Inspection on 25/07/05 for Haddon (32a)

This inspection was carried out on 25th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Haddon (32a) 03/01/08

Haddon (32a) 09/05/06

Haddon (32a) 01/11/05

Haddon (32a) 14/02/05

Haddon (32a) 19/07/04

Haddon (32a) 08/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 32a Haddon Great Holm Milton Keynes Bucks MK8 9HP Lead Inspector Barbara Mulligan Unannounced 25th July 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. 32a Haddon Version 1.10 Page 3 SERVICE INFORMATION Name of service 32a Haddon Address 32a Haddon, Great Holm, Milton Keynes, Bucks, MK8 9HP 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) 01908 262814 mail@macintyre-care.org Macintyre Care Mrs Claire Helen Dove Care Home 14 Category(ies) of Learning disability (14) registration, with number of places 32a Haddon Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6th December 2005 Brief Description of the Service: Set on the edge of Great Holm, no.32a Haddon, owned by MacIntyre Care, is located within a campus style complex, in amongst private housing. It provides accommodation to adults with learning disabilities. 32a Haddon is situated within walking distance of the local shops, church and local pubs. The building itself contains five self contained flats and a small garden area. There is a further complex of buildings that comprise of no. 42a and no. 52a Haddon, the organisations day care services, a hall, a nursery and garden centre, a craft shop, a coffee shop, bakery and an administration office.. The coffee shop and bakery occupy the corner of the site and this provides occupational opportunities for service users and enables local residents to visit the shop. The nursery, garden centre and craft shop also provide occupational activities for service users and are open to the public.The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Service users are encouraged and supported to use public transport to which they have access. 32a Haddon Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 25th July 2005 at 10.30am on a Wednesday morning. The visit consisted of discussions with the senior support worker, and records, policies and procedures were examined. The registered manager and the staff team were holding a team meeting at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Staff training needs to be brought up to date for all staff and the unit needs to be staffed sufficiently to allow staff time off to attend necessary training. Health and Safety measures need to be improved. Several staff need to update their mandatory training, the fire risk assessment needs to be fully completed and the servicing of gas appliances needs to be undertaken as soon as possible. Rotas looked at demonstrated that staff are working on their own in the unit on a regular basis, particularly at weekends. The rotas also showed that there were difficulties allowing staff time off for annual leave or covering staff 32a Haddon Version 1.10 Page 6 sickness. Rotas showed that agency staff are used regularly. This does not provide consistency of care for service users. Serious consideration needs to be given to increasing the staffing ratios in the unit to allow staff to fully meet the needs of service users. Consideration needs to be given to providing service users with comprehensive, accessible, understandable and up to date information, in a suitable format about policies, procedures, activities and services. There was no evidence that work has been carried out in this area and there was nothing available to look at. A consistent approach to quality assurance needs to be maintained by the unit, to ensure that service users views are both sought and acted upon. 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. 32a Haddon Version 1.10 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 32a Haddon Version 1.10 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) These standards were not assessed during this inspection. EVIDENCE: 32a Haddon Version 1.10 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) 9 and 10. Service users are supported to take responsible risks within the context of the home’s risk assessments and risk management strategies that ensure service users can have independent lifestyles. Personal information is handled appropriately ensuring that personal confidences are respected. EVIDENCE: 32a Haddon Version 1.10 Page 10 There is an extensive range of risk assessments. Examples of these include road safety, self-administration of medication, swimming, missing persons, financial risk assessments and travelling alone. There was evidence that risk assessments are reviewed regularly. Day services provide training and tuition to service users regarding personal safety. There is a Health and Safety manual that contained guidelines for missing persons and this was dated 13/06/2003. The head of service has produced detailed guidelines regarding missing persons and these contain information about the different procedures to try for each service user. For example if a service user has their own mobile phone the guidelines have details of individual phone numbers. There is an interim statement/policy dated 09/06/03 regarding confidentiality and access to records. There is a small paragraph included in the statement of purpose regarding confidentiality. Service users records were noted to be accurate, secure and confidential. Training in confidentiality is covered during staff induction and there is information in a staff notes booklet. 32a Haddon Version 1.10 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) 11, 12, 13, 14, 15, 16 AND 17. Links with the local community are good which support and enrich service users social and educational opportunities. Service users engage in appropriate leisure activities inside and outside of the home, allowing individuals to pursue their own interests and hobbies. Staff support service users to maintain family links and friendships inside and outside the home. Service users rights are respected and the daily routines of the unit promote individual choice and freedom of movement. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: 32a Haddon Version 1.10 Page 12 Service users have opportunities to maintain and develop social, emotional, communication and independent living skills through training carried out with the unit staff and day services staff. This includes menu planning, cookery, shopping and bus training. Some service users go to college to learn social skills and life skills. This may include literacy skills, money management, sex education, advocacy, fire training and relationship discussions. Most service users go to work and this may be on site, where there is a coffee shop, a craft shop and a nursery. Day services provide opportunities for further education and service users also attend the local college. There is a learning centre on site that offers food hygiene courses for service users working in the coffee shop. The scheme’s shops and nursery provide varied employment opportunities for service users. The inspector was informed that day services also offer a railway club, dance, drama and an older persons group. Service users take part in varied leisure activities and use local community facilities regularly. These include the local leisure centre, cinema, shops, library, health centre and local pubs and restaurants. Many local residents and members of the public visit the coffee shop where service users are employed, and staff support the service users to become part of, and participate in, the local community. Relations with the neighbours were positive and there had been no problems encountered. Service users have access to transport and use taxis, buses, dial-a-ride and trains, evidence of this was seen in the care plans and through discussions held with service users. Service users vote, and do so by proxy or by attending the local polling station on voting day. Staff recognise that time spent with service users outside the unit, including weekends and evenings, is part of their staff duties. Service users are encouraged and supported to pursue their own interests and hobbies. These include football, swimming, dance, the gateway club, the cinema and horse riding. Where necessary, appropriately trained staff support and advise the service users. Each service user has access to a television and music systems. Service users enjoy an annual holiday and those service users who do not wish to have an annual holiday enjoy day trips and weekend breaks. 32a Haddon Version 1.10 Page 13 There are no restrictions about family and friends visiting. The unit has a lot of contact with families and friends of service users. Service users can chose whom they see and when, and can see visitors in their rooms and in private. Service users open their own mail, and this is collected from the staff block where it is delivered. Staff help service users with reading and understanding the content of their mail, if help is required. Service users have keys to the front doors of their flats. Menus are chosen by service users. Meals are offered three times a day and service users have access to snacks and drinks throughout the day. A record is kept of all meals provided. Service users are weighed regularly and there are risk assessments in place for individuals who refuse to be weighed. One service user is a vegetarian who is are supported by staff to manage this. At the time of the inspection there were no service users who required help to eat or who were fed artificially. 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) These standards were not assessed during this inspection. EVIDENCE: 32a Haddon Version 1.10 Page 14 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. These standards were not assessed during the inspection. EVIDENCE: 32a Haddon Version 1.10 Page 15 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) These standards were not assessed during the inspection. EVIDENCE: 32a Haddon Version 1.10 Page 16 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) 31,32, 33, 35 and 36 Service users benefit from a staff team who are mostly up-to-date with their training, however, some updating of training is needed to ensure that staff are competent to do their jobs. Service users benefit from clarity of individual staff roles and responsibilities ensuring continuity of care. Only limited progress has been made in addressing staffing shortages and as a result there had been some staff turnover and sickness that does not offer consistency of care to the people using this service. EVIDENCE: Staff are aware of the home’s/organisation’s values, policies and procedures through staff training and induction, and reading policies and procedures which staff sign a form to say they have read. The unit operates a link worker system. New staff work alongside more experienced staff until they become competent in their role. The unit has no volunteers at the time of the inspection. New staff undertake an induction to the home and the organisation, which provides the staff member with a personal development portfolio. There are 32a Haddon Version 1.10 Page 17 two newly appointed staff members undertaking their induction. The induction programme covers such areas as understanding physical and verbal aggression and self-harm, cultural and religious needs and the role of the multidisciplinary team. The inspector was informed that no staff member was under the age of 18 yrs. There is one part time domestic staff who has recently been employed to assist with the cleaning of flats. The rotas demonstrated that care staff regularly work alone, particularly at weekends. It is a requirement of the report that care staff do not work on their own during the day shifts. Staffing was not adequate to provide support to service users with evening activities or emotional needs. The rotas also showed that there were difficulties allowing staff time off for annual leave or covering staff sickness. Agency staff are used on a regular basis. This does not provide consistency of care for service users. Serious consideration needs to be given to increasing the staffing ratios in the unit to allow staff to fully meet the needs of service users. The unit does not have its own dedicated training budget. However, training offered by the organisation was seen to be varied and suitable to meet the service aims of the unit. However some mandatory training for staff needs to be updated and is a requirement of the report. There was evidence that care staff receive formal supervision monthly. All staff receive an appraisal with their line manager to review performance against job descriptions and agree development plans. There is one support worker who has completed NVQ level 2 training and the senior carer is working towards his NVQ level 3 training. The registered manager is working towards her Registered Managers award. Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 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 Version 1.10 Page 18 32a Haddon 43. 