CARE HOME ADULTS 18-65 Hatton Grove, 4 West Drayton Middlesex UB7 7AU
Lead Inspector Paula Eaton Unannounced 6 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hatton Grove, 4 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Hatton Grove, 4 Address West Drayton, Middlesex UB7 7AU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 441349 01895 444134 Staylor@hillingdon.gov.uk London Borough of Hillingdon Mrs Sandra Ann Taylor Care Home 17 Category(ies) of Learning Disability (16), Learning Disability over registration, with number 65 years of age (1) of places Hatton Grove, 4 Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8/11/04 Brief Description of the Service: Hatton Grove is a purpose built home for seventeen adults with learning disabilities. It opened in the 1970s and is owned and managed by the London Borough of Hillingdon. It is divided into three self-contained flats, one on the ground floor and two on the first floor. The ground floor flat accommodates service users who have physical disabilities as well as profound learning disabilities. There is a passenger lift for access between the ground and first floor. There is a well-maintained garden to the rear of the building. The home is in a residential area close to local shops and amenities. There is also a railway station a short walk from the home and local bus routes available. Hatton Grove, 4 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours as part of the annual inspection process. The registered manager was on annual leave on the day of the inspection so the senior member of staff on duty assisted with the inspection process. One other member of staff and two service users were spoken to and records, policies and procedures were examined. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hatton Grove, 4 Version 1.10 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hatton Grove, 4 Version 1.10 Page 7 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Service users are assessed prior to admission to ensure the home is able to meet their needs. EVIDENCE: Service users had been assessed before being admitted to the home. Care Management needs led assessments had taken place and a copy kept on file. These assessments covered all areas of need and had been used to develop individual care plans. Hatton Grove, 4 Version 1.10 Page 8 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Service users needs are reflected in their individual plan. Service users are encouraged to make decisions about day to day living and to take controlled risks within a safe environment enabling them to maintain as much independence as possible. EVIDENCE: The care plans examined were comprehensive documents that covered all areas of need including health, behaviour, religion, involvement in activities and sexuality. Care had been taken to assess each individuals needs with much attention to detail giving the person reading the care plan a real sense of the person being written about. There was evidence of care plans being reviewed, however some were overdue. It was evident from the records viewed and from observing staff interacting with service users that service users are encouraged to make choices and decisions regarding day to day activities wherever possible. Any limitations on choice were recorded with clear reasons as to why. For example, one service user has limited access to the kitchen and food due to a risk to his health and safety i.e. scalding. Comprehensive individual risk assessments were also in place covering a range of issues such as moving and handling, using transport,
Hatton Grove, 4 Version 1.10 Page 9 wandering, bathing and risk of choking. The risk assessments included clear guidelines for staff on how to minimise any risk posed. Hatton Grove, 4 Version 1.10 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 A variety of appropriate activities are arranged throughout each week to meet the individual needs and interests of service users including activities that integrate service users into the local community. Service users are encouraged to maintain family relationships and friendships. Dietary needs of service users are well catered for with a balance and selection of food available that meets service users needs and choices. EVIDENCE: All but one of the service users attends a day centre in the community where various activities are available throughout the day. The senior member of staff on duty said that some of the older service users had reduced their attendance at the day centre to three days a week as this is more appropriate to meet their needs. Individual weekly activity programmes were displayed in the home in a suitable format for service users. The senior member of staff on duty said that service users attend a local club on a Thursday evening and that trips out to lunch, the shops and local park occur on a regular basis. Staff were observed arranging to go out with two service users during the inspection and the records viewed showed that service
Hatton Grove, 4 Version 1.10 Page 11 users go out into the community on a regular basis. The senior member of staff spoken to also said that a garden party is held in the summer for service users, their family and friends. A holiday had been arranged to an adapted bungalow in Bognor Regis and plans were being made for another holiday later in the year. Staff and a service user spoken to said that family and friends are encouraged to visit the home and that they are always welcomed. Staff were observed interacting with service users in a sensitive manner, spending time with those service users who were in their rooms and asking them what they would like to do with the day ahead. Each flat has it’s own kitchen for meal preparation. These areas were well stocked with fresh produce and there were snacks and drinks available for service users. The menus for the home were varied and nutritious. Staff were observed assisting service users with their breakfast in a sensitive manner. Hatton Grove, 4 Version 1.10 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication procedures in the home are satisfactory. EVIDENCE: Service users preferred routines are recorded as part of their care plan. Individualised support is given to service users and a key worker monitors their care. Staff were observed being sensitive to service users needs and were taking time to ensure that they understood what was being communicated by the service user they were talking to. Each service user record viewed included a health action plan. This included details of current medication, known allergies, any medical conditions, and contact numbers for involved health care professionals. It also included information regarding any health care appointments and any action needed and incorporated regular health checks such as dental, chiropodist and eye tests. Attention had also been paid to well-woman and well-man health issues such as testicular awareness and breast awareness and appointments had been made for the women to have