CARE HOME ADULTS 18-65
Hazelhurst 1 Broncksea Road Filton Park South Glos BS7 0SE Lead Inspector
Odette Coveney Key Unannounced Inspection 24th August 2007 08:45 Hazelhurst DS0000068902.V340874.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.V340874.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.V340874.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 Lillian Pryce-Jones Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate up to 10 persons with learning difficulties requiring personal care only. Date of last inspection 18th April 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 £675.00 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.V340874.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced key standard inspection and was carried out in one day and took 9 hours by one inspector for the Commission. This inspection was very positive and overall a judgement of adequate was made. It must be acknowledged that the home have worked diligently to meet the previous requirements made at the last site visit to the home and many positive steps have been made to improve the quality of life for individuals who live at the home. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individual’s living in the home. An opportunity was taken to view the home and a number of the records relating to the management of the home and plans of care for individuals were reviewed. The registration certificate for the home was reviewed at this inspection and the information contained within it was found to be accurate. A number of Comment cards were received prior to the inspection, one these was from a relative of an individual who lives at the home, there were some from individual’s who live at the home, and two comment cards were from visiting health/social care professionals who visit individuals at the home. Comments made were reviewed during the visit and these, maintaining individual’s confidentiality, were shared with the registered manager and have been incorporated within this inspection report. What the service does well:
Hazelhurst provides residential support to adults, some of whom have complex needs, staff work well to ensure that individuals are supported in an individualised manner with one to one support provided when required, good strategies are in place in order to direct and guide staff practice. The home is located within the residential area of Filton and is close to local amenities such as day care support services, church, shops and a leisure centre. Good standards of care and service delivery remain at the home. Those spoken with during the site visit said they were happy and enjoyed life at the home. Comment cards received from service users living at the home indicated good levels of satisfaction of life at the home. The registered provider/manager Mrs Pryce Jones is committed to providing a good quality service for those who live at Hazelhurst, she listens to the views
Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 6 of service users and the staff. Morale has improved at the home and staff are able to demonstrate a sound understanding of the diverse needs of individuals living at the home. There is a very open management response to inspection and the development of the service. What has improved since the last inspection?
The manager and staff have worked diligently since the last site visit in order to meet the twelve requirements and the six recommendations made at the last key site visit to the home and are to be commended for moving the service from one of being rated as a poor service, a service of concern to now being an adequate service. Service users have been provided with information in the form of a service user’s guide, this gives individuals full information about the facilities and services which are provided at the home including the aims, objectives and statement of purpose for the home. Service users are aware of their rights and also the rights and responsibilities of the service, as the Registered Manager/Provider has ensured that all service users are provided with a contract outlining the terms and conditions of their placement this describes the services and facilities to be provided by the home and external agencies where required. Service users can be confident that their assessed and changing needs and personal goals are reflected in their individual plan. The Registered Manager/Registered Provider has developed and agreed with each service user an individual plan. For some individuals this includes management of behaviour, with strategies to support individuals appropriately. Staff demonstrated an understanding of individual’s needs and behaviours and gave a number of examples of how individuals are being treated with dignity and respect; furthermore improvements have been made to the use of language within individual’s daily records. Service user’s money and personal property, which is held at the home for safekeeping, is stored securely and is well recorded. The Registered Provider also ensures that service user’s money and property is clearly accounted for. In order to evaluate the risk factors for both service users and staff and to also try to reduce the likelihood of injury or accident, the home have ensured that areas of manual handling risk are assessed. In order to monitor and evaluate situations and ensure that appropriate action has been taken to reduce the likelihood of reoccurrence, The home have ensured that the Commission have been informed of incidents, which have affected those living at the home. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 7 In order that service users can feel their concerns or complaints are listened to and acted upon the Registered Manager/Registered Provider has ensured that a record has been kept of all issues raised or complaints made by service users Service users and staff feel more confident that appropriate action has been taken should an incident occur as the home have reviewed it’s protection of vulnerable adults policy in order that it is in line with the South Gloucestershire Community Care vulnerable adults policy. In order to demonstrate that the home is committed to providing a safe, well maintained and odour free environment for service users the home have ensured that all areas of the home are odour free, furthermore a window restrictor has been fitted to an identified window and also that furniture for service users use is safe. In order to demonstrate that documents at the home comply with current legislation and recognised professional standards and also to provide clear guidance and direction for staff, the home now have in place all policies and procedures as identified in appendix 2. The home has reviewed all of the documentation in place at the home to ensure that accurate information has been provided including an update of individual’s activity records and photographs are now in place with medication records. In order that all risks and hazards are identified including individual needs of service users and what the procedure is at night, the home’s fire risk assessment has been reviewed and updated. What they could do better:
