Inspection on 22/01/08 for Hibernia

This inspection was carried out on 22nd January 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Hibernia Freehills Dodwell Lane Bursledon Southampton Hampshire SO31 1AR Lead Inspector Beverley Rand Unannounced Inspection 22 January 2008 10:25 nd Hibernia DS0000070466.V355005.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 Hibernia DS0000070466.V355005.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. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hibernia Address 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) Freehills Dodwell Lane Bursledon Southampton Hampshire SO31 1AR 023 8040 7354 Hiberbnia@ilg.co.uk Iliace Ltd Mr Matthew David Hibberd Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 5. Date of last inspection N/A Brief Description of the Service: Hibernia is a new service which can accommodate up to five service users with a learning disability. The home is located in a rural area with fields and woodland around it. The home is divided into a one-bedroom self-contained annex and a further four bedrooms, with a communal lounge/dining area and kitchen. Three bedrooms have en-suite facilities with showers and the fourth has a hand basin and sole access to a large bathroom along the corridor. There is ample parking in the front garden and the back garden is divided into two, so that the annex has its own garden. The current fees were not known as service users are funded by the local authority. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the first inspection of this new service and was unannounced. The manager completed the Annual Quality Assurance Assessment, (AQAA) before the inspection. We used the information in this to inform our inspection. We did not receive any completed surveys from relatives. During the inspection, we were unable to talk to service users because of individual needs, but were able to observe some staff interactions with people living there. We also spoke to staff and looked at records such as care plans. The manager was not working in the home on the day of the inspection but he did visit during the afternoon to speak with us. What the service does well: What has improved since the last inspection? This was the first inspection of the home. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hibernia DS0000070466.V355005.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 Hibernia DS0000070466.V355005.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager undertakes full assessments before a new service user moves into the home which ensures their needs can be met. EVIDENCE: The manager told us that referrals are made to a central assessment team within the organisation, who gather as much information as possible from different sources. The information is then passed to the manager, who visits the prospective service user along with a staff member from the assessment team. We looked at assessments for the two service users who live at the home and found them to be thorough, including all aspects of support required and personal preferences. Prospective new service users then visit the home on several occasions, meeting staff and other people who live there. The manager knows the importance of a thorough assessment to ensure that service users are as suited to living together as possible. Hibernia DS0000070466.V355005.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are detailed and reviewed regularly to ensure the home meets the needs of the service users. Service users can make decisions and take risks in every day activities. EVIDENCE: We looked at the care plans for the two service users and found them to be very detailed. They contained a range of information that is important to service users, including information about risk assessment, how they keep safe, their goals and aspirations, how they communicate, their skills and abilities and how they make choices in their life. There were completed forms for likes and dislikes regarding, for example, food. The plans are reviewed every month and amended where necessary. We spoke to staff who were aware of the relevance of the care plan and were informed as to when changes had been made. We also spoke about how service users have input to their care plans. Currently, due to the specific needs of the service users, there is no written involvement but staff feel they are responsive to behavioural clues that part of the plan may need to be changed. Changes to care plans indicate that Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 10 this is the case. The manager said he has been working on the folders which contain all the information about a service user, so as to organise the information into more easily accessible folders. Records showed that service users engage in many different activities outside of the home with staff support. Risk assessments were in place to support these activities, for example, with regard to travelling in a vehicle. Hibernia DS0000070466.V355005.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): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff ensure that service users spend their time as they wish, both at home and in the community. Relationships are promoted and supported and staff respect service users’ rights. Service users are involved in choosing menus and trying new food. EVIDENCE: Staff said that they try to ensure service users undertake some sort of activity twice a day, either at home or in the community. Neither service user goes to college, work or a day centre which staff said was because of personal preference. The service users go out with staff for meals, walks, trampolining and so on. The manager has said in the AQAA that the current service users do not access the community as often as they could, due to their own needs. Staff spoke in a way which showed they were open to seeking new activities and would respond to changing needs. Staff described how they had introduced a new activity for one of the service users by increasing staff to support, taking him there, one staff member going in with a camera and taking a picture. The activity session was booked, but the service user was given the choice to go in Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 12 or not. By booking the session ahead it meant he could have a go straight away, but the staff were clear that the choice was still his if he did not want to. The view was therefore that it was better to book and possibly waste the session than for him to not be able to go until another day. Staff promote service users’ relationships with families. They told us that visitors were made welcome, offered a drink and a biscuit, and could stay for a meal. We have not received any surveys or feedback from relatives. Service users choose their meals, using photographs. One service user has particular issues about the storage of food, and staff have made adjustments to the home’s practice to reduce the anxiety. One service user sometimes likes to stand and watch food preparation rather than make his own food. Staff said one of the service users’ prefers plain food, but that he does sometimes show an interest in what they are eating, for example, the same meal but with sauce. He is then given some to try and if he likes it, his care plan would be amended. Hibernia DS0000070466.V355005.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are met in ways which suit them as individuals. EVIDENCE: Care plans clearly show how to provide personal support to the service users, in their preferred way. Routines are in place for all aspects of personal care. Staff said they all worked in the same way, following the plan. It was evident that each plan was different, reflected individual needs and was based on knowledge of the service users. Triggers for challenging behaviour were well known and creative strategies were in place to reduce these behaviours. Each service user is registered with a local doctor and files showed evidence of visits to the doctor. Staff said the service users were generally quite fit. Neither of the current service users can administer their own medication. Medication was stored appropriately. A Medicines Administration Record, (MAR) is kept for each service user. However, current practice for one of the service users is for the MAR to be signed at the end of the staff shift, not straight after the medication is taken. This is due to the individual needs of the service user, Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 14 and other measures are in place to ensure the staff member does complete the MAR before they leave the home. However, the Royal Pharmaceutical Society guidance, ‘Handling medicines in social care’, identifies the importance of recording immediately. This issue was discussed with staff and the manager, and it was felt there was a solution to this which would meet both the guidance and the service user’s needs, and the manager agreed to change the practice. The MAR sheets also listed a medication for one service user which had never actually been prescribed. The manager said he had tried to get the pharmacy to amend the MAR, but without success. He agreed to try again as MAR sheets must be accurate. The manager said that only staff who have received training in, ‘The Safe Handling and Administration of Medication’ administer medication. Some staff have received local training from the pharmacy and the manager wants to ensure all staff undertake this training. Hibernia DS0000070466.V355005.