CARE HOME ADULTS 18-65
Chapel Hill Hostel 44 - 55 Chapel Hill Crayford Kent DA1 4BY Lead Inspector
Maria Kinson Unannounced 31st May 2005 10.15am 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. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Chapel Hill Hostel Address 44 - 55 Chapel Hill Crayford Kent DA1 4BY 01322 553 201 01322 527 786 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) Mental After Care Association Mrs Diane Flower Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24) of places Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 09.11.04 Brief Description of the Service: Chapel Hill Hostel is owned by Bexley Council, which leases the property to MACA (The Mental After Care Association). It is registered to provide services to 24 people with a mental disorder. The property is a two-storey purpose built home, which is situated close to local amenities and public transport. All bedrooms are for single occupancy and the home consists of the following: a three-bedroom flat for independent living; a one-bedroom bed-sit; House B; House C; and “Hill Top View”. House B has six bedrooms and provides accommodation for people with high dependency levels. House C has eight bedrooms, one of which is used for respite care, one as a ‘crisis’ bed and the remaining six beds provide accommodation to people who require rehabilitation in the shorter term (up to 18 months). “Hill Top View” has six bedrooms and provides accommodation to people needing an intensive slow stream approach to rehabilitation. The home has been built on a hill and does not have disability access. There is limited off-road parking. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 31.05.05 between 10.15am and 17.45pm. A partial tour of the home was carried out but this was limited by the building work that was taking place in Hill Top View. The inspector spent time talking with service users and staff and examined some of the records that were maintained in the home. Eighteen comment cards were handed out or sent to service users, relatives, GP’s and other health care professionals that were in regular contact with the home. Eight questionnaires were returned to the commission. What the service does well:
The home provided clear information in the Statement of Purpose and Service Users Guide for prospective and existing service users. The majority of service users spoken with liked living in the home and felt they were well cared for. Comments made by service users included “I think this is a good place to live”, “the staff are very supportive” and “I have only lived here for a short time but I have been helped greatly with motivation and confidence”. All of the service users that responded to the questionnaire sent out by the commission were satisfied with the food provided in the home. Service users said there was always a choice of food and “ if you want something different you just let the cook know”. Service users were encouraged to participate in the day- to- day running of the home and to take responsibility for keeping their bedroom and the communal areas tidy. The home has a stable team of committed and well-motivated staff. Staff retention was good and a number of staff had worked in the home for several years. Temporary staff were used infrequently, resulting in good continuity of care for service users. Staff felt supported and said that they were able to access relevant training courses and develop new skills. All of the staff spoken with had a good understanding of their role and responsibilities. Staff had established good working relationships with other professionals and had a good understanding of service users needs. Comments made by professionals who visit the home included “I have found the staff very accommodating”, “they are very flexible in regard to client needs”. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 6 The home has a comprehensive complaints procedure and service users were encouraged to raise issues of concern with their key worker, staff or the management team. Regular meetings provide an opportunity for service users to put forward ideas and express concerns about the support they receive in the home and a comment book was provided on each of the units for feedback. Service users told the inspector “We can say what we want” and “The staff are good here, they listen to you, I have never heard anyone say anything different”. This service was managed in an open and transparent manner. Good systems were in place to obtain feedback from staff and service users. 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.
