Inspection on 20/08/08 for Hazelhurst

This inspection was carried out on 20th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazelhurst 24/08/07

Hazelhurst 18/04/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Hazelhurst 1 Broncksea Road Filton Park South Glos BS7 0SE Lead Inspector Odette Coveney Unannounced Inspection 20th August 2008 9:00 Hazelhurst DS0000068902.V370509.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 Hazelhurst DS0000068902.V370509.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. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelhurst Address 1 Broncksea Road Filton Park South Glos BS7 0SE 0117 9855009 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) Pryce-Jones (Filton) Ltd Mrs Hazel Lilian Pryce-Jones Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2007 Brief Description of the Service: Hazelhurst is a care home, which is registered with the Commission for Social Care Inspection, (CSCI). It provides accommodation and personal care for up to ten adults, male or female, who have a diagnosis of learning difficulties. The current maximum fee charged at the home is £824.00 per week, this is calculated based on an assessment of an individuals needs. Hazelhurst is privately owned and is the second care home of the proprietors who also own St David’s Lodge, Fishponds. Mrs Hazel Pryce Jones took over as both the registered Provider and the Registered manager of the home in January 2007. The house is in north Bristol, close to the A38 Gloucester Road, where there are local shops, a library, a leisure centre and churches of various denominations. There is a regular bus service to Bristol centre, which is approximately 3 miles away. The home is also close to the Avon ring road, which connects to the motorway system. The home is a detached house that has been converted and renovated to comply with the Care Homes Regulations 2001 and National Minimum Standards. There are gardens to the front and to the rear of the property. There are communal areas for service users (a lounge, dining room and a sun lounge). There is no provision at the home for respite placements. Wheelchair access is via the rear of the property. A stair lift has been installed to the first floor of the house. All of the service users have a variety of activities that they choose to do during the day, such as attending day centres and college courses. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. The purpose of the visit was to review the progress to the requirements and recommendations from the last key visit undertaken in August 2007 This visit took place on Wednesday 20th August 2008, all of the key standards were inspected it commenced at 09:00 and lasted eight hours. The methods used during this visit included record checks, reviewing the care and associated documents for three people who live at Hazelhurst, a tour of the home and discussion with the manager, three staff, and people who use the service. What the service does well: What has improved since the last inspection? All of the six requirements that were made by us during our last visit to the service in August 2007 had been met, demonstrating a commitment by the provider to comply and meet the regulations. Since our last visit the following improvements have been made: Amendments have been made to the statement of purpose to ensure it is accurate and those who live at the home, and prospective residents are provided with full information. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 6 An individual’s mental health and emotional needs are well recorded and understood by staff at the home and this information and how they will be supported is fully recorded within the service users care plan. Those living at Hazelhurst can feel that their medication is being given to them correctly. Medication given by staff corresponds with records maintained at the home. Also medical appointment records are now better maintained and evidence the support that individuals have been given. Those living at Hazelhurst can feel confident that their property is audited properly and property held for safekeeping is signed in by accountable individuals. What they could do better: Individuals must be assured that the contracts specify the fees and any additional costs to the placement. Contract must also ensure that all policies included within this document contain the correct contact details of the Commission. Improvements should be made to the inappropriate use of language and terminology within care records written by staff. This would demonstrate that staff treat people with respect and have an understanding of individual’s behaviours and how these should be managed. To evidence that individuals are supported with their healthcare and dietary needs the home should improve the records to monitor individual’s weight, where these records are required. In order that those living at the home can be confident that their money is held securely, money held on behalf of individuals for safe keeping must be locked away. Receipts of individuals money spent are held at the home, however there is no system to audit these, this should be implemented to show accountability. Individual’s inventories should be better maintained. To demonstrate that the provider is committed to maintaining an odour free, well maintained environment attention must be given to address the odour in the ground floor toilet and the broken kitchen drawers must be repaired or replaced. In order that those living at the home can be confident that staff have the skills and knowledge to support them appropriately the home must ensure that staff are aware of their role and responsibility to individuals in line with the Mental Capacity Act. Staff must also receive sufficient amounts of training. Training must be provided in key areas such as fire safety, first aid, manual handling and food hygiene. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 7 Manual handling assessments must be reviewed and updated where required to ensure that individuals living at the home are supported safely in this area. To ensure that accurate, safe information is maintained at Hazelhurst it is recommended that the home review their fire risk assessment and update this document if required. 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. The summary of this inspection report can be made available in other formats on request. Hazelhurst DS0000068902.V370509.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 Hazelhurst DS0000068902.V370509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wishing to use the service and their families are given good information about the home. Terms and Conditions/Contract do not contain all of the required information in order that those who use the service are provided with correct information. EVIDENCE: Hazelhurst is a care home registered with the Commission for Social Care Inspection (CSCI) to provide personal care and accommodation for up to ten persons aged 19 years and over. Hazelhurst is owned and managed by Mrs Hazel Pryce - Jones. The home is one of two homes operated by Mrs Pryce Jones; the other home is St David’s Lodge, located in Fishponds, Bristol. The home has a statement of purpose and a service user guide. Amendments have been made to the statement of purpose to ensure it is accurate and those who live at the home, and prospective residents are provided with full information. Information within these documents includes the staffing and management arrangements for the home, the range of services, which can be provided, and how individuals will be supported with their health, personal care, social and emotional aspects of their life. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 10 The home has an established group of individuals that have lived in the home for sometime. There are two vacancies at this current time. As there have been no new admissions to the home for over a year and the current group of people living at the home is settled. The admissions processes for the home were not reviewed during this site visit. We saw at this visit that contracts were in place for all individuals living at the home; however, we saw that these documents did not contain consistent information for all. Contracts had not been fully completed to included what the fees are for the services and any ‘additional extras’ that may be required. We also saw that additional policies that were included with the contracts such as the visitor’s policy and the complaints procedure had the contact details for CSCI as being at Aztec West in Almondsbury; this office was closed in July 2007. Individuals must be assured that the contracts specify the fees and any additional costs to the placement. Contracts must also ensure that all policies included within this document contain the correct contact details of the Commission. This is to ensure that people are provided with accurate information and are fully supported to meet the terms and conditions of the placement. Hazelhurst DS0000068902.V370509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Hazelhurst can be confident that their needs are fully assessed and that they are involved in decision making which balances rights and risk, consequently they have a lifestyle that they are happy with. They know about the information that is held confidentially and are respectfully supported in their daily lives. EVIDENCE: Three persons care plans and their associated documents were viewed by us to determine how the home was supporting the individuals. Through review of care documents it was clear that staff have a good understanding of the needs of those who live at Hazelhurst and had recorded how individuals should be supported in areas such as personal, physical, emotional and healthcare support. Information seen recorded specific details of individual’s likes, dislikes, allergies and healthcare support and provided guidance for staff in order that they support those who live at Hazlehurst in a way they prefer. Through reviewing individuals records were saw that in particular an Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 12 individual’s complex mental health and emotional needs are well supported and understood by staff at the home and this information and how they will be supported is fully recorded within the persons care plan. Clear examples were given to guide and direct staff in order that they support people who live at Hazelhurst in the way they prefer. We saw that care plans are kept under review and are ammended and updated when required in order that individuals changing needs are recorded and known and the service provided is adapted accordingly. During this visit we reviewed records of what individuals do on a daily basis, these records are written by staff and are used by them to monitor the wellbeing of individuals. We were concerned to see that staff had written judgemental statements to describe individual’s actions, such as recording that someone had ‘bad behaviour’ and another person had ‘been demanding’. This is not acceptable practice. Improvements should be made to the inappropriate use of language and terminology within care records written by staff. This would demonstrate that staff treat people with respect and have an understanding of individual’s behaviours and how these should be managed. We saw minutes of meetings held with people who live at the home, they are asked for their opinion about life at Hazelhurst and how this can be improved, individuals requests had been listened to an acted upon demonstrating that the home do engage with individuals to consult with them about decisions which affect their life. We saw that the home had completed risk assessments for activities in which individuals were involved with and these covered areas such as being supported to maintain independence in areas such as food preparation and making hot drinks, all risk assessments seen were well written, detailed and kept under review and ammended should individuals needs change. Records are kept in a locked