Inspection on 30/09/08 for Harestock Hostel

This inspection was carried out on 30th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harestock Hostel 10/10/07

Harestock Hostel 18/12/06

Harestock Hostel 01/11/05

Harestock Hostel 27/06/05

Harestock Hostel 14/12/04

Harestock Hostel 09/07/04

Harestock Hostel 19/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Harestock Hostel Upton Grey Close Winchester Hampshire SO22 6NE The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Walsh Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 42 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: Harestock Hostel Upton Grey Close Winchester Hampshire SO22 6NE 01962886361 01962889422 paul.dundas@hants.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hampshire County Council Name of registered manager (if applicable) Mr Edward Dundas Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 0 care home 15 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). The maximum number of service users to be accommodated is 15. Date of last inspection 3 0 0 9 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home Harestock Hostel supports people who have a learning disability. The home is in Winchester and Social Service own and run the home. There are three homes, two of the houses are for people living in the home all the time and one is used for people staying for short periods at a time. Care Homes for Adults (18-65 years) Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 42 How we did our inspection: This is what the inspector did when they were at the care home ** The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. Mrs C Walsh regulatory inspector, spent on day in the home. She looked at records, spoke with service users and staff, watch how staff work and walked around the homes to make sure it meets the service users needs. What the care home does well Your home does well to give people who want to move into the home information about what it does. Care Homes for Adults (18-65 years) Page 7 of 42 Your home does well to help you to: To make everyday choices. To develop your independence. To visit your local community. Such as shops, pubs and gyms. To keep in touch with your family and friends. Your home does well to well to help you stay well. It helps you visit the doctors, see the nurse, and other health care professionals. Its helps you with your medication. Your home does well to listen to you, and will help you when you are sad or cross about something. It makes sure the staff are trained to keep you safe and stop others from hurting you. Care Homes for Adults (18-65 years) Page 8 of 42 Your home does well to offer you a safe, warm and friendly place to live. It meets your physical needs and you have a room of your own that you can decorate and furnish as you want. Your home does well to have a manager and staff who know what they need to do to look after you. The staff are interviewed and only work in the home if they are safe to do so and they are trained to meet your needs. What has got better from the last inspection The home has got better at giving information about the home to new people who may want to move in. Care Homes for Adults (18-65 years) Page 9 of 42 Your home has also got better at making sure your personal plans and risk assessments tell the staff what they need to do to help you and keep you safe. What the care home could do better Your home could do better to make sure your medication is stored safely. It could also do better to make sure the medications you buy from the chemist wont harm you. It could do better to keep you safe from Care Homes for Adults (18-65 years) Page 10 of 42 infection. And it could do better to keep you safe from the risk of fire. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Christine Walsh 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning Care Homes for Adults (18-65 years) Page 11 of 42 our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 42 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Harestock Hostel does well to provide the people who wish to use the service with information, which tells them about the service, how it is managed, how they will expect to be supported and what facilities are available to them. Improvements have been made to the Statement of Purpose and Service User Guide to include information about the services respite facilities, and for what reasons the service will admit people in an emergency. To ensure the service can meet prospective peoples needs they will carry out a pre admission assessment prior to the person moving in. Evidence: The Annual Quality Assurance Assessment (AQAA) told us that all new residents are admitted by referral from a Care Manager whether funded or self funding and the manager receives a copy of the pre-admission assessment. The AQAA tells what it can do better and its plans for the next twelve months. This includes improving the Service User Guide and Statement of Purpose and ensuring people moving into the service are Care Homes for Adults (18-65 years) Page 14 of 42 Evidence: compatible with residents currently living in the service. This includes people in need of respite support. This was tested by viewing the homes service user pack, which includes the revised Statement of Purpose and Service User Guide, the complaints and admissions procedures. It also includes the new documentation used to assist the prospective residents to plan their care. Four assessment plans were viewed and discussion took place with staff to gather an understanding of the process of assessing and admitting new service users. Following the last visit to the service it was required on a second occasion to revise the Statement of Purpose and Service User Guide, they were required to do this to ensure prospective residents are aware of the services respite facilities and criteria to admit people in an emergency. The Statement of Purpose and Service User Guide has been reviewed and now provides the reader with information about the services emergency respite procedures. A senior member of staff told us that plans are in place to develop the Service User Guide and Statement of Purpose further to include an accessible format for residents who have sensory and cognitive disabilities. The AQAA told us that service users are not admitted to the home unless a care management assessment has been carried out. The assessment documents provided information