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 standard(s) 1 The homes Statement of Purpose and Service Users Guide provide good information about the support and facilities provided in the home. These documents assist prospective service users to make an informed choice. EVIDENCE: The homes Statement of Purpose and Service Users Guide provide detailed information about the support and facilities provided in the home. Since the last inspection some additional information had been added to the Statement of Purpose about the staffing structure. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Service users were encouraged and supported to contribute to the running of the home and take control of their lives. Staff respected the decisions made by service users. EVIDENCE: Service user support plans were not assessed during this visit. The manager said that all plans were being reviewed and updated. Staff were seen spending time with service users reviewing plans and assessing progress. Service users were kept informed about issues relating to their support plan. Staff expected service users to make decisions for themselves. This included deciding how and where they spent their time, managing their finances, medication and cooking if possible. Service users who lacked the confidence to make decisions were supported to become more independent over time. The registered company works hard to ensure that service users are represented throughout the organisation. Service users can choose to attend staff training sessions, become involved in staff recruitment and attend meetings and events. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 10 Service users were encouraged to contribute to the day- to- day running of the home by assisting staff with shopping, cleaning and cooking. Regular meetings were held in each of the houses and service users could write anonymous comments or concerns in the books kept on each house. Service users said they were able to speak freely and felt staff listened to their concerns. All of the service users that responded to the comment cards sent out by the commission indicated that they wanted to become more involved in decision making within the home. This issue should be explored with service users individually and collectively to establish the type of decisions that they would like to be more involved with. See recommendation 1. An independent survey of service users views had been undertaken in the home. The manager was awaiting feedback from the person that conducted the survey at the time of this inspection. Service users said staff were flexible in their approach but would not allow the consumption of strong alcohol or the use of illegal substances in the home. Information about these and other restrictions were clearly laid out in the Statement of Purpose and Service Users Guide. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 standard(s) 13, 15, 16 and 17 Service users were able to choose how and where they spent their time, with guidance and support from staff if necessary. A good selection of food was provided in the home to meet service users nutritional needs and tastes. EVIDENCE: Most of the service users were familiar with the local area and used local facilities and services on a regular basis. Service users told the inspector that they spent time during the week at local day centres, visiting friends and family, shopping and watching television. At weekends there was usually a BBQ or social event in the home. During the summer month’s trips were arranged to the coast and places of interest. Discussions with service users indicated that family members and friends were able to visit at any reasonable time. Some service users spent weekends at their family home or visited family members who live locally.
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 12 Staff had a good understanding of their role and were clear about their areas of responsibility. Procedures were in place about entering service users rooms and staff did not intervene in service users personal time or space unnecessarily. Separate areas were provided for service users who smoke and rules about alcohol and drugs were clearly laid out in the homes documentation and discussed with service users on admission. Staff communicated effectively with service users and took time where necessary to provide further information or advice to assist service users to make decisions. The home employs a part time cook who prepares a cooked meal of an evening. Service users were expected to prepare their own breakfast and lunch with support from staff if necessary. Some of the service users plan and prepare all of their own meals. The menu for the week of the inspection provided a varied selection of food. Service users confirmed that they were able to choose a different meal if they did not like the food listed on the menu and it was evident that individual service users had chosen their lunch. All of the service users that responded to the questionnaire or spoke with the inspector were satisfied with the choice and quality of food provided in the home. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 standard(s) 18, 19 and 20 Service users health and welfare needs were met where possible. Some systems for managing medication in the home could present risks to service users safety. EVIDENCE: Service users were left to make decisions for themselves about the time that they went to bed and got up. The only exception to this was where it was agreed with the service user, and recorded in the support plan, that staff would prompt and encourage a service user to get up. This type of support was provided for service users who had agreed to attend a specific activity or appointment. Service users were encouraged to maintain their independence and learn new skills where possible. All of the service users spoken with during the inspection said that their key worker was helpful and spent one to one time with them each week. Service users were supported to attend appointments or access health care services in the community. Staff said that relations with other health and social care professionals were good and effective systems had been established for obtaining advice and reviewing service users. The health care professionals that responded to the questionnaire sent out by the commission were satisfied with the care and support provided for service users in the home. The
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 14 respondents indicated that staff working at Chapel Hill were “flexible in regard to clients needs”, communicated effectively and worked in partnership. Two medication charts were examined. The management of medication was mostly good but the procedure for recording receipt of medicines was not consistently followed. One drug, which required specific storage arrangements, was not stored appropriately. Staff immediately started to address the options for addressing these issues. Records of administration of medication were good, with all medication signed as given. Service users are supported to manage their own medication where possible. Staff undertook a risk assessment prior to service users self- medicating and lockable facilities were provided for the storage of medicines. Action had been taken to ensure that the temperature in the medication storage areas was monitored and kept at satisfactory level. See requirement 1. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 standard(s) 22 and 23 This home has good systems in place to respond to concerns, complaints and allegations of abuse. EVIDENCE: The homes complaints procedure was displayed on the notice board. The procedure includes a timescale for responding to concerns and contact details for the commission. There was no record of any complaints being received in the home since last inspection and the commission have not received any complaints about this service. Comment books were placed in each of the houses for service users to record concerns or complaints. The home has an Adult Protection and Whistle Blowing procedure. Staff were aware that they should report allegations of abuse to senior staff promptly. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 standard(s) 24 and 30 Work was in progress to improve the physical appearance and facilities in the home. This should provide more privacy and comfortable surroundings for service users. EVIDENCE: On the day of the inspection building work had commenced in Hill Top View. The inspector was told that the work would result in additional space and en suite facilities for some of the service users and the number of beds would decrease to 23. The Registered Manager was advised that an application for a major variation in respect of this work must be submitted to the commission. It was anticipated that the work would take ten to twelve weeks to complete. Agreement had been reached to leave some beds vacant whilst the work was in progress. This should avoid the need for service users to move out of the home. Once the work is complete Hill Top View will become a designated short- term facility for service users requiring respite or in crisis. Action had been taken by staff to maintain service users safety during the work. The house where work was in progress was empty and was sealed off.
