CARE HOME ADULTS 18-65
Halland House Halland East Hoathly East Sussex BN8 6PS Lead Inspector
Elaine Green Key unannounced Inspection 3rd May 2006 08:00 Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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 Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Halland House Address Halland East Hoathly East Sussex BN8 6PS 01825 840268 01825 840630 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) www.garyrichardhomes.co.uk Gary Richard Homes Limited Mrs Sonia Johanna Williams Care Home 30 Category(ies) of Learning disability (30) registration, with number of places Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is thirty (30). Service users will be aged eighteen (18) to sixty five (65) years on admission. That service users will have a learning disability. That one named service user who was over the age of sixty five (65) on admission can be accommodated. 28th November 2005 Date of last inspection Brief Description of the Service: Halland House is situated on the main Eastbourne to Uckfield road in the village of Halland. There are two public houses within walking distance and a bus service providing links to the towns of Eastbourne, Lewes, and Uckfield. The home provides accommodation for up to 30 adults with a learning disability. The property is divided into three areas, a large detached house with two floors and a smaller lodge where the most independent residents live. The lodge has its own kitchen but main meals are prepared in the house. There are large gardens providing an area for relaxation and recreation as well as an area for a gardening project. There is a day centre within the grounds which some of the service users attend and it has a dedicated staff team. The residential fees charged are assessed on an individual basis starting from £520 per week and day care is charged at £30 per day. Copies of the most recent Inspection report are available form the provider upon request. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The National Minimum Standards refer to individuals who reside in Care Homes as “Service Users”. The people who live at Halland House would like to be referred to as “Resident(s)” so throughout this report the term “Residents” will be used. As part of the unannounced Inspection of Halland House, a site visit took place to the home on the 3rd of May 2006 between 8 am and 5pm. As part of the Inspection the Registered Manager completed a Pre Inspection Questionnaire that provided the Inspector with statistical information relating to the home. Residents of Halland House and their relatives or representatives were also given the opportunity to complete surveys and return them to the Inspector. On the day of the site visit, issues relating to the day-to-day running of the home were discussed with the Registered manager and her Deputy. Discussions also took place with five residents and five members of staff. A range of documents were examined including three residents care plans, two recruitment files, a selection of the homes’ policies and procedures and some of the homes daily records. What the service does well:
Prospective residents of Halland House have their needs assessed by the registered manager prior to moving into the home and are given all the relevant information they require in order to make an informed decision about whether or not to reside there. Residents are provided with the opportunity to participate in stimulating and enjoyable activities in the homes’ own day care facility and by accessing the facilities on offer within the local community. Residents are able to make choices about the way they spend their time and about the way they decorate and furnish their rooms. All residents are given the opportunity to have an annual holiday. The food provided is nutritious and wholesome. Mealtimes are relaxed and informal and staff support residents if required. Each of the three distinct areas of the home has it’s own dining room, kitchen and lounge all of which are domestic in character. Those who are able, assist in the running of the home. The medication policies and procedures adopted by the home are safe and residents’ health care needs are met. Referrals are made to the relevant health care professionals when required and adult protection alerting procedures are followed when required. The staff team are open and enthusiastic to new ways of working. They receive appropriate training and are supervised on a regular basis. Informative handovers take place at the beginning of each shift ensuring that all relevant information is passed onto the staff coming on duty. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Further detail is required to be documented in residents care plans in relation to their preferences in regard to the support they receive and the leisure activities that residents participate in on an evening and at weekends. Further risk assessments are needed to be completed in relation to residents safe access to all areas of the home and grounds for ample whether they can access the kitchen alone or if support is required. The complaints policy must specify the relevant contact details and the timescale in which a response will be made. It is required that a minimum of 50 of the care staff employed at the home obtain an NVQ Level 2 or above in care. This requirement was made at the last Inspection. It has been recommended that the quality monitoring system adopted by the home is reviewed and alternative ways are sought to assess residents’ views of the services provided by the home. It is also recommended that the home introduce a pictorial menu for residents that specifies the meals on offer and the alternatives available. Recommendations are made for a cleaning schedule to be introduced and for the guidance for staff to be removed from the dining room walls on the 1st floor.
