Inspection on 28/09/05 for HMT Care Ltd

This inspection was carried out on 28th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 7 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 20/05/05

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 Ltd 48 Albany Drive Herne Bay Kent CT6 8PX Lead Inspector Jenny McGookin Announced 28/09/05 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 Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service HMT Care Ltd 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 01227 743265 N/A HMT Care Limited Christine Janet Elizabeth Bone Registered Care Home 5 Category(ies) of Care Home for Younger Adults (18-65) with a registration, with number Physical Disability of places HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20/05/05 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 Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was intended to address standards not inspected at the unannounced inspection in May 2005 and to check compliance with matters raised on that occasion. This report should, therefore, be read in conjunction with the May report, in order to obtain an overview of the day-to day running of the home. The inspection process took just under eight and a half hours, and involved meetings with two residents, the proprietor, the registered responsible individual, a director, the risk assessment co-ordinator, two support staff, the cook, and attendance at a staff meeting. Feedback comments were also received from two relatives. The inspection also involved an examination of policies, records and other documents (most notably complaints management, staff induction and training). There was no case tracking undertaken on this visit, as this element of the home’s operation was subject to close examination on an additional visit in August 2005 but the findings from that visit are included. All five bedrooms were inspected for compliance with the National Minimum Standards, as well as the communal areas. Interactions between staff and residents were observed throughout the day. What the service does well: This is a home, which offers people in the early stages of Huntingdon’s Disease a domestic, homely setting, and the property continues to be maintained to a satisfactory level – all checks seen were up to date and the décor was judged of a good standard. The location is generally suitable for its stated purpose, convenient for visitors, and offers ready access to community and seafront resources. Residents confirmed that they are generally content and well cared for, and were observed being supported to understand what was happening around them and what choices were available to them. The care plans show good evidence of a holistic approach. There is input from a range of healthcare professionals and some evidence of equipment and adaptations throughout the home. Staff confirmed there was a systematic approach to recruitment, and showed a commitment to challenge and report poor practice, should it ever occur. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 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 Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 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, and some public information requires further attention. 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 help 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: There is a Statement of Purpose and Service User Guide, which usefully describe the facilities, services and principles of care but a number of elements listed by this standard will need to be included or amended to obtain full HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 9 compliance. The detail has been reported to the home separately, but there were some matters of particular note, which are detailed elsewhere in this report, as they have been the subject of complaints over the home’s opening year. Transacting parties need to fully understand their terms of engagement. Taped and video versions are said to be planned but there was no timeframe for this. The reader may be surprised to read what extra charges are payable over and above the funding levels, notably some transport costs (the home does not have its own adapted vehicle), holiday costs and even the provision of specialist chairs. Given the specialist needs of these service users, the reader may have expected the funding levels to be more inclusive. In the event of a resident (by reason of age or disability) falling outside the home’s registration category, the Statement of Purpose properly commits HMT Care Ltd to consult the individual concerned, the Commission, the funding authority and other interested parties. However, it then asserts that the final decision will lie with the Responsible Individual. This is a clear misinterpretation of the regulatory arrangement. Some of the elements reported on in respect of the Statement of Purpose reappear in the Service User Guide. But the Service User Guide raises other questions about the home’s capacity to meet individual needs. Whilst acknowledging (on the one hand), for example, that individuals may “require” free standing heating appliances, air conditioning units and cooling fans, the Service User Guide restricts the home’s responsibility to the upkeep and maintenance of the heating system, so that “decisions about the responsibility for payment of additional requirements will need to be risk assessed”. Feedback on the day of this inspection indicated that the decision to apply to this home was influenced more by its locality (close to where the resident or family had lived) and, in all 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. At the inspection in May 2005, 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. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 10 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. At the inspection in May 2005, matters were raised for attention in respect of the contract with one funding authority, which were still outstanding, though it is accepted that HMT Care Ltd had brought these to the attention of the funding authority in question. HDA provides training, advice and professional workshops to underpin practice at the home. Feedback from one resident and three relatives / friends confirmed their satisfaction with the care given by this home, but there have also been complaints. