CARE HOME ADULTS 18-65
23 Hathaway Road 23 Hathaway Road Grays Essex RM17 5LB Lead Inspector
Sarah Hannington Unannounced Inspection 31st July 2007 5:00 23 Hathaway Road DS0000036448.V345620.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 23 Hathaway Road DS0000036448.V345620.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. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 23 Hathaway Road Address 23 Hathaway Road Grays Essex RM17 5LB 01375 383556 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) Thurrock Council Joyce Kathleen Tree Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Personal care to be provided to up to 4 service users with learning disabilities who require a short break service only. Personal care to be provided to up to 4 service users with learning disabilities under the age of 65 years. Number of service users whom personal care is to be provided shall not exceed 4. Date of last inspection Brief Description of the Service: 23-25 Hathaway Road provides a short break service for young adult men and women, 18-65, with a learning disability and operates from a five-bedroom house. Thurrock Council owns the house. Referrals are usually based from a community care assessment made by individuals Social Worker. The Home is situated in the centre of Grays and is a short walk to the High Street, bus and train stations. The premises are made up of two joined properties, which are maintained, decorated and furnished to a fair standard, providing four bedrooms. There is no off-street parking outside the home as parking is by permit only, although the home does have visitors permits which can be used up to 5 hours and after 6pm - until 9.00am parking is permitted. The Home has a ramp leading to the side door and two good-sized rear gardens. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two and a half hours. During the Inspection the manager was present throughout the process. A tour of the home took place. Staff and residents were spoken with during this inspection. The visit mainly focused on all Key Standards. There were no requirements or recommendations from the last inspection report. Random samples of records, policies and procedures were inspected. What the service does well: What has improved since the last inspection?
Most of the service users who use Hathaway Road know each other through day services; this can either be a positive or negative factor. As a result of this and liaising with day services, more consultation with individuals has gone ahead so the manager can evaluate the compatibility of service users sharing together. The team has developed stronger and closer links with other professionals involved in individuals care packages. Coffee mornings and questionnaires are some of the ways Hathaway Road gauge the quality of the service. Additionally one member of staff has taken on the role as ‘liaison worker’ so that there is a ‘specific’ person to contact regarding any issues, views or any queries both service users and their families may have. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 6 Individual Support Plans have been developed and implemented for all service users. This is a good achievement for the service due to the fast turn over of individuals using Hathaway Road. A new medical form has been developed and is now in use. Linked to this, the home has established a good ‘rapport’ with the local community Nurse. The home is developing different methods of communication and looking towards improving documentation given to individuals by using their recorded communication preferences. The staff are learning makaton signs each week to enable them to support individuals more effectively. The manager has delegated staff different ‘key’ areas of responsibility within the home; this has come from assessing staff skills and their interests in particular aspects of the service provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure, service user consultation. Initial assessments are in place. EVIDENCE: Social workers make a referral to Hathaway Road and provide an initial assessment. Hathaway Road collates information from potential service users, families and other professionals involved within the care package. A statement of purpose and service users guide is given to individuals to enable them to make a decision about the home and services offered. A number of visits are arranged and Hathaway Road carries out its own assessment of that individual to see if they are able to cater for their ‘specific’ needs. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has demonstrated that a person centred care plan process for all service users is in place and that a good system of risk assessing is in place. EVIDENCE: A new Individual Support Plan has been put into place for all service users. This documentation evidences that individuals are consulted with and fully involved. Individual’s views and their family’s views are valued and taken into consideration whilst developing support plans. Communication in general is being developed and documentation given to individuals will be developed into their choices to enable individuals to have a greater say and understanding about their care package. Once a service user is using the respite service, the manager and support staff will hold a number of 1-1 meetings, using observations and monitoring to establish if this action plan is working or if the service user needs are changing. Risk assessments were in place and staff spoken to give a good understanding of different type of risks and also how important it may be for 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 10 individuals to also be able to take some minimal risks to enable independence and exercise choice. Recording by staff in individual’s files evidence that good and effective practice is in place. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users have a varied choice of activities, leisure interests and are encourage to find meaningful work. The home encourages service user involvement within the community EVIDENCE: Most of the service users who use Hathaway Road know each other through day services; this can either be a positive or negative factor. As a result of this and liaising with day services, more consultation with individuals has gone ahead so the manager can evaluate the compatibility of service users sharing together. Individual Support Plans have been developed and implemented for all service users. Service users are fully expected to participate in daily tasks of the home retaining skills and working towards independence. Choice is given to individuals regarding activities, educational and leisure pursuits, as well as supporting individuals usual daily, weekend and evening routines. During the summer holidays staff organise a number of activities and the service users use the local community on a regular basis.