about the character, strengths and needs of the prospective resident. The document also identifies areas where support will be required such as health, personal care, mobility and communication. The admission policy provides guidance for staff on the steps they must take to admit someone and their roles in ensuring the move to the home is done smoothly and potential stress to the resident is minimised. The policy includes guidance for staff on accepting emergency placements. A senior member of staff informed us that the service was actively seeking a re assessment of a service user receiving respite care and support. The member of staff informed us that the service users assessment information was out of date and their needs had changed over the years they have been using the service. This demonstrates that the service recognises the importance of ensuring they are meeting the persons needs appropriately. There is evidence in the residents person centered plans that the information in the pre admission assessment document has been used to inform staff of the support the prospective resident requires. Care Homes for Adults (18-65 years) Page 15 of 42 Evidence: Care Homes for Adults (18-65 years) Page 16 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who use the service now receive the care and support they need and in the way that they prefer as care plans now provide detail for staff. This information is regularly reviewed and kept up to dated. The service does well to encourage and support the people who use the service to make decisions and choices about their lives. The service does well to identify and minimise the risks to people who use the service by ensuring that detailed and up to date information is available to inform staff. Evidence: Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: The AQAA told us that is has identified a number of areas for improvement including clarity of staff roles, resident involvement in planning their care and using a risk assessment system that heightens staff awareness of potential risks to the residents. This was tested by viewing the care plans and risk assessments for four residents, speaking with service users about the care and support they receive, observing practice and speaking with staff. Following the last visit to the service it was required for a second time to ensure care plans and risk assessments provide staff with detailed information. This information was to include how the resident wishes to be supported and how risks to the residents health and welfare can be minimised. There was evidence that the service has been working towards providing a person centered approach to the care and support they provide to the residents. This includes the person making choices and decisions about their everyday needs and wishes. The plans have been developed using the person centered Who Am I document, which encourages the resident and staff member supporting them to complete their personal profile as if they had written it themselves. The personal profiles include details of what name the resident wishes to be known by, their family and friends (Circles of Support), their cultural and religious beliefs, their lifestyle, how they access and move around their home and community, their health care needs and how they communicate their needs. This is not the full list of the areas the personal plan covers but they demonstrate that the service supports the residents using a holistic and person centered approach. A resident was happy to view their personal plan with the inspector and stated that the information in the personal plan had been completed and agreed with their full in put and consent. There was evidence that the personal plan had recently been reviewed and the resident had signed in agreement with the information. A senior member of staff informed us that the personal plans are still being developed but good progress was being made. The member of staff went onto tell us that the resident is at the centre of the plan and they are encouraged and supported as far as possible to be involved in the development of their personal plan. A newly appointed member of staff was complimentary of the personal plans and information held on the residents. The member of staff said this had helped them get to know the needs of the residents and how they wish to be supported. All staff who were spoken with were aware of the importance of following care plans and risk assessment as stated and agreed with the resident to ensure a consistency of care and minimise the risk to their health and welfare. In developing the personal plans using a person centered approach the service has Care Homes for Adults (18-65 years) Page 18 of 42 Evidence: gathered information on how the resident makes choices and what their goals and aspirations are. The plan tells the reader how the resident will make choices and decisions and how these are communicated. To support the residents with communication difficulties alternative communication tools are used, such as picture information boards. A resident told the inspector that they are fully involved in making decisions and choices and specifically liked helping to plan the weekly menu. Observation on the day provided evidence that residents are made aware by staff of what choices and opportunities are available to them. The residents were also kept informed of what is going on in the service throughout the day. Areas where the personal plan identifies there is a need, a clear care plan has been produced to provide staff with guidance on how the resident wishes to be supported. In addition there is an associated risk assessment, which has been developed using a traffic light system. The risk assessment is written onto red, amber or green paper, which tells the reader the level of risk there is in respect of the specific activity. The risk assessments tells the reader what the activity is, such as accessing the community, the level of risk to the resident and what steps the member of staff must take to minimise the risk. Personal plans provide information that where there is a risk of a resident becoming anxious, stressed or behaving inappropriately there are clear guidelines and risk assessments in place to minimise these. A member of staff informed us that these guidelines allow the individual resident to continue to maintain and develop their independence and self-respect. The plans have