Inspection on 10/10/06 for Hamer Cottage

This inspection was carried out on 10th October 2006.

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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamer Cottage 05/02/08

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Turning Point (Hoole Road)

Stanfield House

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

CARE HOME ADULTS 18-65 Hamer Cottage 107/109 Halifax Road Hamer Rochdale OL12 9BA Lead Inspector Jenny Andrew Unannounced Inspection 10th October 2006 09:30 Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 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 Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 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. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamer Cottage Address 107/109 Halifax Road Hamer Rochdale OL12 9BA 01706 525325 01706 642012 hamercottage@ntlworld.com 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) Therapeutic Environments Limited Miss Helen Kate Morris Care Home 12 Category(ies) of Past or present alcohol dependence (12), Past or registration, with number present alcohol dependence over 65 years of of places age (1) Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 12 service users to include: up to 12 service users in the category of A (past or present alcohol dependence under 65 years of age); up to 1 service user in the category of A(E) (Past or present alcohol dependence over 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. New Service since change of ownership 2. Date of last inspection Brief Description of the Service: Hamer Cottage provides care to 12 adults to enable them to develop skills to lead an alcohol free lifestyle and the home adheres to the “dry” rule. Within this number they are registered to provide care to one service user over the age of 65 years. The project is housed in a listed building, which has been adapted to provide 12 single rooms. It is located approximately one mile from Rochdale centre, on the main road to Littleborough. It is close to shops, bus stops and a Post Office. As the house is a listed building, certain alterations cannot be made i.e. the front door is accessed via four steps (although handrails have been provided to each side) and a lift is not provided. The accommodation is therefore unsuitable for anyone with mobility or breathing difficulties. This information is included in the statement of purpose and service user guide. A garden and private car park are not provided, although a number of designated parking spaces are available to the rear of the building. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April of this year, the home changed hands and was bought by a company called Therapeutic Environments Limited. The previous manager had however, continued to work at the home. This was the home’s first inspection since the new company took over. The inspection took place over seven and a half hours with 2 inspectors. The home had not been told beforehand that the inspectors would visit. The inspectors looked at paperwork about the running of the home and the support given. In order to find out more about the home the inspectors spoke with 7 residents, a volunteer project assistant, the manager, administrator and the health and wellbeing officer. In addition, comment cards were sent to residents, relatives and care managers/health care professionals Of these, 2 were returned by residents, 2 by relatives, 2 by care managers and 1 by a G.P. Their opinions are included in the report. The weekly fees were £355 per week as at October 2006. There were no additional charges made. The provider made information about the service available in the form of a pre-admission guide as well as a Service User Guide, which is given to new residents upon admission. A copy of the most recent Commission for Social Care (CSCI) inspection report was generally displayed in the communal area of the home, but on this inspection, it was not. There was however, a copy displayed in the office. What the service does well: Residents and were very complimentary about the project describing it as ‘great’, ‘good’, ‘excellent’, and ‘strict’. They said the staff were ‘brilliant’, “fantastic”, “caring”, “very good”, “like a family to me” and “all nice”. The manager was also liked and respected and described as “very efficient”, “friendly and has a coffee with us”, “honest and straight forward”, “strict when she needs to be” “the best manager we’ve had” and “is a good counsellor”. They considered staff knew their jobs and would always make time for them. They highlighted group work as particularly good as staff were knowledgeable about the topics they discussed. They also valued the rules at the project, which they considered to be important for their recovery and helped to make them feel safe. One person considered the project had enabled him “to open up more” and address his problems. Hamer Cottage was good at welcoming residents into the project and preparing them to work in a focussed way on their needs, which they were encouraged to identify themselves. Residents spoken with described their admission as “very thorough”, “clear and thorough”, “very welcoming” and “felt at home straight away”. Every resident spoken with felt the accommodation was “homely” and had a good atmosphere. Residents made decisions about their recovery from Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 6 the beginning of their contact with the project and were supported by staff to do this. Residents appreciated that some restrictions had to be in place due to the project being a “dry” house. They all said that these were made clear to them both at their assessment visit and upon admission. One person said he had chosen the project because of the strict rules