CARE HOME ADULTS 18-65
Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF Lead Inspector
Jason Denny Unannounced 18 August 2005 15:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hazelwood Address 9 Church Road St Leonards-on-sea East Sussex TN37 6EF 01424 423755 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Graham Robert Jack Vacant Care Home 3 Category(ies) of Learning disability (LD) 3 registration, with number of places Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated will be three (3) 2. The residents will be aged between eighteen (18) and thirty (30) years on admission Date of last inspection 28 October 2004 Brief Description of the Service: Hazelwood is a privately owned establishment offering a safe environment for 3 young adults with a learning disability. The home offers 24-hour care in a homely environment. The home does not provide nursing or disabled access. The home is located in St Leonard’s-on-Sea within easy walking distance of both shops and the seafront. The home has its own vehicle with local transport facilities nearby. All bedrooms are decorated to individuals choice and needs, with all having en-suite bath and toilet facilities. The rooms are of good size and are personalised by the residents. Some rooms have sea views. The communal areas are adequate in size. The home benefits from a large back garden, which service users partly use for growing vegetables and developing horticulture projects. An annual holiday outside of the home environment is offered to residents [service users] who choose both the destination and who to travel with. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [first of two planned before April1st 2006], which took place between 3.30pm and 6.00pm. The Inspection found that of the 16 National Minimum Standards inspected, that 14 of these standards had been fully met with two exceeded in relation to care-plans and staff training. The overall focus of the inspection was on resident’s involvement in the home, their care, and their lifestyles. The inspector started the inspection by speaking with all 3 residents. Communal areas of the home were inspected. A discussion with the deputy manager took place around progress since the last inspection. Meal arrangements were inspected along with a kitchen inspection. Care and activity records, along with staff training documentation were inspected. The inspector observed how staff supported residents as they retuned from their activity work centres. Discussions with residents took place around leisure pursuits and how they make choices and express their views. What the service does well: What has improved since the last inspection?
The refurbishment of both the lounge and dining room is highly impressive creating a positive impression on visitors and residents. Both rooms have been redecorated in modern colours. The flooring has been re-laid with a wooden effect finish. Both rooms have new furniture. A bedroom window has also been repaired.
Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 6 A new day centre has been found for a resident who previously had some gaps in his activity schedule following the closure of a day centre in 2004. The home’s car is now reliable and used for supporting residents. The registered owner of the home has finally put someone forward to be considered for registration with the Commission as the manager. One resident was supported to spend a beneficial month in a specialist centre to assist with a health condition. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The way in which the home assesses prospective or existing residents ensures, that it continues to meets needs. All three residents placed in the home have live there successfully for a number of years and were observed to be compatible with one another. EVIDENCE: The home has now introduced its own form for recording assessment information. In the event of a referral the home has a clear policy and procedure, which includes obtaining the social services care assessment and visiting the Resident before setting up trial visits leading to overnight stays. No emergency admissions are taken. The home is committed to long-term care only. There have been no new admissions since 1996. The inspector observed all 3 residents and spoke with them collectively and individually. All three freely moved around the home at various times one was cooking and others listening to music or talking with staff. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,& 9. Care plans were found to have an exceptional range of useful updated information in a well presented style. The home was found to be meeting resident’s health needs and was fully aware of what additional support it required. The inspector judged that resident’s rights were upheld. EVIDENCE: The home has introduced a wide-ranging and easily accessible care-plan for each individual covering all aspects of this standard. The plan includes likes and dislikes, goal setting, behaviour support strategies, protocols, risk assessments, weekly activity schedules, leisure interests, along with Hygiene and behavioural protocols. The goals are reviewed on six monthly basis, and a report is submitted to a social services review, which is held six monthly. Residents have a copy of their plan and are encouraged to take part in its review. The home constantly reviews activity provision. Each plan is logically laid out and well–presented with an updated photograph of the Resident. Each plan for each Resident was found to have been retyped and reviewed by staff and the resident in July 2005, a month before the inspection. The epilepsy protocol in relation to one resident was found to have been reviewed at the same time along with a reduction in his medication dosage due to an increased risk of falls.
Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 10 Evidence was seen of Residents being involved as fully as practically possible in the running of the home with steps made by staff to encourage individuals to express their rights. Two Residents benefit from active family involvement and representation on their behalf. The other Resident who has no family input has his own external advocate whom he visits every two weeks and attends church with on a monthly basis. The care-plans showed evidence of agreed restrictions such as on caffeine drinks for one Resident due to health reasons. The service has previously informed the inspector that he agreed with this decision. The inspector saw a range of risk assessments, which demonstrated that this standard was wholly met. The home is committed to responsible risk-taking and has a detailed policy, which fully sets out how to assess and manage risk. A resident who recently spent a month in a specialist centre for a health condition was found to have made some improvements in relation to this area of his life. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16 & 17 Residents are able to make a range of choices about their lives with significant consideration given to their views and feelings. The level of resident involvement in the home is excellent. Food served by the home was found to be good in terms of taste variety, and choice. The home was found to have good links with the local community. The home was found to provide a good range of activities based on resident preferences. All residents have active lifestyles which meet their needs and aspirations and which provide opportunity to develop independent living skills. EVIDENCE: All three Residents attend distinct day centres, which according to records and discussions are meeting needs. Extended discussions took place with residents around their activity interests. All three residents were particularly looking forward to their summer holidays to Cornwall and Centerparcs respectively. Each Resident has an active week, which affords opportunities for skill development. Each Resident has an active social schedule based on individual choice. A particular Resident indicated to the inspector, ongoing improvements in his communication and sentence construction over successive inspections.
Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 12 Residents have opportunities to participate in the local community. According to individual interests Residents visit music concerts, pubs, restaurants, local leisure centre, cinema and other areas. All Residents are on the electoral role should they express an interest to be politically active. The home now has presently its own reliable transport facilities. Two Residents have active family involvement. The other Resident sees his advocate on a fortnightly basis. The advocate commented positively to the inspector on the service. None of the Residents were described as having regular friends although their regular attendance at social events affords this opportunity. One resident is going to Cornwall with peers from the day centre he attends. The inspector saw a range of evidence, which indicated that all Residents have their rights to independence and flexible routines respected within reasonable agreed limits. All restrictions are agreed via risk assessments. Residents on a daily basis choose meals. Those records completed showed a range of fresh and healthy ingredients. Food stocks were found to be plentiful with a range of fresh fruit, vegetables and other produce in the home for residents to choose from. One resident was found to be cooking the evening meal that he had chosen that day. The meal was well presented contained a variety of fresh ingredients and was described by residents as tasty. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these standards where inspected on this visit. Standards 18,19 and 20 will be assessed at the next inspection. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home operates in an open manner and has not had a formal complaint for several years. Staff continue to demonstrate an sound understanding on how to prevent abuse and continue to benefit from adult protection training. All residents and visitors are made fully aware of how to complain or raise concerns. EVIDENCE: The home has not received any complaints. There is a clear complaints procedure, which includes details of the commission. Each Resident has a complaints procedure in a suitable format, in their room. All complaints are responded to within 28 days. Resident views are regularly sought and encouraged, as evidenced in care planning and other written records. Comments from visitors and all those involved in the home continue to be positive as evidenced in comment cards sent to the Commission. The home has a full adult protection policy based on preventing abuse of vulnerable people. Staff have also received training in this area via the National vocational Qualifications they have achieved. Staff interviewed were again found to be knowledgeable in these respects. The home have previously acted promptly and sensibly whenever any residents has been at the risk of harm. All residents have clear behavioural management guidelines with staff having done the relevant training. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home was found to be clean, warm, and homely with a number of improvements since the last inspection. The home continues to benefit from investment as evidenced in recent works. Two rooms identified for improvement at previous inspections namely, the lounge and dining room were found to be exceptional. It is recommended that the staircase carpet be replaced to complete the overall impressive finish. EVIDENCE: The inspector toured the communal parts of the home. The home has sufficient space for the 3 Residents with sufficient communal areas to entertain guests in privacy. The lounge and dining room were found to be completely refurbished and redecorated to resident’s satisfaction as confirmed in discussions. The usable space in the lounge had been extended, with new wooden flooring and redecorating, along with new furniture. The dining room was found to be renewed to a similar standard. The garden was found to be reasonably maintained and used by all residents. The carpet on the staircase was found be frayed and damp in part and in need of replacement. The home was found to be clean and fresh smelling. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Residents benefit from having staff that are experienced, well qualified, and who have worked in the home for a long time. EVIDENCE: Staff were found to have a range of relevant care training fully in compliance with TOPSS [now Skills for Care]. All training is linked to the aims of the home as described in its statement of purpose. All 4 regular staff have worked in the home for a number of years and are popular with residents as confirmed in discussions. 3 of the staff have the advanced National Vocational Qualification level 3 which is higher than the Government recommended qualification that at least 50 of staff should have the basic level 2. Staff were recently found to have done refresher training such as Fire safety. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 39 The home was found to be conducted in an open and friendly manner with staff supported to carry out their roles. Despite the lack of a registered manager the home was again found to manage itself and meet resident needs. The owner of the home needs to address shortfalls in sending the Commission clear monthly reports on the quality of care provided at the home. The owner of the home regularly visits and provides support EVIDENCE: The home is currently without a registered manager, as reported at the last 6 inspections. Since the last inspection the owner has put someone forward to be the manager of the home. This person has recently done some shifts in the home. The application did not reach the Commission by the extended deadline. The application is currently being delayed although it is hoped that before the next inspection that a decision is made about whether the applicant will become the registered manager. The acting [deputy] manager has completed her NVQ 3 training. The acting manager has worked at the home for nearly 4 years and is familiar with all issues relating to Resident need.
Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 18 The acting manager wrote all the current care-plans. The acting manager has decided for personal reasons not to apply to become the registered manager. Through discussion the acting manager demonstrated a sound understanding of behavioural approaches to people with complex needs. The manager has a clear job description and responsibilities, which she carries out competently. The Commission is receiving reports of visits by the owner on a two-monthly basis. The reports themselves are not legible in places, are undated in relation to the visits, and lack detail. Additionally the reports do not identify the people such as the residents, referred to. At the inspection a CSCI recommended report format was given to the home for potential use. The home’s owner was given a month to send the Commission a suitable report, clearly presented, including interviews with named residents. The home benefits from active involvement from the owner/responsible person. Resident meetings are held on a periodical basis. Periodic six monthly reviews are set up with social services. The learning disability team regularly liaise with the home and are available for advice on behaviour management issues. Clear evidence was shown of a home geared towards meeting needs. Questionnaires are regularly sent out to visitors and parents to gauge their views, the ones received back were positive. The home has developed a quality assurance folder, which also includes monthly reviews of service provision and regular health and safety audits. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 4 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hazelwood Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x x H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? No 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 39 Regulation 26 Requirement That the Registered Person must make arrangements for section 26 visits and reports to be carried out on a monthly basis. That these reports are sent to the Commission on a monthly basis. That these reports include evidence of named interviews with sufficient numbers of service users [Residents], their representatives, and staff, in order to form an opinion on the quality of care being provided. That this report is clearly presented, dated and sufficiently detailed so as to form an opinion on the quality of the care being provided. Timescale for action 18/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 24 Good Practice Recommendations That the staircase carpet is replaced. Hazelwood H59-H10 S21359 Hazelwood V239707 180805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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