CARE HOME ADULTS 18-65
Chapel Hill Hostel 44 - 55 Chapel Hill Crayford Kent DA1 4BY Lead Inspector
Maria Kinson Announced Inspection 5th December 2005 09:35 Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 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 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) Kingshouse@together-uk.org Together Working for Wellbeing 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 DS0000006812.V267689.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: Chapel Hill Hostel is owned by Bexley Council, which leases the property to Together Working for Wellbeing. 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 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. The home has been built on a hill and does not have disability access. There is limited off-road parking. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 5th December 2005 between 09.35am and 16.55pm. A partial tour of the home was undertaken and the inspector spoke with three service users, two visitors and two members of staff. Care, recruitment and health and safety records were examined. Comment cards were distributed to relatives and other professionals that were in regular contact with the home. Seven comment cards were returned to the commission. Since the last inspection the name of the registered company had changed from Mental After Care Association (MACA) to Together Working for Wellbeing. What the service does well:
This home meets or exceeds all but one of the National Minimum Standards for Young Adults. The home was assessed during this inspection as providing consistently good outcomes for service users. The home was led by a competent manager who continuously strives to develop and improve the service. Retention of staff was good. This provides good continuity of support for service users. The provision of training for staff was excellent. Staff could access a variety of relevant training courses to develop their skills and knowledge. The home had a robust recruitment procedure in place and new staff received appropriate support and training during the induction period. Feedback from service users, relatives and other professionals was mostly good. The comments made by other professionals that were in contact with the home indicated that staff communicated effectively and had a good understanding of service users needs. One professional said “I just wish the home was bigger and there were more beds”. Service users and relatives said that staff were helpful and supportive. Service users were able to help to develop the weekly menu and make meal choices. Feedback about the food provided in the home was good. The arrangements for admitting new service users into the home were satisfactory. Adequate information was obtained about service users needs and strategies to manage risk were considered prior to accepting new service
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 6 users. Service users were encouraged to visit and spend time in the home prior to making a decision to move in. Records maintained by staff were accurate and up to date. Care was taken by staff to keep confidential information secure and to build a trusting relationship with the service user. Service users were encouraged maintain their independence and to participate in the running of the home where possible. Staff supported service users to access training and further education classes and to pursue personal interests where appropriate. The management of medication was good. Accurate records were maintained for medication received and administered in the home. The home provides a flexible self- medication programme for service users who could safely manage some or all of the procedure independently. The home complaints procedure was easy to follow and staff viewed concerns and complaints in a constructive manner. All parts of the home were clean, tidy and odour free. The building was well maintained and health and safety issues were attended to promptly. The home had a good quality assurance system, which includes a comprehensive assessment of all aspects of the service once a year. During the annual review a variety of arrangements were made to obtain feedback from the people that use the service, as it was recognised that some service users may not be comfortable in group situations or talking openly in front of staff. The findings from the review were included in a report about the service. The report identifies areas for improvement and was shared with service users and staff. What has improved since the last inspection?
The homes Statement of Purpose was reviewed and updated on a regular basis. The commission was supplied with copies of the revised document. The work to provide a dedicated respite and crisis unit and to improve the internal decoration and layout of the home was complete. As a result of this work the number of en suite bedrooms had increased to four, the dining area was more spacious and the overall appearance of the home was more welcoming and homely. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 7 Staff had taken action to ensure that adequate hand washing facilities were provided in the laundry room. Records of medication received into the home had improved. 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 DS0000006812.V267689.R01.S.doc Version 5.0 Page 8 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 Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 9 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 and 4. The home provides comprehensive written information about the service for prospective service users. The arrangements for admitting new service users into the home were satisfactory. EVIDENCE: The homes Statement of Purpose and Service User Guide had been reviewed and updated to include information about the opening of the Crisis and Respite unit and new facilities. See standard 19. The manager had developed an operational policy for admission to Hill Top View (crisis beds). Community staff carried out a mental health assessment for prospective service users and forwarded a copy of the assessment to the home, for staff to consider. Senior staff also contacted the service users allocated social worker to discuss the assessment in more detail where necessary. The admission procedure for service users admitted to the other beds in the home was more structured. Staff from the home carried out a formal assessment of the service users needs and the service user was encouraged to visit the home to meet staff and service users. The manager also obtained information about prospective service users during local multidisciplinary panel meetings. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 and 10. Service users assessed needs and personal goals were reflected in their individual plans. Confidential information about service users was handled and stored appropriately. EVIDENCE: The care records for two service users were examined. Both service users had a comprehensive assessment, support plan and risk assessments. Service users were asked to complete a self- assessment on admission to provide more information about their individual needs and preferences. Daily records were up to date, accurate and informative. At the end of each month staff compiled a report about any significant issues or events that had taken place during the previous month. This made it easier to see at a glance what progress the service user was making and whether the plan was working. Support plans were discussed and reviewed with the service user. Service users were given a personal copy of their plan. The Manager and Deputy Manager had attended training sessions organised by the Kings Fund about new models for supporting people with mental health