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 opportunities to influence their care plans, daily routines and some decisions about 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. EVIDENCE: The format of the care plan, which follows on from the preadmission assessment process, is a comprehensive one, clearly designed to address the HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 12 health and social care needs of the residents. These are in the first instance prepared by the registered manager (though training in care planning is planned for senior support staff) and signed by the residents (where able) and / or their representative e.g. relative or care manager. The findings from an additional visit to this home in August 2005 were in many respects consistent with those from the inspection of the other home in the group. The care planning processes did not conspicuously represent the views of the two residents selected for care tracking, their interests, activities or any emerging unmet needs. 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 does not adequately 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. Records showed a good range of risk assessments (daily living routines, history of falls, safety, medication, finances). They are clearly intended to be integral to the format of the care planning process, and are being summarised as appendices to the care plan documents. But this only seemed to apply in the first instance. Less clear, in the case files selected for care tracking, was any evidence of practical interactions between the care plans, day-to-day reporting and risk assessment processes thereon. There should be more demonstrable ownership of these tools by staff. HMT Care Ltd has a dedicated risk assessment co-ordinator who comes into the home every week 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 confidentiality 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. However, there is no record of any take-up of any right of access to information or policies by residents or their representatives, nor of their involvement in the development of policy or practice. The home keeps hard copy and electronic records. Cabinets, computers and office facilities are all properly secured. Each resident has a lockable cash tin to store money and valuables in, but these need to be secured against a firm HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 13 immoveable surface or replaced by more secure facilities (matter raised at the last inspection – May 2005) and found to be still outstanding. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 14 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, 17 11,12. There is some choice and control over most aspects of daily routines. Feedback from two residents and three relatives indicate the home has been able to match their expectations. Other sources, however, (professional, familial and neighbours) need to have their loss of confidence restored. 13, 14. This home offers a 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. 16. The daily routines generally promote choice and independence, subject to individual abilities and available staffing levels. 17. The home receives specialist input to provide nutritious meals, which are generally enjoyed. Staff are available to assist residents. Mealtimes are unhurried and the setting is congenial. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 15 EVIDENCE: Abilities, activities and personal preferences are intended to be established as part of the preadmission assessment process, and confirmed by care plans and day-to-day consultation thereon. Two residents and two relatives confirmed that the home had been generally able to match their expectations, though one resident was teasingly dismissive. This home offers support to residents in maintaining their practical life skills (e.g. household tasks, gardening, cooking); and each resident has access to confidential counselling sessions provided by one of the proprietors and the specialist therapies it buys in (speech and language, physical and physio therapy). Care plans could, however, better reflect the practical details, such as the extent to which residents can participate in house-keeping tasks. Employment and further education may not be realistic prospects for these residents. The registered manager helps residents with benefits / finance problems or seeks appropriate input. Residents were observed being supported to make decisions and choices during the inspection visit. There are some recreational activities both on and off site, and opportunities to access local resources such as shops, seafront, cafes and pubs, library, gym, boat trips, occasional theatre or concerts i.e. mainstream community activities not confined to or identifiable with disabilities. Activities on site include relaxation, massage, TV, videos, DVDs, board games and music. Less clear, however, was the home’s capacity to support residents on a one-toone basis, where interests or activities are not shared or where two staff are required for given tasks, and this has been a source of complaint. An examination of staffing rotas for September 2005, showed there were only 13/30 occasions when there was a third member of staff available during the waking day (i.e. 7.15am-9.45pm) but never more than one from 9.45pm onwards. There is no company vehicle but staff used to have a casual car user allowance if they used their own vehicle to transport the residents. This facility has since been withdrawn. A dedicated adapted vehicle is recommended, so that access to the community is not frustrated by mobility impairment. 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 HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 16 cordless telephone upon request, subject to its availability. The cost of all calls would be charged directly to the resident 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 input from a speech and language therapist and dietician, in the care plan and day-to-day consultation. This inspection was used to meet with the cook, who 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, though she identified further training in catering for people with Huntingdon’s Disease as a training need. 