that the project kept to. The project team had a number of ways of checking out with people what they thought about Hamer Cottage. There was proof that they listened to people’s opinions and made changes where they could. As well as listening to what residents said the manager listened to what staff said and took any action necessary to improve the running of the home. Because the home had these systems in place they were always trying to do better and meet the needs of residents. The manager was very good at her job, making sure that the home ran smoothly so that residents received a quality service. Good systems were in place to make sure that both residents and staff were not treated unfairly (equal opportunities). The document, which residents signed when coming into the project, set out what kind of behaviour would not be tolerated and staff made sure that if problems occurred, that they took action to address them. Residents also had to sign copy policies to show they knew and understood them. Equal opportunities ran throughout all aspects of the running of the home. What has improved since the last inspection? What they could do better: All staff who have to give out medication should do training so that they fully understand how to do this part of their job safely. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 7 Before new staff started work, 2 references were not always being obtained and this practice could result in staff working at the project who may be unsuitable. 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. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 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 Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 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 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. The home had an excellent admission procedure that assisted residents in choosing the right project, which would meet their identified needs. EVIDENCE: Since the last inspection in February 2006, the home had changed hands. The statement of purpose/service user guide had been updated accordingly. The document was very informative and included a copy of the residents’ Licence Agreement, which listed rules and restrictions. This document was signed on the first day of admission. Residents were also expected to sign up to the home’s policies and procedures and signatures to such documents were seen. The guide made reference to the organisations commitment to equal opportunities and that both residents and staff were expected to follow the policy to ensure everyone was treated with respect and dignity. It also highlighted that because of the layout of the building over 3 floors and its listed status, it could not be adapted for people with serious mobility problems or breathing difficulties. A new document had been introduced, which was called the pre-admission guide. It contained useful information that would assist the reader in making a decision as to whether the project would suit them. The manager felt that by giving potential residents this document to read before admission, it would Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 10 lessen the amount of information they would need to read upon moving in, when due to anxieties levels, they might not be in the right frame of mind. Due to the project being short-term rehabilitation, it would not be appropriate for residents to live in the home on a trial basis. A new welcoming letter had been written which was sent out to potential new residents, explaining what would happen on their assessment visit such as answering any questions they had, being shown around the home and meeting some of the other residents. Then, dependent upon the outcome of the assessment, they would be formally notified about whether or not they had been accepted. All the residents spoken with confirmed their initial assessment visit had been welcoming and enabled them to get a real idea of what the project would expect of them. A befriending system was also in place whereby each new resident, upon admission, was introduced to an existing resident who would be responsible for showing them around the home, the local community, and being there if they needed some peer support. In the main, feedback about this was good. However two residents said their experiences had not been as positive as they could have been and felt this was because the people they had been paired up with had been experiencing personal problems themselves. This information was given to the manager at the feedback meeting. Sometimes the home received assessments from the funding authorities but this was not always the case. Discussion took place about this and the manager agreed she would be more pro-active in trying to get such an assessment for each new resident. The in-house assessment document was detailed and covered information relating to health, past history, relationships/support, dietary, cultural and religious needs and legal issues. Residents spoken to confirmed they were fully involved in the assessment process and the 3 copy assessments seen were signed by both the resident and the assessor. Residents confirmed that the project rules and restrictions were made clear to them both during the assessment and admission process. The manager and staff team were continually trying to improve the assessment and admission process for new residents. One new idea that was to be implemented when the next new resident was admitted was to put a plant in their room, together with a hand made welcome card. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 11 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 good. This judgment has been made using available evidence including a visit to this service. Residents’ individual needs and choices were respected and promoted within the confines of risk assessments and project rules, which were recorded in the licence agreement. EVIDENCE: Care plans were checked for three residents. The assessment form was used as a basis to develop the care plan, which was written jointly by the resident and their key worker within the first 3 weeks of admission. The manager felt that residents needed the first week as a settling in and adjustment period, with the second week being spent compiling social histories and backgrounds. Key workers were allocated upon admission and would spend as much time as was needed during this period with their residents. Each key worker session was recorded and signed by both the resident and the worker. At the time of the inspection, the team was all female, but a new male project worker was due to start work shortly, which would enable residents to have Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 12 some choice in the gender of their key worker. were all happy with their appointed worker. Those residents interviewed All the residents spoken to confirmed they had been fully involved in the care planning process and had signed and agreed their plans. Where it was felt other care planning methods would be more meaningful to residents, different formats were used and evidence of this was seen in one of the files inspected. The plans inspected addressed appropriate areas and were reviewed and updated with the resident as needed but as a minimum, on a six weekly basis. Key-worker recordings for one person indicated the resident’s needs had changed but the care plan had not yet been reviewed to reflect this. The manager was to address this with the worker concerned. She had recently introduced an audit of care plans whereby she would spot-check plans to ensure they were accurate and up to date. As well as action planning, the project made use of ‘spider’ outcome charts which residents were asked to complete in order to measure progress towards their recorded aims. Six weekly reviews enabled them to reflect and measure over a reasonable period of time and from checking files, it was pleasing to note that in all 3 files, good progress was seen to have been made. Care managers were also sent review notes. Whilst key-workers sometimes challenged residents’ beliefs or behaviour, feedback indicated residents’ felt they could express their views freely and that they would be listened to. One resident said “I find the sessions really good and I’m beginning to open up now and its really helping me”. In some instances, due to the nature of the project, some restrictions were made in respect of choice and independence. In such instances, risk assessments were routinely completed and reviewed with residents. Other restrictions on choice and freedom were discussed prior to admission and included in the licence agreement and service user guide. One person said he had chosen Hamer Cottage because of their strict adherence to the rules. Residents interviewed said they were both advised and empowered by staff to make decisions regarding their recovery. They valued the feedback they received from their key workers in 1: 1 meetings. They considered the pace of work at the project was appropriate for them and spoke positively of the support and advice they received. Residents were routinely informed of local advocacy agencies which some chose to access such as Alcoholics Anonymous, High Level and the Alcohol and Drug service. Those interviewed spoke positively about their experiences in these external groups. Residents’ rights were clearly stated in the residents’ guide and those interviewed were aware of these. Positive comment was made by a G.P. who said, “I know my patients find the home a lifeline”. One care manager commented that some communication Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 13 problems had been experienced with the agency in the past, but that the problems had now been dealt with. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 14 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, 15, 16 & 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents were encouraged and supported to participate in community activities and to pursue a meaningful and healthy lifestyle. EVIDENCE: Due to funding arrangements, residents were not able to seek paid employment and at this stage in their recovery, it would be inappropriate for them to do so. Residents were however, expected to attend daily compulsory groups and had the option of attending others such as the faith and spirituality group. Residents spoken with really valued the groups, which were essential to their recovery and attendance was agreed in the licence agreement. Group work covered areas around coping strategies, alcohol education, staying sober, life stories and recovery workshops. Positive comments were also made about the single sex male/female groups that were run by voluntary workers. Residents’ opportunities for personal development and training were addressed within the care planning process as recovery progressed. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 15 In the past residents had enrolled on college courses and been involved in voluntary work but this was dependent upon their recovery stage. On the day of the inspection, one resident had an appointment with a voluntary work bureau to check out potential options. Another resident had continued with a distance-learning course, which she had started before coming into the project. Charitable organisations were used by the majority of the residents, both as a drop in centre and to pursue such activities as aromatherapy, creative art, acupuncture, reiki treatment, reflexology and massage. A computer was provided at the project for residents use but Internet access was not provided. One resident said this would be really useful and the provider said he would look into what could be done to address the request. Staff actively encouraged residents to identify past hobbies and interests or select new ones to try. The project had some fishing tackle and bikes that were occasionally used although the bikes needed some repairs. At the time of the inspection, 2 residents were regularly going swimming, one had started fishing, another resident went regularly to the gym and several were said to use the local library. In addition, a small self-help library had been introduced and the manager was purchasing books on a regular basis. A booking-in and out system was in use and it was evident that this new venture had been extremely well received. An in-house social activity programme was in place and varied events had been held. These included quizzes, theme nights and group outings. In addition a monthly relative group was held and birthdays were also celebrated. The theme nights were said to be really popular. A French cultural night had been held in September and the October theme was Eid. A Jewish theme night had been planned in December. During the summer, 2 resident team-building days had been arranged in a country park, which the manager said had been well received. The majority of the residents commented upon how well they got on together and that they enjoyed getting together during the evenings. Residents spoken with said they were informed of local amenities and were supported in initial contact by a befriender scheme e.g. a resident being paired up with them in order to help them settle in and show them round the area. A list of local provision, addresses and phone numbers were included in the residents’ guide. The project had a gym pass which enabled residents to use the local leisure centre at a reduced rate. The inspector was informed staff both enabled and encouraged residents to use community facilities, although finance was at times a limiting factor. Staff helped residents with benefits/finance problems initially and encouraged them to address matters themselves as their recovery progressed. Residents spiritual needs were taken seriously and would be identified as part of the admission process. Information about location of churches was available within the project. Since the last inspection a new faith and spirituality group had been introduced and several of the residents commented that it was a good venue to have discussions and debates. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 16 Family links and friendships were encouraged appropriately as part of the care planning process. Residents often went home for the weekend, although this was on a risk-assessed basis and usually not within the first four weeks of their stay. A relatives/friends group was held monthly so that they could learn more about the work of the project. Just prior to the inspection, the staff group and residents had been in discussion about introducing a new rule whereby intimate personal relationships within the house would be discouraged for clinical and therapeutic reasons. This had stemmed from a problem that had arisen in the house, some time ago. The resident group had agreed on this and the provider had amended the Licence Agreement to include this new, agreed ruling. Residents said visitors were welcome at the project when compulsory groups were not running. Residents could choose where to see them, in communal areas, the privacy of bedrooms or in a private room on the premises. One resident said their visitor had stayed for a meal and that staff had been welcoming. Constraints with regard to visitors were included in the licence agreement and the individual resident held responsible for visitors’ actions whilst at the project. Feedback from one visitor questionnaire commented “We always find the staff very helpful and courteous when we have visited and excellent care always”. Daily routines were planned around group work and the one to one key worker sessions. At other times residents were free to choose their activities, within the constraints of the licence agreement and individual risk assessments. This was known and understood by residents spoken with. Residents had keys for their rooms but understood the need for room searches on occasion. This information was included in the licence agreement. Residents interviewed were satisfied with the food provision. On a Sunday evening they met informally to draw up a weekly menu. This was then discussed at the Monday group meeting when the Health & Wellbeing Worker would give advice on the nutritional content. Feedback indicated that whilst residents accepted the need to eat healthily, they did on occasions feel that the worker’s expectations were too high, such as preparing Bolognese sauce from scratch and not being able to use tinned “mushy” peas. The worker said she tried to ensure that besides being nutritional the meals were as inexpensive as possible given the limited budgets that residents had to manage on when leaving the project. One resident had been advised to cut back on caffeinated drinks. Whilst the resident was unhappy about this, the worker had taken the time to explain to her why this was necessary. Foods requested by individual service users were provided. One resident said due to her medical condition, she had to be careful what she ate but that the food provided enabled her to eat healthily. Another resident said, “I’ve started eating much better since coming to Hamer Cottage and I’m really looking forward to the meal which is being cooked tonight”. Residents took Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 17 responsibility for preparing and cooking meals and cleaning up afterwards. Those experiencing difficulty with this task were assisted by the more experienced and considered the arrangement to be supportive. Residents said they were able to access food supplies to make snacks or drinks whenever they wished. Inspection of menus showed that all shared meals were recorded, as were any special dietary needs. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 18 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 judgment has been made using available evidence including a visit to this service. Residents were supported by the home to manage their own healthcare and to access National Health Service community facilities, thus ensuring their health needs were reviewed and maintained. EVIDENCE: Residents maintained maximum control over their lives, assisted, whenever appropriate, by staff. Discussion with residents and staff and inspection of residents’ files provided evidence of their full involvement in the planning and implementation of their care plans, ongoing progress evaluation and development. Whenever possible care managers were actively involved in this process also. Where residents were identified as having specific mental health care needs, these were included in the care plan, with accompanying risk assessments. Where appropriate, input from families was welcomed but only with the resident’s full agreement. Residents said the encouragement and support given by the staff team was “excellent”, “that staff were always there if needed”, “were brilliant at their jobs” and “we can go to them whenever we want for advice”. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 19 The healthcare needs of individual residents were assessed prior to admission when they were also weighed. If the need for involvement of other professional/therapeutic services was identified, appropriate referral was made. One of the current residents had been referred to a health care consultant and was awaiting an appointment. All new residents were encouraged to register with the GP of their choice as soon as possible after admission and their befriender would usually accompany them on this initial visit. Although independence was actively encouraged, support was given to individuals for attendance at health appointments etc. if deemed necessary. First aid boxes were available to service users at all times and the location of first aid equipment was recorded in the service user guide. Residents’ health was monitored throughout their stay. Inspection of files and interviews indicated any problems identified were dealt with immediately as were health promotional issues e.g. dentists, opticians, dietary needs. The health and well-being worker was well qualified to advise residents about various aspects regarding their health care needs. Within some of the group sessions, discussions were held in relation to health and general wellbeing, for example alcohol education, relapse prevention, coping strategies and health and nutrition. These discussions enabled residents to draw up their own strategies to deal with the emotional and psychological aspects of their illness as well as practical ways of maintaining sobriety. The home’s medication policies describing the safe handling of medicines had been reviewed in consultation with Rochdale PCT. Policy changes had been made with regard to self-administration of medication. Since the last inspection, more residents were self-medicating, provided the risk assessment outcome was satisfactory. Those residents’ who were self-medicating at the time of admission were encouraged to continue to do so. In order to ensure the safekeeping of medication, new lockable medication cabinets were in place in each of the bedrooms. The residents interviewed, who were selfmedicating, confirmed they had a key to their medication cabinet. Where residents were assessed as needing ongoing medication support, prescribed medication was handed to staff upon admission and consent to medication forms were signed and held on file. This medication was then supplied on a daily basis for self-administration with three days supply being given on Fridays when the home was not staffed. Medication was put into sealed plastic bags with dosages for the whole day being mixed together, although the bags were dated and labelled. Since the last inspection when a medication requirement and recommendations had been made, the manager had looked at a safer and more effective way of holding and dispensing drugs. A local pharmacist had been consulted and when the present stock of medication has been completed, he was to deliver ready made up dosette Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 20 containers on a weekly basis, which could be used by both staff and selfmedicating residents. The recording, handling, safe keeping and disposal of medication was satisfactory although the home did not have a controlled drug book. Two staff were however responsible for the administration and signing for all drugs. It is recommended that such a book be purchased. No residents were taking controlled drugs at the time of the inspection. There was no evidence of overstocking of drugs. Unused or unwanted medicines were returned to the pharmacy regularly, and the returns book had been signed upon receipt of the drugs. The good practice of recording any homely remedies or holistic therapies on medication notes was noted. All staff involved in the administration of medication were said to have completed basic training. In addition, some had completed the advanced course and/or the course related to mental health drug administration. It was however, identified from checking the file of one staff member that there was no proof of medication training. Where staff cannot produce copies of training certificates, they must re-take all relevant training. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 21 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 good. This judgment has been made using available evidence including a visit to this service. Satisfactory policies, procedures and practices were in place for complaints and protection of residents, who felt safe living at the project. EVIDENCE: Residents were familiar with the complaints procedure, which was displayed on the notice board in the entrance area. Copies were also distributed to residents on admission. Feedback from residents was in the main, positive about staff listening to them and addressing areas of concern. However, one returned comment card said, “I find sometimes you have to complain several times before complaints are sorted”. The 2 relative feedback comment cards also recorded they were unfamiliar with the complaints procedure. The manager said she would address this at the next relative group meeting. The home did not have many complaints recorded on their log. The manager said the systems in place (i.e. one to one and group meetings and easy access to managers and support workers), meant that issues were addressed as they arose, negating the need for a formal complaint. Discussion took place around the need to log all concerns raised, together with action taken to address the problems. The Commission for Social Care Inspection had received two complaints since the last inspection. The complainant was asked to address their concerns with the manager of the home direct and use the home’s complaints procedure and this was still being investigated. The second complaint was passed back to the provider to investigate and positive action had been taken to resolve it. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 22 Both an internal abuse procedure and the Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure were held at the project. The internal procedure included all forms of abuse as listed in ‘No Secrets’ (DoH Guidance 2000). Contact had also been made with other funding authorities, to access their Protection of Vulnerable Adult procedures. The home had investigated one protection of vulnerable adult (POVA) incident and had invoked the home’s POVA procedure. Satisfactory action had been taken to address the incident. Policies/procedures were in place with regard to equal opportunities, aggression towards staff, bullying, violence/restraint, residents’ monies etc. The licence agreement addressed issues relating to violence, bullying, and intimidating behaviour. Staff were vigilant about monitoring residents behaviour and evidence was seen where a resident had been discharged from the project due to bullying. The manager had fully involved the person’s care manager and arrangements had been made for the person to transfer to another project. Residents’ rights were addressed in the residents’ guide. Residents completing comment cards and those spoken with all said they felt safe living at the project. One resident commented specifically about the home’s strict “dry” rule and said this had been the reason he had chosen to live there as the ruling made the project much safer. The home had an effective on-call service that could be activated whenever the home was not staffed. Residents said that it worked well. One person said, “The staff member came straight away and took over” and another said, “pretty immediate response and I felt comforted”. All the staff had undertaken the Rochdale MBC Protection of Vulnerable Adult training including the voluntary workers. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home was clean and hygienic and good infection control practices were in place, ensuring residents were protected as far as possible. EVIDENCE: The premises were suitable for the stated purpose. Residents spoken with described the project as ‘homely’ and they were all satisfied with their bedrooms. One resident showed the inspectors her room and it was evident she had personalised it and “made it mine”. When a room became vacant, requests could be made to change rooms and from discussions, it was evident that this happened on a regular basis. As the project is housed in a listed building adaptations cannot be made for people with disabilities. This information was included in the referrers’ and residents’ guides. The project is close to communal facilities and a bus route is nearby. The building was both safe and well maintained and a recent asbestos survey had revealed the building was free from this substance. Window restrainers were fitted to 1st and 2nd floor bedroom windows. The new provider had already had the lounge, kitchen and hall re-decorated and new soft furnishings Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 24 had been bought. Plans were in place for the re-decoration of bedrooms, but this was proving difficult, due to full occupancy. However, some rooms had been prioritised and the provider and manager were in discussion about how this could be best managed. The provider had made arrangements for a contract-cleaning firm to come in to clean all the carpets and those that needed replacing had been identified. A handyman visited the project regularly and a maintenance book was seen where jobs were listed and ticked upon completion. Since the last inspection, the home had requested a visit from Environmental Health, resulting in a pest control company visiting on several occasions, due to problems with mice. The home was located next to a pet shop and it had been identified that this was where the problem had stemmed from. As a result of the visits, the problem had been satisfactorily addressed. The home had advised the Commission for Social Care Inspection of the infestation, as was required under the legislation. The Greater Manchester Fire Authority had been involved in assessing the home prior to the new