Inspection on 25/04/05 for Hirst Villas, 6

This inspection was carried out on 25th April 2005.

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 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

Hirst Villas, 6 15/04/08

Hirst Villas, 6 30/07/07

Hirst Villas, 6 18/09/06

Hirst Villas, 6 31/10/05

Hirst Villas, 6 06/12/04

Hirst Villas, 6 09/06/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Hirst Villas, 6 Bedlington Northumberland NE22 5QQ Lead Inspector Jim Lamb Unannounced 25 April 2005 09:30. 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 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 Stationary 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. Hirst Villas, 6 Version 1.10 Page 3 SERVICE INFORMATION Name of service Hirst Villas, 6 Address Bedlington Northumberland NE22 5QQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01670 531799 N/A N/A Northgate & Prudhoe NHS Trust Mrs Shelagh Burgess CRH 6 Category(ies) of LD Learning disability (3) registration, with number of places Hirst Villas, 6 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6.12.04 Brief Description of the Service: Hirst Villa provides personal care and accommodation for 3 female service users with learning disabilities. The home is located in a residential area of Bedlington, close to the town centre. The home is near to good tranasport links, with good access to local shops, the post office and other local amenities. The home is a converted semi detatched house, there are four single bedrooms, the home does not have a lift. All three service users have access to a very attractive rear garden with seating and a summer house. Hirst Villas, 6 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.30 am. It took place over four hours. The inspector spoke to two service users, one was present throughout the inspection and she showed the inspector around the house. The inspector had the opportunity to speak with three members of staff. Policies and procedures and the service users individual care records were also examined. What the service does well: What has improved since the last inspection? The home continues to provide high standards of care for the service users. The providers have always acted immediately to remedy any requirements or recommendations previously identified. Hirst Villas, 6 Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hirst Villas, 6 Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Hirst Villas, 6 Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 3 4 The home has a very detailed user-friendly statement of purpose and service users guide. Staffs have the necessary skills and experience to meet the needs of the service users. The home has appropriate admission procedures. EVIDENCE: Details of the extra charges and what these are for, are in the contract given to service users and are agreed prior to their admission. The homes Statement of Purpose and the Service Users Guide both contained the full range of information required. One service user interviewed confirmed she had been given a copy of the guide. Three service users’ files were checked and on each were a copy of a full needs assessment. They contained a range of appropriate information and the service user interviewed confirmed she was involved in drawing up both these initial assessments and the home’s subsequent service user plans. The 3 service user plans checked by the inspector were comprehensive, and listed details of service user’s needs and actions taken by the staff to meet these needs. Hirst Villas, 6 Version 1.10 Page 9 Two service users interviewed said their needs were met and they were happy with the care offered to them. Three care plans were checked and staff members interviewed. These confirmed that a range of specialist services was provided to service users. Staff interviewed had had a range of relevant training and experience. Hirst Villas, 6 Version 1.10 Page 10 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 standard(s) 6 7 8 9 The homes reviewing system is good with service users being supported and encouraged to have a voice and self-advocacy is promoted. Following detailed assessments staff enable service users to take risks, and they promote independence. EVIDENCE: There is evidence of a comprehensive assessment in the service users’ care plans. There is also a comprehensive risk assessment of service users. There was evidence of advocacy arrangements, as well as family input. Each service user has an allocated key worker. Care plans are drawn up with service users. There is evidence that plans are amended and reviewed on a regular basis. All aspects of standard 7 have been met; self-advocacy is promoted, service users can access a range of external agencies that promote independence, any rights that are restricted are linked to risk assessments. Hirst Villas, 6 Version 1.10 Page 11 Each service user receives support from staff to manage their finances. Service users’ all indicated that they are able to make decisions for themselves. Hirst Villas, 6 Version 1.10 Page 12 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 standard(s) 11 12 13 14 15 16 17 Service users are supported to use community-based activities and have opportunities for personal development. All are supported to pursue their interests and hobbies, maintain contact with family and friends and assist staff with the daily management of the home. Healthy eating programmes are well managed. EVIDENCE: Each service user has a practical life skills assessment carried out and this is reviewed and updated on a regular basis, all service users participate in this process. Validated intervention treatment programmes are accessed if a need does arise. I was informed that the service users have access to a range of communitybased services, which promote and provide opportunities to learn and use life skills. There was evidence that each service user has the opportunity to participate in community-based activities, including supported work programmes, education and training. Hirst Villas, 6 Version 1.10 Page 13 The staff team liaise closely with external agencies in order to monitor each service user progress. All service users are supported to maintain very close links with their families. All are able to choose who they want to see and when. There was evidence that daily routines promote independence, choice and freedom of movement. Service users are involved in housekeeping tasks. The inspector observed staff interacting in a sensitive and respectful manner with service users. The Home’s menus are based on the known likes and dislikes of the service users. At least two hot meals are provided on a daily basis. Service users have access to the kitchen and are able to prepare snacks for themselves if they wish. The service users that I spoke with said that the food was very good. Hirst Villas, 6 Version 1.10 Page 14 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 standard(s) 19 20 The arrangements to ensure that the health care needs of the service users are clearly identified and well managed. Medication procedures are appropriately detailed. EVIDENCE: No service users currently have any moving and handling needs. One service user mainly needs supervision and minimum help with her personal care tasks, such as bathing and dressing. Privacy and dignity are respected at all times. No service users currently have or require any technical aids or equipment. Two service users said that they felt