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. The Service User Guide only makes a commitment to establishing what prospective service users’ religious beliefs are but states that the home “cannot undertake to provide for all cultural needs or religious denominations as it cannot guarantee appropriate staffing, knowledge required to address issues nor the existence of appropriate houses of worship within the local area”. The inspector judged the reader should be able to expect the home to have a sound knowledge of local resources and to be in a position to provide the staffing to meet support needs if this is assessed a priority for prospective service users, either at the outset or as an emerging priority, given their likely prognoses. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 17 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, 20, 21 18. En-suite facilities guarantee some measure of availability and privacy. 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 and a loss of confidence from one healthcare professional will need to be restored 20. Medication arrangements are subject to risk assessment and individual contracts, so that residents have as much choice and control as possible. 21. The registered manager and staff deal with illness and death with sensitivity and respect. 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. 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 last inspection (May 2005) required the home to submit an action plan to HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 18 obtain a more appropriate arrangement, with timeframes. This matter is still outstanding. The care planning process routinely addresses a range of standard healthcare needs. The home also contracts in speech and language therapy, 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. HMT Care Ltd has a policy on medication, but should obtain a copy of the Royal Pharmaceutical Guidance on medication standards and check its own policy for compatibility Records confirm that the residents’ ability to manage their own medication is risk assessed and subject to contract. 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. The extent to which staff have struggled with the moving and handling of residents has been the subject of complaint over recent months. There are no hoists or lifting equipment other than a rising bath seat, and scant evidence of adapted furniture. See section on environmental issues. The challenge will be to strike a better balance between the homely setting and HMT Care Ltd’s duty of care to residents and staff alike, to restore confidence overall. HMT Care Ltd has a policy on the care of the dying and bereavement, which could be further improved by guidance on the retention of records and medication. There was anecdotal information on the extent to which staff empathy for the residents’ prognoses is established at interview, and followed up by staff group meetings and one-to-one support. There was also anecdotal information on the ways in which one resident was supported with the loss of a loved one, his bereavement and commemoration of the loss. HMT Care Ltd. has access to hospice and palliative care services as well as to the Huntingdon’s Disease Association. The manager can support residents to access a solicitor to make a will. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 22. The registered person has produced a complaints procedure, but needs to demonstrate its effectiveness. 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. 23. Staff expressed a commitment to protect residents from abuse. EVIDENCE: The Statement of Purpose and Service Users’ Guide both make reference to the home’s Complaints procedure and commit the home to welcome and treat them seriously, but the detail is in each case available separately. Both documents need to comply with all elements of Regulation 22 i.e. each needs to include a summary of the process and associated timeframes, and information on the complainant’s option to contact CSCI at any stage with contact details to facilitate access. The home’s complaints register is largely being used in practice to detail complaints from staff. Records generally indicate that action was taken in each case, but there were no complaints in the register from any of the residents. The inspector understands that day-to-day issues are being recorded in the homes Cardex system or incident reports. The challenge will, therefore, be for this home to demonstrate that it can translate any expressions of satisfaction into recordable events; so that anyone authorised to inspect the register can assess the extent to which residents feel able to speak up and the home is taking their views seriously. The home does not use independent advocacy services but this option should be more actively promoted. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 20 HMT Care Ltd has a policy on abuse, but should obtain a copy of the Kent and Medway Guidance and check its own policy for compatibility Staff have each expressed a commitment to challenge and report any adult protection issues and demonstrated a clear understanding of the role of the CSCI in such matters. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, 29, 30 24, 28. Residents have a choice of communal areas. The furniture tends to be domestic in style, and 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. 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. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 22 EVIDENCE: 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. The furniture tends to be domestic in style, and this has been the subject of complaint over recent months. HMT Care Ltd should, therefore, look for opportunities to adapt the building further, so that it can pre-empt the residents’ changing needs, rather than react to them (with all the delay that implies), without detracting from its homely setting. Adapted furniture is nowadays much more readily available in discreet models. Notwithstanding HMT Care Ltd’s wish to keep the setting domestic, it has a duty of care to staff as well as the residents. The garden areas, although small, provide pleasant discrete focal points and private areas to walk or sit in. But one accident resulting in a fracture indicates the need to risk assess the ground surfaces and take appropriate action, as a precaution against the risk of further injury. 