provider taking over and had assessed the home as complying with fire regulations. Residents took responsibility for maintaining the cleanliness of the project, which appeared clean. Responsibilities with regard to communal areas were agreed through group meetings and reassigned monthly. Before the residents handed over their cleaning duties, the home had to be thoroughly cleaned and this had happened the day before the inspection. Staff were responsible for, ensuring adequate standards were maintained. Feedback from the residents indicated the rota worked well although two residents felt that some residents did not take their duties as seriously as others and that staff needed to be more assertive with those people. Hand washing facilities, including liquid soap and paper towels, were provided in all bathrooms/toilets. Disposable gloves were provided for staff use and those staff who had worked for the project for some time had completed an infection control training pack. The remaining staff were to do the training as part of their induction. Laundry facilities were sited in the basement and could be accessed without walking through food storage and preparation areas. Impermeable flooring was provided to the area immediately in front of the machines. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 25 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, 34, 35 & 36 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The staff team had collective skills and training to undertake their roles effectively but more vigilance was needed to ensure recruitment and selection policies were adhered to. EVIDENCE: The project was not staffed on a 24 hour basis or over the week-end period. The home did however, have an out of hours call out system that residents said worked well. The call out procedure was included in the service user guide, given to each person upon admission and it contained the mobile phone number that had to be rung in an emergency. The home ensured that the mobile phone was charged on at least a weekly basis. Feedback from residents and relatives was very positive with regard to the staff team. All expressed satisfaction with the level of support provided. The team were said to work well together and morale was good. Since the last inspection, a 28 hour per week project worker had left the home and a new worker had been recruited who was due to start the week following the inspection. This person had been recruited on a 35 hour contractual basis. In the interim, the relief project worker used when staff were on holiday or sick had been standing in. In addition to the permanent staff, 2 volunteer project Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 26 assistants worked some hours each week and feedback from the residents was very positive about the groups they facilitated and the support given to them. The home did recruit people who, in the past, had misused alcohol but had since recovered, as their experiences had proved valuable. The pre-inspection questionnaire showed that recruitment and selection policies/procedures were in place. The files of two staff were checked to see if all the necessary checks had been done before they started work in accordance with the home’s policy. Shortfalls were identified in both files with only one reference having been obtained for each person. The manager and provider said that 2 references had in fact been received, but could not produce the second references. Replacement references should be sought. Satisfactory Criminal Records Bureau checks were in place together with Protection of Vulnerable Adult (POVA) checks and both volunteers had appropriate checks in place. The General Social Care Council Code of Practice was issued to staff as part of the induction process. Since the last inspection, the home had started to include residents in the recruitment process when short listed applicants were to have their second interviews. Several of the residents spoken with had experienced this in relation to the recruitment of the new project worker who was about to start work there. They had been well prepared by the staff team and had clearly found it to be a positive experience. They had been able to formulate their own questions, before the interviews took place and had used the equal opportunity scoring sheets. The outcome of the interviews was that when the staff and residents scores had been added together, the same person had scored the highest marks. This person had therefore been appointed. The staff team was currently all female, but the new worker was male, which would go some way to evening up the gender balance. From speaking with staff it was clear that the project had a commitment to providing suitable training opportunities but due to the staff turnover, the home did not now meet the required 50 ratio of staff being trained to NVQ 2 level or above. One of the project workers had successfully completed the Registered Managers Award but the relief worker and the health & wellbeing worker did not have any NVQ qualifications. This was being addressed with two staff and the new project worker being nominated to start their NVQ level 4 training later this year. The health and wellbeing worker was a qualified NVQ assessor for differing health and safety training. The most recently recruited staff member had completed their Skills for Care training. However, their record showed that evidence to demonstrate competencies was insufficiently detailed. The manager was to address this shortfall when new staff were inducted. Appropriate health and safety training was provided with refreshers within recommended timescales. Training needs for the recently recruited staff had Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 27 been identified and they were to be booked on relevant courses. There was recorded evidence that training needs were discussed during supervision and the information transferred to a training needs profile for action. A training matrix was held for the whole staff group and the manager monitored the number of paid days training staff received each year. The staff team, including the volunteers received regular supervision with the registered manager. Supervision sessions were recorded and held on file and inspection of staff files showed evidence of these sessions. The manager also received regular supervision with the organisation’s responsible individual. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 28 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 & 42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The homed was well managed with good quality assurance and monitoring systems in place. EVIDENCE: The manager was registered with the Commission for Social Care Inspection (CSCI) and had many appropriate qualifications. She had a Business Studies Diploma, a BA Hons in European Marketing, a Diploma in Psychology, a Level 3 Diploma in Counselling and an NVQ Level 4 in care. In addition, in May 2006, she had successfully completed the Registered Managers Award. She demonstrated her awareness of the need to keep updated with contemporary practice by networking with other managers and reading appropriate magazines, books and journals. In addition she had booked on a 6 day practice assessors course at Bradford University. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 29 Feedback from both staff and residents identified the manager was well liked. Residents commented about her always finding the time to spend with them and said she was fair but could also be strict when needed. Many of the home’s policies/procedures had been reviewed and updated as a result of the home having a new owner. Residents had access to a number of important health and safety polices which were included in the residents’ guide for their information. These include fire, infection control, medication, smoking and lifting/handling. The project had attained the Investors in People (IIP) Award, which had been re-assessed in November 2005. The assessor commented in the report that they were ‘satisfied beyond any doubt’ that the home continued to meet the requirements of the IIP standard. Strengths identified included a ‘flexible, approachable and extremely supportive management style’; ‘good use of external expertise’; ‘good use of resident feedback for improvement’; ‘good structured approach to staff training, aided by supervision, appraisals, and skills;’ ‘excellent ethos within the organisation’ through which staff were ‘enthusiastic, supportive and valued’. These statements were fully supported in this inspection by residents/staff feedback and inspection of records. The home had an effective quality assurance and monitoring system in place. Arrangements for seeking feedback about the service included 4 monthly circulation of resident questionnaires which were formulated into a chart; relative group meetings and questionnaires; weekly resident business/house meetings which were minuted; fortnightly staff meetings which were attended by a volunteer representing residents’ views; regular supervision; annual staff appraisals; 6 weekly contact with care managers; internal service user reviews; and joint care management reviews. Residents’ questionnaires were handed out during business meetings and the staff member leading the group would put them in envelopes in order to ensure anonymity. Action was taken to address issues raised. An example of this was given where a resident had felt staff did not do enough random tests of residents to see if they had been drinking. As a result of this feedback, action was taken for more random testing to take place. Requirements and recommendations made at CSCI inspections had been consistently implemented. The pre-inspection questionnaire showed that all required health and safety policies and procedures were in place and resident feedback indicated they felt the environment was free from any hazards. Regular maintenance checks were undertaken in line with legislation and random sampling of such records confirmed they were up to date. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 30 Due to the turnover of staff, not all the current team had completed all the required health and safety training. This was however, being addressed by the manager as part of the staff induction process within the required timescale. Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 31 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 4 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 x 4 X X 3 x Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 18 Requirement The registered person must ensure that persons employed to work at the home who are responsible for giving out medication receive appropriate training. The registered person must not employ a person to work at the home unless they receive 2 satisfactory references. Timescale for action 30/11/06 2. YA34 19 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA20 YA22 YA32 YA35 Good Practice Recommendations The manager should use a controlled drug book for the recording of all such drugs. The staff team should record all concerns, together with action taken to resolve them. At least 50 of staff should hold an NVQ level 2 qualification or above. Evidence for Skills for Care Training should be more detailed and reflect how the outcomes have been measured. DS0000067103.V298179.R01.S.doc Version 5.2 Page 33 Hamer Cottage Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Hamer Cottage DS0000067103.V298179.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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