CARE HOME ADULTS 18-65
Haddon House 145 West Heath Road West Heath Birmingham B31 3HD Lead Inspector
Joe OConnor Unannounced 27 June 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. Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Haddon House Address 145 West Heath Road West Heath Birmingham B31 3HD 0121 475 1681 0121 475 1681 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) Haddon House Ltd Ms Joanna Tuke Care Home 6 Category(ies) of Younger Adults, Mental Disorder registration, with number of places Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 15 March 2005 Brief Description of the Service: Haddon House is a large detached house situated in the West Heath area of Birmingham. It is situated along a service road adjoining the main West Heath Road. The home has six single bedrooms, two of which are on the ground floor and four on the first floor all of which have en-suite facilities. The lounge and dining room are to the rear of the premises. A toilet and shower room are situated on the ground floor. There is a bathroom on the first floor with a grab rail. There are two cars on the front driveway and access to the house is via sloped wooden decking area. There is a well maintained rear garden that also benefits from a wooden decking area that is covered over. This provides an attractive seating area for service users. A sloping ramp leads to a further small patio area and lawn. There is a range of garden furniture for the service users to use. The home has two cars enabling service users to access local facilities and Birmingham City Centre. Local amenities such as shops, banks and the GP practice are close by and the home has good transport connections via bus and rail services. The home is registered to provide personal care and accommodation to a maximum of six adults who have a mental disorder. The home provides three meals a day and is staffed on a twenty four hour basis.
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took during the day. Three service users were present and all were able to convey their views about life in the home. A limited tour of the premises was undertaken. Service users care plans and risk assessments were inspected. Staff recruitment and training records were also sampled. A number of health and safety records were also examined. The Inspector spoke to two members of staff and the manager. Observations of care practice were also undertaken. What the service does well:
Service users live in premises where its external features are similar in design and structure to that of neighbouring properties and its purpose as a care home is not distinguishable. Service users were observed to receive friendly and professional support from care staff. Comments were received from service users that were generally very positive about life in the home. One service user commented, “ I am happy here, the staff listen to my views”. Another stated “ I can have privacy and have a key to my bedroom”. “This place is much better than where I was living before”. Service users appeared well cared for and dressed appropriately for the climate of the day. The atmosphere during this visit was friendly and relaxed. Staff showed an awareness and understanding of the service users needs. They have completed the majority of mandatory training topics and have also completed training in the safe handling of medicines. Staff have also received training in specialist topics such as awareness of mental and health and diabetes. Service users have the opportunity through monthly meetings to communicate their wishes and feelings about the food provided in the home and the activities participated in. Specific dietary requirements are catered for and this was evident when discussing with one service user who spoke about her dietary requirements because of her religion. Service users expressed satisfaction with the meals provided in the home and the food records indicated there was a varied nutritious choice. Transport is provided for service users to go out in the community such as cinema, local pubs and day trips to places such as Warwick Castle and Drayton Manor Park. One service user had recently finished a term at college and had gone out with a member of staff to choose new courses for September this year. Another service user visits a local Baptist church to meet her friends. Service users are able to spend time as they please with no rigid rules or routines.
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 6 Service users have a care plan that sets out how the individual needs of each service user is to be met. A sample of service users care records confirmed that they had access to a range of healthcare professionals such as GP, Optician and Dentist. The service maintains good relationships with specialist professional support services within the area of mental health. The management of service users medication was found to be of an acceptable standard. 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.
Haddon House E54 S16889 Haddon House V231734 270605 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 Haddon House E54 S16889 Haddon House V231734 270605 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) 3 & 5 The needs of the current service user group are being met through the maintenance of detailed records and staff demonstrating an understanding of their needs. Service users have a statement of terms and conditions that informs them of the fees being charged by the service. EVIDENCE: Three service users spoke with satisfaction about the care and support received by staff. One service user stated she liked living at Haddon House and that it was better than another placement where she used to live in Somerset. Another service user felt happy and spoke of how supportive staff were when her mother recently passed away. The third service user said she liked her privacy and this was being respected by staff. Observations were made of staff interaction with service users that was generally positive. Two staff spoken with demonstrated a good understanding about the needs of the current service user groups. Service users records found that information was available as to how the service was meeting the needs of service users, including involvement from professionals from specialist mental health support services. The manager had made amendments to the service users’ statement of terms and conditions to include information about the fees charged by the service, a requirement from the previous inspection. Haddon House E54 S16889 Haddon House V231734 270605 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) 6, 7, 8 & 9 Service users are encouraged to make decisions about their lives through service users meetings. Service users have in place detailed risk assessments concerning any issues around their vulnerability and limitations on their independence. EVIDENCE: Each service user has a detailed care plan that covers all aspects of their daily living activities. There was evidence that service users are part of the Care Programme Approach that is co-ordinated by mental health professionals including a CPN, Social Worker and Consultant Psychiatrist. Care plans are reviewed monthly and referred to where service users physical and mental health had improved. It was noted service users were involved in their development. Each service user has a named keyworker. Discussion with staff and service users found that choices are encouraged. Two service users stated that there was a choice of food available and that they could choose when to go to bed. The manager stated that service users are involved in recruitment of new staff and meet the prospective staff member prior to taking up employment. Service users have a meeting every month where they can talk about future activities and meals.