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) tend to be uniform in style. The inspector was surprised to read in the Service Users’ Guide that the provision of specialist individual seating would be at the residents’ own cost. The inspector would expect the home’s own provision to be based on assessed individual need (current and predictive). There is a multi purpose room on the top floor, with a smokers’ room at the far end. There are some safeguards and adaptations in place. With one exception (smokers room) all upper floor windows have restrictors, 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 was installed at the top of the first flight of stairs with a bell to summon staff assistance. This was only intended as a precautionary measure pending the installation of a lift, but there has been no firm timeframe for this. Although ornate it does have the effect of institutionalising the home, and HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 23 residents do not always seek staff assistance, as requested. Measures have more recently been introduced to operate the gate more safely, there is a pressing need to install a passenger lift. 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. 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. There is, however, 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 access needs to be carefully considered. The ground floor facility can currently only be accessed through the kitchen – this is judged an unsafe and unhygienic arrangement, given the level of mobility impairment observed, and the proprietors were advised at the last inspection to seek the views of Environmental Health Officers on this matter. The inspector was advised on this occasion that the Environmental Health Officers had been contacted but confirmed having had full knowledge of the arrangement at the point of registration, and did not raise any objections. A key-pad facility has been installed on the kitchen door, which, while safeguarding the kitchen area against unsupervised access, has the effect of further restricting access to the bathroom. The bathroom /WC rooms are both 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 (matter raised at the last inspection – May 2005). Bedrooms All the bedrooms are spacious and single occupancy. Each bedroom is reasonably personalised, and each bedroom door can be locked, although one resident said he chooses not to do so. 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. All the residents have been provided with lockable cash tins but these are easily portable and two residents said at the last inspection (May 2005) that they were unable to operate the keys to them. These tins need to be secured against a firm immoveable surface or replaced by more suitable facilities (matter outstanding from the last inspection). HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 24 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 Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 25 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 days of this inspection. Less clear, however, was this home’s capacity to maintain this level or to provide flexibility to allow staff to support individuals in the community without compromising baseline staffing levels in the home. Team working was, however, identified as a key strength. 34. The service users are safeguarded by recruitment processes, some training (though this requires further development) and supervision (though this requires rolling forward to formal documented annual appraisals). EVIDENCE: Staffing Levels The working day is to be interpreted in terms of a 14 hour period each day (i.e. from 7.15am till 9.45pm), and is reported to be staffed accordingly: • Two support staff on each morning shift from 7.15am till 3.15pm; • Two support staff on each afternoon shift from 3pm till 9.45pm. • There is also a shift from 7.15am till 9.45pm, though this applies selectively. At night time there is one waking duty member of staff. There are dedicated staff to do the cooking and cleaning during the weekdays, though support staff would be responsible for some of their tasks in their HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 26 absence. And there is a maintenance man who works 20 hours a week (covering both homes in the group). The inspector understands the registered manager works at this home on Tuesdays and Thursdays – from 8am till 5-6pm - and at the other home in the group on Mondays, Wednesdays and Fridays. She shares the on-call arrangement with her deputy and, as a back up, the directors. The proprietor, registered responsible individual and other directors are said to visit regularly, and there is also regular input from the risk assessment co-ordinator. The manager has complied with the requirement to detail her own on-site hours, but was also required to detail the on-site hours of the directors and ancillary hours (cooking and cleaning) separately, particularly where staff duties were being split between direct care tasks and ancillary work (e.g. weekends) so that anyone authorised to inspect the records could readily evaluate the staffing arrangements. These matters were found to be outstanding. The rotas supplied for September 2005 indicated compliance with the staffing levels as described, and showed three staff on 13/30 days. However they also confirmed one complainant’s assertion that there were regular occasions when individual staff could be working from 7.15am-9.45pm one day, followed by a night shift and then an early shift (7.15am-3.15pm) followed by yet another night shift as described. This is clearly not in the interests of a work/life balance or sustainable performance. Flexibility and team working