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure service users can make their views known. Staff are aware what to do to protect service users if there was a suspicion of abuse. EVIDENCE: The AQAA states there is a complaints/ concerns box in the reception area which is confidential and sets out timescales for response and is available to anyone entering Hibernia. There are also monthly key worker meetings, where complaints and concerns could be heard. The complaints procedure is also available to staff and service users. The home has not had any complaints and we have not received any. The training programme includes Adult Protection and the home has an appropriate policy in place. One staff member told us they had not received any training in this area but the manager said the issues are discussed during the induction and that staff attend training as part of an ongoing programme. Staff were aware of the procedure to follow if there was an allegation or suspicion of abuse. The home looks after the money on behalf of the current service users. The manager has put a system in place, using petty cash, to ensure that service users can access their funds at any time, not just when the manager is in the home. Occasionally, service users go out for a drink and a meal, and two receipts were found which show more than one meal/food item and drinks. The manager said it was likely that the food was eaten by the service user but felt Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 16 that he was unlikely to have had the number of drinks on the receipt: therefore service users had paid for staff drinks. The manager and staff told us that they have recently discussed the issue regarding who should pay for drinks and meals when staff support service users into the community. A policy could not be found which could confirm the issue. We were concerned about this as the current service users would be unable to give informed consent to this practice, and there was no paperwork to evidence this decision being made. However, the manager said that the parents had agreed the practice, and that the parents received their sons’ benefits and gave money to the home to look after on a regular basis, being in a legal position to do so. This is an issue which must be addressed, particularly for future service users who may manage their own finances, to ensure their financial interests are protected. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that service users live in a homely and clean home. EVIDENCE: The home was clean, light, airy and well decorated. We looked at the communal areas and two bedrooms which are vacant. Furniture and furnishings are of good quality. There was evidence around the home of communication with service users such as Picture Exchange Communication drawings which showed where the milk was kept and so on. Service users have personalised their own space and their artwork is displayed. The home was in a state of good repair. Whilst the home has only been open since last year, we were told that if there is a maintenance issue it is dealt with quickly. The home has a laundry which was clean. Staff explained the procedures they followed to ensure minimal risks of cross infection. They also confirmed that Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 18 there were plenty of disposable gloves available which they used appropriately. Liquid soap and paper towels were provided in communal areas. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 19 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, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by trained staff and robust systems are in place to ensure new staff only start work after recruitment checks have been completed. EVIDENCE: Staff confirmed that there were always enough staff on duty to comply with individual care plans and that the use of agency staff was limited as far as was possible, due to the needs of the service users for consistency. The manager said that when agency staff were needed, the agency provided written information about their recruitment checks and so on. A photograph board is updated on a daily basis showing which staff are working in the home on that day so the service users know who will be working with them. Staff told us that Hibernia was a nice place to work. The manager has said in the AQAA that recruitment is his responsibility and that checks such as Protection of Vulnerable Adults, Criminal Records Bureau and references are all completed before staff are work at the home. We looked at the records for two new staff and this was found to be the case. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 20 New staff undergo an induction and the manager ensures that a record is kept of this so that everyone knows what was covered. The training department sends details of every month with regard to what training is planned. The manager said that he identifies training needs, books staff onto courses and lets them know. Training includes First Aid, Infection Control, Fire Safety, Adult Protection and Medication. Five out of ten staff have achieved the National Vocational Award in care and the remaining staff are currently studying for it. The manager told us that staff receive supervision sessions either monthly or bi-monthly and staff confirmed this. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 21 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, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the interests of the service users and the home has a quality assurance programme underway to ensure the home continues to be run in this way. Systems are in place to ensure the safety of service users with regard to health and safety in the home. EVIDENCE: The manager was registered when the home opened. Whilst he has not been a registered manager before, he had three years experience in a senior role in care. He has achieved a National Vocational Qualification in Health and Social Care, level 3. Currently, he is working towards the Registered Manager’s Award. The manager has good systems in place for ensuring the home runs smoothly and says he receives monthly supervision sessions and good line management. Staff meetings are held monthly and staff have input to the agenda. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 22 Relatives have just been sent surveys to seek feedback about service users’ experience of living at the home. Employees are due to receive a similar survey soon. The manager also plans to involve advocacy workers to ensure service users’ views are known to staff. The organisation undertakes monthly visits to the home, as part of the quality assurance monitoring system. The manager has developed his own team monitoring form which he completes on a monthly basis. The checklist covers risk assessments, care plan reviews, key worker meetings, training and so on. He told us that the checklist is based on the national minimum standards. We looked in the fridge and found a quiche which was past its use by date by three days. Staff threw it away when we pointed it out to them. Fire records were up to date and equipment is checked regularly. Potentially hazardous cleaning fluids were all locked away to protect service users. Radiators are covered so that they do not scald service users. Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 Hibernia DS0000070466.V355005.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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