CARE HOME ADULTS 18-65
Hawkstone House Shann Lane Keighley West Yorkshire BD20 6NA Lead Inspector
Michael Smithson Unannounced key Inspection 27 and 28 July 2006 10:00 Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 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) Island Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th March 2006 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. The home now provides accommodation for 10 adult service users with learning disabilities who require significant support in daily living and may present with challenging behaviour. All the bedrooms are singles with 5 being en-suite. A large dinning and separate lounge area are provided in the main building. A further dinning area, lounge and small kitchen are available in the new extension. Service users would be in the age range 18 to 65 and of mixed gender. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) will be inspecting homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between April 2006 and June 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. The entire core National Minimum Standards are assessed and this forms the evidence of the outcomes experienced by service users. On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific area and are known as random inspections. This was the first inspection of this home during the 2006 to 2007 period. The visit was unannounced and completed by 1 inspector. The inspection was undertaken over 1 full day and concluded at a follow up half day. Feedback was provided for the manager at the end of the inspection. Copies of reports for this and previous inspections are available either from the home or can be found on the CSCI website. The views of a number of service users and staff were sought during the inspection and time was spent with the management team. A total of 3 service users were case tracked. Case tracking is the method used to assess whether residents receive good quality care that meets their individual needs. The 21 key standards from the Care Homes for Younger Adults National Minimum Standards were assessed as well as other relevant standards. What the service does well:
The home has created a friendly family style environment for service users. The layout of the home is organised like a family home and this helps to create the general atmosphere. The facilities have been greatly improved by the new extension, which provides a good flexible space, which can be used as a separate unit or part of the existing home.
Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 6 The actual admission procedure is very good with service users and their family being offered amble opportunity to visit the home prior to admission. Prospective service users are encouraged to meet the existing service user group and to meet the staff team. They have the chance to look at which bedroom they have been allocated and start to prepare it for the move. A very good range of activities is offered for service users including outings, leisure pursuits, and arts and crafts. The staff are keen to involve the service users in the local community. Service users are encouraged to assist with a wide range of tasks and daily routines. This includes cooking cleaning their bedrooms and personal laundry. The staff team to avoid risk supervises all the tasks. Service users are encouraged to contribute to the decision making process and are offered a very good level of choice. The key worker system provides all service users with a dedicated worker who has their individual needs at heart. What has improved since the last inspection? What they could do better:
The general organisation and consistency of the records must be improved. This is particularly important with regard to service user information, staff recruitment and training records. The care documentation must include better information about health care needs. The new Ok Health forms provide all the information required but they must be completed for all the service users. The home must provide proper up to date pre-admission assessment information for all new service users and more evidence of service users involvement in the admission procedure. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 7 The service user guide must be completed and made available in a format that meets the communication needs of the service users. The complaints procedure must be included in the new service user guide and be made available to service users in a format that they can understand. The medication system must be improved; this includes the safe storage, recording and administration of medicines. Further training must be provided for staff, particularly those who are responsible for administration of medication. Adult protection training and up dates are required for all staff. The management and team leaders must be prioritised. The manager must complete the Fit Person registration process. The staff recruitment records must be improved and all be available on the premises for inspection. Service users must be protected from staff that are not suitable to work in a care setting. The procedures for referring staff to POVA for the possible inclusion on the Protection Of Vulnerable Adults register must be tightened. A quality assurance and quality monitoring system must be put in place and must include the views of service users. Storage space for toiletries must be provided in all bedrooms. 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.V296035.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using the available evidence. Information for service users about the home is not in a format that meets the communication needs of service users. The pre-admission assessments could be improved and be completed to a more consistent standard. EVIDENCE: The production of a suitable, user-friendly service user guide is still outstanding from previous inspections. The manager is still looking at different suitable formats. However he is planning to have it available in a pictorial version. The records for 2 recent admissions were checked and information was provided regarding an admission planned for the near future. An excellent preadmission assessment and interim care plan format has been produced. However the availability and standard of completion of the record lacks consistency. This means staff do not always have the up to date information Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 10 available. This was confirmed when assessments were not fully completed, one had no name on it and others were wrongly completed. The actual practical admission procedure was very positive. A planned admission had commenced with the service user having visited the home on 3 separate occasions and had started to move personal items into his new bedroom. He has also started to develop friendships with the existing service users. This can only help the admission to be a less traumatic experience and is good practice. The records however need to reflect some of the good work being undertaken. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The care records could be improved through better organisation and consistency. EVIDENCE: The care records for 3 service users were checked as part of the case tracking process. Some of the records were poorly organised and did not all contain up to date information. New care planning formats and health care assessment are available but have not been completed for all service users. At previous inspections it was felt that care plans need to be more service user friendly. A good format has now been produced and must be available for all service users. One of the care plans seen was for a service user with differing cultural needs. A document titled All About Me was available and included detailed information regarding language and cultural needs including basic information of the
Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 12 special dietary requirements. The document had evidence of service user and key worker involvement and had been signed by the service user and the key worker. The document is very informative, however it is not completed for all service users. The newly employed assistant manager has taken on the responsibility for reorganising the care records and achieving better consistency. She is currently going through all the care information to bring it up to date. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 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, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using the available evidence. A good range of activities are offered and service users make good use of the facilities within the local community. EVIDENCE: During discussions with staff and service users it was evident that they are encouraged to make many choices in their daily lives. The current service user group need very little hands on assistance from staff with personal care. However the staff are aware that service users should be offered a choice with regard to daily routines, activities and personal care. A very good range of activities is offered throughout the day. These take place both on the premises and within the local community. Service users enjoy shopping trips, meals out and a good range of leisure activities. A number of service users attend local day centres. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 14 The staff felt that they were encouraged to help organise activities with service users and see it as a key part of the their daily duties. Adequate staffing is available to facilitate a good range of activities. Service users are encouraged to help around the home undertaking basic food preparation, cleaning and personal laundry. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 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, 19 and 20. Quality in this outcome area is poor. This judgement has been made using the available evidence. The standard of health care records for service users could be improved. The current system of recording and monitoring of medication administered to service users is not safe. EVIDENCE: The levels of personal support provided for service users varies. Service users are encouraged to maintain their independence and make choices. A key worker system is in place, which allows staff to focus on individual needs and develop good relationships with service users family and care professionals. A number of the service users did know who their key worker was and understood that they could speak to them about the care they received. The monitoring and recording of service user health care issues lacks consistency. The care records checked as part of the inspection varied in the detail available. However a new health care monitoring document entitled Ok Health provides very detailed information about service users personal health care. However the information is not available for all service users.
Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 16 A spot check of the medication system was undertaken during the inspection. The drug administration records were not fully completed and signatures were missing when drugs had been administered. This made it very difficult for an accurate stock check to be undertaken. Two lots of the same medication were being used for 1 service user. This appeared to be because the new stock had been started before the old stock had been completed; again it proved difficult to carry out an accurate stock check. The team leaders are responsible for the administration and recording of medication. Some training has been provided but clearly further up dates are required. The medication policies and procedures must be reviewed and better monitoring systems put in place. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The levels of adult protection training need to be improved. The complaints information is not produced in a format, which meets the communication needs of service users. EVIDENCE: The availability of the complaints procedure must be improved. The complaints information must be included in the service user guide in a format suited to the communication needs of service users. No complaints had been received since the last inspection, however there is no proper system in place for recording any complaints made. This must be addressed. Some progress is being made regarding adult protection training for all staff. The manager said he was booked on a training course at the end of August and bookings for the remaining staff are being organised throughout the coming year. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 18 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): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using the available evidence. The environment meets the needs of the service users. EVIDENCE: A full tour of the building was undertaken during the inspection. The new annexe extension has been completed providing an additional 4 beds, separate service user kitchen and lounge/dining facilities. The facilities can be used as part of the main building or as a separate unit. The premises are maintained to a good standard of hygiene and decoration and a good range of fixtures and fittings are provided. Service users all have single rooms some having en-suite facilities. Keys are available if required to keep bedroom doors locked and lockable facilities are available within the bedrooms. Service users are encouraged to personalise their bedrooms, however the levels of personalisation does vary significantly. The inspector did note a lack of storage space in bedrooms for personal toiletries. This was particularly evident in the new annexe where toiletries were
Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 19 being stored on a space next to the toilet. Suitable shelving or a cabinet should be provided. The main kitchen was maintained to a good standard of hygiene and contained a good range of both industrial and domestic type facilities. The service users are encouraged to use the kitchen under staff supervision as part of developing their independence skills. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using the available evidence. The recruitment records must be improved and service users offered greater protection. EVIDENCE: The staff recruitment records for 3 staff were checked during the inspection. Not all the information required was available and one file was being held off the premises at the provider’s office. All the staff recruitment information must be held on the premises. Discussions took place with the provider regarding whether a suspended member of staff should be referred to Pova for possible inclusion on the register of staff not suitable to work in a care environment. The provider did agree to contact Pova to see if it would be appropriate for them to investigate the referral. Staff are employed in sufficient numbers to meet the needs of the service users. This includes personal care, skills training and activities. The staff rota is well organised with cover being arranged over a 2 week period. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 21 The new assistant manager is currently completing an audit of all the staff training planned and completed. This will help to identify training gaps and prioritise resources. Interviews took place with 3 members of staff. Two were new to the service and had no previous care experience. The third was an experienced team leader. The new staff felt they had been provided with adequate training and information to allow them to meet the needs of service users and maintain a safe environment. They were both given ample opportunity to work alongside more experienced staff to learn the daily routines. The experienced worker had undertaken a good range of training both during his previous and current employment. He was also nearing completion of NVQ level 3. All the staff confirmed that regular house meetings take place with both staff and service users involved. Separate staff only meetings are then held. Staff also receive individual one to one supervision. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 22 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, 39, and 42. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The home continues to operate without a registered manager. However the recruitment of an assistant manger has had some improvements to the organisation of the records. EVIDENCE: The manager has still not completed the registered manager Fit Person process. The CRB check is still outstanding. A new assistant manager has been employed to assist the manager and to undertake specific duties within the home. The manager does lack a degree of organisational skills and this was evident with regard to record keeping. The new assistant manager has started to organise a number of the records including the service user care documentation. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 23 The home operates very much as a small family unit where both service users and staff are encouraged to contribute to the decision making process. This tends to be through group meetings, one to one sessions and through the key worker system. There is currently no formal quality monitoring system in place. The inspector felt that the home would benefit from the introduction of a self-audit system, which would have highlighted some of the issues found at the inspection at an earlier stage. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 3 2 X X 2 X Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation Reg 5 Requirement The service user guide must be available in a more user-friendly format. (Timescale not met from last inspection 01/06/06) 2. YA2 Reg 14 A pre-admission assessment must be available for all service users. The assessment must be fully completed to provide evidence that the home can meet service users needs. 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. (Timescale not met from last inspection 01/06/06) 4. 5. YA19 YA20 Reg 12 Reg 13 The health care records for service users must be improved. The administration, recording and monitoring of medication must be improved and training
DS0000064324.V296035.R01.S.doc Timescale for action 01/10/06 01/09/06 3. YA6 Reg 15 01/10/06 01/10/06 01/09/06 Hawkstone House Version 5.2 Page 26 provided. 6. YA22 Reg 22 The complaints procedure must be produced in a more userfriendly format. A system for recording complaints must be available. (Timescale not met from last inspection 01/06/06) 7. YA23 Reg 13 Adult protection training must be provided for all staff. (Timescale not met from last inspection 01/06/06) 8. 9. YA32 YA34 Reg 18 Reg 19 The staff training audit must be completed. The staff recruitment procedure must be improved with proper records being available for all staff and kept on the premises. (Timescale not met from last inspection 01/04/06) 10. YA34 Reg 19 Any staff employed at the home that are found to be unsuitable to work in a care setting must be reported for possible inclusion on the Protection of Vulnerable Adults register. The manager must complete Fit Person registration process. (Timescale not met from last inspection 01/04/06) 12. YA39 Reg 24 A quality assurance and quality monitoring system must be put in place. The views of service users must be included. The accident recording form must be changed to one that
DS0000064324.V296035.R01.S.doc 01/10/06 31/12/06 01/10/06 01/09/06 01/09/06 11. YA37 Reg 9 01/09/06 01/11/06 13. YA42 Reg 17 01/10/06
Version 5.2 Page 27 Hawkstone House allows staff to record more detail. (Timescale not met from last inspection 01/05/06) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA25 Good Practice Recommendations Adequate storage for personal toiletries must be provided in all service user bedrooms. Hawkstone House DS0000064324.V296035.R01.S.doc Version 5.2 Page 28 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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