was, however, identified as a key strength by staff who met with the inspector. However, the Commission has received complaints that the staffing levels have, on occasion, dropped to just one. Without proof of intervention by the manager, any of the directors, this is judged unacceptable, given the level of assistance required by individual service users. The Statement of Purpose is designed to include its own example of staffing rotas (though this was not in the sample copy supplied), but points out that this is intended to convey the ideal arrangement. And the Statement of Purpose expressly will not commit the home to a statement of minimum staffing levels, which would, in the inspector’s judgement, have been more instructive. The prospective resident should, in the inspector’s view, have the right to expect contingency arrangements to address stated variables such as staff sickness and annual leave, but listing staff misconduct as one of the anticipated variables is judged likely to cause a loss of confidence. There were, moreover, several references in the Statement of Purpose to anticipated “pressures on staff time at certain periods” to excuse any delays in arrival to support residents with preparing snacks; to access other areas of home; to do their laundry; to support with activities such as smoking or HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 27 outings and, more worryingly, to respond to the call bell system. In the event of hospitalisation, moreover, the Statement of Purpose states that the home is not automatically in a position to provide an escort. Given the likelihood of hospitalisation episodes, this is judged likely to be unsettling. The responsible individual was asked to apply the Residential Forum formula and to report back to the inspector on the staffing arrangement it indicated. At the point of issuing this draft, this matter was still outstanding. Recruitment Each member of staff confirmed that their recruitment process was 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. Training and Supervision Less clear, however, was the extent to which staff are being invested in, or supported thereon. Only two staff induction checklists were completely signed off, and the number of gaps was judged surprising given the staff members’ roles. The Commission has received complaints that newly appointed staff had been given tasks to carry out without training or supervision. Staff verbally confirmed having had a range of mandatory training after their induction, as well as training from the Huntingdon’s Disease Association and its regional advisor. There was, however, no training material to enable an assessment of the quality of the training given; or documentation to show whether it was competency tested in each case. The Commission has received complaints about the perceived inadequacy of some training, and staff identified further training in Huntingdon’s Disease as a training need. Records of supervision were patchy, and some gaps were judged excessive. There has, moreover, been no formal training in giving supervision; and there needs to be evidence of supervision being rolled forward into formal annual appraisals. These gaps must be addressed. . The manager has in turn, identified a range of further training needs, particularly pertinent to complaints raised against the service in its opening year: most notably the management of aggression, self-harm, fluctuating needs, professional relationships and supervision. HMT Care Ltd has its own code pf practice for staff, but none of the staff had been issued with copies of the General Social Care Council Code of Practice, as required. The Responsible Individual undertook to address this. Records confirm that no staff are being employed under 18 years of age and there are no volunteers. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 28 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) 37, 39, 40, 42 37. The Manager’s qualifications and experience as described are appropriate to her role as registered manager, subject to her completion of NVQ4 accreditation. 39. Feedback questionnaires need to be systematically introduced to measure the home’s success in meetings its own aims and objectives as well as the expectations of residents and/or their representatives. 40. Staff have access to policies and procedures and records but the range is not comprehensive 42. All health and safety checks are maintained and in good order, but there are persisting hazards (stairwell, lack of adapted bath and furniture / fittings, rear garden). EVIDENCE: Chris Bone has been the registered manager for both homes in the group since their registration, and has several years’ experience in the care sector. After HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 29 problems with the accreditation agency, considerable progress has been made with her Registered Managers’ Award (NVQ4 accreditation), since the last inspection in May 2005, and she is currently awaiting certification. However, there have been a number of complaints raised against both homes in the group since their registration, which would indicate the need to fundamentally review provision. The property requires substantial investment to make it more suited to the changing needs of the residents. There is also a need to review the appropriateness of having one manager covering both homes. Staff competencies need to be more assured i.e. by commitment to a baseline staffing statement, and by more robust supervision, appraisal and training. And a concerted effort needs to be made to restore the confidence of staff and residents’ relatives and representatives. There are clear lines of accountability within the home and all members of the board have regular contact with each home in the group, though this needs to be documented on rotas. There was also good evidence of Regulation 26 reports on monthly visits carried out by one of the directors. There was only anecdotal information on the range of self monitoring tools in place for this home. There are, for example, reported to be weekly care management meetings involving the proprietor, the Responsible Individual, the manager and her deputy to