CARE HOME ADULTS 18-65
Hazelwood 9 Church Road St Leonards-on-sea East Sussex TN37 6EF Lead Inspector
Jason Denny Unannounced Inspection 27th January 2006 08:40 Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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 Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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 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) Mr Graham Robert Jack Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of Service Users to be accommodated will be three (3) The Service Users will be aged between eighteen (18) and thirty (30) years on admission 18th August 2005 Date of last inspection 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 Leonards-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 Service Users. 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 Service Users [service users] who choose both the destination and who to travel with. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 8.40 and 11.30 am. The Inspection found that of the 13 National Minimum Standards inspected, that 10 of these standards had been fully met, others nearly met, with two exceeded in relation to care-plans and staff training. The overall focus of the inspection was on Service User’s involvement in the home, their care, and their lifestyles. The inspector started the inspection by speaking with and observing all 3 Service Users before they went out for their daily activities. Communal areas of the home were inspected. A discussion with the deputy manager took place around progress since the last inspection. Care and activity records, along with staff training documentation were inspected. Discussions with Service Users took place around leisure pursuits, educational activities, relationships, and how they make choices and express their views. The inspection also allowed an opportunity to ensure that the home had tightened security measure around visitors and the storage of medication following an incident in October 2005. Comment cards were sent to the home prior to the inspection, which were completed, by service users and relatives with positive comments made. Positive comments continue to be made by social services that fund service users. This report should be read in conjunction with the last Unannounced Inspection report of 18/08/05, which covered 18 areas. What the service does well:
The home is well established with all Service Users having successfully lived there together for a number of years. The home benefits from stable staff team and deputy manager, which has not changed for several years. The staff team as a whole are exceptionally well trained, highly experienced and skilled at meeting the needs of learning disabled young people. The owner of the home visits regularly and has a positive active involvement. All Service Users spoken with indicated that they liked living at Hazelwood and that they all enjoyed active lifestyles based on their preferences and choice and had opportunities to learn life skills and make choices. Service Users have clearly developed trusting relationship with the supportive staff and have their own routines. The home continues to be clean and homely throughout. A range of measures is in place to protect Service User’s welfare and interests. The administration of the home is good especially the care records, which show a range of highly useful information and show how Service Users needs are being met. Each Service User also receives a good amount of individual attention and input from staff. All Service User’s health and general care needs are carefully monitored and reviewed. The service is clearly built around the needs of the individual Service Users. The owner of the home has
Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 6 improved all aspects of the environment over the last 2 years including bedrooms and communal areas. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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 the following standard(s): None of these standards were assessed. Standard 2 was found to be fully met at the last inspection. All other standards have been previously met. No new service users have moved into the home for several years. EVIDENCE: Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 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 the following standard(s): 6 Care plans are exceptional with all needs clearly met and closely reviewed. EVIDENCE: All 3 care-plans were examined. 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, dislikes, goal setting, behaviour support strategies, protocols, risk assessments, weekly activity schedules, leisure interests, along with Hygiene protocols. The goals are reviewed on six monthly- basis, and a report is submitted to a social services review, which is held six monthly. Service Users have a copy of their plan and are encouraged to take part in its review with views recorded. The home constantly reviews activity provision. Each plan is logically laid out and well–presented with an updated photograph of the Service User. Two of the plans were found to have recently been retyped and reviewed by staff and the Service User in July 2005 and October 2005. The epilepsy protocol in relation to one Service User 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. Service Users are able to make a range of choices about their lives with significant consideration given to their views and feelings.
Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The home provides a good range of activities based on Service User preferences, abilities, and diverse needs. EVIDENCE: Service Users are able to make a range of choices about their lives with significant consideration given to their views and feelings. The level of Service User involvement in the home is excellent. The home was found to have good links with the local community. All Service Users have active lifestyles which meet their needs and aspirations and, which provide opportunity to develop independent living skills. All three Service Users attend distinct day centres, which according to records and discussions are meeting needs. Extended discussions took place with Service Users around their activity interests. Each Service User has an active week, which affords opportunities for skill development. Each Service User has an active social schedule based on individual choice. A particular Service User indicated to the inspector, ongoing improvements in his communication and sentence construction over successive inspections. Service Users have opportunities to participate in the local community. According to individual interests Service Users visit music concerts, pubs,
Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 11 restaurants, local leisure centre, cinema and other areas. This was again confirmed in discussions with service users and in records examined . Two Service Users have active family involvement. The other Service User sees his advocate on a fortnightly basis. The advocate has previously commented positively to the inspector on the service. None of the Service Users were described as having regular friends although their regular attendance at social events affords this opportunity. One Service User went to Cornwall last Summer with peers from the day centre he attends. All service users choose their own summer holiday each year. The inspector saw a range of evidence, which indicated that all Service Users have their rights to independence and flexible routines respected within reasonable agreed limits. All restrictions are agreed via risk assessments. All service users spoken with[3] indicated satisfaction with their current programme of activities and their individual day centres which reflect their diverse tastes and interests. One service user was found to be improving the range of the activities he undertakes as evidenced in a report by his day centre manager. The home vehicle was found not to be working for the last two months although this was not affecting outcomes. All service users are picked up for their respective day centres and the Main town of St Leonards-on-Sea is within easy walking distance. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Service users health needs are closely monitored and reviewed. All service users receive excellent care and attention based on helping them to be as independent as possible and to have a good quality of life. Medication arrangements have improved. EVIDENCE: Discussions with the deputy manager and a review of one service user’s records showed the close way that a epilepsy condition was being monitored with a range of support to help the service user have a better quality of life which is affected by the condition. Records showed continuous review of medication and follow up medical appointments. The service user was found to be well during the inspection. All staff were seen to treat service users with respect and dignity with all encouraged to become as independent as possible within a sensible risk assessed framework. Medication management was inspected with staff recently reminded to ensure that the cabinet and office are locked at all times when the room is empty following an incident with a visitor gaining access. Medication Stocks and records were shown to be in order. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home operates in an open manner and has not had a formal complaint. Staff continue to demonstrate an sound understanding on how to prevent abuse although refresher training would be helpful to maintain and update awareness. All Service Users and visitors are made fully aware of how to complain or raise concerns. EVIDENCE: The home has not received any complaints since records began in the home. There is a clear complaints procedure, which includes details of the commission. Each Service User has a complaints procedure in a suitable format, in their room. All complaints would be responded to within 28 days. Service User 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. 3 of the 4 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 Service Users has been at the risk of harm. All Service Users have clear behavioural management guidelines with staff having done the relevant training. None of the staff have done formal prevention of abuse training for at least two years and so the home is advised to access the most up to date training to maintain staff awareness. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The ongoing modernisation and renewal of the home is near completion creating a good impression on visitors and benefits for service users. EVIDENCE: The inspector toured the communal parts of the home. The home has sufficient space for the 3 Service Users with sufficient communal areas to entertain guests in privacy. The lounge and dining room were found to be completely refurbished and redecorated to Service User’s satisfaction as confirmed in discussions and previous inspections. All bedrooms are en-suite bathrooms/toilets. The usable space in the lounge had been extended, with new wooden flooring and redecorating, along with new furniture. The dining room has been renewed to a similar standard. The garden was found to be well-maintained and used by all Service Users. The carpet on the staircase was again found be frayed and damp in part and in need of replacement. The owner has written to the Commission to confirm that this will be replaced once all building work is competed. Plastering on the top floor was found to be taking place after the recent fixing of a damp problem. The kitchen is being replaced during the coming year. The home was found to clean and fresh smelling. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 36 Service Users 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 Service Users 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. The remaining member of staff has started the basic level 2 National Vocational Qualification in Care. Staff were recently found to have done refresher training such as Fire safety. It was recommended that all staff also do refresher Prevention of abuse training. The home deputy has developed a useful written supervision format to give staff support and monitor performance and learning. The deputy discussed how supervisions had not occurred for some time where previously they were two-monthly. Although there may not always be much to discuss given the close staff working, the home are still required to show evidence of regular supervision in keeping with a professional service. The owner of the home or manager is also required to show evidence of supervising the deputy.
Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Despite the lack of a registered manager the home was again found to manage itself and meet Service User needs. The owner of the home needs to address shortfalls in sending the Commission regular monthly reports on the quality of care provided at the home. EVIDENCE: Since the last inspection an applicant put forward to be the manager of the home has been unsuccessful in their application. In light of this the owner of the home has put himself forward to manage the home subject to an effective rota and on-call system being demonstrated due to this person living outside the area and managing another nearby home. The acting [deputy] manager has completed her NVQ 3 training. The acting manager has worked at the home for nearly 5 years and is familiar with all issues relating to Service User need. The acting manager wrote all the current care-plans. Through discussion the acting manager demonstrated a sound understanding of behavioural approaches to people with complex needs. The Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 17 manager has a clear job description and responsibilities, which she carries out competently. The Commission is occasionally receiving monthly section 26 reports of visits by the owner although none have been received for 5 months. The last report received was clear and had more detail. The owner is required to send one monthly report on a regular monthly and timely basis along with any delayed reports. If the owner becomes the manager then this requirement will no longer apply. The home benefits from active involvement from the owner with the deputy confirming regular visits including some shifts being worked. Service User meetings are held on a periodical basis. Periodic six monthly and annual 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, which continue to be positive. The home has developed a quality assurance folder, which also includes monthly reviews of service provision and regular health and safety audits. Since the last inspection the home has introduced a visitors book, which as seen in the inspection all visitors have to complete. The homes policy has also been reviewed in light of an incident which had no impact on service users but which was a concern. The deputy manager confirmed that all equipment maintained in the home continues to be serviced as per schedule, such as the boiler and electrical equipment. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 18 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA36 Regulation 18[2] Requirement Timescale for action 27/03/06 2. YA39 26 That the Registered Person must ensure the resumption of regular written Supervision for all staff to occur at least six-yearly. That the Registered Person must 27/02/06 make arrangements for section 26 visits reports to be sent to the Commission on a monthly basis. That these reports include evidence of named interviews with sufficient numbers of service users [Service Users], 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. Requirement of the last 2 Inspections. Requirement first made 18/08/05 Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 20 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 YA23 Good Practice Recommendations That Formal Adult Protection / Prevention of Abuse training is organised for all staff. Hazelwood DS0000021359.V274671.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Sussex Area Office 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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