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 10 Risk assessments were in place that covered topics such as prevention of falls and a personal risk assessment that highlights any areas of vulnerability for service users when they are out in the community. These were reviewed monthly. Haddon House E54 S16889 Haddon House V231734 270605 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) 11,12, 13, 15, 16 &17 Service users are given opportunities for personal development through accessing appropriate community resources with staff support. Service users are able to access leisure activities that are age appropriate. Service users maintain good relationships with staff and have contact from relatives. There are no unnecessary daily routines. Service users have access to wholesome nutritious meals with a varied menu demonstrating choices available. EVIDENCE: Each service user has a timetable of activities during the week. One service user stated that she regularly goes out to the local shops and visits Northfield Baptist church where she can meet her friends and travels by bus. Another service user had gone out with a member of staff to look at college courses for next September. The service user stated she wanted to work animals having previously worked in a pet shop. She had recently gone to York on a residential course that covered how to become more independent. Service users are able to access local facilities such as the local pub, shops, cinema and restaurants. There was evidence to confirm that service users were able to maintain contact with friends and family. One service user has maintained a friendship with another service user in another service in the Solihull area. Two service users
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 12 did express concern that a proposed holiday in Spain might not go ahead because the villa that had been built by the organisation was not ready. The manager stated that she was looking to arrange an alternative holiday and that the service users would not miss out. Two vehicles are provided by the organisation. Observations at the time of this inspection indicated that there was a good relationship between staff and service users with no unnecessary restrictions apparent. Staff are aware of service users’ routines and these were respected. Two service users stated they had a key to their bedroom. A sample of the food records indicated that service users have access to a range of healthy meals and that a record is maintained to confirm what had been eaten. One service user who is a Muslim is able to have a Halal diet. Service users stated that they liked the food and were involved in the shopping. Haddon House E54 S16889 Haddon House V231734 270605 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, & 20 Service users receive personal support and choose when they require assistance. Service users are able to access community and specialist primary healthcare services through good recording systems. Medication management is promoting service users’ good health. EVIDENCE: The service has a team of predominantly female staff as the current resident group are also female so appropriate gender care is provided. Three service users stated they could get up and go to bed when they wanted to. A sample of service users records referred to instances where service users had completed personal care tasks. Each record examined also had evidence of current manual handling assessments. There was documented evidence to confirm when service users had seen healthcare professionals such as GP, Dentist and Optician. Further evidence confirmed that specialist support and intervention is accessed from Community Psychiatric Nurse and Consultant Psychiatrist. One service user’s care plan had detailed guidelines in place how their diabetes should be managed and how often blood tests had to be taken. It was noted that service users are weighed but a sample of the weight charts found that these were not occurring on a monthly basis.