breast screening where appropriate. It was evident from the records that service user health needs were being continuously monitored. Hatton Grove, 4 Version 1.10 Page 13 The medication store and records in flat A were examined. Boots pharmacy provides the medication for the home. Although medication was generally appropriately stored it was noted that not all liquid medicines had the date of opening on them. There were also some unexplained gaps in the medication administration record sheets. The receipt and disposal of medication was appropriately recorded. None of the service users in the home self medicate. Hatton Grove, 4 Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Systems in the home for dealing with complaints and protecting service users need to be improved to ensure the protection of service users. EVIDENCE: There were complaints procedures displayed in various places in the home and a complaints leaflet was available in the main office on the ground floor. However, the displayed complaints procedures were very old and the information contained in them was not accurate. The complaints leaflet was also incomplete, as it did not contain contact details for the Commission for Social Care Inspection. The home must have an up to date complaints procedure that contains all of the required details. The staff on duty were unable to locate the complaints record at the time of the inspection. The only information available regarding the protection of vulnerable adults was outdated. There was a policy and procedure available dated 2001 and a leaflet dated 2002. These documents need to be reviewed and up to date information on the protection of vulnerable adult needs to be available in the home. It was also noted from staff training records that staff have not received training regarding this issue. Hatton Grove, 4 Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26 and 30 The home provides a clean, comfortable and safe environment for service users to live in. EVIDENCE: The home is situated in a quiet cul de sac close to local shops, businesses and transport links. Each flat in the home is suitably furnished and well maintained. The furnishings and décor are domestic in character and provide a comfortable and pleasant environment for service users. It was noted that the corridor carpet in flat C looked heavily stained. This was discussed with the senior member of staff on duty who said that the carpet had been laid fairly recently and that it was a fault with the carpet and not a stain and that the home had already made arrangements for it to be replaced. Service users individual bedrooms had been personalised and were comfortable and homely. There were pictures displayed and service users were surrounded by their personal possessions. Each bedroom is lockable but staff said that service users choose not to use these locks. The home was clean and tidy on the day of the inspection. There are appropriate laundry facilities based on the ground floor of the home, which
Hatton Grove, 4 Version 1.10 Page 16 were also clean and tidy. It is recommended that infection control procedures are displayed in this area. Hatton Grove, 4 Version 1.10 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 The level of permanent staff in the home is unsatisfactory and does not offer consistency of care to the people using this service. Service users needs are met by appropriately trained staff. EVIDENCE: There was a good ratio of staff to service users on duty on the day of the inspection. However, staff rotas show that there is a very high ratio of agency staff being used by the home due to staff shortages. This has been an ongoing issue since the last inspection that has not yet been resolved. The senior member of staff on duty said that posts had recently been advertised across the whole of learning disabilities services for the London Borough of Hillingdon. It was evident from the records viewed that regular staff meetings are taking place. Staff records could not be viewed on this occasion as the registered manager was on annual leave and the staff on duty did not have access to employee records. Individual staff training records were viewed. These are all kept in a training folder providing a good overview of the training provided in the home. Staff had received training in moving and handling, first aid, fire awareness, epilepsy awareness and training in the administration of rectal diazepam.
Hatton Grove, 4 Version 1.10 Page 18 Some specific training relating to working with individuals with learning disabilities had also taken place and some staff are working towards NVQ level two and three. As mentioned earlier in this report there was no evidence of any training taking place regarding the protection of vulnerable adults. Hatton Grove, 4 Version 1.10 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 There are adequate systems in place in the home to ensure the health, safety and welfare of service users are protected and promoted. EVIDENCE: Health and safety maintenance and servicing records were viewed. Equipment used in the home such as hoists and the assisted bathing facilities were being regularly serviced. All gas and electrical equipment was also being tested as required. The home has a monthly monitoring system in place to ensure that health and safety matters are addressed. Fire safety equipment was being regularly tested and regular fire drills were taking place. There was also an up to date fire risk assessment in place. Appropriate procedures are in place for accident reporting. Hatton Grove, 4 Version 1.10 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 x x x 3 Standard No 11 12 13 14 15
Hatton Grove, 4 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 1 x 3 x Version 1.10 Page 21 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x Hatton Grove, 4 Version 1.10 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard 6 20 20 22 Regulation 15(2)(B) 13(2) 13(2) 22(2)(7) (a) Requirement Care plans must be reviewed on a regular basis Liquid medicines must have the date of opening written on them. Medication administration records must be completed at all times. An up to date complaints procedure that contains contact details for the CSCI must be produced and available in the home. Training regarding the protection of vulnerable adults must be provided for staff An up to date policy and procedure regardign protection of vulnerable adults must be avaialbe in the home. The London Borough of Hillingdon must employ more permanent staff for Hatton Grove. Timescale for action 1/07/05 6/05/05 6/05/05 1/08/05 5. 6. 23 23 13(6) 13(6) 1/09/05 1/09/05 7. 33 18(1)(a) 1/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Hatton Grove, 4 Version 1.10 Page 23 No. 1. Refer to Standard 30 Good Practice Recommendations Infection control policies and procedures should be displayed in the laundry room. Hatton Grove, 4 Version 1.10 Page 24 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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