Inspection on 15/06/05 for Hamelin

This inspection was carried out on 15th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hamelin 03/01/07

Hamelin 13/12/05

Hamelin 15/12/04

Hamelin 27/07/04

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

CARE HOME ADULTS 18-65 Hamelin Farewell Road Totnes Devon TQ9 5LT Lead Inspector Graham Thomas Announced 15 June 2005 th 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. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hamelin Address Farewell Road, Totnes, Devon, TQ9 5LT 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) 01803 868971 01803 867565 enquiries@thepriory.org.uk Katherine H L FinniganThe Very Rev Archpriest Benedict Ramsden, Mr Simeon Ramsden, Mrs Lilah Ramsden Michael Thomas Davison Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15th December 2004 Brief Description of the Service: Hamelin is owned by The Community of St. Anthony and St. Elias and is one of a number of their homes in the South Hams and Plymouth areas. Currently registered for five people with a mental disorder, the service has access to well developed outdoor activities programme which is available to the whole Community. Service Users are within easy reach of local amenities in the town centre nearby.Where the whole Community of St. Anthony and St. Elias is referred to in this report, it will be described as “the Community” Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection, a pre-inspection questionnaire was examined. Comment cards were received from all 5 service users and three relatives. During the inspection, three service users were spoken with individually and two others were seen briefly. The inspector interviewed three staff and joined all staff and service users for a meal. A tour of the premises was conducted. All the care plans and other documents were examined. What the service does well: What has improved since the last inspection? What they could do better: Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 6 Service users’ plans are not reviewed regularly enough. Risk assessments have not been made for all service users. Some relatives do not know about Hamelin’s complaints procedure. The way the medicines are recorded could be improved. 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. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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 Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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) 2 Service users are assisted in their choice of home by a thorough pre-admission assessment process. EVIDENCE: There were no recently admitted service users. However, individual files contained pre-admission assessments conducted by the referring bodies and/or the Community’s staff. Restrictions on choices and freedoms had been identified and individual care plans devised for each service user. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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 and 9 Service users are well supported to make decisions about their lives. However, they cannot be sure that their individual needs are clearly identified in their individual plans. EVIDENCE: All the care plans were examined. Individual, goal-focussed plans were present on each file. These did not all show evidence of review at the required intervals and had not all been signed and dated by staff or service users. The plans set out restrictions on choices and freedoms and details of planned interventions though these were not always identified. One service user had obtained work since the last inspection. This was not described in the care plan nor had it been risk assessed. Risk assessments and risk management plans in other files were missing. On a day-to-day basis, staff were seen involving service users in choices of activities and meals. Support to widen service users’ choices was reflected in individual plans and in discussion with service users. For example, this had been achieved through work placement, outdoor activities and support to contact family members. Limitations on choices and freedoms, often imposed under mental health legislation, were clearly identified in the plans. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 10 Environmental risk assessments are held and some activity risk assessments were seen. However individual risk assessments were not available on some files and some of those seen required review and updating. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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) 12, 13, 15, 16 and 17 Service users are well supported to maximise their individual choice of lifestyle. EVIDENCE: Discussion with service users and staff as well as individual plans showed that there were ample opportunities for personal development. This included an outdoor activities programme, work placements for one service user, and assistance with claiming benefits. During the inspection, two service users went to the nearby town centre to shop and visit a local café. Another two service users visited a local activity and sports centres to participate in climbing and badminton. Service users spoke highly of the Community’s outdoor activities programme which includes a variety of opportunities such as canoeing and moor walking. This programme is run by a well-qualified and experienced co-ordinator. One service user has been supported to follow his own particular interest in surfing. In addition, the Community has its own Arts co-ordinator and facilities in the home for music and other creative activities. During the inspection, one service user was enjoying music played by the Community’s Head of Music. Staff are variously Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 12 skilled in areas such as music, and outdoor pursuits. The arrangement of staffing enables activities to take place at all times. Service users confirmed that they are supported to maintain contact with friends and family both nationally and abroad. For one service user, this has entailed a trip to South Africa to visit his family. The privacy of each service user is respected. Staff ask permission before entering bedrooms and each bedroom has a lock to which service users have a key. Observation showed that staff and service users interact well. Those service users who wish to be alone have this choice respected. Housekeeping tasks are shared with service users to the extent of their ability. Service users confirmed that meals are planned on a daily basis by staff and service users. Service users and staff eat together in the dining area. A high degree of choice was apparent in the content of the meal, eating times, and whether to join the group or eat alone. The meal sampled was contained fresh ingredients, was attractively presented and taken in a relaxed and congenial atmosphere. A record is kept of meals taken which is reviewed by the home’s Manager. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users are adequately supported to maintain good physical and mental health. Minor risks are posed to service users in the home’s systems concerning medicines. EVIDENCE: Service users spoke highly of the individual support received from staff. Individual service users follow their own programmes around which the home’s routines are fitted flexibly. For example, two service users had taken a packed lunch to an activity on the day of inspection. A third service user decided, at the last minute, to join the group for lunch whilst another chose to eat alone. Individual styles and tastes were reflected in service users clothing and hairstyles. Individual files showed evidence of both routine and specialist healthcare appointments for both physical and mental health. Service users confirmed that staff support them in attending appointments. A new system for the administration of medicines has recently been adopted. Recording was found to be accurate regarding receipt, administration and disposal of medicines. A number of recent administration errors had been identified in the accident/incident record. Prompt action was taken and systems introduced to minimise the risk of recurrence. Some, but not all, boxed and bottled tablet were recorded using a “countdown” method. No controlled drugs were in use at the time of inspection. One homely remedy was Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 14 in use. The approved list of homely remedies required updating. Patient information leaflets were not available for all medicines though there was a BNF reference book available for staff. All medicines are securely stored in a locked cabinet within a locked room. There was a record of regular pharmaceutical checks. Training in the administration of medicines is currently conducted by the Community’s own staff. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Service users’ concerns and complaints are properly handled by staff. There are sound systems in place to protect service users from abuse. EVIDENCE: A complaints procedure is in place and records of complaints were seen which included details of outcomes. The complaints procedure includes details of how to contact the Commission. Feedback from relatives / supporters indicated that not all were aware of the complaints procedure. Service users felt that their views would be listened to. Not all relatives who gave feedback to the Commission were aware of the home’s complaints procedure. Procedures regarding abuse and neglect are in place. These include a policy on whistle blowing. The staff interviewed were aware of vulnerable adults procedures and all had received training as part of their induction. Staff also receive training in understanding and managing physical and verbal aggression including, de-escalation and breakaway techniques as well as control and restraint. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Hamlin provides a homely comfortable and safe environment for service users. EVIDENCE: Hamelin lies within a short distance from Totnes where all local amenities are available. Externally, the building has become very shabby. White rainwater goods have become very mouldy and the exterior paintwork needs refreshing. The Manager told the inspector that work was due to commence on this in July 2005. The home is comfortably furnished in a domestic style and was clean and free from offensive odours on the day of inspection. All areas are well lit and ventilated. Work has now been completed in upgrading fire safety in the home. This includes the fitting of new fire doors throughout with approved closure devices. There was evidence of ongoing decoration and refurbishment. This included plans seen for a new kitchen and a recently redecorated bathroom. The bathroom on the lower ground floor is due for refurbishment. A record was seen recording maintenance work which had been requested / completed. The home’s separate laundry has impermeable floors and washable walls. There are hand washing facilities. Confirmation has been received by the Commission the washing machine complies with water supply and fittings regulations. A new tumble dryer has been installed since the last inspection. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 17 Policies and procedures are in place concerning hygiene and the control of infection and staff receive training as part of their induction. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Service users benefit from a staff group with diverse experiences and training but this does not include training which is nationally recognised as appropriate to their needs. EVIDENCE: Staff training and development is managed centrally by the Community. Staff confirmed that they had received comprehensive induction and foundation training including health and safety topics, mental health issues and the prevention of abuse. This was further evidence by certificates held on file. Some staff have qualifications relevant to elements their work such as in music and counselling. None of the current staff group holds and NVQ qualification. Staff confirmed that a meeting concerning NVQ training had been held and that they were applying to commence the course. The home will not meet the present requirement for 50 staff to be trained to NVQ level 2 by the end of 2005. Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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) 39 and 42 Service users views do not yet adequately underpin the development of the home. Hamelin provides a generally safe environment though individual risk is not adequately assessed and monitored EVIDENCE: A quality assurance system has been agreed for the whole community which has been discussed with the Community’s Health and Safety Officer who is responsible for its development. This includes Registered Providers’ visits, one of which had been recently undertaken. The application of the policy is not yet evident in the home in terms of service user involvement or a clear annual development plan. Staff confirmed that they receive training in health and safety topics during induction. Hazardous substances are kept in a locked room and data sheets are available in the home. Up-to-date records of gas, electrical and fire checks and maintenance were seen by the inspector. There has been substantial recent work in the home to upgrade fire safety systems. This includes the fitting of new fire doors. A maintenance log was seen. Risk assessments for Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 20 environmental hazards have been conducted though individual risk assessments were missing and/or out of date. A record is maintained of all accidents. Safety procedures were posted in the home and policies and procedures were available for inspection. 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 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Hamelin Score 2 3 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 21 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score x 3 3 4 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 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. 3. Standard 6 9 35 Regulation 15 14 18 Requirement All service users plans must be reviewed with the service user every 6 months Risk assessments for all service users must be completed and regularly reviewed A plan must be produced detailing how the numbers of NVQ qualified staff will be raised to meet the national Minimum Standard and a copy provided to the Commission Timescale for action 15.7.05 15.7.05 31.12.05 4. 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. Hamelin Refer to Standard 20 20 20 22 Good Practice Recommendations Patient Information Leaflets should be obtained for all medications. An up to date list of approved homely remedies should be obtained A consistent method of countdown recording should be used for tablets which are not blister packed. Relatives and supporters should be made aware of the homes complaints procedure D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 23 Hamelin D54-D07 S3714 Hamelin V221396 150605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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