Inspection on 20/05/05 for HMT Care Ltd

This inspection was carried out on 20th May 2005.

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

The inspector found 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

HMT Care Ltd 08/06/06

HMT Care Ltd 28/09/05

HMT Care Ltd 26/11/04

HMT Care Ltd 02/08/04

HMT Care Ltd 19/01/04

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

CARE HOME ADULTS 18-65 HMT Care Limited 48 Albany Drive Herne Bay Kent CT6 8PX Lead Inspector Jenny McGookin Unannounced 20/05/05 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. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service HMT Care Limited Address 48 Albany Drive, Herne Bay, Kent, CT6 8PX 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) 01227 742992 HMT Care Limited Christine Janet Elizabeth Bone CRH 5 Category(ies) of Care Home for Younger Adults (18 - 65) registration, with number Physical Disability x 5 of places HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 November 2004 Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with neurodisabilities, particularly Huntingdons Disease. There are two homes in the group. Both homes caters for people of either sex, within the age range of 1865 years. 48 Albany Drive is a large Victorian detached house. Its layout extends over three floors with a small mezzanine landing, leading to the top floor. The Home has 5 spacious single bedrooms, each with its own en-suite toilet and wash hand basin facilities. There are two communal bathrooms/WCs (located on the ground and first floor), and a shower room on the third floor. The main kitchen is on the ground floor and there is a second on the first floor. The lounge/ dining room is on the first floor and there is a large multi-purpose room on the second floor, which is also where the designated smoking area is located. The property has an enclosed garden to the rear, which has a patio area, and discrete section for herbs, flowers and vegetables. There is garden to the front and side, laid to lawn with rose borders. There is off road parking for two vehicles, and unrestricted kerb-side parking. The Home is situated within easy walking distance of the local shops and amenities of Herne Bay. The Home can also be accessed from London via the M20/ M2 route, or a British Rail station nearby. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was intended to introduce the new inspector to the staff and residents; to check compliance with matters raised from the last inspection (November 2004); and to reach a preliminary view on the day-to day running of the home. The inspection process took just over nine and three quarter hours, and involved meetings with two residents, four support staff, the registered manager and two directors. The inspection also involved an examination of records and documents and one resident’s case file. All five bedrooms were inspected for compliance with the National Minimum Standards, and the inspector also checked some communal areas. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? What they could do better: HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 6 The layout of the home requires further investment / adaptation if it is to maintain its capacity to meet the needs of its residents. The staircase has, for example, proved to be hazardous, despite precautionary measures and a lift is planned. The directors acknowledge that there needs to be an adapted bath, as the current arrangement is not acceptable. However, plans to replace the existing WC / bathroom on the ground floor with an adapted bath and walk in shower need to address the question of access – as access through the kitchen area is not appropriate. A dedicated house vehicle is strongly recommended, suitably adapted to safely carry residents with neuro-disability – so that residents can continue to enjoy community resources. Some records need to be better secured. A legend is required for staffing rotas, so that anyone authorised to inspect them can evaluate compliance with the National Minimum Standards. One element of the staffing arrangement is, however, as described in the last two inspection reports (i.e. since August 2004). That is to say, the registered manager divides her time between the two homes owned by the Company. As the Requirement that she identified on the staff rota the management hours spent in this Home has not been addressed in sufficient detail it continues to be difficult to establish just how much time she actually spends managing this Home. This will continue to be a Requirement. 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. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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 HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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, 2, 3, 4, 5 1. Not all the documentary information necessary for potential residents to make an informed choice is available. 2. There is a systematic preadmission assessment process, which identifies needs, preferences and interests 3. This home was set up to provide a specialist service for people with Huntingdon’s Disease and accesses a range of specialist healthcare professionals and provides a counselling service to ensure it maintains its capacity to meet the residents’ individual needs. 