office area and clear policies are in place at the home in respect of confidentiality. We saw that these areas are also covered within staff induction and further noted that when staff spoke with us about individuals who live at the home they ensured that the conversation could not be overheard by others and were respectful at all times. Hazelhurst DS0000068902.V370509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Hazelhurst are supported appropriately to develop in response to their identified social, health and dietary needs. People take part in their local community and keep contact with family and friends. Rights and choices are always taken into account in an effort to ensure a quality of life that supports the individual and enables them to experience a lifestyle they prefer and benefits them. EVIDENCE: Individuals are supported to attend college, swimming, arts and crafts, trips out, relaxation and visits to church. Annual holidays are arranged for those individuals that benefit. For some of the individuals a holiday would not be beneficial due to the way the individuals react to change however from conversations with staff and the manager it was evident this is constantly kept under review. We saw that three of the people who live at the home were Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 14 going to Holiday in Benidorm in September and one of the people told us they were looking forward to the holiday and ‘we always go on good holidays here’ It was evident from conversations that the holidays were tailored to the individual and staffed according to the assessed needs of the individual. Records contained reference to a wide range of activities including: college, social events, holidays, shopping trips, massage, rambling and computing courses all of which are appropriate to identified individual needs. All of the people living at the home have a bus pass, which enables them free travel on public transport buses. The attitude and approach of the staff team promoted independence and supported people, where able, to make decisions about lifestyles and daily routines. We saw that since our last visit to the service the home has introduced ‘life skills days’. These days occur once per week and individuals are supported to develop independence skills. This initiative started in June of this year and individuals have been involved in general activities around the home, including tidying their rooms, laying tables and preparing vegetables. Staff spoke positively about the progress that individuals had made and examples given were that that individual’s communication skills had improved and people were using their own initiative to complete tasks. We commended the idea and saw in records that people had developed new skills. We also saw one individual using the kitchen to prepare themselves a drink. We discussed with the manager and staff other areas of skill that should be explored with people such as budget management and developing skills, which they themselves have said they would like to learn. We look forward to reviewing this area during our next visit to the service. We saw notes to confirm that meetings are held with the people who live at the home. The last meeting held was in February this year, areas that were discussed included; menu planning, staff, how to raise concerns and complaints and what to do in the event of a fire. We saw that individual’s comments and views were encouraged and recorded. We saw that people living at the home are supported to maintain contact with and visit their family. Hazelhurst DS0000068902.V370509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported in a way that ensures their rights are respected in all aspects of their personal and health care. The service involves outside agencies, where necessary, to ensure all needs are met enabling individuals to be confident in the care they receive. Individual’s needs are met by current medication procedures. EVIDENCE: Care planning documentation and files contain clear details of how individuals are to be supported. Very specific details were recorded that ensured that care staff are clear about how the person wants to be supported. Regular reviews and consultation take place, this ensures that any changes in care needs are identified and promptly responded to. Thorough examination of care documentation evidenced that individuals are well supported with their health care requirements in order to access services. There were records of when individuals have visited the dentist, optician’s district nurses and general practitioners. Records showed that where there had Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 16 been concerns about individual’s health the home had made prompt contact with the GP or other services that have been needed, such as hospital appointments and specialist services. We saw that all individuals are seen by a clinical psychologist on an annual basis that the medication and the wellbeing of the individual are reviewed, other professionals are consulted and an action plan is set for the continuing support of the person, this support plan is tailored to the needs of the individual and changes are prompt if needed to ensure peoples emotional needs are met. Records read by us demonstrated that individual’s health and personal care needs were being met. The home has developed links with the community learning disability team and individuals are referred as their needs change. During this visit we spoke with a clinical physiologist who was attending a review at the home. Part of this review was to look at the risk assessments and behaviour management plans. This person told us that the person concerned had made good progress at the home and that the home were meeting this persons needs. Some people at the home are supported to maintain a healthy diet. We saw that each person had in place a record of their weight and it was indicated that these weights should be monitored and checked on a monthly basis. For some people these records