23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 12 Communication books are used between staff and main carer as a means of sharing relevant information. Relatives and the main carer’s are very much involved and there is a carers monthly meeting outside of the service to get any feedback from them. Once a service user is admitted the staff and individual, ‘plan out’ meals for the week. Together they do the shopping and participate in preparation and cooking of these meals. The staff encourage individuals to have a balanced diet alongside any take always or fast food preferred. This allows choice but also gives balance to a nutritional diet. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user personal healthcare support is well managed and written information was evidenced as good. General documentation within the home is being maintained to good standard. Good medication systems and practice are in place. EVIDENCE: A new medical form has been developed and is now in use. Linked to this, the home has established a good ‘rapport’ with the local community nurse. Whilst in placement at Hathaway Road if any medical needs arise whilst individuals are staying then their own GP, or health services are used. The home also has emergency access to a local GP and dentist if need be. The care staff carry out any appointments made prior to admission. All medical appointments, followups or observations are recorded in individual’s personal folder. Consultation around health care and self-care needs are assessed prior to the initial admission and is monitored through out future stays. The home has developed stronger links in general with other professionals involved within the care package of a ‘specific’ individual and this forms part of the individual care plan. Care plans are reviewed in the year but changed in between if need be.
23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 14 A professional assessment is in place for any ‘specialist’ equipment need by an individual. Staff that administer and account for medications within the home have had training. Medication is stored in a lockable cabinet alongside MAR sheets. Medication administration records had no omissions and administration was carried out correctly according to ‘the Royal Pharmaceutical Society guidelines’ and relevant legislation. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints procedure. The homes policy, procedures and training of staff protect residents from abuse. EVIDENCE: The complaints procedure is included in the statement of purpose and the service user guide. The complaints procedure is in a format that can be easily understood within the service user guide. The home has had no complaints or Adult Safeguarding issues since the last inspection and nothing has been reported to the CSCI office. Staff have a good knowledge and awareness around ’ no secrets’, Safeguarding guidance and the whistle blowing’ policy. All staff have had Safeguarding training. The manager books courses so that staff knowledge around these issues is updated and refreshed. Service users have a locked cabinet within their bedroom to keep monies and valuables in. Staff actively encourage individuals to use money at all times to encourage independence, responsibility and retain/teach skills. Finances are well accounted for and recording systems evidence good practice is in place. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home environment is good and provides a clean, comfortable and safe environment in which to live in. EVIDENCE: Hathaway Road offers service users a comfortable, warm, homely environment. The home is furnished to a good standard, providing televisions, music centre and video player. The home has two lounges and this allows service users to have space away from others other than their bedrooms. The home is clean, comfortable, homely and free from any odours. The premises are maintained to a good standard and offers service users a home from home service. However the home needs to develop further a maintenance record/plan that can easily identify future re-decoration and renewal plans. Track and account for current work being carried out. Sign off work completed and evidence why work cannot be completed.
23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 17 The property consists of two houses being converted into one, and the home has still kept two gardens, which are separate from each other. This allows a service user to carry out activities in one half and for someone else to have a quite time. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty, their experience and skill was able to meet the needs of service users. A good recruitment policy, procedures and records are in place. EVIDENCE: Hathaway Road has a well-established permanently employed staff team. This gives service users consistency and good quality of care. The rota evidences that there are sufficient numbers of staff on at all times. The team collectively have a wealth of experience; knowledge, skills and most of the staff have completed their NVQ training. The manager is NVQ4 and RMA qualified. Recruitment is to a good standard, all staff is CRB checked, have references in place and all hold all expected documentation within their folders. Staff have good training opportunities and have a ‘specific’ individual training programme in place. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems are good and the home is run in the best interests of service users. The health, welfare and safety of both the service user and staff is promoted and protected. There is a good quality assurance monitoring process implemented, however a better recording system of the results need to be developed. All certificates required by regulation were available and seen to be satisfactory. EVIDENCE: The manager is experienced, well organised and has a good understanding of service users, families and of staff needs. The manager has a clear vision of how the service is to be developed. Hathaway Road provides a service that is moulded by the individual service user needs and aspirations. In general, views of both the services users and their families underpin the documentation and practice within the home. Staff are supported well by means of one-to-one meetings, supervision, appraisals and training. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 20 One of the ways in which the quality of service is assessed is by the use of surveys sent out by the home. Although information is evaluated by the manager and used to improve the service, recording systems need to be developed further to evidence the outcomes/action plan reflecting these changes made and views. Information should be collated into a report and that it is made available to all interested parties. Along side the surveys, coffee mornings with families are regular and any concerns, issues, suggestions or queries can be raised during this time. Additionally one member of staff has taken on the role as ‘liaison worker’ so that there is a ‘specific’ person to contact for both service users and their families. All certificates evidencing compliance to relevant legislation were in place on the day of the inspection and ensured the health and safety of all staff and service users. 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 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 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA24 Good Practice Recommendations The home must ensure that a maintenance record/plan is in place. This record needs to be able to identify future redecoration and renewal plans. To ‘track’ current work, sign off work as completed or why work cannot be completed. The home must ensure that Quality-monitoring information is collated and actions plan with outcomes are completed and a copy forwarded to CSCI office. 2 YA39 23 Hathaway Road DS0000036448.V345620.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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