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 and 43. 38, 39, 40, 41, Overall health and safety procedures are not being adequately maintained. Mandatory training needs to be updated for several staff, servicing of gas appliances needs to be undertaken as soon as possible and the units fire risk assessment needs to be fully completed, to ensure the safety of service users, staff and visitors to the unit. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The home operates an inconsistent approach to quality assurance with little evidence that service users views are sought or acted upon. EVIDENCE: Staff understand and can relate to the aims and purposes of the home. This is achieved through regular staff meetings, staff supervision and annual appraisals. There is a communications book, handover meetings, service user plans and training. The home has a complaints procedure in place and a whistle blowing policy, which enable staff and service users to voice concerns and affect the way in which the service is delivered. Macintyre Care has an equal opportunities policy in place and this was looked at during the inspection. The unit has a service plan that is drawn up and agreed with the team. There is also a mission statement that all staff are aware of and this was evident through discussions held with staff. There is an Investors in Care report and a Portfolio of continuous improvement report. Both of these are updated annually and these were seen. Internal audits include staff sickness, service users monies, staff raining, accidents/incidents, service users support plans, NVQ monitoring forms, risk assessments and agency monitoring. The unit has not undertaken any service user surveys during the last twelve months. Feedback is obtained through flat meetings and link worker meetings. However these have not been taking place due to present staff shortages. 32a Haddon Version 1.10 Page 19 Copies of the Regulation 26 visit were looked at. These were taking place although not on a monthly basis. Reports were not being received by the Commission on a regular basis and will be a requirement the report. All policies are kept in staff offices and are easily accessible to staff. The policies and procedures need to be more service user friendly. Some new policies that have recently been reviewed contain pictures making them easier for service users to understand. Service users have access to their own records and information about them. Fire Safety Records were looked at. The unit’s fire risk assessment is written in pencil, is not fully completed, dated or signed. This needs to be completed as soon as possible and is a requirement of the report. Records were seen of weekly fire alarm testing, emergency lighting checks, regular servicing reports of fire equipment and a copy of the most recent fire inspection. There is a record of monthly fire evacuations and these are carried out with service users. Fire training records observed demonstrated that not all staff are up to date with mandatory fire training. This has been made a requirement of the report. Moving and Handling training and first aid training need to be updated for several staff and has been made a requirement of thee report. There is an annual service agreement for boilers and certificates seen are dated 12/11/2003. This needs to be undertaken again as soon as possible and is a requirement of the report. Hot water is not thermostatically controlled, but hot water outlets are risk assessed and tested weekly. PAT testing is carried out annually and these records were seen. The records for this indicated that this was last undertaken on 17/12/2004. Window restrictors are in place and these are risk assessed. A monthly check of the environment is carried out and security checks of the premises are undertaken nightly. A new Health & Safety manual is available for staff. This is detailed and informative and attempts have been made to ensure this file is user friendly, it contained a picture guide. Records were seen of accidents and incidents and these are monitored on a monthly basis. There are data sheets and COSHH risk assessments in place. These are dated14/04/2004. Insurance certificates are displayed in the unit. Service users are not involved in the business and financial planning of the unit. However, they are involved in budgets for their own flats/homes. There is a central administration office that ensures systems are in place to cover budget monitoring, financial planning, quality monitoring and human resources planning. 32a Haddon Version 1.10 Page 20 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 Score x x Standard No 22 23 Score x x Page 21 32a Haddon Version 1.10 3 4 5 X x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x 3 2 3 3 2 3 32a Haddon Version 1.10 Page 22 yes 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 33 Regulation 18 Requirement The Registered Manager is required to ensure that care staff are not rostered to work on their own at any time during the day shifts. The registered provider is required to ensure that the unit is adequately staffed to allow care staff to attend necessary training as needed without leaving the unit short of staff. The registered manager is required to ensure that an effective quality assurance monitoring system is in place to measure success in achieving the aims, objectives and statement of purpose of the home. The registered provider is required to ensure that Regulation 26 reports are sent to the Commission on a monthly basis. The registered manager is required to ensure that all mandatory training for care staff is up updated as necessary. The registered manager is required to ensure that the fire risk assessment for the home is Version 1.10 Timescale for action 30/07/05 2 35 & 33 18 30/09/05 3 39 12 30/12/05 4 39 26 30/09/05 5 42 18 30/12/05 6 42 13 30/08/05 32a Haddon Page 23 fully completed. 7 42 23 The registered manager is required to ensure that servicing of all gas appliances is undertaken as soon as possible, or provide to the Commission evidence that this has been undertaken. 30/08/05 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 33 Good Practice Recommendations It is seriously recommended that consideration is given to increasing the staff ratios in the unit to allow staff to fully meet the needs of service users. 32a Haddon Version 1.10 Page 24 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 32a Haddon Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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