Inspection on 08/06/06 for Heathlands

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathlands 02/08/07

Heathlands 08/12/05

Heathlands 05/09/05

Heathlands 29/10/04

Heathlands 28/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Heathlands (Walton-on-the-hill) Heathlands Chequers Lane Walton-On-The-Hill Surrey KT20 7ST Lead Inspector Pat Collins Unannounced Inspection 8th June 2006 10:00 Heathlands (Walton-on-the-hill) DS0000013852.V299312.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 Heathlands (Walton-on-the-hill) DS0000013852.V299312.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. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathlands (Walton-on-the-hill) Address Heathlands Chequers Lane Walton-On-The-Hill Surrey KT20 7ST 01737 817882 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 Avenues Trust Limited Ms Madeleine Sorensen Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 46-60 YEARS OF AGE 8th December 2005 Date of last inspection Brief Description of the Service: Heathlands is a care home providing personal care for six adults of mixed gender with profound or severe learning disabilities. The home admits service users with complex needs including challenging behaviours and autistic traits. The premises is a detached, two storey building which is domestic in size and character. Its location is central to the pretty, semi-rural village of Walton on the Hill. Local shops are within walking distance. Larger shopping facilities also a range of leisure amenities, countryside and parkland are all within easy travelling distance. All bedrooms are single occupancy and are situated on the ground and first floor, accessible by stairs. Toilet and bathing facilities are on both floors. Communal areas comprise of a fitted kitchen with separate utility room, dining room, lounge and sun – lounge. The home has a car park and a secure, large, secluded garden also dedicated transport facilities. The organisation operating the home is a registered charity and major provider of support service for adults with learning disabilities in the South East of England. Weekly fee charges ranged between £1505 and £1523 as of May 2006. Additional charges were for hairdressing, clothing and toiletries, transport and some leisure activities costs. Prospective service users and their representatives are informed about the home’s services and facilities in a Service Users Guide document available from the Avenues Trust. Also a copy of the home’s latest CSCI inspection report. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Heathlands care home for the inspection year 2006 and 2007. It brings together the cumulative assessment, knowledge and experience of service provision at the home over the past 12 months. It also takes account of the findings of an unannounced inspection visit undertaken by one regulation inspector on 8th June 2006. The duration of this was just under ten hours and all key national minimum standards for adults were inspected. A tour of the premises was undertaken and records, policies and procedures were sampled. Staff on duty were interviewed during the visit. The home manager and regional manager were also consulted by telephone. The inspector had contact with all service users, all of whom had communication difficulties. Some had limited speech and others had no verbal communication. Judgements were made about service users welfare based on the inspector’s interpretation of their gestures, moods and behaviours, also on information contained in records and feedback from staff. The inspector would like to thank all who contributed to the inspection process. What the service does well: The environment offered a ‘ homely’ and positive atmosphere for service users, whilst appropriately taking into account challenging behaviours, most risks and safety issues. The management and operation of the home valued diversity and promoted equality of opportunities for service users within individual capabilities. Direct observation of practice, discussions with staff and record keeping demonstrated that the staff team had a clear understanding of the social model of disability. The rights and choices of service users were promoted in the home’s operation. Service users were afforded choices relating to the décor and furnishings of bedrooms. Significant effort had gone into ensuring a person centred approach towards personalising private space. At the time of the inspection visit staff engaged service users in domestic routines. Examples of these were cleaning tasks, shopping for food at the supermarket and unloading shopping bags from the car and putting the shopping away. They were involved in food preparation, setting dining tables and loading and unloading the dishwasher. Service users had a choice of healthy meals and drinks. Their independence and freedom of movement within the home was promoted; any limitation on this were clearly recorded and underpinned by risk assessments. Service users were enabled to practice their religious beliefs at local church services. Service users benefited from individualised, suitably structured activity programmes. Within these were opportunities to establish relationships with other people, including peers, external to the home environment. The activities programmes included sessions spent at specialist day centres in the Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 6 community; also support from staff in the use of a wide range of social and leisure community facilities. Service users had opportunity to go on annual holidays. This year two service users and two staff enjoyed a holiday in Bournemouth where they stayed in a hotel. Other holidays were being planned. The management of the home ensured integration of service users within their local community. The home was a member of the local residents association. Staff and service