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 17 Signs warning service users not to enter the building were displayed and staff had implemented new strategies to maintain service users safety whilst the usual system for alerting the fire brigade was out of use. Communal areas were comfortable but some of the furniture in the lounge in Hill Top View and the kitchen cupboards in house B were worn or broken. The manager said that all parts of the home affected by the building work would be redecorated and new furniture purchased where necessary. Overall infection control measures were good. Alcohol hand gel was provided for staff to use when administering medication and adequate standards of hygiene were maintained throughout the home. The only exception to this was the laundry, which did not have hand-washing facilities. See requirement 2. All parts of the building were clean, tidy and odour free. Bexley Environmental Health Department had awarded the home a Silver Clean Food Award in recognition of the standard of cleanliness maintained in the main kitchen. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 36. This home has a stable and competent team of staff who work in partnership with service users to meet their health, welfare and personal needs. EVIDENCE: The duty roster for the week beginning 30th May 2005 was examined. The roster was a little difficult to read in parts due to amendments. The roster indicated that there were at least four support staff on most daytime shifts and one waking and one sleeping member of staff overnight. Each shift included at least one or more senior staff member and the shift leader was clearly identified. The Registered Manager works Monday to Friday and is supernumerary. Staffing numbers were increased during busy periods. Staffing numbers should be reviewed prior to opening the new respite/crisis unit. See recommendation 2. The home has a stable team of committed and knowledgeable staff. Retention of staff was good and there were no staff vacancies at the time of this inspection. Comments made by service users indicated that staff listened to their views and were supportive. Service users said they could approach staff or management at any time to discuss concerns and were encouraged to speak up if they had any complaints.
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 19 Staff had access to individual supervision sessions each month and could also attend weekly group supervision sessions if they wished. New members of staff were supernumerary for two weeks, whilst working alongside experienced staff and undertaking training. New staff were not expected to undertake complex tasks such as medication and key working until they felt confident and ready to do so. Since the last inspection an appraisal system had been introduced to review staff performance and consider staff training or development needs. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 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) 37, 38 This home is managed by a competent and experienced manager. The manager provides good leadership and support for staff and service users. EVIDENCE: The manager has been in post since 2003. Since this time the manager has undertaken a variety of training including the Registered Managers Award. Senior staff were encouraged to make decisions for themselves but could discuss issues of concern with the management team at any time. Staff were actively involved with some aspects of managing the home and accompany the manager to some meetings and visits. This provides an opportunity for staff to learn new skills and develop new areas of interest. On the day of the inspection the manager had arrived at the home early to make sure that the builders had adequate information and were taking appropriate safety measures. Staff had reassessed fire safety risks to service users and implemented new strategies to minimise risks where possible.
Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 21 Both staff and service users said the manager was approachable and helpful and felt confident that issues of concern would be addressed promptly. It was apparent through feedback from service users, staff and other professionals that the home was well organised and managed. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 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 3 x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x x 4 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chapel Hill Hostel Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 23 No 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 20 Regulation 13 Requirement The Registered person must ensure that a record is maintained of all medicines received in the home and that all medicines are stored appropriately. The Registered person must ensure that adequate hand washing facilities are provided in the laundry room. Timescale for action 01 October 2005 2. 30 13 14 October 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. 2. Refer to Standard 8 33 Good Practice Recommendations The Registered Manager should undertake further work to establish how service users could become more involved in decision making in the home. The Registered Manager should review staffing levels prior to opening the new crisis and respite unit. Chapel Hill Hostel G51 G01 S6812 Chapel Hill V211933 310505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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