Inspection on 18/04/05 for 39 Hawthorne Grove

This inspection was carried out on 18th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

39 Hawthorne Grove 07/03/08

39 Hawthorne Grove 31/08/06

39 Hawthorne Grove 10/10/05

39 Hawthorne Grove 22/11/04

39 Hawthorne Grove 27/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hawthorne Grove (39) 39 Hawthorne Grove Trowbridge Wiltshire BA14 0JF Lead Inspector Sally Walker Unannounced 18th April 2005 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 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 Stationary 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. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hawthorne Grove (39) Address 39 Hawthorne Grove Trowbridge Wiltshire BA14 0JF 01225 767441 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Service Limited Mr Graeme Barnell Miss Adele Lena Caroline Flegg Care Home Only 3 Category(ies) of LD Learning Disability (3) registration, with number PD Physical Disability (3) of places SI Sensory Impairment (3) Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: No more than 3 service users may be accommodated at any one time. Date of last inspection 22nd November 2004 Brief Description of the Service: 39 Hawthorne Grove is run by Milbury Care Services Limited which has a regional office in Henley Oxfordshire. The home is located in a residential area of Trowbridge and the property is owned by the West Wiltshire Housing Association. The home is a detached bungalow that did not stand out from the adjacent properties. 39 Hawthorne Grove in its statement of purpose stated that it was the service users’ permanent home for as long as this was appropriate to their needs. Service users received personal care and support throughout the day from a permanent staff team, with two staff sleeping in at night. Each service user had their own single bedroom, one of which had ensuite facilities. There was a large sitting room, a domestic kitchen and dining area, separate toilet and separate bathroom. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection started at 9.05am and finished at 12.00 noon. Two staff and Miss Flegg were spoken with. The care plans and daily report books were examined together with the communication book, fire safety logs and the house routines and checks file. Two of the service users were about to go out for the day and the other service user had gone to their day service. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 7 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 standard(s) 5 No judgements were made as the home does not intend to take any further service users. However current service users were not protected by an individual written contract that either they or their representative had signed. EVIDENCE: The home has offered the current service users, who have lived at the home for some time, “a home for life”. Miss Flegg reported that she was still waiting for some of the relatives to return the signed contracts. This was a recommendation outstanding from previous inspections. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 8 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 standard(s) 6,7 & 9 Service users are not supported by good detailed care plans. Staff rely on their knowledge of service users, gained over a number of years of working with them. Service users had little opportunity to make decisions about their lives. Service users are being put at unnecessary risk from the manager’s reluctance to improve standards of record keeping. EVIDENCE: The requirement for each service user to have a plan of care giving full details of person care giving, social support and healthcare need and reflecting the complex care needs of the service users has not been actioned over the past 2 inspections. However the files had been reduced to make sure only up to date information was available. Some work had gone into recording service users preferences and risk assessments were more detailed. A communication sheet showed good evidence of staff having detailed knowledge of service users’ methods of communicating with detailed guidance to staff on how to respond. However the daily records did not show whether this guidance was being used with staff mainly recording a list of what service users had done during the day. There was little written evidence of service users being encouraged to make decisions. Many of the documents needed to be signed and dated. Miss Flegg said that staff were getting used to new recording methods and went on Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 9 to say that new care plans were in progress. She said the new plans would show how staff were expected to work with service users over a 24 hour period. The record do not show evidence that service users are supported by a team of experienced and well trained staff who have a knowledge of working with people with complex care needs. Although it was clear from talking to staff, Miss Flegg and observation that staff did indeed have experience and access to a range of training. Separate monitoring charts were not identified in the care plan and no rationale was available as to why they were needed. The requirement to include recommendations made by healthcare professionals had not been actioned as the care plans had not been revised. The requirement that service users were never transported in wheelchairs without the use of foot plates had been met with guidance to staff in a policy. Wheelchair foot plates were seen by one service user’s wheelchair in their bedroom. As a matter of good practice there was a shortened version of the care details for the agency staff who worked at the home for some shifts to reduce the amount of private and personal information that service users may not wish to be shared with a third party. Also confidential information about service users was not being recorded in the communication book kept in the kitchen. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 15 Service users benefit from a range of individual and group activities in the local environment suited to their individual choices based on staff’s knowledge gained over a number of years of working with them. EVIDENCE: One service user attended a day service. Another service user’s day service had closed and the home was trying to find alternative activities. The home had its own vehicle for service users to use for trips. Staff said they had got to know all the local facilities which were accessible. Staff were planning service users holidays; to theme parks and holiday camps. If a service user could not cope with large crowds or with being away for a long time, then shorter breaks or days out would be planned. Miss Flegg said that the company allowed £200 per service user. The menu for the week was displayed in the kitchen. There was no choice but dishes were a mix of traditional fare with some ready meals. There was sufficient provisions in the fridge to prepare the evening meal which was listed as quiche with salad and potatoes. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Service users were not supported in receiving their preferred plan of care. The storage of medication continued to impinge on service users use of their communal space. Checking of the correct medication and paperwork had improved. Service users did not benefit from a group of staff who were recently trained in up to date administration and control of medication. The service users good access to healthcare professionals was impeded by advice not being taken up in the care plans. EVIDENCE: There was some detail about service users preferred routines for the giving of personal care. Healthcare professional advice had still not been included in the care plans. Miss Flegg said that the new care plans would identify all of the service users preferred routines with regard to all aspects of their lives not just physical care. All staff were trained to administer medication in their induction although they reported that they had not received recent updated training. None of the service users administered their own medication. The medication continued to be stored in a locked filing cabinet in the service users communal area. Miss Flegg identified the new cabinet which had been fitted in the staff accommodation and said that she was still awaiting the shelving to be sent and this was being dealt with by the operations manager. The requirement that all received medication was checked against the medication administration record to confirm current date and current Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 12 prescription had been actioned; one staff explained that the person on duty would check the medication when it arrived and signed the log to denote this. A district nurse was visiting one service user that day. Staff said that service users were well supported by their GP and would attend the surgery for appointments or have home visits without any problems. Staff would always accompany service users to appointments. Staff said that the GP was very understanding of the service users’ learning disabilities. Service users also had good access to the Clinical Psychiatrist with regular monthly reviews at the home. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 13 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 standard(s) 23 Service users are protected from abuse, neglect and self harm. EVIDENCE: One of the service users had a member of staff’s partner as an advocate and Miss Flegg said that this had been agreed with the placing agency but there was no written evidence of this on file. Service users were not now paying for meals that they had already paid for as part of the fee or for staff meals. Following the issuing of an immediate requirement notice at the last inspection and after a visit by the inspector to check on compliance, Miss Flegg had reimbursed all the monies to service users. There was no evidence to suggest this practice continued. A policy was now in place which all staff had been made aware of. The service users’ balance sheets on monies held on their behalf showed evidence of having been audited in January 2005 following the last inspection. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 14 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 standard(s) 24, 27, 29 & 30 Service users benefit from living in their own single rooms in a house in a residential area. Although it has been adapted and equipment provided to meet environmental needs, it retains a domestic character. The home is clean with no unpleasant smells. EVIDENCE: The home is situated in a residential area and does not stand out from the others in the road. The grounds were well kept. There was a ramp to the front door. The home was warm and clean and decorated within the last year. There was no unpleasant smell. There was a bathroom with toilet and a separate toilet, both were lockable and used by service users and staff. One bedroom had its own ensuite facility. Overhead tracking for a hoist was available in a bedroom and the sitting room. The laundry was domestic in character with a washing machine in a room with a toilet. Staff had good access to protective clothing and gloves as good infection control measures. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 35 Service users were supported by a group of staff who were well known to them. Staff do not show in the home’s records how they put their experience and training into action in supporting service users. EVIDENCE: There was a team of 6 permanent staff and one bank staff. Miss Flegg also managed another home in the company and was not included on the rota. She spent her time between the two houses. The duty rota provided a minimum of 2 staff at all times during the waking day and 2 staffing sleeping in at night. Miss Flegg said that one vacant post was being advertised and she would short list when the paperwork returned from the regional office. There was a training matrix showing which training had been undertaken by each staff. There were core subjects in safety with regard to fire, moving people, food and first aid. Other core subjects included non-violent management of behaviours, epilepsy and protection of vulnerable adults. Staff were also undertaking the Learning Disability Award Framework accredited training with 2 having completed the training. Three staff had NVQ Level 2 and three were undertaking Level 3. Recent related training that staff had undertaken included philosophy of care, keyworking and food hygiene. Although there was a good range of training available there was little evidence of how this was put into practice in staff’s work with service users as detailed in the care notes. Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 16 Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Service users are not protected by swift action to address requirements made by the Commission or other agencies. Service users are being placed at risk due to any unguarded radiators or pipe work. EVIDENCE: Miss Flegg said she had completed the Registered Managers Award and was awaiting external verification. The requirement to ensure that work was carried out as detailed by the Chief Fire Officer’s representative and the Environmental Health Officer had been actioned in part with the requirements of the Environmental Health Officer still outstanding. Miss Flegg reported that the operations manager had been discussing the matter with the housing association which owns the building but she was currently on long term sick leave and no one else from the organisation was covering her work save on an emergency basis. Similarly the requirement to provide an action plan with dates for completion of the covering of central heating radiators to ensure guaranteed low surface temperatures Hawthorne Grove (39) Version 1.20 Page 18 D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc had not been actioned. Miss Flegg said she did not know the outcome of meeting with the operations manager and the housing association. The requirement to address the requirements of the report of the Chief Fire Officer’s representative had been actioned. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x 2 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 x 3 3 Standard No Hawthorne Grove (39) Score Version 1.20 Page 19 D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 3 x 3 3 x x 31 32 33 34 35 36 x 3 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x 2 x 2 x Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 20 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 YA 6 Regulation 15 Requirement The registered person must ensure that each of the three service users individual plan of care is filled out in full and records all aspects of personal care giving, social support and healthcare needs to reflect the complex care needs of service users. (Not actioned at 18th April 2005). The registered person must supply the Commission with an action plan giving dates for the works to be carried out to meet the requirements of the Environmental Health Officers report. (Not actioned at 18th April 2005). The person registered must provide the Commission with an action plan showing the dates when the radiators will be fitted with guards to ensure low surface temperatures. (Not actioned at 18th April 2005). The person registered must ensure that the daily reporting on meeting service users care needs is related to the guidance given in the care plans. (Not actioned at 18th April 2005). Timescale for action 31st May 2005 2. YA 23 23 31st May 2005 3. YA 42 13(4) 31st May 2005 4. YA 41 17 18th April 2005 Hawthorne Grove (39) D51_D01_S36132_HAWTHORNEGROVE(39)_V220386_180405_Stage4.doc Version 1.20 Page 21 5. YA 19 12(1)(a) 6. YA 3 12(1)(a) 7. YA 20 18(1)(c)(i ) The person registered must ensure that any advice or recommended action given by healthcare professionals is put into practice and identified in the care plan. (Not actioned at 18th April 2005). The person registered must ensure that any advocacy services are agreed by placing agencies and that there is no conflict of interest for the protection of service users. The person registered must ensure that staff are regularly trained in the administration and control of medications 18th April 2005 18th April 2005 30th June 2005 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 YA 20 Good Practice Recommendations The person registered should inform the Commission when the medication cabinet is in operation allowing the storage of medication to be less intrusive on service users living space. (Not actioned at 18th April 2005). The person registered should ensure that both parties sign the contract and that service users or their representatives are given a copy. (Not actioned at 18th April 2005). 2. 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