had not been completed for a number of months. In order to evidence that individuals are supported with their healthcare and dietary needs the home should improve the records to monitor individual’s weight, where these records are required. The medication administration procedure and policies were discussed with one of the senior staff. The medication administration records were seen for three of the people who live at the home and it was found that there were no gaps within the records and that samples of staff signatures were recorded. There was a photo of each person at the front of their medication administration record so that any new staff can be sure that they are giving medication to the right person. It was noted that allergies and key information about medicines was recorded on the medication administration records. The medication trolley was seen and it was found that medicines were being stored correctly with the home using a monitored dosage system. Those living at Hazelhurst can feel that their medication is being given to them correctly. Medication given by staff corresponds with records maintained at the home. During the visit we observed the staff talking and assisting individuals. This was always done in a sensitive, caring and respectful manner. The atmosphere in the home on the day of the visit was relaxed. Staff, the manager and those living at the home were observed to have good relationships. Staff responded to the needs of people in a polite and professional manner. Hazelhurst DS0000068902.V370509.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible those living at the home are protected from harm by having policies and procedures, however improvements must be made to the security of people’s money and auditing of receipts. EVIDENCE: The complaints procedure for the home is displayed on the notice board in the entrance of the home and is also detailed in the Service User Guide, a copy of which is provided to all people living at the home. We viewed the complaints logbook held at the home; there were no recorded complaints. No complaints were raised with CSCI prior to or during our visit to the service. At our last visit to the home we reported that those living at Hazelhurst would feel confident that their property is audited properly and property held for safekeeping would be safer if records were signed in by two accountable individuals. We saw that this requirement had been met and regular checks are made to ensure that individual’s property is accounted for, however we saw that records of individual’s personal property had not been reviewed since May 2007; it is recommended that these records are reviewed at least annually or sooner if items are purchased. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 18 We saw that the home have a secure safe in place, however money is transferred from this area and put in a drawer so that individuals have access to money if key holders are not on duty. During the whole duration of our visit this drawer was not locked. We reviewed the cash and records of money held for safekeeping for three people and saw that records and money held were correct. In order that those living at the home can be confident that their money is held securely, money held on behalf of individuals for safe keeping must be locked away. Receipts of individuals money spent are held at the home, however there is no system to audit these, this should be implemented to show accountability. There are staff working at the home that have either achieved or are undertaking a National Vocational Qualification in Care, (Health and Social Care, Level 2 & 3) and this has a core unit that incorporates adult protection and staff responsibility should they have any suspicions or concerns. It was noted when reviewing staff training files that staff have completed training in the protection of vulnerable adults. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at Hazelhurst live in a clean, homely, safe environment that reflects their choices and enables them to be involved in daily activities in the home and the community, however improvements must be made to control odour in the home. EVIDENCE: The house is situated within the residential are of Filton, South Gloucestershire and enables people who live at Hazelhurst to integrate into the local community. At our last visit to the service we made two requirements, these were that attention must be given to the front and rear gardens of the home and the ‘clutter’ on the outside of the home must be removed. Both of these requirements had been met by the home and no further concerns in this area were noted. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 20 During our visit to Hazlehurst individuals were observed sitting in the lounge, the dining room and going into their rooms, looking very relaxed and comfortable in their environment. The home is ‘homely’ with soft furnishings such as plants, ornaments and pictures and photographs, all enhancing the areas within the home. All communal areas and two bedrooms were seen during this visit which were clean and reflected individual choice. We saw that the dining area had new furniture and had been redecorated since our last visit. There is a small selfcontained area adjacent to the dining room where people living at the home can make drinks and snacks. During this visit we saw one person making good use of this area making themselves hot drinks. They told us that they used this facility often and they liked the freedom and independence it gave them in this area. The home has sufficient bathroom areas for individuals with both shower and bathing facilities in place; these are close to individual’s private rooms. Since our last visit those living at the home have benefited from the installation of a new bathroom suite on the first floor. The area had been redecorated and a shower had been fitted. We noticed that there was an odour in the toilet on the ground floor. We went in this area first thing in the morning, after the areas had