their privacy is respected. There was evidence within the service users care records that they have access to external health care services. G.P.’s visit when necessary, and service users are referred for specialist health care if appropriate. All service users receive regular health care checks. I examined the records and the procedures for the administration of medication; these appeared to be appropriately detailed. The medication systems were examined for ordering, receiving and administering and disposal. All were found to be well maintained. I was informed that the dispensing pharmacist offers good support and advice. Hirst Villas, 6 Version 1.10 Page 15 Hirst Villas, 6 Version 1.10 Page 16 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 standard(s) 22 23 The service user present said that all complaints are handled fairly and objectively, she said that complaints are always taken seriously and acted upon. The homes complaints procedures should be provided in a format that is easily understood by all service users and potential new service users. Information of how to contact the CSCI must be included. EVIDENCE: The home does have a complaints procedure, which the inspector saw. It does not contain details of how to contact the CSCI to make a complaint, or is written in a way to ensure that service users fully understand its contents. One service users interviewed confirmed that she had been given copies of the procedure and that staff listened to their complaints and dealt with them fairly. She spoke of her key worker supporting her and helping her to complain. The home does keep a record of complaints. The home has a Whistle Blowing policy procedure as well as, the Local Authorities Vulnerable Adults procedures. The home also has a copy of the D.H. “NO SECRETS” for further information. The Home maintains detailed financial records on behalf of the service users; each has an individual bank account. There was evidence of personal spending and receipts are kept. Hirst Villas, 6 Version 1.10 Page 17 Hirst Villas, 6 Version 1.10 Page 18 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 standard(s) 24 25 26 27 28 29 30 The home is extremely well maintained, clean comfortable warm and safe. Each service user has a spacious single bedroom decorated to their own taste. No specialist equipment is currently necessary. EVIDENCE: On the day of the inspection the home was clean, well decorated and well maintained. The home is in a residential location. Two service users interviewed did say it was homely and comfortable. The grounds were tidy, safe, attractive and accessible. The fire service and the environmental health department had made visits to the home. Requirement made by these organisations had been actioned. The home does have an appropriate amount of sitting, recreational and dining space. There are sufficient rooms for a variety of activities to take place. Service users can see visitors in private in their own rooms. The dining areas are large enough to cater for all service users. There is a smoke-free sitting room. Hirst Villas, 6 Version 1.10 Page 19 Furnishings and fittings were domestic in design and in good condition. Lighting was sufficiently bright and also domestic in design. The home does have a sufficient number of baths, showers and toilets. These were close to bedrooms, lounges and dining areas. Doors had privacy locks. Room sizes did meet the minimum required. Room dimensions were such there was space on either side of the bed when necessary to enable access for carers and specialist equipment. Service users’ bedrooms checked all had opening windows. The rooms were centrally heated and the heating level could be controlled within each bedroom. Radiators and pipes were guarded. Lighting levels were sufficient and there was emergency lighting throughout the home. Water is stored at over 60°C. Valves are in situ at water outlets to ensure water is provided close to 43°C to prevent scalding. The home was clean and free from offensive odours. The laundry facilities appeared to be well organised. The washing machine has the specified programme to meet disinfection standards. Hirst Villas, 6 Version 1.10 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 36 There are sufficient staff employed to meet the needs of the service users. All are aware of each other’s roles and responsibilities. The staff confirmed that they receive regular training and supervision. EVIDENCE: Staff levels on the day of the inspection did meet the agreed level. Samples of 4 weeks’ rotas were checked and these stated the required numbers of staff were on duty: 2 staff between 8am and 9pm with one sleep-in between 9pm and 8am. Staff spoken to and service users interviewed said that staffing levels were appropriate. All the staff were over 18 years of age and those left in charge were at least 21. Training needs of staff are identified via supervision and appraisal sessions. The training programme has been reviewed to ensure it meets The National Training Organisation requirements for the first six months. Staff interviewed confirmed they receive three days paid training. Hirst Villas, 6 Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 40 41 42 The home is well managed and there are appropriate policies and procedures in place to ensure safe working practices. The health and safety of the service users is paramount EVIDENCE: The registered manager has many years experience in senior management, in the last year all of the staff team have attended several courses to keep themselves up to date. Staff interviewed were clear about the their responsibilities. Staff interviewed spoke positively about the manager saying she had encouraged both staff and service users to contribute to the development of the service. Service users are informed when inspections take place and have access to inspection reports. These are also summarised and discussed in service user meetings. Copies are available for relatives/others to see Hirst Villas, 6 Version 1.10 Page 22 The organisation has developed a range of new policies and procedures which have been linked to the National Minimum Standards. The records inspected were found to be appropriately completed, these included the fire log book, accident book, personal allowance records, Health and Safey manual, and I was provided with information which verified that appropriate maintenance contracts for the home are in place. Water storage tanks are checked annually. Finance records have previously been forwarded to the CSCI to verify that the home is viable. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No Hirst Villas, 6 Score Standard No 24 25 26 27 Version 1.10 Score 3 3 3 3 Page 23 6 7 8 9 10 LIFESTYLES 3 3 3 3 x Score 28 29 30 STAFFING 3 3 3 Standard No 11 12 13 14 15 16 17 4 4 4 4 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x 3 3 3 x Hirst Villas, 6 Version 1.10 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 22 Regulation 22 Requirement The home must provide service users with a user friendly complaints procedure and include details of how to contact the CSCI. Timescale for action 1 8 05 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 Good Practice Recommendations No recommendation were identified. Hirst Villas, 6 Version 1.10 Page 25 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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 Hirst Villas, 6 Version 1.10 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!