Minor amendments are made to the statement of purpose to ensure it is accurate and service users, and prospective service users are provided with full information. In order that an individuals mental health and emotional needs are well supported and understood by staff at the home it is required that this information is fully recorded within the service users care plan. In order that service users can feel that their medication is being given to them correctly, it is required that medication administered at the home must correspond with records maintained at the home. It is further recommended that medical appointment records should be better maintained in order to evidence the support that individuals have been given. In order that service users can feel confident that their property of audited properly it is required that property held for safekeeping is signed in by two accountable individuals. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 8 In order that service users can enjoy fully the facilities provided at the home it is required that attention is given to the front and rear gardens of the home and also that ‘clutter’ at the outside of the home is removed. In order that service users can be confident that staff have been appropriately trained it is recommended that the home obtain confirmation from the pharmacist that staff at the home have received medication competency training, also if the home developed an audit of the staff training to provide an overview of training completed and planned for the future. Services users would be assured of effective communication and continuity of service delivery if staff meetings were held at the home, these should also be recorded. Furthermore if policies and procedures show that these documents are kept under review to ensure they contain clear and accurate information. 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.V340874.R01.S.doc Version 5.2 Page 9 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.V340874.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Prospective, and current service users have the information they need to make an informed choice about where to live, current service users have an individual contract in place. Individual’s aspirations and needs are assessed and monitored by the home. EVIDENCE: The home in place a detailed statement of purpose this was found to contain all of the required information in order that individual’s can make an informed choice as to whether the services and facilities provided. The document is readily available to service users and their relatives. This document contains information about the management structure of the home, information about staff ratios and training, information about the home and how individuals are supported in aspects of their life, as outlined within their individual plan of care. The statement of purpose outlines the aims and objectives of the home, which promotes and supports individual’s rights in respect of privacy, dignity, independence, rights, fulfilment and choice. Furthermore there is information about the admissions process and how individuals can make a complaint if they are not happy. It was found that the details for the Commission were out of date and therefore a requirement was made that minor amendments are made to the statement of purpose to ensure it is accurate. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 11 At the last site visit a requirement was made that a service user’s guide must be produced in order to provide sufficient information to service users. This had been completed and contained all of the required detailed information, including a copy of the last inspection report. Following a review at the last site to the home a requirement was made that all service users must be issued with a completed contract outlining the terms and conditions of their placement. The documents for three individuals were examined during this site visit and it was found that this requirement had been met. These contracts contained clear information about the individual fees are expected to pay, information about safety within the home, visitors and notice periods Comprehensive care management and care plans have previously been seen on file. The home has developed comprehensive person centred care plans based on wishes and choices from the information provided by the service users as part of the ongoing placement within the home. The daily records maintained within the home provide clear evidence that individual’s current and changing needs are identified and met. Clear information was in place to show the involvement of specialist services and professionals, ensuring a multi-disciplinary approach. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 12 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, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals assessed and changing needs and personal goals are reflected within their care plan, however some improvements are needed to ensure that all areas of emotional support are recorded and supported. Individuals are supported to make decisions about their lives and are supported with this; individuals are also supported to take risks in a safe manner. EVIDENCE: The care and associated documentation for three service users were fully examined during this site visit. All care plans reviewed showed a clear understanding of the individual needs of service users, they contained clear guidelines for staff. In addition to the main care plans the home also had information about behavioural strategies to support individuals with complex needs and daily support information. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 13 These care plans had been developed since the last site visit and it was clear that these had been given a great deal of time and attention. They were comprehensive; however, it was noted that one individual required support that had not been recorded within their plan of care and therefore it is required that an individuals emotional and mental health support needs are recorded with clear guidance recorded in order that this individuals is well supported. A requirement was made during the last site visit to the home that manual handling risk assessments must be in place for all service users. These were seen, were sufficiently detailed and provided information on how individuals should be supported. Daily records of individuals were reviewed during this visit and it was noted at the last that there were occasions when recording had been inappropriate and not factual and a recommendation was made that consideration must be given to the use of language in individual’s records. Although there had been significant improvement in this area it was found that there were still a few judgemental comments made, this recommendation will be reviewed at the next visit to the home. At the last visit to the home it was found that individuals files were not well ordered and it was recommended that the home undertake a general review of service user’s files. This visit found files to be well structure and all contained current accurate, appropriate information. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 14 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, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported to participate in activities of their choosing and to maintain relationship with their family. EVIDENCE: Evidence in care records showed that staff support individuals to become part of and participate in, the local community in accordance with assessed needs and individual’s wishes. Information seen in care records show that staff have helped individuals with their integration into community life through making use of local facilities and activities such as shops, pubs, leisure centres and places of worship. Activities and outings are organised in accordance with individuals expressed wishes. During the day of the site visit two service users went out for the day to a day centre, others were seen spending time in their rooms, the lounge and the garden, one other service user was away from the home on a holiday.
Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 15 Two service users spoken with said they were looking forward to attending college in September to undertake a cookery course, another service user told the inspector that they had enjoyed their day, they had been working at a farm that day and spoke with excitement of how they had spent their day. Records of support from day service showed that individuals will be attending arts and crafts sessions with college in September and individuals, through day service support, enjoy regular trips out for lunch, pottery and rambling. It was recommended at the last site visit that activity records/schedules of individuals should to be updated, this had been completed and records were sufficiently detailed. Mrs Pryce Jones confirmed that those individuals who choose to go are supported twice a week to attend church. The home had a thank you card from a relative of an individual at the home to say how much their relative had enjoyed their trip to the studios of Emmerdale farm. Mrs Pryce Jones confirmed that some service users had been away to a cottage in Wales earlier this year and others would be going on day trips to places of their choosing. Individuals were going to a local pub for Sunday lunch and told the inspector they were looking forward to this. Individual’s rooms contained many of their personal possessions such as small items of furniture, ornaments, pictures and photographs. During the inspection staff were observed asking Individual’s for their views and opinions and were encouraged to make choices on aspects that affect their life. Staff on duty interacted well with the service users and used individual’s preferred form of address. Information was recorded within care documentation of individual’s likes and dislikes and special diets that are catered for at the home. The kitchen was found to be clean and tidy with good stocks of both fresh and frozen foods. Records seen demonstrated that individuals are offered alternatives and choices at mealtimes. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 16 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, 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals receive personal support in the way they prefer. Service users physical and emotional needs are met with individuals being supported with the current system of medication practices that are in place, however this would be improved if records were better maintained. EVIDENCE: Procedure for medication administration, handling, records and storage were assessed. The home had policy and guidelines on medication. A local pharmacy provides medication using a monthly monitored dosage system. A check of the blister packs indicated that medication had been administered as recorded. However there was one drug which was not clearly accounted for, It is required that medication administered at the home must correspond with records maintained at the home. All medication seen was stored securely. The pharmacy supply printed medicines administration record sheets each month. Records of administration of medicines were clear. Records are kept of medicines received into the home. Waste medication is recorded and disposed of via the supplying pharmacy. A recommendation was made at the last site visit to the home that photographs to be in place on medication records, these were seen and the recommendation had been met.
Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 17 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 been visited by dentist, optician’s district nurses and general practitioners, however it was found that not all visits and support had been recorded and did not fully reflect the support that individuals had received, therefore a recommendation was made that medical appointment records should be better maintained Two comment cards were received from health and social professionals prior to the site visit these said that the home the home communicates clearly and works in partnership with them, that staff demonstrate a clear understanding of the care needs of service users and that they are satisfied with the overall care provided to service users at the home. Mrs Pryce Jones had full understanding of the needs of individuals living at the home. Staff clearly identified the values that the home promotes and to be afforded to the individuals living at the home: Dignity, Right and Privacy. All the care documentation and related information seen promoted good care based on the above values. All of the service users are allocated a key worker; staff spoken with had a clear understanding of their role and responsibilities. There were guidelines for dealing with the levels of aggression for an individual. These were about positively diffusing situations. The manager stated that physical aggression is rare and restraint has been not been used at all. The home completes a report on incidents of aggression and the action taken. The records were clear and contained sufficient detail. It was noted that information was in place to demonstrate that individual’s wishes concerning terminal care and arrangements after death have been discussed. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 18 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. There are sound and robust complaints and adult protection protocols in place. Audits of individual’s property would be better accounted for if two staff signed entries within records. EVIDENCE: The following four requirements were made during the last site to the home, which was undertaken in April 2007 and were as follows: • Service user’s money must be held securely, individual cash and personal property must be recorded and accounted for. The personal monies held at the home for three individuals were checked and were found to be correct. This requirement had been met and all monies held for safekeeping corresponded with records held at the home. However it is required two responsible individuals must sign in property held for safekeeping at the home. Investigations into complaints must be fully documented with outcomes recorded, the inspector viewed the complaints logbook at the home and although there were no recorded complaints in place there were processes in place to ensure that any issues would clearly recorded and be dealt with in line with the homes own complaints procedure. • Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 19 • The Commission must be notified of incidents, which affect the wellbeing of service users. The home have kept the Commission informed of incidents and have been able to demonstrate that reported incidents have been dealt with appropriately in line with the best interests of the individual involved. The home’s Protection of Vulnerable Adults policy to be reviewed and updated where required, this document was found to now contain all of the required, correct protocol information. • All of these areas were reviewed and the requirements set at the last site visit to the home were found to have been met. There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the CSCI and South Gloucestershire Social Services. A copy is made available in the entrance hall of the home in a pictorial format for service users, along with copies of previous inspection reports. The Commission has received no complaints since the last inspection. All of the comment cards received from service users prior to the site visit recorded that they all knew who to speak with if they wanted to make a complaint; individuals said they would speak with Hazel, staff or their social worker. No concerns were raised to the inspector during this site visit. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, and satisfactory Criminal Record Bureau disclosures. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 20 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, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. live in a Home that is safe and the quality of furnishings are of a high standard and suitable for the needs of residents, however some improvements are required in order that the gardens are better maintained. EVIDENCE: Hazelhurst is a small residential care home, set within the residential area of Filton, the home is three storeys and is semi detached. There is an enclosed rear garden, which service users enjoy There are adaptations in place throughout the Home and specialist equipment including mobility aids, sensory aids, a stair lift and bathing aids. There is a spacious dining area and a comfortable lounge area with a small sun lounge. Individuals were observed sitting in the lounge, the sun lounge and going into their rooms, looking reasonably relaxed and comfortable in their environment The home has sufficient bathroom areas for individual’s with both shower and bathing facilities in place.
Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 21 A requirement was mad during the last site visit to the home that the identified bedroom window must be made safe. This room was visited and a safety catch had been fitted to the window ensuring that it had limited opening. Mrs Pryce Jones further confirmed that she has plans to change/replace the windows in the future and is part of the renewal plans for the house. It was noted at the last site visit to the home that the odour identified in service users bedroom must be eliminated, it was noted during this visit that flooring had been replaced within areas of the home and no odours were apparent during this visit to the home. A recommendation was made at the last site visit to the home that the home clear/remove clutter from the first floor landing, this area was found to have been removed. The inspector saw that the home had purchased new dining tables and chairs and Mrs Pryce Jones and service users confirmed that the dining area was going to be redecorated within the next two weeks. During this site visit the lounge was in the process of being decorated, the worn fireplace had been removed, new flooring was being laid, new furniture and soft furnishing had been purchased making the whole room feel brighter and fresher and a pleasant area for service users to enjoy. A new industrial washing machine and tumble dryer have been purchased since the last site visit. Due to the refurbishments it was clear that a lot of items had been replaced within the home and due to other commitments within the home Mrs Pryce Jones had not had time to give attention to the gardens and the grass was overgrown, requirements were made that attention must be given to the front and rear gardens of the home and clutter must be removed from the side of the house. Mrs Pryce Jones confirmed that she had enquired about a gardener for the home and arrangements for the ‘clutter to be removed. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 22 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): 31,32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from clarity of staff roles and staff who are trained and recruited in line with the home’s policies and procedures. EVIDENCE: There is a well- established staff team at Hazelhurst. During the inspection staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home. The duty rota showed that there are sufficient numbers of staff on duty with flexible working by staff in order to meet individual’s needs and aspirations. Staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individual’s. The staff team have a varied range of knowledge and skills, they were observed by the inspector to be good listeners, effective communicators and were interested and motivated in meeting the needs of those living at the home. A comment card received prior to the site visit, which had been completed by a relative of a service user, recorded that ‘all staff appear to be caring and considerate’.
Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 23 In order that service users can be confident that staff have been appropriately trained it is recommended that the home obtain confirmation from the pharmacist that staff at the home have received medication competency training, also if the home developed an audit of the staff training to provide an overview of training completed and planned for the future. Staff files were viewed and all of the required documentation was in place in respect of recruitment and selection practices and it was found that these were robust. Records of formalised one to one supervision support sessions were seen, these evidence that staff are given appropriate information and advise and are supported by the manager within their role. Contracts were in place for staff which had been signed and dated by staff, this document included terms and conditions of employment, equal opportunities, disciplinary and grievance procedure. Training certificates seen on staff files showed that staff have undertaken training in key core areas such as fire prevention, manual handling, first aid and the protection of vulnerable adults. In order that the manager can have a clearer overview of training completed and plan for future training needs it is recommended that a training audit for staff be completed. Hazelhurst DS0000068902.V340874.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, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. The home is run in the best interests of the service users. The home is well managed ensuring that individual’s interests and rights are promoted and protected by a committed staff team. 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 both the registered Provider and the Registered manager of the home in January 2007. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 25 Mrs Hazel Pryce Jones has a wealth of knowledge and experience in working with and supporting those with a learning disability and of care of older people and has previous management experience in developing and supporting a staff team. Prior to and during the inspection Mrs Pryce Jones was able to demonstrate a clear understanding of the aims and objectives of the home and of her role and responsibilities for both service users and the staff team. Staff spoken with said that they are positive that Mrs Pryce Jones is committed to ensuring the needs of service users are met, that ideas and suggestion are listened to with regular individual supervision being held for continuity of care and effective communication. This would be improved if staff meetings were held more regularly and if these meetings were recorded. A required was made at the last site visit to the home that those identified required policies and procedures to be in place at the home and be available. These were available; it was recommended at this visit that there must be evidence to show that policies and procedures are kept under review to ensure they contain clear and accurate information. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of resident’s staff and visitors. The home has robust policies and procedures in relation to aspect of health and safety. The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipments and recording of training and testing of equipments were satisfactory. Staff has attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. A requirement was made at the last site visit to the home that the home’s fire risk assessment must be reviewed and updated. This document was reviewed during this visit and was found to have been well met. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision. This provides the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents’ care. The home have developed questionnaires for service users to ask them their opinion about life at the home and how things could be improved. These were issued to individuals in July and those indicated high levels of satisfaction. Mrs Pryce Jones said that any areas requiring attention would be done so on an individualised basis. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 26 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 3 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 3 25 X 26 X 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 3 3 3 X Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15(1) Requirement Identified service users care plan to contain full detailed information as to how they will be supported with their mental health needs. Medication administered at the home must correspond with records held at the home. Two responsible individuals must sign for property held for safekeeping on behalf of individuals at the home. Attention must be given to the front and rear gardens of the home. The ‘clutter’ on the outside of the home must be removed. Timescale for action 24/09/07 2. 3. YA20 YA23 13(2) 17(2) 24/08/07 24/09/07 4. 5. YA28 YA28 23(2) o 23(2) o 24/09/07 24/09/07 Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 28 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 YA19 YA32 YA32 YA38 YA40 YA1 Good Practice Recommendations Medical appointment records should be better maintained. An audit of staff training to be undertaken in order to provide an overview of training provided and planned for the future. Evidence must be obtained from the pharmacist to confirm that staff have undertaken medication competency training Staff meetings should be held at the home, these should also be recorded. Policies and procedures should evidence that these documents are kept under review to ensure they contain clear and accurate information. Minor amendments are made to the statement of purpose to ensure it is accurate. Hazelhurst DS0000068902.V340874.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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
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