Inspection on 26/09/06 for 18 Hawthorn Crescent

This inspection was carried out on 26th September 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

18 Hawthorn Crescent 28/08/08

18 Hawthorn Crescent 25/07/07

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Southfields

Thorndene

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33 St John`s Church Road

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 18 Hawthorn Crescent 18 Hawthorn Crescent Worthing West Sussex BN14 9LU Lead Inspector Mrs M McCourt Unannounced Inspection 26 September 2006 12:00 th 18 Hawthorn Crescent DS0000067148.V298687.R03.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 18 Hawthorn Crescent DS0000067148.V298687.R03.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. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 18 Hawthorn Crescent Address 18 Hawthorn Crescent Worthing West Sussex BN14 9LU 020 8544 8900 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.caremanagementgroup.com Care Management Group Limited Mrs Rositsa Taseva-Mancheva Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection New Registration Brief Description of the Service: 18 Hawthorn Crescent is a care home that is registered to provide care for four adults with learning disabilities between the ages of 18 and 65. The Registered Provider is Care Management Group Ltd and the Registered Manager is Rosita Taseva-Mancheva. The current scale of monthly charges are 1450.00. This information was provided on the Pre-Inspection Questionnaire received prior to the inspection. There are additional charges for hairdressing, toiletries, trips out, holidays and clothes. The home is a semi-detached property, situated in a quiet residential street, just outside Worthing’s town centre. There is easy access to all community facilities, including local rail and bus stations. The home has just finished undergoing major upgrading work that has included changing the internal structure and decorating throughout. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection was undertaken by one Inspector on Tuesday 26th September 2006 and lasted a total of six hours. Pre-inspection planning took approximately two days. A full tour of the building took place and included the observation of Health and Safety matters, hygiene issues, decorative order and a general overview of the atmosphere created within the home. Three staff members, one Service User, the Registered Manager and an Area Manager were spoken to at the time of inspection. Case tracking was carried out by examination of relevant records and information held on the staff and residents. The Inspector was able to observe staff interaction with Service Users during the early part of the inspection. What the service does well: What has improved since the last inspection? The home has recently been taken over by Care Management Group, and therefore it is not easy to see what has improved in such a short space of time. However, the Service Users have just moved back into a newly decorated home, which is bright, clean and comfortable 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 6 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. 18 Hawthorn Crescent DS0000067148.V298687.R03.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 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. The outcome for Service Users was found to be adequate. Service Users’ needs are assessed prior to moving into the home, although it is important that the Registered Manager has maximum involvement in the referral and admissions process. The home should ensure a signed contract between the home and the Service User is in place, detailing breach of contract. EVIDENCE: A statement of purpose was sent with the Pre-Inspection Questionnaire and was found to be detailed and clear. A Service Users Guide is also available and written in plain English, using symbols. The document includes a clear complaints procedure and details of rooms to be occupied, fees and so on. The home does have a referral procedure, with prospective Service Users allocated a referral co-ordinator. A Service User recently admitted to the home had received three visits and one overnight stay covering a period of ten days. The Registered Manager told the Inspector that she had had some concerns about the Service User’s compatibility due to the lack of information available. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 9 Discussion with the Regional Operations Manager confirmed that the Service User’s needs were indeed higher than first identified, but that the home was in the process of accessing specialist health care in order to meet the individual’s needs. A Service Users agreement was sent with the Pre-Inspection Questionnaire, but on examination of Service Users’ files it was found that there is nothing in place between the home and those living at the home. This situation was confirmed by the Registered Manager. A thorough risk assessment procedure is place. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 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): 6, 7 and 9. The outcome for Service Users was found to be good. The home demonstrates an ability to involve specialist health professionals as and when necessary. Family members or representatives should be involved in the process of implementing individual care plans. EVIDENCE: It is not possible for Service Users to be involved in drawing up care plans, but the home should encourage relatives and family members to provide as much information as they can during the admission process. Care plans are reviewed, but due to the recent moves, these are a little behind. For the new Service User admitted recently there was evidence of specialist reports from health professionals involved in their re-assessment, including Physiotherapy, Speech and Language, Wheelchair and so on. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 11 There were no records of Service Users’ meetings. The Registered Manager said that a meeting was held in May, but there was no written record available. A missing persons procedure is in place. Records and files are held in a lockable drawers within the office which is also lockable. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. The outcome for Service Users was found to be adequate. Service Users do access day centres and college placements, however a more varied choice of activities should be made available for them to access during the evenings and weekends. Service Users should be supported with daily tasks in a sensitive and appropriate manner. EVIDENCE: Opportunities to develop and learn life skills are limited due to the level of disabilities. There are on-going communication issues between the home and a local the day centre, which the manager is working on improving. Discussion with one Service User highlighted the fact that she doesn’t think that she gets involved in enough activities outside the home. She said that 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 13 she does go out in and around Worthing Town Centre, but would like to go to the cinema/theatre/etc more often. Opportunities to meet other people are possible at the day centre or college only. Staff were observed knocking on doors in the presence of the Inspector. Discussion with a Service User found that she liked the staff team and enjoys the food that is prepared. She told the Inspector that she attends a day centre four times per week and college every Friday, where she studies cooking. The Inspector observed a Service User being helped to eat. The process looked hurried and the Service User was given little or no time to rest between mouthfuls. In addition, the meal was interrupted when the telephone rang, and the staff member went to answer it, without properly explaining to the Service User where she was going or how long she would be. The Registered Manager said that although all staff have been trained in how to assist people to eat, she would remind them of good practice issues surrounding this matter. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 14 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 and 20. The outcome for Service Users was found to be adequate. Although Service Users do receive personal support it is not always in a manner in which they may prefer. Medication procedures are in need of review and improvement. EVIDENCE: Service Users are offered individual support and were observed to be wearing clothes chosen by them. A diary system is used to record appointments. Once attended, the outcome is written up on a feedback sheet and held in the Service Users’ own personal file. Monitoring and reviewing of specific health conditions does take place, with the home involving specialist care professionals where necessary. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 15 A medication policy and procedure is in place and covers administration, storage, errors and so on. The home has a pharmacy contract with Lloyds Pharmacy. On examination of MAR sheets, several gaps in signing were found. Storage of medication was good, with stock kept tidily in a metal, lockable cabinet. The Inspector reminded the Registered Manager that the home should keep an accurate rolling record of stock. For example there was no way of knowing how many paracetamol tablets were in store. In addition vitamins that are stored and administered to one of the Service Users did not have their name or required details on the containers. The communication book included some entries of when medication had not been administered properly, or had been missed. This is unacceptable and must be addressed. The registered provider must ensure that appropriate steps are taken to remedy this situation and a requirement has been made in respect of this. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 16 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 and 23. The outcome for Service Users was found to be adequate. Service Users do not feel their views are listened to, and more needs to be done to ensure their concerns are acted on. All concerns, regardless of how minor, should be recorded in order to track outcomes. EVIDENCE: The Commission for Social Care Inspection has not received any complaints in respect of this service. A clear and straight forward complaints procedure is in place which incorporates symbols to help Service Users understand it. A book is used to log complaints. There were none recorded. The Inspector advised the manager that any complaints, regardless of how minor, should be recorded. A Service User had told the Inspector that she had complained several times to the Registered Manager about an issue within the home. The manager confirmed this to be true, but had not recorded any of them. The Inspector discussed the importance of putting concerns in to writing, otherwise the home is not seen to be taking its own policies/procedures seriously. The Registered Manager then went on to tell the Inspector of another incident that had occurred at the day centre, involving a Service User who had not been helped properly with personal care. Again, the concern had not been recorded anywhere. The registered provider must ensure that appropriate steps are 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 17 taken to remedy this situation and a requirement has been made in respect of this. There is one copy of the West Sussex County Council Adult Protection procedures available, to be shared between both 16 & 18 Hawthorn Crescent. The Inspector is of the opinion that each house should have an up-to-date copy, for easy access by staff should the need arise. The home does have its own policies and procedures on abuse issues. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 18 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 and 30. The outcome for Service Users was found to be excellent. Service Users live in a homely, comfortable and safe environment. EVIDENCE: The property has been re-decorated, renovated and extended to accommodate four people, with Service Users moving back into the house about two months ago. On the day of inspection the home was immaculate, bright, clean and homely. Bedrooms have been made larger and where necessary adaptations and specialist equipment has been installed for the benefit of Service Users, including ceiling track hoists, wet rooms and specific equipment for individual needs. The Inspector was invited to look around one of the bedrooms by a Service User. The room had been decorated to suit personal taste. All four bedrooms have en suite facilities. Shared spaces include the kitchen/diner and a garden, which has wheelchair access. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. The outcome for Service Users was found to be adequate. Staff should be suitably qualified and competent to take on the role of support worker. Service Users would benefit from a well supported and supervised staff team who have a clear understanding of the communication and physical needs of the client group. EVIDENCE: The home employs six staff, and is currently recruiting to increase numbers in order to provide care for the extra fourth Service User. Four of the staff have NVQ or equivalent (some being qualified nurses in their own country of origin). On the day of inspection there were three staff on shift; one went with a Service User to the day centre to assist with care, one was on a split shift and one staff member was working from 8am through to 10pm. The Inspector asked if she was happy working this long shift and she replied that she has asked to work long shifts to fit in with her childcare arrangements. Two 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 20 members of staff spoken with said that they do not like working the split shift system. Staff records were looked at by the Inspector and found to contain inconsistencies with regard to recruitment records, however it should be noted that all staff were employed by the previous company. A CRB for one staff member has been lost. The Registered Manager agreed to address this matter as soon as possible. Care Management Group has a training department that oversees company training for individual homes. A training and development plan was sent to the Inspector as part of the Pre-Inspection Questionnaire. The Inspector was of the opinion that some mandatory refresher courses are now overdue. Staff would also benefit from particular training subjects, such as; equalities training and subjects specific to the needs of the Service Users. Supervisions are not carried out regularly, but this could be due in part to the recent movement of Service Users from one house to another and back again. One staff member last had supervision on 24th August 2006 and before that December 2005. The second staff member had supervision on 21st July 2006 and before that November 2005. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 21 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, 39, 41 and 42. The outcome for Service Users was found to be adequate. The home should implement a quality assurance tool, specific to the home in order to ensure the views of people involved in the home are sought on a regular basis. Staff are required to be trained and to follow in all Health & Safety matters. EVIDENCE: The Registered Manager is Mrs Rositsa Taseva-Mancheva. She has managed the home since August 2002. She is a qualified social worker in her home country of Bulgaria, having worked with children there. She has both her RMA and NVQ level 4. Mrs Taseva-Mancheva told the Inspector that she had received lots of management training and is due to update her mandatory subjects, such as 1st Aid, food hygiene, etc. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 22 Staff, Service User and relatives questionnaires are sent out on a yearly basis. The completed forms are sent back to head office before being forwarded back to the home. They are not published. The Registered Manager said that CMG have more quality assurance systems planned, but they have not been implemented yet. Policies and procedures are in place and are reviewed regularly by the company. Food hygiene procedures were not being followed correctly. The Inspector found uncooked chicken sitting directly on top of salad produce and two jars of food had not been dated on opening. Health & Safety training is provided, but as previously highlighted, mandatory training needs updating for many of the staff team. 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 23 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 3 2 2 3 x 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 3 28 3 29 x 30 4 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 x 2 x 3 2 x 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 31/12/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (1) – The registered person 31/12/06 shall establish a procedure for considering complaints made to the registered person by a Service User or person acting on the Service User’s behalf. (2) – The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. Requirement 2 YA22 22(1) & (3) 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 25 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 YA2 Good Practice Recommendations New Service Users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective Service User, using an appropriate communication method and with and independent advocate as appropriate. 7.4 – Staff can demonstrate how individual choices have been made; and record instances when decisions are made by others, and why. For example; Service Users’ meetings. 12.1 – Staff help Service Users to find and keep appropriate jobs, continue their education or training, and/or take part in valued and fulfilling activities. 14.1 – Staff ensure that Service Users have access to and choose from a range of, appropriate leisure activities. 17.7 – Mealtimes are relaxed, unrushed, and flexible to suit Service Users’ activities and schedules. 35.4 – All staff receive equal opportunities training, including disability equality training provided by disabled trainers; and race equality and anti-racism training. 36.4 – Staff have regular, recorded supervision meetings at least six times a year with their senior/manager in addition to regular contact on day to day practice. 39.6 – Feedback is actively sought from Service Users about services provided through e.g. anonymous user satisfaction questionnaires and individual and group discussion, as well as evidence from records and life plans, and informs all planning and review. 42.9 – All staff receive induction and foundation training and updates to meet Skills for Care specification on all safe working practice topics in Standards 42.2 and 42.3. 2 YA7 3 4 5 6 7 8 YA12 YA14 YA17 YA35 YA36 YA39 9 YA42 18 Hawthorn Crescent DS0000067148.V298687.R03.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Southampton Hub 4th Floor, Overline House Blechynden Terrace Southampton Hampshire SO15 1GW 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. 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