Inspection on 27/06/06 for Hazelwood House

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazelwood House 12/07/07

Hazelwood House 14/11/06

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hazelwood House 22 Newbarn Road East Cowes Isle Of Wight PO32 6AY Lead Inspector Janet Ktomi Unannounced Inspection 27th June 2006 12.00 Hazelwood House DS0000065137.V289776.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 Hazelwood House DS0000065137.V289776.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. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelwood House Address 22 Newbarn Road East Cowes Isle Of Wight PO32 6AY 01983 280039 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) The Regard Partnership Limited Mrs Joanne Lorraine Parry Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection of the service with a new provider. Brief Description of the Service: Hazelwood House is a registered care home providing care and accommodation for up to eleven younger adults with Learning Disabilities. The home provides all single bedrooms, some on the ground floor suitable for people with mobility needs. The home has communal areas, lounge and dining room and pleasant enclosed gardens. The home is situated in East Cowes with good public transport links to Newport, Ryde and the mainland. The home was purchased by the Regard Partnership in December 2005. The home is managed by Registered Manager, Mrs Joanne Parry. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 27th June 2005. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately six hours, commencing at 12.00 midday and being completed at 6.30 p.m. All core standards and a number of additional standards were assessed. The inspector was able to spend time with the care staff on duty and was provided with free access to all areas of the home, documentation requested and service users. Prior to the visit a new service pre-inspection questionnaire was sent to the home and returned within the required time scale. External professional questionnaires were sent to people identified in the pre-inspection questionnaire as having regular contact with the home. Comment cards were returned from two GPs, one community learning disability nurse and five care managers. Service user and relative comment cards were sent to the home and these were completed and returned. Ten service user comment cards and six relative comment cards were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to many of the people who live at the home who also showed the inspector their private accommodation. What the service does well: All service users stated that they liked living at the home and that the staff and manager were all kind and helpful. Service users have active lives and are supported to follow their interests and maintain contact with family and friends. Most service users have lived at the home for many years and have highly individual private accommodation (bedrooms). Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 6 Comment cards were returned by ten of the eleven people who live at the home. All stated they liked living at the home. What has improved since the last inspection? What they could do better: Although the inspector found many positive aspects of the service a number of requirements are made following this inspection. The manager must review all care plans and ensure that they accurately reflect the service users’ strengths and support/care needs. Care plans must be reviewed at least every six months. Care plans must be dated and signed where possible by the service user and if this is not possible, by a representative. Risk assessments must be dated and signed. Risk assessments must be reviewed, preferably every six months, with the care plan review. Diary books, which are records of events in service users’ lives and support/care received must be fully completed. Health action plans must be completed for all service users. Issues identified in the environment check of the home undertaken by the Regard Partnership Health and Safety manager in April 2006 must be fully completed. Thermostatic valves on baths must be working correctly and ensure that water cannot be distributed above 43ºC. Full pre-employment checks including at least two written references must be undertaken prior to new staff commencing employment in the home. The Regard Partnership reference forms supplied to referees must be dated by the person providing the reference. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 7 All staff must receive an induction for which written records must be maintained and available for inspection. Medication administration sheets must be fully completed and the manager must implement a system for checking that all staff are signing to confirm medication has been administered. 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 House DS0000065137.V289776.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where they live. The home would only admit people whose needs it could meet and who would be compatible with the people already living at the home. EVIDENCE: The manager supplied a copy of the home’s brochure and service users’ guide to the inspector with the pre-inspection information. The brochure provides information in a format suitable for service users including pictograms and supporting text. The service users’ guide contains more detailed information in typed format that could be read to and discussed with a prospective service user by their relative or care manager. At the time of the visit to the home the service had no vacancies and had been fully occupied for in excess of eighteen months. The home has therefore not admitted any new people to the home since the new providers purchased the home. The inspector discussed with the manager the procedure she would undertake should the home have a vacancy. The service users’ guide states the home’s admission procedure. This includes contact with care managers and prospective service users visiting the home for a day and weekend. Discussions with the manager indicated that the views of the people who already live at the Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 10 home would be sought and taken into consideration when deciding whether to admit a new person to the home. The manager discussed with the inspector the level of need the home can meet and confirmed that should a new service user have any special needs then training for staff would be organised. The home has good links with the community learning disability nurses who stated on the comment card ‘work in partnership to facilitate clients healthcare needs’. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The manager must ensure that all care plans accurately reflect the care needs of the service user. Care plans should be stored at the front of folders or with daily diaries. Care plans must be dated and signed where possible by the service user or their representative. Only forms relevant to the service user should be in the care plans. Care plans must be reviewed every six months and when needs change. Risk assessments must be dated and signed and kept under regular review (ideally risk assessments should be reviewed with care plans every six months). Service users are encouraged to make choices and their personal finances are appropriately managed. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 12 EVIDENCE: All service users have individual care plans, three of which were seen by the inspector. The support/care needs of individual service users are detailed in the resident skills assessments which cover all aspects of daily life, stating what tasks people can accomplish unaided and what support may be required to accomplish other activities. The resident skills assessments are held at the back of a large folder, labelled care plans, containing lots of other information about the service user. The inspector discussed this with the manager and she is to consider moving the resident skills assessments (which provide the care plan details) to the front of the folder or linking them with the daily diaries where records of activities and support provided are recorded. The resident skills assessments (care plans) were not dated or signed either by the person completing the care plan or by the service user or their representative. The home is now using the Regard Partnership care planning forms. These were seen within the care plan folders. The manager must ensure that only the relevant forms are included in each folder. Within a very independent male service user’s folder were forms for menses, bowels and epilepsy seizure charts (although he does not have epilepsy). Care plans must be relevant for the individual concerned. The inspector noted that one care plan did not accurately reflect the needs of the service user. This stated that he was completely independent in having a bath. During previous discussions with the manager in respect of the non-functioning of the thermostatic bath valves she had stated that they check even the most able person’s bath water temperature before they get into the bath. Not all care plans were seen to be reviewed every six months. The manager stated that care plans are reviewed with service reviews, however some care managers only undertake a review once per year. The manager must ensure that a review of the care plans is undertaken every six months. Care managers do not need to be present as reviews can occur between the service user and key worker. The manager must review all care plans and ensure that they are full and accurate records of care needs and how these must be met. Care plans must be dated and signed, where possible by the service user or their representative, and reviewed at least every six months and when needs change. Discussions with service users indicated that some were aware they had care plans others were not. This was also the response in the service user comment cards received. The manager explained that each service user has a diary which records support/care provided, activities undertaken and any other relevant information specific to the person. These records were viewed. One record, for Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 13 a service user with high support needs, had no entries for the preceding four weeks. Full and accurate records of events pertaining to individual service users must be fully maintained with records being made by the staff supporting the service user and on the day of the event. The inspector also viewed the risk assessments for the same people whose care plans had been viewed. Risk assessments are held within care plan folders and in a separate risk assessment folder. Some risk assessments seen were dated 2001 with no indication that they had been reviewed since this date. The manager had undertaken new risk assessments, these had not been dated or signed either by the person completing the risk assessment or by the service user or their representative. Risk assessments must be dated and signed and kept under regular review (ideally risk assessments should be reviewed with care plans every six months). The home has appropriate procedures and information on all service users in order to respond appropriately to unexplained absences. Discussions with the people who live at the home indicated that they are able to make choices in respect of most aspects of their lives. People are able to choose what they eat, how they spend their time and who they spend time with. Service users are encouraged to participate in the normal domestic activities in the home however if they choose not to this is respected. One service user ‘disappeared’ after the evening meal with the staff laughing as he always did this to avoid washing up. Some service users stated they kept their rooms clean with others informing the inspector that the staff did this for them. The inspector discussed service users’ personal finances with the deputy manager who also showed the inspector the records maintained in respect of one service user. The arrangements and records would appear to be appropriate and well maintained. Service users’ benefits are paid into an account held by the provider. The home withdraws the service users’ personal allowance every week and this is paid into the service user’s own named bank or building society account. Service users are then supported to save or spend money appropriately. Service users stated that they decide what to spend their money on. Service users showed the inspector things in their bedrooms they had purchased. Hazelwood House DS0000065137.V289776.