been cleaned and later during the day, the odour remained. To demonstrate that the provider is committed to maintaining an odour free well maintained environment attention must be given to address the odour in the ground floor toilet We saw that the home were awarded a five star food hygiene award following a visit from a South Gloucestershire Environmental Health Officer in October 2007. At this visit we saw that the kitchen was clean and tidy, however we noted that there were three drawers, which were broken. In order that the provider can continue to demonstrate that a well maintained environment is provided it is required that the broken kitchen drawers must be repaired or replaced. It should be noted that generally the home has a rolling programme of maintenance both renewing old and repairing items that get damaged. The registered provider of this service has improved a great deal the quality of décor and furnishings at the home since she took over the home in 2007. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual’s needs are generally met by competent, well-trained and supervised staff, which ensures their safe quality of life. Improvements in training would ensure that at all times peoples needs are met by appropriately skilled staff. EVIDENCE: There is a well-established staff team at the home. At the time of the visit there were sufficient numbers of staff on duty to meet the needs of those living at the home. Upon arrival at the home two senior staff were on duty and a domestic member of staff. Mrs Pryce Jones arrived at the home during our visit. There have been no changes in the staff team since our last visit. Staff told us that there are occasions when agency staff have been used at the home, however this has been in exceptional circumstances to cover holidays and sickness. The small staff team have developed good relationships with those who live at Hazelhurst and have a sound understanding of their needs, wishes and aspirations to enable them to live a fulfilling life. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 22 During our last visit we recommended that an audit of staff training to be undertaken in order to provide an overview of training provided and planned for the future. This had not been done. Mrs Pryce – Jones told us that this is a priority for her and that this would be completed. We will review this during our next visit to the home. At this visit a sample of staff training files were examined, information seen showed that staff have undertaken core skills training such as fire safety, manual handling, first aid as well as National Vocational Qualification in care practice at levels 2 & 3. We did note that there was a number of staff that had completed this core training some time ago and the timescales for refresher updates had lapsed. We also found that there are staff that are not receiving sufficient amounts of training. In order that those living at the home can be confident that staff have the skills and knowledge to support them appropriately the home must ensure that staff are aware of their role and responsibility to individuals in line with the Mental Capacity Act. Staff must also receive sufficient amounts of training. Training must be provided in key areas such as fire safety, first aid, manual handling and food hygiene. Improvements in training will ensure that staff have the appropriate skills to continue to support the people who live at Hazelhurst appropriately The recruitment files for two members of staff were seen. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and most staff had received the required six sessions a year. Areas of discussion included guidelines and policies of the home, individual’s expectations and an evaluation of their performance and how this can be developed. Staff told us that they had benefited from supervision discussions in order to improve practice at the home and ensure consistency for those who lived there. During our visit we spoke individually to staff members on duty that said they are very happy within their role at the home and said that they felt well supported both by the manager, staff knew who to speak with if they were unhappy. Staff we spoke with were fully conversant with the support that individuals require at the home and gave sound examples of how individuals are given choices and how their rights are promoted. They told us how individuals are treated as adults, and are involved with care review meetings, daily consultation and recording individuals wishes and also the monitoring and recording how these are met by the home and other services There are two part time deputy managers who support Mrs Pryce Jones with the management of the home. These staff members told us that they had Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 23 commenced a National Vocational Qualification (NVQ) at level 3 in care management. They told us that they were pleased to be undertaking this award as they feel it will enhance their skills and their performance at work. These staff members confirmed that their NVQ assessor was visiting them later that day in order that they can be assessed of their competency in respect of medication administration and practice. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those living at Hazelhurst are supported in a service where their needs and views underpin daily life. The service is provided to promote their welfare and in their best interests, which ensures they have a standard of life they are involved in choosing. There are some concerns over the health and safety of individuals who live at the home, manual handling assessments must be kept under review to ensure that people are being supported appropriately, fire training must be provided for staff and the fire risk assessment should be reviewed. EVIDENCE: Hazelhurst is privately owned and is the second care home of the proprietors who also own St David’s Lodge, Fishponds. Mrs Hazel Pryce Jones took over as Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 25 both the registered Provider and the Registered manager of the home in January 2007. Mrs Price Jones is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. Feedback received spoke positively of the care provided within the home and effective communication systems. Practice observed was of good relationships between those who live at the home, staff and management. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was fully completed and sufficiently detailed. We recommended during our last visit to the service that staff meetings should be held at the home, these should also be recorded. At this visit staff told us that Mrs Price Jones was approachable and listened to them, however meetings had been arranged (due to circumstances beyond the control of the home) had been cancelled and no staff meetings have been held since our last visit. In order to ensure effective communication, continuity of service deliver the recommendation remains and will be reviewed at our next visit to the service. During our last visit to the service we reviewed a number of the documents in place and recommended that policies and procedures should evidence that these documents are kept under review to ensure they contain clear and accurate information. These were reviewed during this visit. With the exception of the admissions and the complaints policies (as outlined in standard 1-5 of this report) the documents seen by us had been reviewed and updated by Mrs Pryce – Jones. There are procedures and protocols in place in order to ensure the health, safety and welfare of those who live and work at the home. These include fire and equipment checks, and regular maintenance of equipment. We saw that manual handling risk assessments were in place for all who live at the home. We were concerned to note that two peoples assessments had not been reviewed or updated for over a year, this was of particular concern as one person was previously assessed as being at ‘high’ risk of falls, and had experienced a number of falls yet their assessment had not been reviewed. Another person had also experienced falls yet their assessment had also not been updated. It is required that manual handling assessments must be reviewed and updated where required to ensure that individuals living at the home are supported safely in this area. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 26 Fire records were sampled at this visit and were up to date, with internal checks of fire safety equipment being carried out at appropriate intervals. In addition an external company carries out quarterly checks of the fire equipment. We did note that the homes fire risk assessment had not been reviewed since July 2007. To ensure that accurate, safe information is maintained at Hazelhurst it is recommended that the home review their fire risk assessment and update this document if required. We also noted that staff have not received sufficient fire instruction (see training section of this report), this training must be provided to ensure staff have the skills and competencies required in this area. We saw that the home maintain service equipment at the home, we saw evidence that the stair lift was serviced in March 2008, the fire alarm system and emergency call bells were serviced in January 2008. We also noted that boilers were also serviced to ensure their safe use in March 2008. The few accidents and injuries that have occurred at the home since the last inspection have been properly recorded and dealt with appropriately. Mrs Pryce Jones was very proactive during the inspection in responding to and discussing areas that the service needs to or could improve in. Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 2 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 2 X Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 28 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. Standard YA5 Regulation 5 (c) Requirement Contracts must contain information about the fees which are to be paid and must contain accurate information within the included policies. Money held for individuals living at the home must be stored securely. Odour in the ground floor toilet area must be eliminated. Broken and missing drawer fronts in the kitchen must be repaired or replaced. Staff must be provided with sufficient amounts of core training such as first aid, manual handling and basic food hygiene. Manual handling assessments must be reviewed and updated to ensure individuals are supported safely. Staff must receive fire training to ensure they maintain their knowledge of their responsibility in this area. Timescale for action 20/10/08 2. 3. 4. 5. YA23 YA30 YA24 YA32 13 (6) 13 (3) 23 (2) b 18 (1) c (ii) 13 (5) 20/08/08 20/09/08 20/10/08 20/01/09 6. YA42 20/10/08 7. YA42 4 (d) 20/10/08 Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 29 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. 4. 5. 6. Refer to Standard YA6 YA19 YA19 YA23 YA23 YA32 Good Practice Recommendations Consideration should be given to the use of language and terminology within individual’s daily records to ensure it is respectful. Records of individual’s weight, for monitoring purposes should be better maintained. Information should be provided to staff in respect of the Mental Capacity Act in order that they can be aware of their role and responsibility in this area. Inventories of individual’s personal property should be reviewed and updated in order that they contain accurate information. A system should be developed by the home in order to audit the receipts, which show what individuals have spent their money on. An audit of staff training to be undertaken in order to provide an overview of training provided and planned for the future. Staff meetings should be held at the home, these should also be recorded. The homes fire risk assessment should be reviewed to ensure it contains accurate information. 7. 8. YA38 YA42 Hazelhurst DS0000068902.V370509.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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