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 7 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. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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 Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can test-drive the home. Prospective residents are supplied with the information required in order to make an informed decision about whether to reside in the home. EVIDENCE: The manager explained that she assesses prospective residents prior to them moving into the home. A pre admission assessment was examined and was found to be in order. The manager assured the Inspector that as required at the last Inspection, following any future preadmission assessments she will confirm the prospective resident in writing of the outcome and specify whether or not the home is able to meet their needs. The manager explained that the first month’s stay is on a trial basis enabling prospective residents to test drive the home and this is specified in the contract. Contracts were examined and confirmed this. The homes statement of purpose and service user guides were examined and found to be satisfactory. They are both available in symbolic language format. The manager has given assurances that all residents in the home are provided with copies of these documents. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 6,7,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents care plans provide the information required for staff to support service users in their daily living but are not always reviewed and amended as required. EVIDENCE: Three residents’ care plans were examined. Improvements have been made in relation to the amount, quality and detail of the information they contain and they now reflect residents’ daily lives more accurately. In relation to 2 of the care plans there had been changes to the needs of the residents one in relation to health care needs and one in relation to communication but the care plans had not been updated. Through talking to staff and the observation of practice on the day of the site visit it is evident that the needs of both these residents are being met. It is required that in future care plans should be updated when changes occur and not just at scheduled reviews. Residents’ personal goals are specified in their care plan and progress made towards meeting these goals is documented. All care plans contain a weekly
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 11 timetable illustrating the activities participated in this should be extended to include the preferred activities for evenings and weekends. Though improvements have also been made in respect of documenting the risk assessments undertaken for each resident, further risk assessments are required. These must specify whether or not individuals can safely access areas of the home and grounds unsupervised and if not what measures are taken to ensure residents safety e.g. doors locked or staff support required. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents with the opportunity to access the community and participate in meaningful and appropriate activities. Residents are provided with a healthy diet. EVIDENCE: Through discussions with residents and staff and the examination of daily records it is evident that many residents lead active lifestyles. The day care facility at the home is open every day including weekends when it can be accessed for recreational and leisure activities such as table tennis and pool. Trips out are organised at the weekends and some evenings. A group supported annual holiday is provided for those who want to go. Some residents are able to assist in the running of the home and participate in activities such as doing their own laundry, laying the table, food preparation etc. Care plans specify family relationships and peer group relationships pertinent to the individual. Residents and staff stated that residents’ visitors are
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 13 welcomed into the home and that some of the residents visit their families on a regular basis. Records confirmed this. One resident has a diary which is completed daily to ensure that staff at the home and the residents relatives are aware of all the activities etc that she has participated in. This is considered to be good practice. The Inspector joined residents on the 1st floor for lunch. The food served was hot, homemade and nutritious. The atmosphere during lunchtime appeared relaxed and staff interacted with residents appropriately, offering support when required. The dining room has some homely features but it is recommended that the information for staff currently displayed on the dining room wall be removed and that a pictorial menu is provided for residents stipulating the meals on offer and the alternatives available. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are met and personal support is provided appropriately. The homes’ medication policies and procedures are safe. EVIDENCE: Some care plans include instruction and guidance for staff to follow in relation to residents’ preferences for how they receive personal care. It is required that all care plans specify whether or not a resident has preferences. Care plans include a section relating to personal presentation indicating individual likes to dress. As previously stated not all the care plans that were examined reflected the residents’ current health care needs. However, observation of practice on the day of the site visit, an examination of records and discussions with residents and staff confirms that residents health care needs are met. The Inspector sat in on four staff handovers during the site visit where residents’ health care needs were discussed in detail including specifying contingency plans for how a particular residents needs were to be met throughout the day. Referrals are made for input from health care professionals when required and residents receive support and treatment in the privacy of their own rooms.