been developed using the person centered Who Am I document, which encourages the resident and staff member supporting them to complete their personal profile as if they had written it themselves. The personal profiles include details of what name the resident wishes to be known by, their family and friends Circles of Support, their cultural and religious beliefs, their lifestyle, how they access and move around their home and community, their health care needs and how they communicate their needs. This is not the full list of the areas the personal plan covers but they demonstrate that the service supports the residents using a holistic and person centered approach. A resident was happy to view their personal plan with the inspector and stated that the information in the personal plan had been completed and agreed with their full in put and consent. There was evidence that the personal plan had recently been reviewed and the resident had signed in agreement with the information. A senior member of staff informed us that the personal plans are still being developed but good progress was being made. The member of staff went onto tell us that the resident is at the centre of the plan and they are encouraged and supported as far as Care Homes for Adults (18-65 years) Page 19 of 42 Evidence: possible to be involved in the development of their personal plan. A newly appointed member of staff was complimentary of the personal plans and information held on the residents. The member of staff said this had helped them get to know the needs of the residents and how they wish to be supported. All staff who were spoken with were aware of the importance of following care plans and risk assessment as stated and agreed with the resident to ensure a consistency of care and minimise the risk to their health and welfare. In developing the personal plans using a person centered approach the service has gathered information on how the resident makes choices and what their goals and aspirations are. The plan tells the reader how the resident will make choices and decisions and how these are communicated. To support the residents with communication difficulties alternative communication tools are used, such as picture information boards. A resident told the inspector that they are fully involved in making decisions and choices and specifically liked helping to plan the weekly menu. Observation on the day provided evidence that residents are made aware by staff of what choices and opportunities are available to them. The residents were also kept informed of what is going on in the service throughout the day. Areas where the personal plan identifies there is a need, a clear care plan has been produced to provide staff with guidance on how the resident wishes to be supported. In addition there is an associated risk assessment, which has been developed using a traffic light system. The risk assessment is written onto red, amber or green paper, which tells the reader the level of risk there is in respect of the specific activity. The risk assessments tells the reader what the activity is, such as accessing the community, the level of risk to the resident and what steps the member of staff must take to minimise the risk. Personal plans provide information that where there is a risk of a resident becoming anxious, stressed or behaving inappropriately there are clear guidelines and risk assessments in place to minimise these. A member of staff informed us that these guidelines allow the individual resident to continue to maintain and develop their independence and self-respect. Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: Care Homes for Adults (18-65 years) Page 21 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions and develop individual living skills. The home ensures the people who use the service are provided with support and guidance to plan and prepare healthy meals. Evidence: Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: The AQAA told us that staff support the residents to access local and community based activities, maintain contact with family and friends, be involved in and participate in taking ownership of making decisions and to lead in planning mealtimes. This was tested by viewing personal plans, daily activities, menu plans, observing practice and speaking with service users. Each residents personal plan has an activity record that identifies the activities they enjoy and a record of activities they have been involved in each day. The plans include attending college, going to the gym, going to the pub and regular visits to or from relatives and friends. Residents are encouraged to attend these and access their community. This was observed on the day of the visit when arrangements were being made for residents to attend various activities, which by their enthusiasm and facial expressions they appear to enjoy. For residents with limited verbal communication a daily picture board is completed to inform them of what is happening throughout their day, which included attending day services, in house activities and quiet time. A resident who had been to the gym said that they had enjoyed the session, feedback from the member of staff confirmed that the resident had really enjoyed the session and appeared to get a lot from the activity. The personal plans tell us that the service considers the diverse cultural and religious beliefs of the residents and arrangements are made for residents to attend various church denominations and religious events of their choice. The AQAA tells us that the service recognises that there is a lack of activities away from learning-disabled groups and that it could do better to address this with the wider community. A senior member of staff told us that this area for improvement was being addressed and some residents are acknowledged as part of their local community, such as the local pub, shops and churches. The staff on duty told us that there has been an increase in staffing levels which has enabled them to provide a more flexible approach to organising and supporting residents to access activities. During handovers residents activities for that day and the next day are discussed. Plans are then put in place to organise support and where necessary transport. Residents are supported to maintain contact with family and friends, this was evidenced in records held in their personal plan. The information tells the reader about relationships that are important to them and the contact they have with those people. Daily notes record if contact has been made with family and friends, which includes visiting the family home for the weekend or speaking with a family member on the phone. Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: Through observation the staff showed us they treat residents with respect and uphold their dignity, privacy and individual choices. Information in personal files inform the reader, the name by which residents wish to be to known by, and what behaviours and non-verbal clues are telling staff about how they are feeling. A member of staff spoken with at the time of the visit was aware of their roles and responsibilities in respect of providing an individual approach and valuing residents for who they are. The member of staff went onto say as part of her induction she was made aware of the importance of promoting freedom of choice, independence and self respect with the residents. This shows us that the service takes seriously the importance of treating and respecting residents individuality and diverse needs. Residents have access to their own bedrooms when they wish and have access to all communal areas of the home. For residents who require supervision for their safety, staff provide support to access areas such as the kitchen, garden and the community. Mealtimes are led by residents and their wishes. This includes residents taking responsibility to plan, shop for and prepare meals. A member of staff said that they support residents to make healthy options, offering advice when planning the menu to ensure they are considering foods such as fruit and veg. The menu appeared balanced and provided healthy options. A resident said they enjoyed their food. A senior member of staff informed us that when necessary they will seek advice from health care professionals when they have concerns about a residents diet. The service provided evidence that they have recently sought advice from Voices (Voluntary Organisations Involved in Caring in the Elderly Sector). Voices advice and provide information on healthy eating for older people with Dementia. This was evidenced in a residents personal file and demonstrates that the service is aware of the importance of ensuring residents with dementia receive a nutritional well balanced diet. Care Homes for Adults (18-65 years) Page 24 of 42 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home does well to ensure the people who use the service receive the appropriate support with their personal care, health care and medication in the way in which they require and prefer. However the service must ensure all medications are stored correctly and homely remedies are given following the advice of a general practitioner. Evidence: The AQAA told us that the life history, personal preferences and health care needs of the residents are integral to care planning. It told us that staff receive training in managing medication and residents may undertake self medication where appropriate. This was tested by viewing personal plans and medication records, speaking with residents and staff. The personal plans provide detail on how residents wish to spend their day including what time they like to get up, go to bed, when they like to bathe and how to support them with their personal grooming. Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: A member of staff said they were aware of residents individual support needs as the staff are encouraged to read the plans, be involved as a keyworker to support residents with their everyday needs and be involved in reviewing their personal plans. There was evidence of regular reviews taking place and service users being involved. At staff handovers residents individual achievements and daily activities are discussed and celebrated, this system of communication is another way of ensuring all staff are aware of how the residents have spent their day and progress they may have made. A senior member of staff informed us that the service has good links with primary care and specialist health care teams. Residents personal plans provide evidence that their health care needs are regularly monitored and reviewed. The plans also provide information on specific health care needs, what action is required and how staff must support them with these health care needs. On the day of the visit, arrangements were being made for a resident to visit their GP. A comment card from a GP told us: The care service is very client orientated And a specialist health care professional to us: The care and attention to most individuals is very good, but communication between health care professionals and staff could be improved. The service has systems in place for the administration of medication. The home uses a monitored dosage system (MDS) supplied by a recognised high street pharmacy. Medications are received, recorded and disposed of using systems as recommended in the Royal Pharmaceutical Guidelines. It was noted that the medication cupboards were clean and tidy, however the position of the medication cupboards do not meet the Royal Pharmaceutical Guidelines and must be moved. The medication cabinets are situated in a locked cupboards in the laundry room in each unit. Advice was sought from the commission for social care inspections pharmacy inspector who confirmed that the laundry room was an inappropriate place to store medications due to varying temperatures and the risk of contamination from unclean surfaces. It has been feedback to the registered manager that a requirement will be made to remove all medication cabinets from all laundry rooms. A requirement will also be made for the service to seek guidance from a general practitioner if it is safe for residents to take certain homely remedies whilst taking other prescribed medications. It is important to seek this advice just in case the mixture of medications may have an adverse affect on the resident. The AQAA told us, following a suitable risk assessment residents can self medicate if they wish to. Currently there are no residents who have been risked assessed as able to administer their own medication. A senior member of staff told us that they are Care Homes for Adults (18-65 years) Page 26 of 42 Evidence: working towards supporting some residents to achieved this area of independence. Each resident has a list of medications prescribed, which includes regular and