assess the residents, staffing arrangements and their environment. And the National Minimum Standards are said to be used periodically to set up action plans. However, there was no documentation available to evidence any of this. The Risk Assessment Co-ordinator, however, readily produced evidence of the regular audits he carries out of the premises and practices, and he also gets involved in health and safety training. All the maintenance records seen were up to date, in good order and backed up with periodic environmental risk assessments. There were, disappointingly, no questionnaires for the funding authorities, the Huntingdon’s Disease association or other stakeholders, and the inspector was advised that no input from any independent advocacy services was planned unless called in to address specific issues. The Pre-Inspection Questionnaire requires homes to confirm whether listed policies are in place and whether reviewed. 11/42 listed policies were not in place. These included key issues raised by complainants: continence management, nutrition; harassment, sexuality, record keeping. The arrangements for business planning and managing residents’ finances were not inspected on this occasion. HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 30 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 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 3 2 2 1 3 Standard No 11 12 13 14 15 16 17 2 N/A 3 3 2 2 3 Standard No 31 32 33 34 35 36 Score x 1 1 3 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 HMT Care Ltd Score 3 2 3 3 Standard No 37 38 39 40 41 42 43 Score 2 x 1 1 2 1 x H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 31 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 YA1 Regulation 4(1)© & Schedule 1 5(1) Requirement The Statement of Purpose must be checked against all the elements of this standard and regulation, to obtain full compliance The Service User Guide must be checked against all the elements of this standard and regulation, to obtain full compliance The Statement of Purpose and Service Users Guide need to comply with all elements of Regulation 22 i.e. each needs to include a summary of the process and associated timeframes, and information on the complainant’s option to contact CSCI at any stage with contact details to facilitate access. All versions of complaints procedure need to comply with all elements of Regulation 22 i.e. each needs to include a summary of the process and associated timeframes, and information on the complainant’s option to contact CSCI at any stage with contact details to facilitate access. There is a pressing need to Timescale for action 31 01 06 2. YA1 31 01 06 3. YA1 22 31 01 06 4. YA22 22 31 01 06 5. YA29 23 31 12 05 Page 32 HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 6. YA29 23 7. YA40 18 install a passenger lift. An action plan must be submitted, committing HMTR Care Ltds to a timeframe. The directors are required to 31 12 05 submit an action plan, committing HMTR Care Ltds to a timeframe, for the installation of a Parker Bath / walk in shower in place of the existing ground floor WC/bath, Access needs to be carefully reconsidered. HMT Care Ltd needs to ensure 31 12 05 that all the policies listed by the CSCI are in place and available to staff 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 YA6 Good Practice Recommendations Care plans should 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 Care plans should better reflect the extent to which residents can participate in domestic tasks A dedicated adapted vehicle is recommended, so that access to the community is not frustrated by mobility impairment. The home should have a sound knowledge of local religious resources and to be in a position to provide the staffing to meet support needs if this is assessed a priority for prospective service users, either at the outset or as an emerging priority. Further training in catering for people with Huntingdons Disease was identified as a training need by the cook. The challenge will be for this home to demonstrate that it can translate any expressions of satisfaction into H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 33 2. 3. 4. 5. YA6 YA11 YA13 YA13 6. 7. YA17 YA22 HMT Care Ltd 8. 9. 10. 11. 12. YA23 YA25 YA26 YA27 YA29 13. 14. YA29 YA40 recordable events; so that anyone authorised to inspect the register can assess the extent to which residents feel able to speak up and the home is taking their views seriously. The home should actively promote the use of independent advocacy services. 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 Each residents lockable cash tin should be secured against a fixed surface or alternative provision made The communal bathroom /WC rooms should have more hygienic flooring which should be comfortable underfoot and non-slip HMT Care Ltd should look for opportunities to adapt the building further, so that it can pre-empt the residents’ changing needs, rather than react to them, without detracting from its homely setting. Notwithstanding HMT Care Ltd’s wish to keep the setting domestic, it has a duty of care to staff as well as the residents Rear garden. One accident indicates need to risk assess the ground surfaces and take appropriate action, as a precaution against the risk of further injury. Policies. The following matters are raised for attention: - Abuse. HMT Care Ltds should obtain a copy of the Kent and Medway Guidance and check its own policy for compatibility - Care of the Dying and Bereavement. This should also address the retention of records and medication after death - Medication. HMT Care Ltds should obtain a copy of the Royal Pharmaceutical Guidance on medication standards and check its own policy for compatibility - Code of Practice. HMT Care Ltds should obtain copies of the GSCC Code of Practice, supply each member of staff with a copy and check its own statements for compatibility - Complaints. This policy needs to fully comply with Reg 22 HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI HMT Care Ltd H56-H05 S47536 HMT Care Ltd V242147 280905 Stage 4.doc Version 1.40 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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