CARE HOME ADULTS 18-65
HAZEL VIEW 21 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH Lead Inspector
Steve Webb Unannounced 8 August 2005 @ 10:15 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. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hazel View Address 21 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH 0118 9427608 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) Purley Park Trust Limited Vacant Care Home 5 Category(ies) of Learning Disability registration, with number of places HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Two designated people aged 65 years or over are accommodated by prior agreement. Date of last inspection 31/01/05 Brief Description of the Service: Hazel View is one of the three original ‘outlying houses’ within the Purley Park Trust, and is now one of eight separate small units within the estate. The unit accommodates five adults of either gender, (currently five males), with a learning disability, in a pleasant unit providing each service user with their own bedroom. Communal accommodation consists of a shared lounge/kitchen/dining area, with comfortable furnishings, toilets and a bathroom. One service user has an en suite. Residents and staff work together on various aspects of the day-to-day running of the unit. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 10.15am and 2.30pm on 8/8/05. The inspector was assisted by the head of care and unit team leader. The inspection included discussion with service users, inspection of records and files, examination of the premises and lunch with service users. This was a positive inspection, with service users seen relaxing in the unit. The service users confirmed they had enjoyed their holiday to Butlins. The unit were working to address some difficult behavioural issues with one service user, but had sought appropriate external support, and worked well with the family on the issues. Some redecoration works are now needed to the building, but other areas have already been addressed. What the service does well:
The service has a thorough assessment process in place, and meets the individual needs of service users well. The advice of external professionals is also obtained where necessary. The needs, wishes and preferences of service users are established and recorded within essential lifestyle plans and care plans, and each service user has a contract, signed, where possible by next of kin on their behalf. Staff now receive training on risk assessment, and training in general is provided well to meet their needs. Service users can access a range of appropriate activities, supportive sessions, both on and off-site and are part of the wider community. Where possible contact with family is encouraged and supported. The physical and emotional health needs of service users are addressed and reviewed effectively, and the unit manages medication effectively. Service users can express their views about the service via regular residents meetings as well as through the complaints procedure. They also have access to the head of care and chief executive on-site. Their views have also been obtained as part of the quality assurance system established by the service, though the report has yet to be published. The unit is homely and comfortable and appropriate for the needs of the current group.
HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 6 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 7 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 HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 8 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, 5 The individual needs, wishes and aspirations are assessed and recorded effectively. Each service user has a written contract on file. EVIDENCE: The most recent admission transferred into the unit from the old main house, and was assessed under the previous system. However, the relevant records and formats under the new assessment and care planning system were in place. These include an essential lifestyle plan, which identifies individual preferences, likes and dislikes around personal care support, daily routines, activities etc. The current admissions system is known to include appropriate prior visits and a comprehensive assessment process. Each of the service users has a contract, though only two are signed by their next of kin. In one case the next of kin have declined to do so despite the contract being forwarded to them, and in two cases, there are no next of kin, and care managers will not sign them. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 9 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) 9 Service users are supported to take risks within an appropriate risk assessment framework. Some improvements are recommended in terms of also holding risk assessments collectively, and staff countersignature. EVIDENCE: There is an appropriate risk assessment system in place though copies were only available within individual files. It is recommended that copies of all current risk assessments are assembled into a collective file for ease of staff reference, especially given that staff from other units work in Hazel View at times and may not be as familiar with the service users needs. This would also provide a place for relevant risk assessment copies relating to residents of other units on-site, with whom staff may come into contact, and for a signature sheet for all staff to countersign to confirm they have read the risk assessments. Specific risk assessments had been developed in response to emerging issues around one service user, and had been acted upon appropriately when the level of identified risk had escalated. All staff receive in-house training on risk assessment, and risk assessments are reviewed at least annually.
HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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 Service users take part in a range of appropriate activities and can access these on and off-site. They are part of both the on and off-site communities. Where there is family contact, this is encouraged and supported. EVIDENCE: Service users access a wide range of activities, both on and off-site, some as part of individual weekly activities plans, and others of a spontaneous nature. On the day of inspection, service users were mostly relaxing in the house, and some were due to attend Monday Club that evening. One had been to horticultural therapy. Each service user has an individual activities plan for regular scheduled activities. Available activities include karaoke, golf, pub visits, bowling, pottery, shopping, swimming, computing, bible studies, horticultural therapy, attending church and church-run events such as coffee mornings and on-site art and craft sessions run by Reading College, as well as off-site college sessions. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 11 One service user cooks the evening meal for the whole group one evening a week and others have varying involvement in household tasks. One service user attends supported employment. In the house there is TV, video, DVD’s and puzzles and games. Four have already had a group holiday to Butlins, one is going in September, and one is going on a second\ holiday with service users from another house. Two of the group regularly attend church and access local shops unescorted. One service user has daily family contact, and e-mails his family weekly, one other has family contact, two have no family, and one has a relative but there is no contact. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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) 19, 20 The physical and emotional needs of service users are addressed, and appropriate external professional advice is sought. Though none of the service users is able to manage their own medication, the unit has an appropriate system in place to do so on their behalf. It would be good practice to obtain the medication information sheets for prescribed medications and include these in the medication file for staff information. EVIDENCE: Some of the behaviour of one service user has been causing concern and the appropriate external professionals have been involved to address these. The unit has also discussed the issue with the service user’s family. Appropriate safety steps have also been taken in response to his actions, within the context of risk assessment, in order to try to manage some of his behaviours. This is an ageing group and one service user has had cataracts operated upon, and the age-related changing needs of another are also being addressed. None of the service users is able to manage their own medication, and the unit has an effective system in place to manage this on their behalf. Appropriate
HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 13 records are maintained of medication coming in, its administration and any returns to the pharmacist. A double signatory system has been introduced to ensure that all medication is given as it should be. The team leader and one carer have so far received training on medication, and external training is due to be provided. It would be good practice to obtain the medication information sheets for prescribed items and include them in the file for staff reference. Service users receive annual medical checkups and medication reviews. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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 The views of service users are sought through various forums and recorded, and any complaints would be logged in the unit complaints log. EVIDENCE: The unit has an appropriate complaints procedure in place, and the unit has a complaints log, though this was empty to date. A lot of day to day issues relating to community living are resolved at the monthly resident meetings, which are minuted. The team leader and one of the carers have worked at the unit for an extended time, so the service users are familiar with them. These meetings also enable planning for holidays, discussion of menus and other domestic issues. All of the service users are able to make their views understood. Service users can also access the head of care and chide executive, both of whom are based on-site. Service user views have been sought through a quality assurance process, though the resulting information is still being collated. A report is due to be made available in the near future, and should be copied to the inspector. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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 Service users live in a homely and comfortable environment, which protects their wellbeing for the most part, though a self-closer should be fitted to the laundry door to maximise safety. EVIDENCE: The environment is homely and pleasant, though in some areas there is a need for redecoration. There are photomontages from previous holidays framed on the wall, which indicate the service users enjoyment of the holiday. The photos of the recent holiday to Butlins were also shown to the inspector. New curtains had been provided in the bedrooms, the kitchen had been refurbished, with new cupboards, tiling, flooring etc. though the worktop next to the sink was already beginning to swell and needed sealing. A new dining table and lounge furniture, had been provided, together with some new bedroom chairs. The bedrooms were individualised reflecting the personality and interests of their occupant. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 16 There was an unpleasant odour in one bedroom, and ongoing work will need to be done on aspects of hygiene and behaviour to address this. The laundry door needed a self closer to be fitted. The lounge door had already been fitted with one. In this unit it was felt not necessary to risk assess for the fitting of an appropriate holdback for the lounge door, since the service users were used to this being kept closed. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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) 35 The needs of service users are met by an appropriately trained staff team. EVIDENCE: The organisation now has one post dedicated to coordinating the training across all of the units, which ensures a consistent approach and a good overview of cyclical needs. Spreadsheets of training needed or completed, for units or individuals can be produced as required. A thorough range of core training is now provided to all staff. The unit has no manager at present but is otherwise fully staffed. The team leader has NVQ level 2, and has almost completed level 3. She plans to commence her level 4 after this. One carer has level 3, one new carer is still undertaking foundation training and will then commence NVQ. HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 18 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 The health, safety and welfare of service users is effectively promoted for the most part, though the frequency of fire drills should be increased and a fire risk assessment for the unit needs to be produced. A certificate for the fiveyearly testing of the electrical installation is also required. EVIDENCE: The relevant safety-related certification was present apart from a record of the five-yearly electrical installation testing. This will need to be done if records indicate it is overdue. Records of fire drills indicate only one drill so far in 2005. At least two drills with full evacuation should be held and it is strongly recommended that four drills per year take place, though two need not involve evacuation of service users. This helps to ensure that the needs of any new staff are met, and enables various fire scenarios to be practiced. Three staff have a current food hygiene certificate and one is booked to do this course. All have current first aid certification.
HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 19 As already noted, a range of appropriate risk assessments have been produced and are regularly reviewed. However, an overall fire risk assessment for the unit was not present, and needs to be produced and copied to the inspector. As already noted, a fire door self-closer should be fitted to the laundry door. (Requirement made above under Standard 24). HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 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. 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 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
HAZEL VIEW Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 21 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. Standard 24 Regulation 23 Requirement A self-closer should be fitted to the laundry door. This requirement remains from the previous inspection. A certificate for the five-yearly testing of the electrical installation should be obtained and copied to the inspector. The frequency of fire drills should be increased. An overall fire risk assessment for the unit should be compiled and copied to the inspector. Timescale for action 10/9/05 2. 42 13 10/11/05 3. 4. 42 42 23 23 10/10/05 10/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 20 24 Good Practice Recommendations Consider holding copies of service user risk assessments collectively, for ease of reference, and obtaining staff countersignatures to confirm they have read these. Consideration should be given to obtaining the medication information sheets for any prescribed medication and filing these in the medication file for staff reference. It is suggested that the worktop surrounding the sink is sealed carefully to prevent further ingress of water.
H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 22 HAZEL VIEW HAZEL VIEW H52-H01 S11171 Hazel View V235286 020805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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