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 11 needs. The new model includes developing a ‘wellness toolbox’ for each service user. The service user provides specific information for their personal ‘toolbox’ about what they feel contributes to or triggers their ill heath, what type of interventions help them to recover, a list of the activities they like and things that make them feel well. The ‘toolbox’ also includes a daily maintenance plan, so that staff know what support the service user requires on an ongoing basis and a crisis plan outlining the support the service user requires when their health declines. Further training about the recovery model was planned for staff and the management team were hoping to adapt the tool to suit local needs prior to implementing it in the home. This initiative is commended as it places the service user at the centre of the service delivery. Staff were aware of the need to share information on a ‘need to know’ basis and were sensitive when dealing with personal issues. Information recorded was factual and did not include personal views or opinions. Service users files were stored securely. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 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): 11, 12, 13, 16 and 17. Service users were supported to learn new skills and to lead active and fulfilling lives. The food provided in the home met service users needs and tastes. EVIDENCE: Service users educational needs were discussed during review meetings. Where appropriate service users were referred to agencies that specialised in providing retraining or work experience. Some of the service users living in the home were undertaking part time work or attend local education classes. The home is located close to community mental heath resources where service users can learn new skills and obtain advice and support. Staff assisted service users to access training, prepare for interviews and provided support if necessary when undertaking unfamiliar tasks such as travelling to a new area. Service users were encouraged to participate in the running of the home and take responsibility for keeping their personal space clean and tidy. Regular house meetings were held in each flat and social events such as BBQ’s, an open day to launch the new company name and karaoke sessions had taken
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 13 place since the last inspection. Service users were given a key for the front door and their bedroom. Staff only entered service users bedrooms with their permission or if they had concerns about their welfare. Key workers encouraged service users to take part in activities in the home and community. Discussions with service users indicated that some of the service users had played table tennis and darts, had visited the cinema, bowling alley and shopping centres and had enjoyed an outing to the coast. The menu was prepared one week in advance by the cook and service users. The menu for the week prior to and the week of the inspection were examined. Although there was only one choice of food listed on the menu a range of alternative dishes were listed and had been provided for specific service users. Some of the service users were self- catering and were responsible for purchasing and preparing their own food. All of the service users spoken with said they liked the food provided in the home. One service user reflected the comments made by all of the service users spoken with when he said, “we can have what we like”. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 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. Consistent and flexible support was provided for service users. Service users were supported to manage their own healthcare and to access community health care services. The management of medication was good. The arrangements for selfmedication were flexible and maximise service users independence. EVIDENCE: Feedback from health and social care professionals that were in regular contact with the home was good. All of the professionals that responded to the questionnaire sent out by the commission said that staff had a good understanding of service users needs and were satisfied with the overall care provided in the home. Visitors spoken with during the inspection said that “staff were knowledgeable and helpful” and “this is an excellent service”. Each of the service users was allocated a key worker who was responsible for reviewing and updating plans and providing individual support. All of the service users had established a good working relationship with their key worker who they spent time with each week. One of the service users required assistance with personal hygiene. This service was provided by an agency. Service users were able to choose how and where they spent their free time, subject to restrictions outlined in the support plan or risk assessments. As the
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 15 home provides rehabilitation there is an expectation that service users will develop a routine based on their personal objectives and goals. The previous requirement to ensure that adequate records were maintained about medicines received in the home had been addressed. The home provides a flexible, staged self-medication programme for service users. This arrangement enabled some of the service users to take responsibility for all or part of their medication and to become more independent over time. Risks were assessed prior to service users commencing self medication programmes and were reviewed when service users were unwell or were experiencing difficulties. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 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. This home has good systems in place to respond to concerns and complaints. EVIDENCE: The complaints procedure was included in the Service User Guide and Statement of Purpose. The procedure includes a timescale for responding to concerns and contact details for the commission. During the past year the home had received two complaints. Complaints were investigated and responded to in a timely manner. The commission have not been made aware of any other complaints or adult protection issues relating to this service. The home had a good system for safeguarding service users personal money. Two sets of records were checked and were found to be correct. Two signatures were obtained for all transactions. The manager carried out regular audits to ensure that the homes procedure was followed. Service users were encouraged to manage their own finances where possible. At the time of this inspection twelve service users were doing this. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 17 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 and 30. This home provides a clean, comfortable and homely environment for service users and their visitors. EVIDENCE: The work to update some of the facilities in the home and create a dedicated crisis and respite unit was complete. This work had resulted in three additional en suite bedrooms in Hill Top View, a larger dining area and improved comfort for service users in terms of décor and furnishings. The home had lost one bed as a result of this work. The Registered Person must submit an application to vary the homes registration to reflect the reduction in the number of beds in the home. See requirement 1 and standard 41. Two of the new en suite bedrooms rooms were viewed. The rooms were pleasantly decorated, homely and welcoming for service users. Service users were pleased with the changes that had been made. The previous requirement to ensure that hand washing facilities were provided in the laundry room had been addressed. All parts of the home were clean, tidy and odour free. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35. This home has a stable team of well-trained and competent staff that provide good support for service users. EVIDENCE: The arrangements for staffing the home were stable and the staff team had not changed since the last inspection. The home had two designated relief staff that cover staff sickness and annual leave and some of the permanent staff work additional hours when necessary. This provided good continuity of care for service users. Service users were mostly satisfied with the support provided by staff. One service user said, “Staff are good they listen to you”. The Manager said that staffing levels had been reviewed prior to the opening of the new unit but additional staff were not required. This issue should be reviewed on an ongoing basis. Since the last inspection some small changes had been made to the homes recruitment procedure. The probation period for new staff had been extended to six months and applicants now had to complete a small written exercise during the interview. A new post of trainee social care worker had recently been created and was about to be trialled in the home. The successful
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 19 applicant will have a one year contract, be supernumerary for six months and have a named mentor. If successful this initiative should help to provide a well- trained supply of staff for the future. Staff can access training from a number of sources. The registered company provides structured induction and foundation training to nationally recognised standards and ongoing training. The manager can access external training courses to meet staff needs where necessary. In addition to this staff can attend training arranged by the local Mental Health Trust or local authority and government funded distance learning training packages. Individual training records were maintained for each member of staff but induction records for recently appointed staff could not be viewed. The manager should ensure that these records are available for inspection at future inspections. See recommendation 1. Since the last inspection some staff had attended various training sessions such as recruitment and selection, moving and handling, infection control, hearing voices, risk assessment, life coaching and medication. The manager had identified that some staff required computer skills training. This training was due to take place in 2006. Staff said the home was well managed, that they received good support from senior staff and access to training was excellent. The provision of training in this home exceeds the National Minimum Standard. 69 of support staff had attained a vocational qualification at level three or above. Some of the other members of staff were undertaking this training. This exceeds the target set by the Department of Health. The home has one NVQ assessor and Verifier and some of the senior staff were undertaking assessors training. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 41 and 42. This home was well managed and led. The atmosphere in the home was open and supportive, which made service users feel comfortable and safe. EVIDENCE: The management arrangements were unchanged. The Manager and Deputy Manager continue to work hard to support staff, service users and relatives. The home had good systems in place for monitoring the quality of care provided in the home. This included monthly quality reports and an annual review of the service. During the annual review questionnaires were sent to service users, relatives and staff and group meetings were held in the home to obtain feedback about the service. A report about the findings from the audit was compiled and areas for improvement were identified. Consultation with service users was excellent and records indicated that service users views were listened to and acted on. The work to reconfigure and refurbish the home was complete (see standard 19). The manager was advised to submit a variation application to the
Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 21 Commission, so that the work that the work that had been undertaken could be assessed and the registration certificate amended to reflect the reduction in the number of beds. See requirement 1. Fire safety equipment was serviced at regular intervals and records were maintained about in house fire safety checks. Staff did not always record the time that fire drills were carried out. See recommendation 2. A selection of health and safety records were examined. Records indicated that appropriate action was taken to maintain service users and staff safety. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 4 3 X 4 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chapel Hill Hostel Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X 3 4 X 2 3 X DS0000006812.V267689.R01.S.doc Version 5.0 Page 23 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. 1. Standard YA41 Regulation 39 Requirement The Registered Person must submit an application to vary the homes registration from 24 to 23 beds. (Registration Regulations Part IV regulation 12). Timescale for action 10/04/06 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 YA41 YA42 Good Practice Recommendations The Registered Person should ensure that staff induction records are available for inspection. The Registered Person should ensure that fire drill records include the time the drill was carried out. Chapel Hill Hostel DS0000006812.V267689.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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