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users have varied and active lives, are able to participate in their local community and have visitors to the home. Service users are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: The inspector was able to meet with and talk to most of the people who live at the home. Ten of the eleven service users returned pre-inspection comment cards. Five relatives returned comment cards. Service users talked with the inspector about what it is like living at Hazelwood House. Service users talked about their weekly activities and holidays planned and undertaken. Service users all have individual weekly plans containing a range of external activities (day services, college and supported work placements) as well as leisure activities in the evenings and at weekends. All Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 15 service users have at least one day at home each week when they are supported to undertake their domestic activities such as cleaning their bedrooms and doing laundry. Some service users support care staff to complete the weekly shop for the home. As previously stated service users are encouraged to undertake domestic task but can opt out if they choose to do so. As well as planned weekly activities the home also organises ad hoc activities such as trips to pubs and places of interest. Each service user has a diary in which activities and the service user’s views/responses to the activities should be recorded. These records were viewed and found to be incompletely recorded. One viewed had not been completed for four weeks. If completed these would provide a record of activities undertaken by the service user. Service users stated in the comment cards returned prior to the visit that they have lots of things to do and that they enjoyed living at the home. The inspector believes that service users have a good lifestyle however the records must reflect this. One professional comment card raised the issue of holidays for service users. This was discussed with the manager who confirmed that the home does support service users to have a holiday. The majority of service users must pay for the cost of the holiday and the provider pays for the staff costs to accompany the service users. One service user is funded by a mainland local authority and the cost of his holiday is included in his fees, he therefore does not have to pay the cost of his holiday. Two of the people who live at the home have lease cars via their mobility allowance. The arrangements for this were discussed. The people who lease the cars have first call on the use of the cars. Should the cars be used for other people who live at the home then a record of the miles travelled is maintained and at the end of the month these are added up and charged at 20p per mile. The money paid goes to the person who is leasing the car. The Regard Partnership pays the petrol costs for all service users. Service users who lease the cars do not pay a mileage amount. This arrangement appears satisfactory as the people who lease the car get priority use and are not financially disadvantaged by using all their mobility money towards the cost as some is repaid by other service users depending on miles used. Ten of the eleven people who live at the home completed comment cards and all stated that they could have family or friends to visit them. During the visit the inspector spoke with most of the people who live at the home and all stated that they could have visitors, either family or friends. One service user discussed his plans to have his girlfriend visit and cook her a meal. Sample menus were provided to the inspector prior to the visit to the home. These indicated that service users are provided with a varied nutritious diet. All but one comment card stated that the service user was able to choose what they eat. During the visit to the home the inspector was able to talk to staff and observe the meal preparation for people at home during the visit. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 16 Individual sandwiches and lunch options were provided based on what people had said they wanted. The main meal is in the evening as many service users are out during the day and take a packed lunch. At the end of the visit service users were seen helping to prepare their own lunches in the evening to take with them the next day. Staff stated that menus are decided by service users, with one describing how quiches had been requested and she had learnt to cook these. Staff on duty eat with the service users to provide role models and assistance if necessary. Staff were aware of individual likes and dislikes of the people who live at the home. Service users stated they liked the food, were able to choose what they wanted and could eat where they wished. One service user has his own kitchen area in a bed-sit arrangement, and organises his own breakfasts and lunch. The plan being to develop his cooking skills as part of an independence programme. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. People living at the home receive appropriate support to meet their care and health needs. As previously identified there is a need to review all care plans to ensure that they accurately reflect the care/support needs of the people who live at the home. Also previously stated the home must ensure the diaries are fully completed as these provide the record of care/support received by service users. Risk assessments must be dated, signed and reviewed at least every year. The home uses a key worker system however there is a need to ensure that temporary key workers are allocated when a key worker goes on extended leave. All service users must have a completed Health Action Plan. The medication administration records must be fully maintained with no gaps. The manager must implement a checking procedure. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 18 EVIDENCE: Discussions with the people who live at the home indicated that they receive the level of support they require. Discussions with staff indicated that they have a good knowledge of the people who live at the home and are aware of their individual support and care needs. Service users confirmed that they are able to get up and go to bed at whatever time they wish although they are encouraged to get up in time for day services or work. The home uses a key worker system however there is a need to ensure that temporary key workers are allocated when a key worker goes on extended leave such as maternity leave. As previously identified there is a need to review all care plans to ensure that they accurately reflect the care/support needs of the people who live at the home. Also previously stated, the home must ensure the diaries are fully completed as these provide the record of care/support received by service users. Risk assessments must be dated, signed and reviewed at least every year. Service users stated that the staff would organise for them to see a doctor if they were ill. They also told the inspector that they had been to opticians and dentists within the previous year. The manager stated that all service users have had a health action plan completed. One was selected at random and this was found not to have been completed. The remaining health action plans were viewed and had been completed. The manager stated that the key worker for the person who did not have a completed health action plan had been on maternity leave and was due back soon after the visit. The manager must consider how temporary key workers can be provided for service users whose key worker is absent for an extended period of time. All service users must have a completed Health Action Plan. Comment cards received from care managers and relatives indicated that service users are appropriately cared for. The community learning disability nurse and GPs who returned questionnaires were positive about the home’s ability to meet all healthcare needs. The arrangements for medication were reviewed. The home uses a blister pack system for all drugs that can be stored in this way. Medications are stored in an appropriate lockable cupboard in the office that is secure when not in use. Also in the office is a small fridge, again lockable, for medications that must be stored at cooler temperatures. Daily fridge temperatures are recorded, however it is recommended that the home purchase a maximum/minimum thermometer as the manager stated that the staff have on occasions inadvertently turned off the fridge. The medication administration records were also viewed. Three of the eleven records were incomplete as gaps had been left when staff had not signed to confirm that medication had been administered or indicated why this had been Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 19 omitted. The blister packs would indicate that the medication had been administered. The inspector discussed these with the manager and she is to identify the staff concerned and discuss with them their failure to sign the records. The manager must implement a checking procedure to ensure that the medication administration records are fully completed. At the time of the visit there were no controlled medications in the home. The manager and staff stated, and the information supplied with the pre-inspection questionnaire confirmed, that all staff that administer medication have completed a BTEC certificate in medication administration. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 20 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 and 23 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The people who live at the home are able to make complaints that would be appropriately investigated and resolved. The home would respond appropriately to adult protection concerns. The home must ensure that full recruitment checks are undertaken on new staff before they commence employment at the home. EVIDENCE: The pre-inspection questionnaire completed by the manager stated that there had been no complaints to the service since the new providers purchased the home in December 2005. Comment cards received from relatives, GPs and care managers confirmed that they had no concerns or complaints about the service. The questionnaires completed by the service users also stated that they had no complaints or concerns. The home’s complaints procedure is detailed in the service users’ guide with the information available in pictorial format in the home’s brochure. Discussions with the people who live at the home indicated that they would tell a member of staff or the manager if they had any complaints. Most of the people who live at the home attend external day services, college or sheltered work placements and would be able to discuss any concerns or complaints with people outside the home. Observations of the interactions between the people who live at the home and care staff indicated that they would be able to discuss any concerns or make complaints with the staff or their key workers. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 21 The home follows the Isle of Wight Adult Protection policy and procedure. A quick reference policy was seen on the office wall as to the actions staff should take should they suspect that an incident of adult abuse may have occurred. Discussions with the manager and care staff indicated that they were aware of the actions they should take. Training information supplied by the manager indicated that many of the staff have attended adult protection awareness training. The manager supplied the inspector with a copy of the training the Regard Partnership has arranged for the home. This indicated that all staff will have access to a full day’s abuse awareness/adult protection training in mid August 2006. Staff are also due to attend a one day De-Escalation Workshop also in August 2006. The home’s policies and procedures in relation to the management of service users’ personal finances have been described within a previous section of this report and should ensure that service users are protected from the risk of financial abuse. The home must ensure that full recruitment checks are undertaken on new staff before they commence employment at the home. Two written references must be received. When viewing the staff files, one file was found to have only one reference. The Regard Partnership provides reference forms for people providing references on potential employees. These have a section for the person providing the reference to sign but there is no request for them to date the reference. It is therefore not possible to confirm if references are received prior to people commencing employment or received after staff have started working at the home. All service users who completed comment cards stated that they felt safe living at the home. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 22 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, 25, 26, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The Regard Partnership must ensure that the issues identified in their own health and safety audit undertaken in April 2006 are fully completed. Their own time scale of four weeks has already been exceeded by several months. The manager must ensure that the thermostatic bath water temperature valves are working correctly. EVIDENCE: The premises is suitable for its stated purpose and meets service users’ individual and collective needs in a comfortable and homely way. The Regard Partnership Health and safety manager undertook an inspection of the home in April 2006. Following a tour of the home he produced a list of concerns and recommendations. A copy was provided to the inspector. This list contained twenty concerns that were to be actioned within four weeks. The manager stated that these had not been actioned and the inspector was able to confirm this during her tour of the home. The list covered a variety of health and safety concerns including wheelchair access to the home and garden, redecorating, Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 23 additional hand rails on stairs and important fire prevention work. A number of these issues, especially those relating to fire safety are very important and the provider’s and manager’s failure to ensure that these have been completed is a concern to the inspector. The Regard Partnership must ensure that the issues identified by its own health and safety audit are fully completed and provide the Commission with written confirmation that this has occurred. A number of the people who live at the home showed the inspector their private accommodation. Bedrooms seen were very individual and people stated they liked their bedrooms. Bedrooms contained all the required fixtures and furniture and were equipped with a washbasin. Bedrooms are mainly located on the first floor with two on the second floor and several on the ground floor suitable for people with limited mobility. All bedrooms are for single occupation. The home has an appropriate number of WCs and bathrooms located around the home. The manager and service users confirmed that there is sufficient hot water when they want to have a bath. The manager stated that the baths are fitted with thermostatic valves however these are not functioning and water does come out above 43ºc. This places service users at risk of injury if they get into a bath containing too hot water. The manager stated that staff check the temperature of all baths and service users confirmed this. Service users are not only placed at risk of injury from the hot water but this also prevents their full independence, as even the most able must have staff support to have a bath. The manager must ensure that the thermostatic bath water temperature valves are working correctly. Non-slip flooring must be fitted in all bathrooms and WCs as identified also by the Regard health and safety audit. The home provides service users with a large lounge and smaller dining room. The home also has a large private enclosed rear garden and adequate car parking facilities to the front of the home. The home does not have a private meeting room however as most service users are out of the home during the day, either the lounge or dining room could be used for meetings without adversely affecting people who are in the house. The dining room was identified by the Regard health and safety audit as being in need of redecoration. The wallpaper in the lounge is also starting to show signs of age and consideration should also be given to redecoration of this room. One of the people who live at the home has additional physical and mobility needs. Service users could have friends or relatives who have restricted mobility visiting them at the home. The garden path needs to be widened to facilitate wheelchair access and the paving stones levelled and secured to avoid the possibility of slips and trips. A ramp is required to provide suitable access for wheelchair users instead of the step at the back door. These issues were also identified by the Regard health and safety audit and had not been actioned within the provider’s own timescales. These must be actioned and written confirmation provided to the Commission that this has occurred. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 24 On the day of the inspector’s visit to the home, the home was found to be clean, hygienic and free from offensive odours. Infection control equipment was available to care staff. The laundry was not observed during the visit to the home. There had been no previous concerns in respect of the laundry and none were raised by the Regard health and safety audit other than the provision of a non-slip floor and that the home should have a maintenance agreement with a local contractor for the commercial washing and drying machines. Service users stated that they are supported to keep their bedrooms clean and tidy. Information supplied by the manager prior to the visit to the home stated that most of the staff have undertaken a BTEC in infection control. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 25 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): 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of suitably competent and qualified staff. The manager must ensure that a temporary key worker is provided should the service user’s key worker be on extended leave. The manager must ensure that two written references are obtained before a new staff member commences employment. The Regard Partnership reference forms must be dated by the person supplying the reference. Induction records must be maintained for all new staff. EVIDENCE: The manager supplied copies of the home’s staffing rotas with the preinspection questionnaire. The manager explained the staffing rotas to the inspector during the visit to the home. Some of the people who live at the home have additional 1-1 hours funded by their placing authority. These are detailed on the staffing rotas. Discussions with staff and the people who live at the home indicated that there are sufficient staff to meet service users’ needs. Comment cards received from relatives stated that there are sufficient staff on duty, that they are satisfied with the overall care provided with an additional comment ‘my son is very happy at Hazelwood House where he receives Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 26 genuine care despite his rather demanding disabilities. The staff should be praised for all they do’. External professionals also stated that they were satisfied with the overall standard of care provided adding ‘excellent person centred approach to care provision’. Care staff also undertake the cooking within the home. Food hygiene training has been organised for July 2006. The home has a cleaner for two hours per weekday who keeps the communal areas and bathrooms clean. Care staff support service users to undertake their laundry and keeping their bedrooms clean and tidy. No staff have left since the home was purchased by the Regard Partnership in December 2005. The manager explained to the inspector how she covers staff holidays and sickness. The home has a small number of bank staff and their own staff provide additional cover when necessary. All service users have key workers. As previously stated the manager must ensure that a temporary key worker is provided should the service user’s key worker be on extended leave. The manager provided the inspector with a list of training staff have undertaken and with information about the training the Regard Partnership have arranged for 2006. The pre-inspection questionnaire also stated that 10 of the 13 care staff have at least NVQ level 2. This equates to approximately 80 , well above the required 50 . Care staff stated that they felt they had the necessary skills to meet service users’ needs. All staff are aged over 21 years and undertake sleep-in duties. The people who live at the home stated that they like the staff and were able to name their key workers. Interactions observed during the visit between service users and care staff were warm and positive. The home has recruited three people since December 2005. The manager stated that applicants are able to meet service users during their interviews and service users’ views and her observations of interactions are included in decisions about appointment. The recruitment records for these staff were viewed. One staff member recently recruited had only one reference on file but had commenced working at the home. The Regard Partnership provides referees with a form to complete. This form contains a space for referees to sign but does not require them to date the form. Reference forms seen had not been dated therefore the manager could not demonstrate that they had been received prior to the new member of staff starting work at the home. There were no induction records available for two of the three people recruited since the new owners purchased the home. The manager stated that Regard personnel department have induction forms and send these to the home but she has not yet received these. Records of induction must be maintained for all staff. The Regard Partnership must ensure managers have the necessary forms. In the absence of the Regard forms the manager must maintain her own records. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 27 The home accommodates both male and female people, however its staff team are all female. The manager stated that she would like to employ male staff but had had no male applicants. This was discussed and the manager and the Regard Partnership are to consider how they may attract more male applicants. Other similar care homes on the Island have successfully recruited male care staff although it is acknowledged that care work remains a predominately female profession. Service users stated they would like male staff. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 28 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, 41 and 42. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The home is managed by an experienced and qualified manager. The Regard Partnership undertakes quality audit activities however they must ensure that the information gained from audits is used to improve services. The record keeping within the home must be improved. Health and safety issues identified must be resolved. EVIDENCE: The manager was previously the registered manager of the home prior to its purchase by the Regard Partnership. The manager is experienced and has NVQ level 4 in care and the Registered Manager’s Award. Positive comments were made about the manager by external professionals and relatives. The manager stated that she felt supported by the management structure provided by the Regard Partnership and felt able to discus issues or concerns with her direct line manager. Observations of interactions between the manager and the Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 29 people who live at the home were warm and friendly; service users stated they would tell the manager if they had any problems or complaints. At the time of the unannounced visit to the home the manager’s line manager from the Regard