users engaged in a weekly activity of delivering leaflets and papers for local community groups. What has improved since the last inspection? What they could do better: Whilst acknowledging improvements in care planning and risk assessments, there remained the need to ensure all care plans and risk assessments were regularly updated. Some aspects of care planning also required further development. Discussed also was the need for risk assessments to be evidenced specific to the open storage in some bedrooms of toiletries and disposable razors; also creams and ointments prescribed for external application. A review of fire safety was needed regarding the ongoing practice of wedging the kitchen and lounge doors open. Also financial practices and related record Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 7 keeping should be further reviewed. The service users guide and statement of purpose must be updated. Also a current employers liability insurance certificate displayed. 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. Heathlands (Walton-on-the-hill) DS0000013852.V299312.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 Heathlands (Walton-on-the-hill) DS0000013852.V299312.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): 1,2,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available to prospective service users and their representatives about the home was well produced and comprehensive. This enabled representatives of prospective service users to make informed choices regarding the home’s suitability. Some elements of the statement of purpose and service users guide required updating. Arrangements for pre-admission assessments were adequate, ensuring prospective service users needs and aspirations were identified and met. EVIDENCE: The home’s statement of purpose and service users guide required updating. Service users guides had been produced and personalised using pictorial and widget symbols. These were kept in the office. There had been no new admissions since the last inspection. The service users file sampled contained detailed information relating to individual needs. Admission decisions for this individual had been based on the outcome of a comprehensive needs assessment carried out prior to admission. Pre-admission procedures had been well managed. The approach by management at that time had ensured this individual and his family had been treated with respect and understanding for the life changing decisions they needed to make. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 10 All specialist needs were met through specialist community learning disability services providing professional services, support and guidance as required. Health care needs were met through primary and specialist services. Staff individually and collectively had the skills and experience to deliver the services and care which the home offers to provide. Staff mostly demonstrated they could communicate effectively with service users using individuals’ preferred modes of communication. Some new staff awaited training in use of makaton as a form of communication. Provision was made of suitable shower and toilet facilities for service users who had difficulty in accessing baths. Also ground floor bedroom accommodation and bathing facilities were available for these individuals. Clear information relating to contracts/terms and conditions, fees and extra charges was available on service users files. These were not in pictorial formats however to aid service users’ understanding of the content. Heathlands (Walton-on-the-hill) DS0000013852.V299312.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, 8, 9, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans sampled were clearly written, reflected needs, goals and assessed risks. Whilst person centred planning was not always evident by records examined, in practice this approach was central to the home’s management and operation. Systems enabled service users to be involved in decision making relating to their lives. Care practices and routines promoted service users involvement in the running of their home. Overall risk - taking procedures were mainly satisfactory though some shortfalls were identified. EVIDENCE: Service users each had a named key worker and co-key worker. Individual care plans had been produced for all service users. Staff reported that five of the six service users accommodated had had care reviews undertaken by care management this year. Minutes of review meetings were awaited. On the file sampled it was not evident from record keeping whether any changes had been made to the care plans for this individual at the review meeting in March 2006. The outstanding review meeting for another service user was reported to being arranged. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 12 Staff informed the inspector of a concerted, collective effort being made by the team to implement person centred documentation (PCP) in accordance with the Avenues Trust Policy. The manager and some staff had received training in the past in person centred approach to care planning. It was evident from records and information on walls in service users bedrooms that this was being implemented gradually. Staff informed the inspector that dedicated time was now allocated weekly for key workers to progress this work. It was stated that the home manager and senior support workers planned to attend a refresher training session on PCP’s to be able to further support and guide staff in their implementation. Observations of the content of the service users’ file sampled, though not recorded in accordance with person centred planning formats supplied, did provide a holistic profile. Though the ‘MY Plan’ records were incomplete and other PCP documents, the information available was sufficient to enable understanding of the needs and aspirations of this service user. There was a list of missing documentation and an action plan that the key worker was following for completion of the PCP process. Discussed with the person in charge was the need to have care plans in place addressing the dietary and communication needs of this individual. It was noted this service user understood some verbal communication. The key worker for this individual acknowledged that staff should also use makaton in their communication with him, which they were not doing at the time of the inspection visit. Risk assessments and risk management strategies for this person had mostly been recently updated. Discussed was the need to ensure the practice of open access to toiletries, disposable razors and creams and ointments for external application in some bedrooms to be underpinned by records of risk assessments. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home meets each of these assessed standards very well. It was demonstrated that service users were encouraged and supported in leading fulfilling lives. They were enabled to integrate in the community and supported in maintaining family links. Service users enjoyed a healthy, varied diet and were offered choice of food. EVIDENCE: Staff practice was directly and indirectly observed also their interaction with service users throughout the course of the inspection visit. Their approach was enabling, respectful and age-appropriate. Service users engaged in a structured individualised activities programme that was displayed in pictorial format on walls in bedrooms and in the dining room. These activities included dedicated time for service users to spend with key workers/staff to develop and practice activities of daily living and promoted independence. Examples of this observed during the inspection were service users engaging in cleaning activities in their rooms supported by staff. They Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 14 were also involved in making their beds and changing bed linen, in laundry practices, in food preparation, setting tables and unloading the dishwasher. Two service users were involved in shopping for food at the local supermarket. On their return to the home other service users assisted them and staff in unloading the shopping from the car and putting it away. Service users were also encouraged to be involved in maintaining the garden. Staff stated that one service user took a particular interest in this activity. Two service users attended the Mosley Horticultural Centre and others attended the Croft Day Centre. Service users were unable to undertake paid employment due to incapacity related to their disabilities. Service users enjoyed shopping with staff and used a range of community leisure facilities. They engaged in activities at social clubs, enjoyed art sessions, movement and music sessions and cookery classes and used sensory facilities. On the day of the inspection service users enjoyed eating a cake baked by a service user earlier that day at a day centre. Service users were stated to be involved in baking cakes and biscuits in the home with a staff member. There was commitment to equality of opportunities for service users, the activities programme ensuring integration of service users in their local community. The home is a member of the local residents association. Last year the service users and the team had entered and won first prize in the village competition for “the best dressed house”. This was not only a great achievement which brought pride and pleasure to all involved but had further assisted the process of integrating service users within their local community. It was noted that service users and staff now engaged in the regular delivery of leaflets and papers for local community groups. Service users accessed many community facilities. Example of these were pubs, cafes, theatres, swimming pools and in the local recycling project. They also had opportunity to take an annual holiday in small groups supported by staff. This year two service users stayed in a hotel by the coast supported by two members of staff. Other holidays were stated by staff to be under discussion. Information received from staff and comments from relatives recorded in a recent survey carried out by the Avenues Trust established good team effort in supporting service users’ in maintaining contact with relatives and friends. Observations and discussions with staff confirmed that food was considered to be highly important and the social importance of mealtimes was recognised. Staff engaged individual service users in the preparation of meals during the course of the inspection. Also in setting and clearing dining tables. The menu examined afforded a varied, balanced diet and staff demonstrated how service users were assured a choice of food and drinks. Staff stated that service users were involved in menu planning using pictures. The meals served during the inspection visit were nicely presented and appetising. The consistency of meals was prepared to meet the needs of individual service users with swallowing or chewing difficulties. Staff sat on both tables to provide the required level of Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 15 assistance and to safeguard individuals’ at risk of choking. Mealtimes were observed to be relaxed and service users given time to enjoy their food. Independence with eating skills was appropriately promoted. Food storage was satisfactory and fridge and freezer temperatures recorded daily. Discussed was the need to ensure records of food probing temperatures were also maintained. Service users were being encouraged to drink plenty of fluids to guard against dehydration on the day of the inspection visit. The weather was very hot and humid at the time. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff promoted service users’ right of access to health and specialist services. Personal support was provided to maximise service users privacy, dignity and independence. Personal care practices were subject to regular review within the team to ensure an appropriate balance between staff’s duty of care and rights of service users to exercise control over their lives. Medication practices promoting health. Ageing, illness and death of service users was managed appropriately. EVIDENCE: All service users living in the home required assistance with personal care. In the care records sampled the individual personal care needs of service users were documented in care plans. Care practice and routines for daily baths and twice daily showers for some service users was discussed with support workers. The inspector was informed that practice was subject to regular discussion within the team to ensure this was based on equality principles and rights and choice considered. It would be helpful to include in care plans the frequency of baths and showers and to be explicit regarding how to recognise through behaviours and gestures when service users do not wish to have a bath or shower. Staff confirmed that only female staff engaged in intimate personal care practice for female service users in accordance with the Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 17 organisation’s gender policy. Discussed was the need to ensure equal opportunity in this matter is also extended to male service users. The needs of service users determined deployment of female only waking night staff at the home. Service users were registered with a general practitioner, (GP) and visited the medical practice as and when necessary with staff support. There was access to specialist support and advice if required. Service users also benefited from regular aromatherapy and reflexology session from a qualified therapist. The home had minimal rules and service users were stated to have some choice of staff working with them. The records demonstrated that staff monitored the health of service users effectively. Waking night support worker used a two - way alarm for monitoring risks relating to nocturnal seizures for a service user with a history of epilepsy. The team encouraged service users to lead healthy lifestyles by promoting opportunities for exercise. In addition to walking, swimming and bowling, service users used a treadmill and exercise bike that they had collectively purchased. There were clear risk management strategies in place for use of all exercise equipment. The key worker of a service user imminently due to be admitted to hospital for a surgical procedure had produced a detailed, holistic care plan for that individual. This was intended as a guide for hospital staff providing a baseline of his needs, goals and aspirations. Also to aid communication and suggest suitable techniques and strategies for responding to his needs and management of behaviours. Some staff expressed anxieties about this individual’s reaction to being cared for by hospital staff he did not know. It was stated to be not the policy of the Avenues Trust to deploy staff to stay with service users when hospitalised. The team had discussed daily visits to the hospital during his stay involving other service users to support and reassure this individual. Since the last inspection the home had changed pharmacy supplier. Observations of the storage, recording, administration and disposal of medication confirmed the management of medication was satisfactory. A monitored dosage system was in operation. Staff responsible for medication administration had received appropriate training including assessment of practice. Medication prescribed for administration ‘as required’ (PRN) was administered in accordance with written protocols. These described clearly the circumstances in which PRN medication should be administered, promoting consistency of practice. Medication prescriptions were reviewed at least annually by the GP. Discussed was the need to ensure that PRN medication protocols were also regularly reviewed. Homely remedies were approved by the GP. Discussed was the need to stock the approved analgesic for administration if required for service users. The stock supply of the drug was marked ‘for staff use only’. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 18 Health action plans were being further developed and future training planned for staff in this area. Service users had access to optician’s, dental services and dietician advice if required. Weights were monitored and records maintained. Other clinical observations were monitored and recorded in accordance with individual care plans. Regular breast screening appointments were made for individual service users. The practice of staff cutting service users toenails was noted. It was recommended that staff receive appropriate foot care training. On the file sampled the wishes of relatives had been explored specific to death and dying and these recorded on service users files. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaint procedure was accessible to service users and their relatives and had been effectively implemented in the past. Service users were well protected by the organisation’s recruitment practices. The whole team had received recent refresher training on safeguarding vulnerable adults and staff new in post had also received this training as part of their induction. A shortfall in standards for safeguarding vulnerable adults when the home manager is off duty has been addressed. All staff had access to the organisation’s whistle blowing procedure. Those interviewed were clear of what action to take in the event of an allegation or suspicions of abuse. Since the last inspection an incident was reported to the police in which money belonging to a service user could not be accounted for. Whilst financial practices had since been