as required medication. As required medications are supported by care plans that detail when the medication needs to be administered, such as when a resident is feeling overly anxious. Only staff who have undertaken medication training are responsible for ensuring residents receive their medication. A senior member of staff confirmed that they receive training from the organisation, which covered such areas as storage, procedures for administration and side effects. The AQAA told us that a new policy for the management of medication has been introduced and two staff will be trained as trainers to undertake the rolling training programme and their competency to work with staff in this capacity will be assessed. Policies and a training pack were evident at the time of the visit and the registered manager later confirmed that two staff were training to be trainers. The AQAA went onto tell us that there are four storage areas for medication, which are audited each day and signed for by staff during handover. This was witnessed at the time of the visit. Care Homes for Adults (18-65 years) Page 27 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures it listens to and acts upon the concerns raised by the people who use the service. The home ensures the people who use the service are safeguarded from potential risk of harm. Evidence: The AQAA told us that they provide all new residents with written information on how to make a complaint and they have a robust Safeguarding Adults procedure that takes account of the no secrets principles of multi-agency working. It goes onto tell us that all staff are trained on the issues relating to safeguarding. This was tested by viewing the homes current complaints policy, the complaints log book, residents behavior support plans and speaking with residents and staff. The complaints procedure details how residents can make a complaint and what action must be taken to resolve it. There is an accessible format for residents who have limited communication Tell Us What You Think which has been produced using large print and pictures. We were informed by a senior member of staff that each new resident will be issued with the complaints procedure on admission to the service. The AQAA tells us that the home has not received any complaints in the last year. The Care Homes for Adults (18-65 years) Page 28 of 42 Evidence: service has a complaints log where if the service receives a complaint it will record the nature of the complaint and what action was taken by the service to resolve it. A senior member of staff stated that the home encourages open dialogue with resident and their and relatives and the service holds individual monthly meetings with the resident where they have an opportunity to express any concerns they may have. A resident said that they know how to make a complaint. The resident said they would speak with their keyworker or the manager and a member of staff was clear about the procedure in responding to complaints. The staff are provided with safeguarding of vulnerable adults training, which provides them with the knowledge to identify various types of abuse and how to report these. A member of staff spoken with at the time of visit confirmed that they had received training and was aware of their roles and responsibilities in maintaining residents health and wellbeing and reporting incidents of concern. The member of staff said: If I witnessed someone being abused I would report it straight away. The same member of staff was aware of the whistle blowing policy. Some residents have very complex needs and present with behaviours that challenge. There are detailed intervention plans in place and we were informed that the home monitors the wellbeing of residents on a regular basis. When required, support is sought from specialist health care teams who are skilled in managing challenging behaviours. Residents are supported with the management of their money, and their care plans detail the level of support required. The home has good systems for managing and monitoring residents spending, and supports them to develop their personal skills in managing their own money. Care Homes for Adults (18-65 years) Page 29 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures the people who use the service live in a warm, comfortable and clean environment that meets their physical and social needs. The home ensures its staff receive appropriate training to minimise the risk of cross infection, however the use of communal terry towels, bars of soap and the placement of the medication cupboards in the laundry room poses a potential risk of cross contamination. Evidence: The AQAA told us, the service has been refurbished to provide accommodation that meets the relevant care standards and each house/unit has dedicated domestic and laundry facilities, which the staff have been trained to use. This was tested by touring the homes within the service, which provide permanent residential care. Seeking the permission of a resident to view their bedroom, speaking with resident to obtain feedback on the homes facilities and viewing staff training records. Harestock Hostel is a purpose built service owned and managed by Hampshire County Council. It is made of up four separate units, two of which are used for permanent Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: residential care and the others as a respite and assessment units. For the purpose of this visit the two permanent units/homes were toured. Each unit/home has been designed to meet the physical and social needs of the residents and each resident has a room of their own. Kitchen and bathing facilities have been designed to meet physical needs such as adjustable working surfaces and wet room/shower room. The bedrooms are personalised to reflect the residents interests and personality. The bedrooms viewed at the time of the visit were observed to be clean, tidy, comfortable and tastefully decorated. A resident told us that they had chosen the decoration of their room and is responsible with the support of staff for keeping it clean and tidy. The residents weekly activity charts included time for cleaning personal bedrooms and assisting with their laundry. Despite the units/homes being clean and tidy they lack the personal touch of most residential services. It was discussed with a senior member of staff that the units/homes would benefit from redecoration and refurbishment with