4. Prospective residents or their representatives have the opportunity to visit the home to assess the quality, facilities and suitability of the services it offers for themselves. The admission process also includes a flexible trial stay, before each admission is confirmed 5. There is a contract governing each placement, underpinned by a Code of Practice for staff and a Charter of Rights for residents. EVIDENCE: A number of elements were missing from the Service Users’ Guide, so it is currently not fully compliant with the National Minimum Standard. No other languages are currently warranted. A taped version was produced – although HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 9 it had since been lost and had only been partially recovered. If this format is useful, it should be reinstated. Feedback on the day of this inspection indicated that the decision to apply to this home was influenced, in one case, more by its locality (close to where the resident and his family had lived) and, in both cases, limitations of the care home sector generally to meet the needs of people with Huntingdon’s Disease - than by any public information produced by the home itself. There is a standard preadmission assessment form, to ensure a consistent approach; to check the prospective resident’s suitability and to check the home’s capacity to meet their needs. The admission process routinely involves any care manager involved. One resident confirmed having visited the home before their admission and staying for a snack. The other resident was not able to visit and the decision to admit was made on their behalf. There is a trial period (usually a month, but this is interpreted flexibly and can extend to three months) before each admission is confirmed. Each placement is confirmed by a contract with the funding authority. Fees are set at a level to provide care that the Huntingdon’s Disease Association (HDA) requires. Any individual variations are to do with increases different boroughs are applying to the base level set by this home. Additional care needs are set six months later with the care manager. One contract, however, despite a set up date of 2003, made several references to outdated legislation and associated guidance, and will, therefore need to be updated. It also gave the option of complaints being referred to the Registration Authority only if it has not been possible to resolve the complaint. This is an incorrect interpretation of the National Minimum Standards. This must be attended to. HDA provides training, advice and professional workshops to underpin practice at the home. Both residents spoken to on this occasion spoke well of the care they had received at this home. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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, 10 6. The preadmission assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. Residents are involved in these processes as far as they are able to be. 7. Residents were observed being supported to make decisions, and observed interactions between staff and residents were respectful during this inspection. 8. Residents have a number of opportunities to influence their care plans, daily routines and the running of the home, and their level of involvement is a matter of personal choice. 9. There are risk assessments to cover individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information is generally satisfactory, though some documents were not properly secured within files. EVIDENCE: HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 11 The format of the care plan, which follows on from the preadmission assessment, is a comprehensive one, clearly designed to address the health and social care needs of the residents. These are in the first instance signed by the residents and their representative e.g. care manager. Less clear, however, was the extent to which residents were actively engaged in this process thereon i.e. at reviews, and how the home established the resident’s own perspective and any emerging unmet needs. One resident was teasingly dismissive of the process, and had to be reminded of the various ways in which he was consulted on a day-to-day basis. The other was aware that there was a care plan and was aware that there were meetings to check care plans out but did not seem otherwise engaged. Managing the behaviour and comprehension of individuals at different stages of Huntingdon’s Disease must be a central theme to this home’s practice, but care planning documentation needs to better reflect the practical steps required to address those individual needs. Examples could include the identification of specific triggers and management techniques. Care plans should be summarised monthly so that progress and trends can be tracked by anyone authorised to inspect them. Risk assessments are integral to the format of the care planning process (daily living routines, history of falls, safety, medication, finances) and summarised as appendices to the care plan documents. These summaries are signed by the resident and dated. HMT Care Ltd has a dedicated risk assessment co-ordinator who comes into the home every Wednesday or as required to carry out environmental assessments, which link with the personal care assessments carried out by the registered manager. The risk assessment co-ordinator also gets involved in inspections by other regulatory bodies, such as fire officers, and staff induction (health and safety, manual handling and fire safety). There are clauses governing confidentiality in placement contracts, and this is underpinned in the Code of Conduct outlined in the Service Users’ Guide. The residents’ right of access to their records is also summarised in the Charter of Rights in the Service Users’ Guide. The home keeps hard copy and electronic records. Cabinets, computers and office facilities are all properly secured. However, some documents and, in one case an account card, were not secured within files and this must be attended to as a precaution against loss or disarray. Each resident has a lockable cash tin to store money and valuables in, but these are easily portable and more secure provision needs to be arranged. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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) 12, 13, 15, 17 12. There is some choice and control over most aspects of daily routines Residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. 13. This home offers a limited range of activities inside and outside the home, and records activities 15. There are open visiting arrangements, and the home is well placed for access to local community resources. 17. Meals are enjoyed, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. EVIDENCE: Abilities, activities and personal preferences are established as part of the preadmission assessment process, and confirmed by care plans and day-today consultation thereon. This home offers support to residents in maintaining their practical life skills, and this is underpinned by confidential counselling sessions provided by one of the proprietors and the specialist therapies it buys in (speech and language, HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 13 physical and physio therapy). Residents were observed being supported to make decisions and choices during the inspection visit. There are recreational activities both on and off site, and opportunities to access local resources such as shops, seafront, cafes and pubs, gym, snooker, and football matches i.e. mainstream community activities not confined to or identifiable with disabilities. There is no company vehicle but staff have a casual car user allowance if they use their own vehicle to transport the residents. A dedicated adapted vehicle is recommended, so that access to the community is not frustrated by mobility impairment. Although one resident was teasing about the location of this home within the ageing population of Herne Bay, it soon became apparent that he was, nonetheless, able to enjoy aspects of a lifestyle suited to his own age group and gender and that facilities, activities and outings were being arranged to suit his individual interests. The home maintains records of activities for each individual, which include scope for their feedback or refusal to participate. There are open visiting arrangements, and there was anecdotal information on the extent to which staff support residents to maintain family links and friendships inside and outside the home. Each bedroom has a telephone point, though the installation of a telephone would be at the resident’s own expense. Residents can use the home’s cordless telephone upon request, subject to its availability. The cost of all calls will be charged directly to the SU or their financial representative. The use of mobile phones bought for the residents by the home is, as a condition, restricted to “pay as you go” to avoid large telephone bills accumulating. Dietary needs and preferences are also established as part of the preadmission assessment process, and confirmed by the care plan and day-to-day consultation. One of the care assistants, with a particular interest in cooking, has recently become the cook and keeps a list of each resident’s likes and dislikes. There was anecdotal information to confirm that individual needs (e.g. soft food options) and preferences were being catered for. The dining area is a congenial setting but residents can choose to eat in their rooms. See, however, section on environment re proximity of en-suite WC facilities. Adapted eating aids include plate guards, large handled cutlery, feeder beakers, and non-slip mats. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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) 18, 19 18. En-suite facilities guarantee some measure of availability and privacy, but there needs to be a suitably adapted bath. Staff are available on a 24 hour basis to assist residents. 19. The home accesses a range of healthcare services, standard and specialist, though there are some constraints on choice 20. Medication arrangements are subject to risk assessment and individual contracts, so that residents have as much choice and control as possible. EVIDENCE: All the bedrooms in this home are single occupancy, so that personal care and medical examinations / treatments can be given in privacy. Each bedroom, moreover, has an en-suite cubicle containing a WC and hand-basin, so that the availability of these facilities is assured. One resident’s door lock had buckled but was scheduled for repair. There is, however, no suitably adapted bath at this home, though one is planned. One resident is obliged to use the adapted bath at the other home in this group, which requires transport and fitting in with bathing schedules there. The home is required to submit an action plan to obtain a more appropriate arrangement, with timeframes. The care planning process routinely addresses a range of standard healthcare needs. The home also contracts in speech and language therapy, HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 15 physiotherapy (a physical therapist, and a physiotherapist) and offers onsite counselling sessions. There is access to the community dietician. The home is served by three GP practices, although the home had to go through the HFSA in the first instance because local practices’ books were closed. The residents each have different GPs as a result, even within the same practices – but this is not a question of personal choice. The residents’ ability to manage their own medication is risk assessed, and subject to regular review. Two residents said that staff look after their medication for them, and one said there was a little contract governing this – which is renewed every six months. One resident said that otherwise s/he would either forget or take the medication or take it all at once. The medication storage arrangements are secure and access to medication is restricted. The temperature of the fridge used to store some medication is regularly monitored and recorded. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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 22. Residents know who they can tell if they have any issues causing dissatisfaction, and these matters are dealt with. Some matters are raised for attention in respect of documentation, to obtain full compliance with all elements of this standard. EVIDENCE: The Service Users’ Guide has a section on complaints but this needs to comply with all elements of Regulation 22 i.e. it needs to include a summary of the process and associated timeframes, and information on the complainant’s option to contact CSCI at ay stage with contact details to facilitate access. Each resident confirmed that they knew who to tell if they had any complaints, and there was anecdotal information on how day-to-day issues are resolved. However, the home is only recording formal complaints in its complaints register – day-to-day complaints are being recorded in the homes Cardex system or incident reports. Four members of staff were separately asked what they would do if they encountered any adult protection issues and each expressed a commitment to challenge and report it. Three had a clear understanding of the role of the CSCI in such matters and all four knew how to contact the CSCI. All four said this had never occurred in this home HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29, 30 24. The furniture is domestic in style, and comfortable. There are homely touches throughout. Precautions have been introduced to make the home environment more safe, and more are scheduled. 27. Each bedroom has an en-suite WC and wash basin cubicles, so that their availability and privacy is assured. Communal bath and WC facilities are accessible to communal areas. 28. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 29. There is a range of equipment and adaptations but it is only partially wheelchair accessible; the proprietors are planning to install an adapted bath and a lift 30. The home is well maintained, clean and free of offensive odours. Consideration must be given to providing an alternative route for access to the ground floor WC/bathroom. EVIDENCE: HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 18 The layout of this home was judged generally suitable for its stated purpose when it was first registered, given it was originally set up for people in the early stages of neuro-disability, but it is now in need of some adaptation to meet their changing needs. All areas of the home were inspected and found to be homely, comfortable and clean. The furniture tends to be domestic in style and there were homely touches throughout. The garden areas, although small, provide pleasant discrete focal points and private areas to walk or sit in. The home has a “No Smoking” policy which is clearly stated in the Service Users’ Guide – one top floor room has been designated a smokers room Communal Areas There is one Lounge / Dining Room on the first floor (which is carpeted at the lounge end and has wood laminate flooring at the dining area end). All the chairs (dining and lounge) are uniform in style – a range of chairs (e.g. some with arms, or set at different heights) would give residents more choice. There is a multi purpose room on the top floor, with a smokers’ room at the far end (one wall had become smoke stained and will require redecorating). There are safeguards and adaptations in place. With one exception (smokers room) all upper floor windows have restricters, and all radiator have guards. There is a wooden handrail along the 1st floor corridor and grab rails in communal WC/bathroom facilities. All rooms have call bells and all staff carry pagers. There are handrail surrounds on communal WCs and two bath seats. Because of an identified trip / slip hazard on the staircase, a large wrought iron gate has been installed at the top of the first flight of stairs with a bell to summon staff assistance. This is only intended as a precautionary measure pending the installation of a lift. Although ornate it does have the effect of institutionalising the home, and residents do not always seek staff assistance, as requested. Kitchen There are two kitchen facilities (the main kitchen is on the ground floor and the second is on the first floor), both of which were found to be clean and well maintained, although one freezer unit clearly required defrosting and milk in one unit had been left exposed. Communal Bathroom / WCs There is one communal bathroom/WC on the ground floor and another on the first floor i.e. reasonably accessible to bedrooms and communal areas. However, the ground floor facility can only be accessed through the kitchen – this is not a hygienic arrangement. There is currently, moreover, no suitably adapted bath at this home. One resident is obliged to use the adapted bath at the other home in this group, which requires transport and fitting in with bathing schedules there. This is clearly not an appropriate arrangement. The directors are looking to install a Parker Bath / walk in shower in place of the existing ground floor WC/bath, but HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 19 access needs to be carefully reconsidered. The bathroom /WC rooms are carpeted to