reviewed observations identified this to be an area requiring further improvement. EVIDENCE: Service users did not have meetings with peers but were included in staff meetings. These were stated to be managed sensitively giving due regard to confidentiality. The home had a comprehensive complaints procedure and service users had access to a pictorial format complaint procedure in their Service Users Guides. There had been no complaints since the previous inspection. The home manager and staff were aware that service users were disempowered through the degree of their disabilities from using the complaint procedure. The home manager had raised the lack of advocacy for three of the service users with care management. Communication difficulties of service Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 20 users inhibited efforts by the inspector to establish from them directly their feelings of whether they were listened to by staff. Procedures and policies were available for staff’s reference relating to safeguarding vulnerable adults, confidentiality, bullying and whistle blowing. The staff recruitment policy required all new staff to have an enhanced disclosure issued by the Criminal Records Bureau before taking up post. Since the last inspection an incident had been investigated under multi-agency vulnerable adult protection procedures and had been unsubstantiated. The home manager was following up practice issues arising from this. Whilst the organisation had robust safeguarding vulnerable adults procedures in place these had not been followed by the senior support worker to whom this incident had been reported in the absence of the manager. The whole team had since received refresher training on safeguarding vulnerable adults and on the relevant procedures. Discussions with the manager at this time confirmed the need for her to clarify her own responsibilities within her job description relating to staff suspensions or other action for safeguarding vulnerable adults. Observation of systems and procedures for the management of finances in the home identified some shortfalls. Key holding practices were not in accordance with the organisations procedures. It was recommended that the home implement the evopack system available to her for the safe storage of service users money. Also for records to be maintained of service manager’s authorisation of money withdrawals from service users’ accounts exceeding the amount permitted without authorisation. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 21 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, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This family-scale home provides a comfortable, good standard of accommodation suitable to the needs and lifestyles of those accommodated. The home was clean and hygienic and designed to maximise independence. EVIDENCE: The environment of the home was comfortable, clean and tidy and overall well maintained. Services and facilities were appropriate to meet the needs of service users and the home’s location was central to village shops and other community amenities. The all-single occupancy bedrooms afforded a good standard of accommodation that had been decorated to reflect the individual tastes and interests of service users. The individual needs of a service requiring a low arousal environment were balanced against the groups needs. Particular attention had been given to provision in this individual’s bedroom. There was an ongoing programme of redecoration in the home. Communal areas were domestic in character and suitably equipped. Service users had access to a large, well maintained, secure furnished garden. Exercise equipment was available for service users’ to use in the pleasant sun lounge Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 22 overlooking the garden. The environment had been suitably assessed for specialist aids and adaptations to meet individual needs. A walk - in shower facility was available on the ground floor. The utility area containing a washing machine and tumble dryer was suitably secure. The garden was tidy and safe. A new shed was being erected and the home manager reported awaiting agreement to her request to convert the brick built separate building in the grounds currently used for storage. The team wished to use this as an additional activity area. This area would need new floor covering, a system for heating and redecoration. The home manager was aware of the need to consult all relevant agencies regarding this proposed development. The senior support worker in charge stated that new radiator covers were on order. Also the broken bath panel in the first floor bathroom had been reported to the maintenance department. Attention was drawn to the need for suitable paper hand towels to be provided in bathrooms and toilets. Noting this provision was stated to not be made owing to behaviours of individual service users it was suggested the home manager consult other home managers within Surrey who had managed to overcome this problem through provision of alternative supplies. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 23 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, 35 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff on duty were enthusiastic and committed to supporting service users in a way that ensured their needs were met. There was evidence of effective team working. Staff on duty demonstrated they had the skills and experience relevant to their role and responsibilities. A programme of staff training and development was ongoing including NVQ training. The standard was not met however for 50 of support workers to have a care NVQ Level 2 or equivalent. Owing to personnel records not being accessible at the time of the inspection it was not possible to fully evidence that recruitment policies and procedures safeguarded service users. Information received from recently appointed staff and past evidence indicated thorough recruitment procedures were followed. EVIDENCE: The senior support worker and support workers present at the time of the inspection demonstrated an understanding of the needs of service users. They reported enjoying working at the home. Relationships between staff and service users were observed to be appropriately informal and friendly. Staff were mostly skilled in their communication with service users. Discussed at the inspection visit were observations that staff were not using makaton signing to aid communication with a named service user even though indicated this should be used. It is acknowledged that two staff were new in post and had Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 24 not had makaton training. All service users were stated to understand verbal communication. Consultation with the home manager by telephone confirmed the operation of the home had significantly benefited from a recent successful recruitment initiative. Two new support workers had taken up post since the last inspection and another had been recruited and was going through vetting procedures. The team had further benefited from the transfer of an experienced, suitably qualified support worker to the home from another Avenues Trust home. It was noted that one of the senior support workers was currently deployed in another care home however whilst undertaking ‘fast track’ management training. There had been no turnover in staff since the last inspection. The manager was aware of some staffing issues, which were receiving attention. Personnel records were stated to be stored on the premises however these were not accessible for inspection in the absence of the manager. It was therefore not possible to verify that these records contained all statutory information and full vetting procedures followed. Information from staff recently recruited described thorough staff recruitment and vetting procedures. It was stated that new staff had not been permitted to take up post until full CRB Disclosures were received, including POVA checks. All staff had training portfolios. Those sampled evidenced induction training, which included first aid, basic food hygiene, health and safety, COSHH, moving and handling and safeguarding vulnerable adults training. Foundation training and NVQ training was in place. All staff completed learning workbook within their six-month probationary period linked to NVQ level 2 training under the Learning Disability Award Framework. The home employed three first level nurses. Two senior support workers held NVQ in care Level 3 qualifications and one support worker was working towards this qualification. Since the last inspection the home manager had undertaken training needs analysis for the staff team. Individual and collective training needs of staff were being addressed through a training programme. Recent training additional to statutory training in accordance with the organisation’s policy included managing diversity, epilepsy, safeguarding adults, information technology and administration of medication. Planned future training included nutrition, makaton, information technology, financial techniques; person centred planning tools and management, health action planning and intensive interaction. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 25 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, 40, 41, 42 Quality in the outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home had improved since the last inspection. The manager had made application for registration and this was being processed. She was noted not to be studying currently for qualifications at level 4 NVQ in both management and care. Quality assurance and quality monitoring systems involved consultation with relatives/advocates of service users. Policies and procedures safeguarded service users rights and best interests. Whilst mostly the health, safety and welfare of service users were safeguarded some shortfalls were identified in this area. EVIDENCE: The manager had submitted an application for registration since the last inspection and this was being processed. She was experienced in the care of adults with learning disabilities however does not have qualifications in management and care at NVQ Level 4. Contact with the manager during the inspection confirmed that she was no longer enrolled on the registered managers award programme but stated her intention to apply to study for this Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 26 qualification in the near future. Observations of records and the overall operation of the home confirmed significant improvement in the home’s management and administration since the last inspection. The home manager reported good support from her line manager following a recent change. She also attributed positive changes to an increase in senior support worker hours following the transfer of an experienced full time senior support worker to the home in December 2005. This had enabled further delegation of responsibilities as appropriate. Also the home manager accredited improvements to team effort, the recruitment of additional permanent staff and increase in numbers of staff approved as drivers. Staff consulted were positive about the manager’s management style, which was described as inclusive. Those interviewed considered the home to be well managed and stated they received adequate direction from the home manager. There was evidence of practice mostly reflecting the home’s policies and procedures. The home had a comprehensive list of policies and procedures and a program for reviewing and updating procedures was evident. Staff had access to all relevant policies and procedures. Medical records and personnel records were stored confidentially. All other records were records stored openly