attention to providing a homely feel. It was also noted that the kitchen of unit twenty-five was in need of repair and refurbishment. The service is to consider how the residents might feel about their environment and make plans to make improvements. Each unit/home has an enclosed garden where there is room for relaxation, fun and opportunities to maintain their garden. A resident said that they enjoyed gardening and will help keep the garden tidy. The AQAA told us that all staff have received or will receive infection control training. Training information and staff who were spoken with at the time of the visit confirmed this. There was evidence that the service provides detergents, equipment and protective clothing to guard against cross infection. However on touring the units a bar of soap was found in a bathroom, liquid soap dispensers had not been refilled and terry towels were being used for communal use. The communal use of terry towels and bars of soap in toilets and bathrooms raises the risk of cross contamination and therefore the service must consider how they can minimise the potential risk of cross infection. Each unit/home has a separate laundry facility with washing machines that can wash at high temperatures and have sluice facilities. Although these areas were observed to be clean and relatively tidy they are not consider a clean place to store and administer medication. The service will be required to move the medication cabinets to an appropriate place, which meets the Royal Pharmaceutical Guidelines. Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: Care Homes for Adults (18-65 years) Page 32 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures the people who use the service are supported by competent, skilled and appropriately recruited staff in such numbers that meets their individual needs. Evidence: The AQAA told us that there has been good retention of staff since the service opened Recruitment of staff is based upon their skills, experiences and qualification and they have more than 50 of their staff holding a recognised qualification. The AQAA went onto tell us that the deployment of staff will be based on capabilities and competency to meet residents individual needs and each shift is led by a designated team leader. This was tested by viewing staffing levels and observing practice on the day, viewing training data and speaking with residents and staff. The registered manager was not available at the time of the visit therefore confidential recruitment information could not be accessed. A new member of staff provided evidence of the recruitment process. The home was busy at the time of the inspection visit as residents were undertaking various activities with staff support. This included supporting residents to access day services, community based activities and supporting them in daily life skills such as personal care, preparing meals and social interaction. Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: The staff appeared organised and well informed of what was going on for each resident at anyone time during the day. The staff routine includes a handover at every shift where as many staff as possible attend and each give a handover of the health, wellbeing and activity of each resident. Each member of staff is required to read and sign that they have read the communication book and diary. Checks are also carried out to ensure correct procedures have been followed with regards to residents personal monies, medication, use and whereabouts of keys and health and safety. A resident said that the staff are always available when they need them: And The staff are nice A newly appointed member of staff said: In my opinion the provision has a very caring, professional staff team who provide an excellent service to our residents. The residents needs are paramount. Staff are encouraged by Hampshire County Council to undertake a national vocational qualification (NVQ) and will support them to undertake NVQ levels 2 and 3. Currently the home has more than 50 of its permanent staff trained or working towards a NVQ. Staff recruitment files could not be accessed at the time of the visit as the manager was not available. The AQAA told us the Recruitment complies to the corporate standard, with all checks being undertaken by the Human Resources Department and all staff complete a probation period before contracts of employment are made ‘permanent’. The previous visit to the service told us that all required checks are undertaken and a newly appointed member of staff confirmed that they had completed an application, attended an interview, provided identification and names of referee’s. The same member of staff said she did not start working in the home until all her checks were in place. Another member of staff said in a Have Your Say Comment Card: It was made clear to me that references and a CRB check must be obtained before I could start, even though I already worked for Hampshire County Council. Staff undergo an induction into the home where they are supported by a named member of staff to become familiar with the needs of the residents, the ethos of the service and the way in which the service works day to day. The AQAA told us that in the last twelve months the induction process has become more robust. A newly appointed member of staff said she felt fully supported during her induction. Another said: Care Homes for Adults (18-65 years) Page 34 of 42 Evidence: I had a very depth, excellent induction. Individual staff training records could not be accessed as the manager was not available. However a matrix of training was available in the office, which provided information on the type of training and how many staff, had a attended or needed updates. Staff confirmed that they have received mandatory and service specific training such as fire safety, food hygiene, adult protection and medication. Some staff said they had received dementia care training and found the course very beneficial. A senior member of staff told us that all staff had recently attended a full week of training which included an introduction to corporate policies and procedures, new regulations, service changes and the Mental Capacity Act. The member of staff said that the staff team had found the week very useful and gave them clear direction on how the service wishes to move forward. Care Homes for Adults (18-65 years) Page 35 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A