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 14 Medication management was found to be of an acceptable standard. Care must be taken however, to ensure that staff clearly define the use of the F code on the Medicines Administration Records (MAR Charts). All staff have completed accredited medication training. Haddon House E54 S16889 Haddon House V231734 270605 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&23 A complaints procedure is in place for service users that is written in an accessible format. Service users feel staff listen to their views and concerns and these are responded to by the manager. Staff receives appropriate training in the protection of vulnerable service users backed up by appropriate policies and procedures. EVIDENCE: There is a complaints policy and procedure that is written in an accessible style for service users. Neither the service nor the CSCI have received any complaints during the last twelve months. Service users stated that they would be would able to go to the manager in they had any complaints or concerns. In discussion with staff and from a sample of staff training records, it was found they had undertaken training in the abuse of vulnerable adults and challenging behaviour. Two staff provided satisfactory responses that they would be able to challenge poor practice and report any incidents to the manager. There is an adult protection policy and procedure including a copy of the Multi Agency Guidelines published by Birmingham City Council. The management of service users personal allowances was not assessed but will be looked into at the next visit. Haddon House E54 S16889 Haddon House V231734 270605 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 &30 The premises is maintained and cleaned to an acceptable standard. Service users are able to move freely around the premises without any apparent hazards. Service users health and safety is maintained through the availability for staff of procedures for the control of infection. EVIDENCE: A partial tour of the premises was undertaken at the time of this inspection. The building was found to be clean and tidy with no foul odour present. Service users expressed satisfaction with the cleanliness of the premises. The premises had a separate laundry area that was found to be clean and tidy. It was noted that a requirement from the previous inspection for the covering of the decking area to the rear of the premises during wet weather, had been addressed. Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 17 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, 33, 34, 35 & 36 Service users are supported by staff that are competent and qualified to meet their needs. Current staffing levels meet the needs of service users. The staff rota does not make clear shifts being worked by staff and the manager. Staff recruitment records meet the requirements of the regulations ensuring protection of for the service users. Staff are offered and provided training that enables staff to undertake their duties in meeting the needs of the service users. However, all staff are overdue training in food hygiene. Staff supervision does meet the required level of frequency. EVIDENCE: Staff demonstrated an understanding around the needs of the current service users and provided positive interactions with the service users. Two staff spoken with stated they were qualified at NVQ Levels 2&3 and they were undertaking NVQ Assessors training. The levels of staffing were found to be adequate at the time of this inspection. However, the staff duty rota did not state the hours worked by staff and the manager. In discussion with service users and staff they stated there were enough staff on duty. One new member of staff had been recruited since the last inspection to a night waking post. There was a vacancy for a team leader position and a senior carer which the manager was arranging for recruitment to these posts. Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 18 Staff recruitment records were found to be satisfactory with evidence of proof of ID, CRB check, birth certificate, passport, job application form, contract and two references. There was also evidence that photographs were in place a requirement from the previous inspection. There was evidence on three staff records sampled that they had completed training in areas such as fire safety, manual handling, food hygiene, and first aid. However, it was noted that a number of staff were overdue updated training in food hygiene. Staff had also completed training in diabetes. Certificates of training courses completed were on file. The manager maintains a record of training and it was found a number of staff had been booked for infection control training following this inspection. There was evidence that staff had completed a detailed induction programme. During the course of this inspection a representative from Omega Training Ltd was visiting the service to meet with a number of staff that were completing NVQ training. The representative provided positive comments with regard to staff’s commitment to NVQ training and also stated that the manager would always seek advice and ensure staff met any deadlines to complete learning modules. The representative stated that service users were well cared for and that the interactions form staff were friendly and professional. The frequency of staff supervision was found to be satisfactory. Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 41 & 42 Service users live in a home that is run by a competent management team. There is an open and relaxed, friendly atmosphere that benefits service users and staff. The records were generally up to date for the safety of service users. The welfare and safety of service users is promoted and maintained with some minor improvements required. EVIDENCE: The Registered Manager has had a wide range of experience of working with service users who have mental health problems. She was able to demonstrate a good understanding of the needs of the current group of service users. The manager is currently completing qualification towards the Registered Managers Award. The atmosphere was found to be relaxed and friendly which benefits the service users. All three service users spoken with stated they would be able to approach the manager if there were any concerns. Staff spoken with also stated that they found the manager to be approachable. One stated that she felt the manager had assisted her professional and personal development. Staff meetings occur on a monthly basis.
Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 20 The records were found to be generally up to date and locked in a secure facility. Records with regard to health and safety were found to be satisfactory. There was evidence to confirm that the fire alarm was being tested weekly and the emergency lighting every month. A recent fire drill had occurred prior to this inspection. It was noted that an inspection and testing of the premises hard wiring was overdue. The accident book was examined and it was good to see there were no accidents since the last inspection. However, it was noted that a number of incidents had not been reported to the CSCI via Regulation 37 notification. Records were being maintained on a daily basis for the freezer and refrigerator. Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Haddon House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 2 x E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 22 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. 2. Standard 19 33 Regulation 12(1)(a) 18(1)(a) Requirement The Registered Person must ensure service users weight is monitored every month. The Registered Person must ensure the staff rota must state the following: Person in charge Hours Worked Handovers Must include record of whether rota actually worked. The Registered Person must ensure that it notifies the CSCI without delay any incident that adversely affects the well being of service users. The Registered Person must ensure that the hard wiring for the premises is inspected and tested to confirm its worthiness. The Registered Person must ensure that all staff receive up to date training in Food Hygiene. Timescale for action 27 July 2005 27 July 2005 3. 42 13(4) 37(1) 27 June 2005 4. 42 13(4) 23(2) ( c) 18(2) 27 July 2005 27 July 2005 5. 6. 7. 35 Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 23 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 Good Practice Recommendations Haddon House E54 S16889 Haddon House V231734 270605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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