Partnership was visiting the home to undertake a mock inspection and Regulation 26 visit. The line manager stated that he views his role as quality assurance within the home as well as supporting the manager. He stated that he undertakes mock inspections every three months and provides actions required to the manager. These are then reviewed within his monthly visits. Regulation 26 visits are completed monthly and reports are provided to the manager. The manager showed the inspector the file containing the Regulation 26 reports. These cover the appropriate areas to enable the provider to monitor the service provided. The Regard quality manager describe the other measures undertaken to ensure the quality of the service provided. The inspector was shown questionnaires that are sent to relatives and external professionals. The Regard Partnership has not yet completed a full audit of Hazelwood House as it has only owned the service for approximately six months and the manager will forward a copy of the full quality audit involving the questionnaires once this has been completed. As previously stated the Regard Partnership undertook a health and safety audit in April 2006 and identified twenty concerns that should have been rectified within four weeks. These were still outstanding at the time of the visit to the home. The areas identified covered some important areas such as fire prevention and banisters on stairs. The point of a quality audit is to identify areas for improvement and then ensure that these are achieved. There is little point in undertaking a quality audit, identifying areas for improvement and then not resolving these issues. When a quality audit such as this is undertaken the provider and manager must ensure that the areas identified are rectified within the timescales. Throughout the visit to the home the inspector viewed a number of records. These have been detailed previously in the relevant sections. The standard of record keeping in the home requires improving. As previously stated there were gaps in the medication administration records, care plans and risk assessments must be reviewed, dated and signed, records of care and support provided must be improved. Staff recruitment and induction records were also incomplete. Records were stored securely in a locked office. The Regard Partnership and the registered manager must ensure so far as is reasonably practical the health, safety and welfare of the service users, staff and visitors. The Regard Partnership and the manager must ensure that all the concerns identified by the Regard Partnership health and safety audit are fully complied with. The manager must ensure that all care plans accurately reflect the care needs of the service user. Risk assessments must be dated and signed and kept under regular review (ideally risk assessments should be reviewed with care plans every six months). All service users must have a health action plan. The manager must implement a checking procedure to ensure that the Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 30 medication administration records are fully completed. The manager must ensure that the thermostatic bath water temperature valves are working correctly. The manager must ensure that two written references are obtained before a new staff member commences employment. Induction records must be maintained for all staff. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 31 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 X 1 1 X Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 32 N/A 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 YA18YA41 Regulation 15 Requirement The manager must ensure that all care plans accurately reflect the care needs of the service user. Care plans should be stored at the front of folders or with daily diaries. Care plans must be dated and signed where possible by the service user or their representative. Only forms relevant to the service user should be in the care plans. Care plans must be reviewed every six months and when needs change. Full and accurate records of events pertaining to individual service users must be fully maintained with records being made by the staff supporting the service user and on the day of the event. Risk assessments must be dated and signed and kept under regular review (ideally risk assessments should be reviewed with care plans every six months). DS0000065137.V289776.R01.S.doc Timescale for action 01/08/06 2. YA6YA18 YA41 17 01/08/06 3. YA9 13 (4)(c) YA18YA41YA42 01/08/06 Hazelwood House Version 5.2 Page 33 4. YA18 YA19 12(1)(a) 5. 6. YA19YA41 YA20 YA41 12(1)(a) 13(2) 7. YA24 YA39 YA42 23(2)(b) 8. YA27 YA42 23(2)(c) The manager must ensure that service users have a temporary key worker if their key worker is on extended leave. All service users must have a health action plan. The manager must implement a checking procedure to ensure that the medication administration records are fully completed. The Regard Partnership must ensure that the issues identified by its own health and safety audit are fully completed and provide the Commission with written confirmation that this has occurred. The manager must ensure that the thermostatic bath water temperature valves are working correctly. The manager must ensure that two written references are obtained before a new staff member commences employment. The Regard Partnership reference forms must be dated by the person supplying the reference. Induction records must be maintained for all staff. 01/09/06 01/09/06 01/08/06 01/09/06 01/08/06 9. YA34 YA41 YA42 19 01/08/06 10 YA34YA42 19 01/08/06 11. YA35 YA42 18 (1)(c(i)) 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 34 1. 2. YA20 YA33 The manager should consider purchasing a maximum/minimum thermometer for the medications fridge. The manager and the Regard personnel department should consider how they can attract more male applicants when advertising care positions for the home. Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hazelwood House DS0000065137.V289776.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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