Inspection on 01/05/07 for Hemmet House

This inspection was carried out on 1st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Hemmet House 76 Bedington Gardens Carshalton Beeches Surrey SM5 3HQ Lead Inspector Adrian Gordon Key Unannounced Inspection 1st May 2007 10:00 Hemmet House DS0000068518.V337309.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 Hemmet House DS0000068518.V337309.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. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hemmet House Address 76 Bedington Gardens Carshalton Beeches Surrey SM5 3HQ 020 8788 3947 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) Independent Lifestyle Options Ltd Philip Richard Williams Care Home 7 Category(ies) of Physical disability (7) registration, with number of places Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection New service Brief Description of the Service: Hemmet House provides accommodation for seven disabled adults. It is situated in a quiet residential area close to the shops and facilities of Wallington in Surrey. Bus and train links are also located nearby. Two floors are wheelchair accessible and a lift provides access to the first floor. Information about the service is available in a comprehensive Statement of Purpose and Service User Guide. Fees for the service are £995 per week. There may be small variations according to local authority increases. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and completed over the course of one day. The inspection consisted of a tour of the premises, examination of records and observation of care practice. We met all the residents, one relative, four members of staff, the manager and the registered provider. Feedback questionnaires were received from all the residents, six relatives and six members of staff. What the service does well: What has improved since the last inspection? What they could do better: The service has achieved good or excellent judgements in all outcome areas. However, to further protect the welfare of people who live at the home, medication records must be improved and staff recruitment records must hold all the required information. Although it is good that Individual Support Plans promote the social goals of residents, these must be made more extensive to include all identified needs. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents are fully involved in the process of moving to the home. EVIDENCE: A detailed Statement of Purpose and Service User Guide is available. The Guide holds useful information about the home, including a statement of resident’s rights. This has been given to each person that lives there. The people who chose to live at Hemmet all lived at the same establishment previously. They were able to visit the building while it was being developed and make suggestions about fixtures, fittings and adaptations. Most residents were able to choose which room they wanted. One person said ‘when I saw the house on my first visit I knew this was where I wanted to live’. The manager and some of the staff team knew the residents beforehand and had a good understanding of their needs already. This has made the transition much easier. Needs assessments are in place for each resident and cover areas such as personal care, communication, personal safety and medical history. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. 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. The person centred service provided ensures that residents are fully consulted and supported to take risks of their choosing. EVIDENCE: Individual Support Plans are in place for all the people that live at the home. These focus on the social needs for each resident, including what they would like to achieve and how best to support them in doing this. However, not all assessed needs are included in the support plan, for example one resident needed to do regular physiotherapy exercises, but it was not specified in their plan how to support them in this. Support plans were also not dated which makes it difficult to carry out a review on time. Residents confirmed that they are involved in taking decisions in all aspects of their care and the running of the home. One relative commented that the residents ‘are able to decide how they live their lives in the say way as Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 10 ordinary members of the community’. Records of resident meetings showed good involvement. The Service User Guide makes it clear that residents are encouraged to ‘have a real say in the development of services available…’. Risk assessments are in place and these are up to date. A statement in the Service User Guide makes it clear that residents ‘have the right to take personal responsibility for (their) own actions and expect all staff to accept that a degree of risk is involved’. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy varied lifestyles and take an active part in the local community. An excellent range of meals is enjoyed by all. EVIDENCE: There is a strong emphasis on meeting the social needs of people who live at the home. Hemmet House is close to local facilities such as supermarkets and banks. There are also two local college that provide adult education, a nearby leisure centre and accessible pubs and restaurants. The home has an adapted vehicle to transport residents if needed. Residents are assisted to participate in adult education or voluntary work. One resident talked about how they do help out at a wildlife centre which they clearly enjoyed. Other recreational activities available include swimming and drama. On the day of the inspection, some residents had enjoyed wheelchair dancing. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 12 The Service User Guide has a statement of resident’s rights. These include the right to receive an anti-discriminatory service, the right to live their own lifestyle, and the right to invite who they choose into their room. One person commented that a relative living in the home had their cultural needs met and there were no problems. A light hearted menu meeting was observed where residents reviewed last weeks meals and made suggestions for the coming week. Ideas for the menu were creative and it was clear that food was enjoyed by all. Main meals are made from fresh ingredients and fruit is always available. Equipment to assist residents to eat independently is available. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Healthy lifestyles are promoted, however medication recording must be improved in order to further protect residents. EVIDENCE: Residents were observed to be supported in the way that they wanted. One resident said ‘it is our house and staff are in the background to help when needed’. The manager said that this approach was important, so that independence is promoted and residents see the home as their own. All the people who use the service are registered with a local GP. Staff are aware of the health needs of residents and how these are to be met. Support from external professionals, such as physiotherapists is available if required. Health Action Plans are not in place but are being developed. The medication folder contains relevant procedures and a list of staff authorised to administer medication. Risk assessments are in place for Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 14 residents who self administer. There were some inconsistencies on Medication Administration Record (MAR) sheets. One medication stated ‘use as directed’ on the MAR sheet and the container. This is not a clear direction. One medication stated on the container ‘avoid grapefruit juice’, but this was not written on the MAR sheet. There were two unexplained gaps on the MAR sheet for Baclofen liquid and when this was replaced by tablets, the MAR sheet was confusing. Medication profiles, which explain details of medication, reason for it being taken and any side effects were not in place. However a member of staff started to work on these when it was pointed out. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information about how to complain is provided, which ensures that all residents know who to approach if they have concerns. EVIDENCE: A complaints procedure is in place and is included in the information given to the people that use the service. All residents confirmed that they knew how to make a complaint. No complaints have been received by the CSCI or the home since it opened in December 2006. Two compliments from relatives have been recorded. A policy for the Protection of Vulnerable Adults (POVA) is in place. As part of their induction when the home opened, staff were informed about abuse issues. Training for staff on POVA is being provided later in May 2007. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good standard of living due to spacious, well furnished communal space and a large garden. EVIDENCE: Hemmet House is a large attractive property in a quiet residential area and in keeping with neighbouring houses. The home is laid out over three floors. The ground floor has a large lounge, dining area and kitchen which are well furnished and spacious. The kitchen has lowered surface so that wheelchair users could make use of it. Original artwork on the walls gives the place a homely feel. There is access to a large, well maintained garden at the rear. Bedrooms are located on all three floors and there is an accessible lift from the ground floor to the first floor. Stairs lead up from the first to second floor. Bedrooms are suitable for the people who live there, and specialist equipment Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 17 is available for those that need it. Wi-fi is available throughout the home for residents that want to access the internet or send emails. The home was clean and maintained to a high standard. From observation the kitchen/dining area was used as a place where people gathered informally to chat and relax. One resident uses a portable hoist to assist in using the bathroom. In order to promote independence the home should consider installing a ceiling track. The manager said that this had been considered at planning stage but ceilings did not have the necessary strength. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good, person centred service from a competent, knowledgeable and supportive staff team. EVIDENCE: Many of the staff team knew the people who use the service before they moved in. This has made the transition a lot easier for residents as the team know their needs well. Staff get on very well with residents and the atmosphere in the home was light hearted and relaxed. One resident said that ‘staff are very helpful and supportive’. Recruitment records are well organised and include application forms, a Criminal Records Bureau Disclosure and contract of employment. Some records did not contain proof of identity or a photograph, and one person only had one reference. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 19 An induction checklist is used for all new staff. Training is in line with Skills for Care guidance and covers areas such as Medication, Manual Handling and Disability Awareness. One staff commented that ‘training is excellent’. Supervisions are well recorded and demonstrate that staff are supported in their role. Work issues are reviewed and goals set, together with any action needed to make them happen. Comments received from staff include ‘management always have time to listen to staff input’ and ‘we…are able to approach management with confidence’. All six questionnaires received from staff were positive about the support they receive. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management approach to the home ensures that the service is run in the best interests of people who live there. EVIDENCE: The registered manager has a lot of relevant experience and will shortly complete the Registered Managers Award. He is keen to develop a service that is centred around the people that live there and to make it a ‘family’ environment. The registered provider is also closely involved in the home and helps out in day to day activities, particularly cooking. Feedback about management from staff, residents and relatives was entirely positive. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 21 The home has only been open for five months but ongoing feedback about progress is welcomed by management. This comes from residents, relatives and staff during meetings or informal chats. A questionnaire has been developed to gain more formal feedback on the service. Monthly monitoring visits are also being carried out. Necessary health and safety checks are in place and the manager carries out a monthly inspection of the premises to ensure safety is maintained. Weekly fire point tests are carried out. Information about the Control of Substances Hazardous to Health (COSHH) is not detailed enough and data sheets for all chemicals must be obtained. COSHH materials are stored appropriately. Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 22 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 4 2 3 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 X 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 4 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 4 3 X X 2 X Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 30/06/07 2 YA20 13(2) 3 YA34 19, Schedule 2 13(4) 4 YA42 To promote the welfare of residents, Individual Support Plans must show how all needs will be met, and the Plans must be dated. In order to further protect the 04/06/07 health of residents, Medication Administration Record sheets must give clear directions and have no gaps in recording. Medication profiles must be in place. To further protect residents, 30/06/07 recruitment records must contain al the information required by the Regulations. In order to minimise risk to staff 30/06/07 and residents, data sheets must be obtained for all Control of Substances Hazardous to Health materials Hemmet House DS0000068518.V337309.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA29 Good Practice Recommendations To promote independence and assist mobility it is recommended that ceiling tracking be installed rather than rely on a portable hoist. 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