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 15 Medication records were examined and found to be in order. Staff were observed administering medication during the site visit and followed the homes policies and procedures which are safe. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 22,23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Albeit the complaints policy and procedures have been reviewed further amendments are required. The homes’ adult protection policies and procedures protect residents from abuse and harm. EVIDENCE: The home has reviewed and amended their complaints policies and procedures and they are now a lot clearer. Copies of these documents are available in symbolic language. Further amendments are required so that the contact details for the directors of the company and the Commission for Social Care Inspection (CSCI) are included and that the timescale in which a response will be made is specified. Some residents can display a level of behaviour that may be challenging. Guidelines for staff to follow in relation to managing this behaviour is included on their care plans thus minimising the risk of harm. Some staff have received training in relation to the protection of vulnerable adults and a programme for all staff to receive this training is in place. Referrals are made to the local social service department when an adult protection alert is required in line with local guidance. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 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): 24,25,26,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable and residents own rooms promote their independence. EVIDENCE: Two residents showed the Inspector their bedrooms. Both of these rooms were personalised and located in the area of the house best suited to the individuals’ needs thus maximising their safety and independence. Residents have their own belongings in their rooms and can choose their own décor and furniture. One resident explained how she had chosen the colour of her room herself and had bought furniture for her room with the support of her key worker. Each of the three areas of the home has its’ own lounge area. These are homely in character. New leather sofas and armchairs have been purchased providing ample seating for the number of residents who reside there. The areas of the home inspected on the day were found to be clean tidy and hygienic. Residents and their key workers are responsible for keeping bedrooms clean and tidy. Some staff are responsible for ensuring that
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 18 particular areas of the home get cleaned but as there is no record kept, it is not possible to ascertain how regularly this takes place. It is recommended that a cleaning schedule is introduced and that a record is kept of when each task is completed. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 19 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): 32,33,34,35,36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are good and consistently followed. All staff receive regular documented supervision and appropriate training. The home is staffed by an effective staff team. EVIDENCE: Each area of the home has a designated staff team and although they may be called on to work on other units to cover on occasions, on the whole they work with the residents on their designated unit. This provides continuity in the care and support provided to residents of the home. On the day of the site visit the Inspector observed four handovers one of them being the main morning handover. One member of staff was sick and the affect of this would have on the services provided to the residents was discussed in depth resulting in a reorganisation of the way staff were deployed throughout the home. This ensured that the services provided to the residents were not affected and trips out etc could still go ahead. The handover was comprehensive and informative including a short summary for each resident and discussions in relation to the health care and emotional needs of residents who required additional support for the day. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 20 Four members of staff stated that they were shadowed by experienced staff for the first week of their employment and that they had completed the home’s own induction programme. They also explained that they receive formal documented supervision from a senior member of staff. Records relating to staff training, induction and supervision were examined confirming that appropriate training is provided for all staff and that supervision takes place on a regular basis. Each member of staff receives an annual appraisal from the deputy manager where training needs are identified and a training and development plan is implemented. Two recruitment files were examined and were found to contain all the relevant information and confirmation that all the require checks had been undertaken satisfactorily prior to them being deployed to work in the home. The home continues to work towards 50 of the care staff employed obtaining a National Vocational Qualification (NVQ) Level 2 or above in Care. The manager assured the Inspector that the current staffing levels could meet the needs of the residents and that an extra carer has been employed. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 21 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): 37,39,41,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and experienced and the management and administration systems are good. EVIDENCE: The registered manager is appropriately qualified and has the experience required to run the home and meet its statement of purpose, aims and objectives. The manager explained that the deputy manager is responsible for ensuring that all staff are appropriately inducted and trained. Staff training includes issues relating to health and safety of residents and staff, moving and handling and fire safety. The home was required at the last Inspection to ensure that all areas of the home and grounds were assessed as to service users safe access. The home has undertaken a large piece of work in relation to this requirement and information in relation to environmental risk assessments are now included on
Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 22 residents care plans. While it is recognised that this piece of work was achieved within the timescales, further requirements are made in relation to this as specified in the ‘Individual needs and choices’ section of the report. The home has a quality monitoring system in place the results of which are audited and used to assess areas that are in need of improvement. While the Inspector recognises that the home does encourage all residents to complete a survey annually and that they encourage relatives and care managers to support them in doing so, it is recommended that they review the system they are currently using and that they find alternative and additional ways of assessing the views of the residents of the home. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 23 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 24 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. 2. Standard YA4 YA7 Regulation 13(4b)15(1,2bc )16mn 13(4b)15(1,2bc )16mn Requirement Timescale for action 30/06/06 3. YA22 22(1,2,3,6,7,8) 4. YA32 19(5b) Residents care plans must be reviewed when needs change. Care plans should specify 30/08/06 residents’ preferences in relation to the support they receive, a timetable of preferred leisure activities should be included and risk assessments in relation to residents safe access to all areas of the home must be undertaken specifying the support required if any. That the home complaints 30/06/06 policy be reviewed and amended to specify timescales and the contact details for the company directors and the CSCI. It is required that a minimum 31/12/06 of 50 of the care staff employed at the home obtain an NVQ Level 2 or above in care. This requirement was made at the last Inspection. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 25 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. 3. 4. Refer to Standard YA17 24 YA30 YA39 Good Practice Recommendations That the guidance for staff to follow is removed form the dining room walls on the 1st floor. That a pictorial menu is provided in all the dining rooms and that this specifies all the meals on offer for the day including the alternatives. That a cleaning schedule is introduced and that a cleaning record is kept. That the quality monitoring system currently being used is reviewed and that alternative and or additional ways of assessing the views of the residents of the home are found. Halland House DS0000021424.V289684.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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