on shelves in the office/sleep in room. The office was understood to be usually locked when not in use. Throughout the service there was a good understanding of the equality and diversity needs of service users. Staff were confident in delivering good quality outcomes in the areas of age, disability, gender and beliefs. Internal quality assurance and monitoring systems had improved since the time of the last inspection. External monitoring systems included monthly visits by the regional manager on behalf of the responsible individual in accordance with statutory requirements. Monthly provider visits focusing on outcomes for service users were structured by relevant national minimum standards. There was contact and discussion between the regional manager and the inspector at the time of the inspection. A new development had been written incident data analysis for each home supplied monthly by staff from the organisation’s quality assurance department. For the past 18 months the quality department had focused on person centred planning implementation in homes, providing input, support and training to staff teams. Quality auditing systems were in evidence. An annual survey of the views of relatives/advocates had been last conducted in August 2005. It was recommended that a record be held with the returned questionnaires detailing any action taken to address shortfalls in standards highlighted by feedback. Arrangements for the health, safety and welfare of service users and staff though mostly adequate did require some attention. Health and safety checks had been carried out this month but there were noted to be times when these Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 27 audits were missed. Specifically wedging open lounge and kitchen door, which was necessary for operational reasons; also for meeting service users needs. It was positive to note individualised fire safety protocols for service users where risks had been identified by the home’s fire risk assessment. Regular fire drills were evident and in accordance with policy at least one fire drill annually took place on night duty. The need to ensure night drills were carried out at a reasonable hour was discussed with the senior support worker in charge at the time of the inspection visit. It was noted that portable electrical appliance testing was overdue. The inspector was informed that twice this had to be cancelled outside of the home’s direct control. Attention was drawn to the requirement to display a current public and employers liability insurance certificate. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 1 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 3 12 3 13 4 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 1 x 3 3 2 2 x Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 6(a)(b) Requirement For the statement of purpose and service users guide to be updated and forwarded to the CSCI. This requirement is brought forward from the last two inspection reports. Timescales for compliance by 05/11/05 and 08/01/06 were unmet. Timescale for action 08/08/06 2 YA6 15(2)(b) 17(1)(a) 3 YA9 YA42 4 5 6 YA24 YA30 YA32 For care plans to be all updated at the time of reviews also risk assessments and records maintained of review meetings. Some care plans require further development. 13(4)(a)(b)(c) For the open storage of toiletries, disposable razors and prescribed ointments and creams in some bedrooms to be supported by records of risk assessments. 23(2)(b) For replacement of the broken bath panel in the first floor bathroom. 16(2)(j) For provision of suitable hand drying facilities in toilets and bathrooms 18(1)(a) For the home to have a clear DS0000013852.V299312.R01.S.doc 08/07/06 15/06/06 08/08/06 08/08/06 08/09/06 Page 30 Heathlands (Walton-on-the-hill) Version 5.2 7 YA34 19(1)(a) Sch 2 strategy to ensure 50 of staff including bank or agency staff have a minimum of NVQ in care level 2 qualification or equivalent. Details of the action being taken for compliance to be supplied to the CSCI within this timescale. For personnel files to contain all statutory documentation and CRB records maintained containing all information in accordance with CRB policy. This requirement is brought forward on the basis that access was restricted to the necessary files at the time of the last two inspections. It was therefore not possible to evidence this requirement is met. For the home manager to have qualifications in management NVQ Level 4. Details of the action taken for compliance to be provided to the CSCI within this timescale. For a current public and employers liability insurance certificate to be displayed. For night fire drills to be conducted at a suitable time. For portable electrical appliance testing to be carried out. For further review of fire safety in the practice of wedging open the lounge and kitchen doors. Consideration could be given to fitting battery operated door guards in consultation with the fire officer. 08/07/06 8 YA37 9(2)(b)(i) 08/08/06 9 10 11 12 YA41 YA42 YA42 YA42 25(2)(e) 12(1)(a) 23(2)(c) 23(4)(c)(i) 08/07/06 15/06/06 08/08/06 08/07/06 Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA17 YA19 YA20 YA23 Good Practice Recommendations For menus to be produced in pictorial formats. For staff to receive formal training in foot care which includes cutting toenails. For PRN medication protocols to be regularly reviewed. For review of key holding and financial practices and record keeping to ensure compliance with the organisation’s own policies. It is also recommended that the use of the evopack system be implemented for the safekeeping of service users money. Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Heathlands (Walton-on-the-hill) DS0000013852.V299312.R01.S.doc Version 5.2 Page 33 - 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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