make them comfortable underfoot and non-slip (slipping is said to be a problem). While this is understandable, this is not a hygienic arrangement. In the 1st floor bathroom /WC, the hand basin and mirror are mounted onto a platform, which was likely to affect its accessibility. The tiling on one wall above the cistern in this room needed finishing to obtain a continuous impervious surface. Bedrooms All the bedrooms are spacious and single occupancy. Each bedroom is reasonably personalised, and, with one exception (which is scheduled for repair) can be locked. All the bedrooms were inspected and found to be personalised and well maintained. In terms of their furniture and fittings, they were generally compliant with the provisions of the National Minimum Standards, except in respect of the provision of bedside lights and tables. Each bedroom door can be locked, although one resident said he chose not to do so, and another door lock was scheduled for repair. All the residents have been provided with lockable cash tins but these are easily portable and two residents said they were unable to operate the keys to them. These tins need to be secured against a firm immoveable surface or replaced by more secure facilities. All the bedrooms have at least two double electrical sockets, but these are all sited at skirting board height, which means residents have to stoop or ask staff to help them to operate them. The home should look for opportunities to resite them at a more accessible height. Each bedroom has a telephone point for private landline or Internet, though this would be at the resident’s own expense. Where the home has bought residents mobile phones, these are “pay as you go” to prevent bills mounting up. Every bedroom also has a TV point – though the provision of personal TVs is also at the resident’s own expense. Each bedroom has an en-suite cubicle containing a WC and hand-basin. This clearly ensures these facilities are readily accessible to them and that privacy is assured. However, these cubicles are not completely enclosed, which may have implications for the safety of meals the residents may decide to take in their bedrooms. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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) 33, 34 33. There was compliance with the staffing levels as described on the day of this inspection, and there is some flexibility to allow staff to support individuals in the community without compromising staffing levels in the home. Team working was identified as a key strength. 34. The service users are safeguarded by recruitment processes, training and supervision EVIDENCE: Reliance was placed on the responses of staff, the manager and proprietors, to questions based on the National Minimum Standards on this occasion. These standards will be subject to more robust evaluation at the announced inspection. The working day is interpreted in terms of at least 14 hours and is fully staffed accordingly i.e. from 7.15am till 9.45pm. The morning shift is from 7.15am till 3.15pm; the afternoon shift is from 3pm till 9.45pm. In each case there should be at least two care staff on duty. At night time there is one waking duty member of staff. The registered manager works at the other home in the group on Mondays, Wednesdays and Fridays – from 8am till 5-6pm and shares the on-call arrangement with her deputy and, as a back up, the directors. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 21 Mr Glenister (one of the directors, and Health & Safety lead officer) works at Albany Drive most days, and the other directors visit regularly. The risk assessment co-ordinator comes in on Wednesdays and as required. There are dedicated staff to do the cooking and cleaning during the weekdays. And there is a maintenance man who works 20 hours a week (covering both homes). The home currently has one vacant part time secretarial post – 20 hours a week There was compliance with these staffing levels as described on the day of this inspection, although staffing rotas were not analysed on this occasion. The manager was advised to include a legend on staffing rotas to explain any codes used; to detail the on-site hours of managers (i.e. her own or the directors); and to record ancillary hours (cooking and cleaning) separately, particularly where staff duties are split between direct care tasks and ancillary work (e.g. weekends) so that anyone authorised to inspect the records can readily evaluate the staffing arrangements. Staff confirmed that the staffing levels were adjusted to take outings into account. This is a staff group, which identifies flexible working and team working as its strengths. Each member of staff confirmed that the recruitment process was systematic and thorough – that it systematically required two references, and that satisfactory checks were carried out, including CRB checks. A contract is issued following a satisfactory probationary period. Probationary periods are not confirmed if staff refuse to do the mandatory training. There is induction and mandatory training (e.g. manual handling, fire safety, adult protection, health and safety). The Risk Assessment Co-ordinator gets involved in staff induction e.g. H&S, fire safety. The home also uses distant learning e.g. for manual handling. The manager retains the original training certificates, wherever practicable. It is recommended that where photocopies are kept, they are signed / dated by the manager to confirm having seen the originals. Staff identified further Huntingdon’s Disease specific training needs e.g. behaviour management and nutrition, which the manager should follow through. All four staff confirmed that they had regular supervision sessions every six weeks. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 22 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) These standards were not assessed on this occasion EVIDENCE: HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 3 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 3 3 2 1 2 Standard No 11 12 13 14 15 16 17 3 N/A 3 3 3 2 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 HMT Care Limited Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 24 yes 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 YA18 Regulation 12 Requirement Timescale for action 31 07 05 2. YA22 22 3. YA24 23 4. YA30 16 An adapted bath is required at this home. The home is required to submit an action plan, with timeframes. This must include an access route which does not require travelling through the kitchen The complaints register needs to 31 07 05 be used to aggregate all issues causing satisfaction; and record how they are resolved and the timeframes involved, so that anyone authorised to inspect them can judge the effectiveness of the process, and any emerging trends. An action plan must be 31 07 05 submitted in respect of the installation of a passenger lift, including timeframe. This matter is outstanding from the last two inspections (i.e. August 2004) The home needs to request an 31 07 05 inspection visit by the Envoronmental Health Officers. A view be sought over a) accessing the ground floor bath/WC through the food preparation areas, b) use of carpeting in WC/bathroom areas, H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 HMT Care Limited Page 25 5. 33 schedule 4(7) c) eating meals in bedrooms which have WC cubicles The manager was advised to 31 07 05 include a legend on staffing rotas to explain any codes used; to detail the on-site hours of managers (i.e. her own or the directors); and to record ancillary hours (cooking and cleaning) separately, particularly where staff duties are split between direct care tasks and ancillary work (e.g. weekends) so that anyone authorised to inspect the records can readily evaluate the staffing arrangements. Matter oustanding from the last two inspections (i.e. August 2004) 6. 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 YA1.2 Good Practice Recommendations Service Users Guide. The following matters are raised for attention to obtain full compliance with this standard. - References to NCSC on pages 3 and 19 need to be updated to CSCI - The reference to the complaints procedure needs to comply with Reg 22 i.e. to include summary of the process and associated timeframes, and information on the complainant’s option to contact CSCI at ay stage with contact details to facilitate access. The Guide needs to summarise the relevant qualifications and experience of the registered provider, manager and staff The Guide needs to state the fees charged, what they cover, and the cost of ‘extras’ One placement contract (Greenwich), despite a set up date of 2003, makes several references to outdated legislation and associated guidance, and will, therefore need to be updated. It also gave the option of complaints being H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 26 2. YA5 HMT Care Limited 3. YA6 4. 5. 6. 7. 8. 9. 10. YA6 YA10 YA10 YA13 YA25 YA25 YA27 11. YA27 12. 13. 14. 15. YA28 YA28 YA35 YA35 referred to the Registration Authority only if it has not been possible to resolve the complaint. This is an incorrect interpretation of the National Minimum Standards. This must be attended to. Care plans shoul document the extent to which residents are actively engaged in this process i.e. at reviews, and how the home established the resident’s own perspective and any emerging unmet needs. care planning documentation needs to better reflect the practical steps required to address individual needs, and should be reviewed monthly Documents and other important items should secured within files as a precaution against loss or disarray. Each residents lockable cash tin should be secured against a fixed surface or alternative provision made A dedicated adapted vehicle is recommended, so that access to the community is not frustrated by mobility impairment. Bedside lights and tables should be provided, unless their non-provision can be justified by documented consultation or risk assessment. The home should look for opportunities to re-site electrical sockets three feet from the floor, so that residents do not have to stoop to operate them or ask for staff assistance 1st Floor bathroom / WC. the tiling above the cistern requires finishing off to obtain a continuous impervious surface. The mounting of wash basin and mirror on a platform should be reviewed in respect of its accessibility. Consideration should be given to alternative flooring in communal bathroom/Wc areas. The advice of the Environmental Health Officer and an Occupational Therapist should be sought. Consideration should be given to providing a range of chairs e.g. dining room chairs with arms, armchairs at different heights etc. so that residents have a choice. Smokers Room. The radiator should have a guard. One wall had become smoke stained and will require redecorating) It is recommended that where staff training photocopies are kept, they are signed / dated by the manager to confirm having seen the originals. Staff identified further Huntingdon’s Disease specific training needs e.g. behaviour management and nutrition, which the manager should follow through. HMT Care Limited H56-H05 S47536 HMT Care Ltd V227406 200505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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