment process. One member of staff said they had recently been involved in work to complete an induction pack for agency staff. All staff felt 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 19 that training opportunities were numerous, and the course detail comprehensive. It was clear from discussion that development opportunities gained had benefited and guided the team’s work with service users. Staff files seen evidenced regular documented supervision and appraisal meetings and the manager could evidence an up to date supervision-planning matrix. Regular staff meetings took place and minutes were seen. All staff are encouraged to take turns at chairing the meetings and for suggesting agenda items. The manager felt this encouraged frank and open discussion and consolidated the team’s accountability for decisions ultimately taken. Standing items on staff meetings addressed Health and Safety, Equal Opportunities and Training opportunities currently available. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41, 42, 43. Service users benefit from a service that is safe and well managed. EVIDENCE: The registered manager is experienced in working with adults with learning difficulties, and holds a Diploma and an N.V.Q. Level 4 in Management. She is currently working towards additional units for the Registered Managers Award. The registered manager has recently reduced her employment contract from 37 to 22.25 hours per week. The manager discussed the arrangements in place to meet the demands of her role and the management of the home in her absence. She said that additional administrative hours have been contracted to support the change and the senior support worker, who continues to work full time hours, is available on rota to meet the shortfall. The new situation was discussed with staff on duty. It is to the credit of the team and the careful management of the situation that the outcome does not appear to have had a negative effect on staff or service users. The team 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 21 evidenced that while acknowledging the change and some of the limitations to communication this brings with it, they continue to work cohesively and effectively for the benefit of the service users they care for. The manager said that Kent County Council Head Quarters Personnel Section are still sending through missing file items for some staff files held in the home. It was discussed that the contents of all staff files must be addressed to satisfy the information required for the purposes of CSCI inspections and to safeguard the best interests of service users. Two staff files inspected were stored securely, up to date and contained the information required by regulation. The manager could evidence an annual development plan for the home based on a systematic cycle of planning, action and review. The health and safety policy and other associated guidance are clear and available. Staff had a good awareness of health and safety issues and follow guidance closely. Risk assessments are in place and staff and service users know and practice emergency procedures. The fire evacuation guidance for service users was in widget form. Service users evidenced their understanding of what to do in the event of a fire. Certificates and up to date reports demonstrate that the home had adequate insurance cover and ensures the routine inspection and servicing of equipment, gas and electrical appliances. Regulation 26 visits are made regularly with a copy sent to the Commission. 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 3 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1 & 2 The Hedgerows Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 3 X X 2 3 3 DS0000037839.V262978.R01.S.doc Version 5.0 Page 23 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 YA41Y Regulation 19, Sch 2 Requirement The registered person shall ensure that the personnel files held at the home contain all of the information as listed under Schedule 2 of the Care Homes Regulations, for the purposes of CSCI inspections. (Previous timescale of 21 July 2005 not fully met) Timescale for action 31/12/05 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 YA22 Good Practice Recommendations It is recommended that the information currently held within the homes complaints file be reviewed, to ensure sufficient information demonstrates how a complaint has been investigated to the point of resolution / conclusion. (This recommendation has been repeated from the last inspection dated 9 June 2005) It is strongly recommended that the written information available for staff pertaining to PRN medication commonly used, be expanded upon, to include its purpose, amount to be taken, under what circumstances and possible contraDS0000037839.V262978.R01.S.doc Version 5.0 Page 24 2 YA20 1 & 2 The Hedgerows indications (This recommendation has been repeated from the last inspection dated 9 June 2005.) 3 17 (2) Schedule 4 It is recommended that the current formats used for recording staff duty rosters be revised and the fragmentation of information eliminated. Records should clearly show all individuals working on any one day/ night, define their role in the home, the hours worked and record whether the planned roster was worked or not. It is recommended that The Pharmacy Inspector be consulted as to the current facilities and practices at the home. The Inspector will arrange the referral. 4 YA20 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 1 & 2 The Hedgerows DS0000037839.V262978.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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