CARE HOME ADULTS 18-65
Hawkstone House Shann Lane Keighley West Yorkshire BD20 6NA Lead Inspector
Michael Smithson Announced Inspection 22nd November 2005 9.30 Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 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 Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 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. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hawkstone House Address Shann Lane Keighley West Yorkshire BD20 6NA 01943 865654 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) Isand Ltd Mr John Martyn Calver Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection N/A Brief Description of the Service: Hawkstone House is large detached house standing in its own grounds. Its proximity to Keighley town centre gives easy access to shopping, transport links and leisure facilities. All the bedrooms are singles with one being en-suite. A large dinning and separate lounge area are provided. The home provides accommodation for 6 adult service users with learning disabilities who require significant support in daily living and may present with challenging behaviour. Service users would be in the age range 18 to 65 and of mixed gender. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and took place over the morning and afternoon of the 22 November 2005. The second and final inspection for this year will be unannounced. Copies of inspection reports should made available at the home or from the CSCI website. Hawkstone House is a newly opened establishment. The home opened in the summer of this year. This was the first inspection ever undertaken at the home. The current manager has only recently taken up the post following the resignation of the original Registered Manager. The current manager has not yet completed the Fit Person process. The change of manager has resulted in a number of changes in the short time the home has been opened. The changes have been made to reaffirm the philosophy of care and maintain consistency between the provider, manager and the staff team. This being the first inspection at the home the inspector undertook a broad view of all aspects of the care provided, the records and discussions with service users and staff. The home refers to the people living at the home as residents. This will be respected in this report. What the service does well:
At the time of the inspection only 3 residents were living at Hawkstone House. Further admissions are planned over the next 2 weeks. The admissions were well planned and allowed staff and residents the time to get to know each other. The residents spoken to during the inspection felt happy and were settled. The home has a very good pre-admission process which allows the manager and the staff time to make sure that the placements are appropriate and are inline with the categories of registration. The inspector joined the residents for lunch. The residents assisted the staff in the preparation of the meal and residents were offered a choice. The staff take their meals with residents which helps to reinforce the friendly family environment. The mealtime was used as an opportunity to plan the activities for the remainder of the day and discuss issues relating to life at the home. A good range of activities are offered. These include resident involvement in daily routines and daily duties. Residents are encouraged to help keep their
Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 6 bedrooms tidy and help with personal laundry and shopping. A range of leisure activities take place both in small groups or on a one to one basis. Residents have enjoyed trips to the cinema, bowling and swimming. The home operates a key worker system, which allows residents the opportunity to discuss their individual needs. The staff spoken to during the inspection demonstrated a very good understanding of the role. What has improved since the last inspection? What they could do better:
The manager was aware that he needed to make changes to a number of records, policies and procedures he inherited from the previous manager. The process of making the changes is underway. The current care plans are informative but do not fully reflect the views and wishes of the residents. The manager is keen to change the format to produce the care plans from the resident’s views of their life at the home and their hopes and aspirations for the future. The current accident records are not adequate. The format does not provide enough space to fully record the circumstances relating to accidents. The recordings must be more detailed and follow up information recorded. The manager must audit the records to make sure the information is well recorded and any health and safety issues are met. The Adult Protection policy and procedure must be up dated to include more details for the staff team. The procedure must include instruction on how to respond to an allegation or suspicion of abuse and information regarding who to contact. The staff induction format must be improved. The induction must include more information regarding the philosophy of care at the home and provide more detail regarding health and safety. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 7 Further fire safety training must be provided to make sure that all staff fully understands the fire evacuation procedures. A record must be kept providing the names of the staff attending. The 2 staff that have not undertaken the Basic Food Hygiene training and must do so at soon as possible. Risk assessments must be completed to ensure that residents are safe using the kitchen facilities and preparing meals. The staff should consult with Enviroment Health to determine safe practice. A staff supervision system must be put in place. The staff should receive at least 6 sessions a year. The manager must complete the registration application form and return it to CSCI so the registration can progress. The provider must undertake the Regulation 26 visits and provide a written report available for inspection. A format must be produced for notifying CSCI of incidents and accidents, which may occur at the home. The staff team must be made aware of the need to provide CSCI with this information. The service user guide and complaints information must be changed to a more user friendly format. The manager is looking at a pictorial format. This is good practice. The manager is also looking at a pictorial format and procedure for recording complaints. A record must be available of the level of fees paid by residents. The level of fees must correspond to the payment recorded on the terms and conditions. The terms and conditions of residency must be reviewed to make sure they relate to the care provided at the home. The payments made for activities and outings must be made clear and the circumstances under which residents may be given notice needs to be expanded. The terms and conditions must make clear under what circumstances residents with challenging behaviour may be expected to pay for any damage caused. 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. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 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 Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Hawkstone House provides prospective residents with information regarding the home, however the format needs to be more suited to their communication needs. The homes admission procedure allows residents the opportunity to visit the home prior to admission. EVIDENCE: A statement of purpose and service user guide has been produced. The documents provide information regarding the service provided. However further work is required to produce the service users guide in a format which is suited to the needs of the residents. The new manager is looking to introduce a pictorial and audio version. A pre-admission assessment is available which is completed during the domiciliary visits. The information obtained provides the basis for the completion of the care plans. The pre-admission assessment also allows the manager to determine that the proposed placements are suitable and in line with the registration categories. Prospective residents are offered the opportunity to visit the home prior to admission. They are encouraged to stay for a meal and where possible an overnight stay. All residents are admitted on a trial period. This is good practice. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 10 Terms and conditions have been produced, however all current placements are Local Authority funded and will receive a Local Authority contract. The manager is looking at up dating the current contracts to provide more detail regarding payment of activities and conditions for termination of the placement. A record must be provided of the level of fees paid by residents and this must be available for inspection. The level of fees paid must correspond with the level of fee recorded on the terms and conditions. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 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, 8, 9 and 10. Detailed assessment and care plans are produced, however again the format must be changed to reflect the views of service users. Risk assessment is used to help residents take acceptable risk and maintain independence. Residents are encouraged to make choices in their daily lives. EVIDENCE: The records for the 3 residents currently living at the home were checked during the inspection. The records contain the information required; however it is not in a format suitable to the philosophy of the home. The manager is aware that the care plans do need to be changed to better reflect the wishes and views of the residents. He is planning to include the residents in the completion of the care plans and allow them greater access to the information. The residents are consulted on every aspect of their daily lives and are offered a wide variety of choices. The residents can give their opinions on how the home operates both individually and during the house meetings. A key worker system is in place, which is used to make sure the individual needs of residents are being met. The 2 residents spoken to during the inspection were aware that they had a key worker.
Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 12 During discussions with 2 of the residents and from observations made it was evident that the residents felt comfortable in the environment and were happy to approach staff for assistance. There was a very friendly atmosphere noted between the staff and the residents. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 13 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): 11, 12, 13, 14 and 17. A very good range of activities are offered which allow residents the opportunity to engage in appropriate leisure activities. EVIDENCE: A good range of activities are offered for residents. Both group and individual activities are offered. The activities tend to be linked to normal daily living. They encourage residents to take part in all aspects of the daily routines within the home. These include helping to keep their bedrooms clean, assisting with personal laundry and preparation of meals. A good range of leisure activities are offered these include outings, swimming and the cinema. Again they are organised in groups or on a one to one basis. The home has only recently opened and they are still trying to develop links with the local community and find out what resources are available. None of the current residents attend day services or work placements, however this is something the manager and the staff are discussing with residents. The menu and shopping for food is quite flexible and includes the wishes of residents. They help with menu planning for the week and help with the
Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 14 shopping. Residents are encouraged to help staff with the preparation of the meals. However the manager is aware that they need to look at specific risk assessments to allow residents to use the kitchen safely. A visit is planned by Environmental Health and it was advised they use the visit as an opportunity to discuss the resident’s safety in the kitchen. All except 2 of the staff have undertaken Basic Food Hygiene training. The 2 outstanding are due to attend a course in the near future. The resident involvement in the preparation of meals has helped to forge the positive relationships between the staff and the residents. The staff eat with the residents, which again creates a positive friendly environment. They use the mealtimes as an opportunity to discuss planned activities and the daily routines. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 15 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 and 19. The health and social care needs of residents are met. EVIDENCE: The health care needs of the residents are included in the care plans. All the residents have been registered with a local GP. The residents maintain contact with other agencies including Social Workers and Community Psychiatric services. One resident has been diagnosed as suffering from diabetes. The manager is making contact with local support services to help provide training and support for the staff team. A blood sugar monitoring record has been produced and the manager is planning to establish the safe blood sugar levels for the resident. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Residents are protected from abuse, however the adult protection procedure does need to up dated. The complaints procedure does need to be more accessible for residents. EVIDENCE: The complaints procedure is included in the information provided for residents and is on display in the home. However the manager is looking to make the information available in a more user friendly format and again look at incorporating a pictorial format. No complaints have been made since the home opened. The manager is looking at a suitable system to record any complaints. The current adult protection policy and procedure does not provide all the information required. The provider did say they had obtained a copy of the local authority No Secrets guidance however it could not be located on the day of the inspection. Some adult protection training has been provided for a number of the staff team. However I did advise the manager contacts the local authority adult protection unit to obtain an up to date version of the No Secrets guidance and look at accessing the training provided. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. EVIDENCE: A full building inspection was not undertaken during this visit. However the inspector did spend time in the communal areas and in 2 residents bedrooms. The areas seen were maintained to a good standard of decoration and cleanliness. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 31, 32, 33, 34, 35 and 36. The staffing was adequate for the numbers of residents currently living at the home. Further induction training is required. EVIDENCE: The home currently caters for 3 residents. The staffing arrangements are due to be discussed during a meeting planned between the manager and the provider. Further recruitment is due to take place for permanent night staff. The staff team has been reorganised to now include team leaders who will take charge of the home in the absence of the manager. The staff rotas are being organised around the needs of the residents and the planned activities. The recruitment records for all the current staff were checked and all the required information was available. The manager has introduced a new staff recruitment procedure, which includes an interview format, which includes equal opportunities. The staff team has undertaken a number of the mandatory training courses and these have been recorded. However the manager is due to undertake a training audit to make sure all staff feel happy with the training received. During discussions with one member of staff it was noted that she had not been provided with adequate fire safety training. Further training must be provided and the names of the staff attending recorded.
Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 19 Three of the staff has completed NVQ level 2 during previous employment. The manager is looking to organise further training through a local college. A staff supervision programme is being implemented and a format to be used has been produced. Regular staff meetings are being held which give the staff the opportunity to contribute to the day to day running of the home and the decision making process. During discussions with 2 members of staff it was clear that they had a good understanding of the daily routines and the individual needs of residents. They understood the philosophy of the home and the need to give residents the opportunity to make choices. They felt they had adequate time to spend with residents and were encouraged to organise a wide range of activities. The staff had a good understanding of the key worker role and confirmed that they made the residents aware that they were their key worker. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 20 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, 38, 41 and 42. The views of residents and staff are included in the decision making process. The policies and procedures do need some up dating to reflect the current philosophy of the home. EVIDENCE: The current manger has only worked at the home for a short period and has not completed the registration process. However he had previously been registered at a home for service users with learning disabilities. The manager is currently completing NVQ level 4 and the Registered Managers Award. The manager has made changes and improvements to a number of areas during his short time at the home. The staff interviewed felt that he had introduced more structure and given them a greater understanding of their role and how the resident’s daily lives and input into the home could be improved. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 21 Detailed policies and procedures are provided, however these were mainly produced by the previous manager. The current manager is undertaking an audit to make sure the information relates to his philosophy for the home and that all the information required is available. A format must be available to inform CSCI of any serious accidents and incidents which may occur. The staff must be made aware of the procedure. The current accident records are not adequate. The format does not provide enough space to fully record the circumstances relating to the accident. The recordings must be more detailed and follow up information recorded. The manager must audit the records made make sure the information is well recorded and any health and safety issues are met. The provider must undertake the Regulation 26 visits and provide a written report available for inspection. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hawkstone House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 1 3 X X 2 2 X DS0000064324.V255000.R01.S.doc Version 5.0 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA1 YA5 Regulation Reg 5 Reg 5 (1)(b) Requirement The service user guide must be available in a more user friendly format. The terms and conditions should provide more detail regarding dealing with challenging behaviour and termination of the placement. The service user plan must be produced in a format, which reflects the wishes and aspirations of service users. It should be produced in a more user friendly format. The complaints procedure must be produced in a more user friendly format. A system for recording complaints must be available. The Adult Protection procedure must provide more detail for staff. The staff induction programme must be expanded to provide more training regarding the philosophy of the home. All staff must be provided with good quality induction training. A staff supervision system must be implemented.
DS0000064324.V255000.R01.S.doc Timescale for action 01/02/06 01/02/06 3 YA6 Reg 15 01/02/06 4 YA22 Reg 22 01/02/06 5 6 YA23 YA35 Reg 13(6) Reg 18(1)(a) 01/02/06 01/02/06 7 YA36 Reg 21 01/02/06 Hawkstone House Version 5.0 Page 24 8 9 YA37 YA41 Reg 9 Reg 17 The manager must complete and 14/12/05 return the Fit Person registration application form. The accident recording form 01/02/06 must be changed to one that allows staff to record more detail. A record format must be produced to informing CSCI of the Reg 37 notification and the Reg 26 visits. A record must be kept of the level of fees paid. 10 11 YA42 YA42 Reg 18(1)(a) Reg 23(4)(b) All staff must be provided with 01/02/05 Basic Food Hygiene training. All staff must be aware of the 21/12/05 fire safety procedures. A detailed record of the names of the staff receiving the training must be kept. 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 Refer to Standard YA17 Good Practice Recommendations Consultation should take place with Environmental Health to make sure that appropriate risk assessments are in place for service users to safely use the kitchen. Hawkstone House DS0000064324.V255000.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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