competent manager manages the home with a skilled staff team who ensure the home is safe and run in the best interest of the people who live there. Evidence: The AQAA told us that the service has a registered manager, they have tools to assess the quality of the service and fire safety equipment and procedures are in place to maintain a safe environment of the residents. This was tested by speaking with the manager over the phone, viewing the outcome of managers registration interview report. Speaking with staff and residents regarding quality, touring the building and viewing documents in respect of health and safety. Mr Dundas the registered manager was not available at the time of the visit but a brief conversation was held on the phone where the manager offered his support via phone if required. A senior member of staff assisted with the inspection process and appeared well equipped with the required knowledge to answer questions and gather information. Care Homes for Adults (18-65 years) Page 36 of 42 Evidence: Mr Dundas has recently registered with the Commission for Social Care Inspection under the Care Standards Act 2000. He demonstrated through the registration process that he has the required knowledge and skills to ensure the people who use the service receive good outcomes. Staff were complementary of the support they receive from the manager and the changes that have been made which have made improvements to the delivery of care and support. A member of staff said the manager is open to new ways of working and will allow you to try new ways of working unless it would be detrimental to the health and wellbeing of the residents and staff. The member of staff also said that Mr Dundas is very strong in protecting the residents right and views and will support residents to move on if it is deemed in their best interest to do so. A resident who was spoken with said he liked the manager and enjoyed completing his person centered plan with him. The service provided evidence that the service has a number of tools to measure the quality of the service and seek the views of the residents. We were informed that the service does not hold residents group meetings but does hold monthly meetings with each individual resident. In these meetings their personal plan is reviewed, goals and wishes from the previous month reviewed and further goals and wishes planned for the future. An explanation of why a goal may not have been met is recorded in the their personal plan. We were told that during these meetings residents are encouraged to express positive aspects of their care and comment on what they feel the service could do better. A copy of a regulation 26 report was viewed, (a regulation 26 report is a record of an audit undertaken by someone other than the registered manager and records quality outcomes for the people whop use the service). The report told us that a visit is made monthly to the service and areas such as personal plans, risk assessments, incident reports, complaints, staff and environment records are audited. The senior member of staff said that the person carrying out the audit will speak with residents and staff to seek their views. There are safe systems in place for fire safety and it was evidenced that staff receive regular fire safety training. Regular checks are made on fire safety equipment but on the day of the visit it was noted that a number of fire doors including those to residents bedrooms were not closing properly, holes where locks had been removed had not been plugged and an intermittent strip to another door had been removed and not replaced. We were informed that changes to locks had created the problem. It was agreed that immediate action would take place to rectify the concerns and on the same day of the visit repairs were made. The home must also ensure where a door is a fire door and a notice requires it to be kept locked at all times then staff must comply with this notice. Whilst touring one of the units/homes it was established that a cupboard bearing the sign had been left unlock. This information was handed over to all staff at handover. Care Homes for Adults (18-65 years) Page 37 of 42 Evidence: The AQAA informed us and this was confirmed by a member of staff that there are working groups for specific areas of health and safety including fire safety and storing hazardous substances (COSHH). A senior member of staff informed us that the health and safety of the building is regularly monitored and maintenance concerns are dealt with as promptly as possible. Substances that may be hazardous to health are securely locked away and there are notices discreetly displayed around the home. This is to remind staff to test and record hot water temperatures and follow good hygiene practices. Records seen provided evidence that all utilities such as gas and electrical systems and small electrical appliances are regularly checked to ensure they are in good working order. Care Homes for Adults (18-65 years) Page 38 of 42 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 39 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Medicines must be stored at 17/10/2008 the correct temperature and humidity so as to ensure that the medicines are fit for use. The people who use the service must recieve their medications using safe systems for storage and administration to avoid medications becoming spoiled or ocntaminated. 2 20 13 Homely remedy medicines 17/11/2008 must be checked out with a GP or pharmacist before they are administered to the person using the service. You must ensure none perscribed medications do not contra indicate with perscribed medication as this could potentially place the people who use the service at risk of ill health Care Homes for Adults (18-65 years) Page 40 of 42 3 30 13 The service must ensure there are suitable systems and equipment in place to prevent infection, toxic conditions and the spread of infection 17/11/2008 The people who use the service must be protected from the potential risk to their health and welfare. 4 42 24 The service must ensure it is 17/11/2008 following fire procedures at all times, this includes ensuring door which indicate they must be kept locked are kept locked at all times. The people who use the service must be protected from the potnetial risk of fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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