Inspection on 08/06/06 for HMT Care Ltd

This inspection was carried out on 8th June 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

HMT Care Ltd 28/09/05

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 Limited 48 Albany Drive Herne Bay Kent CT6 8PX Lead Inspector Mrs Susan Hall Unannounced Inspection 8th June 2006 10:30 HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service HMT Care Limited Address 48 Albany Drive Herne Bay Kent CT6 8PX 01227 742992 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) HMT Care Limited Christine Janet Elizabeth Bone Care Home 5 Category(ies) of Physical disability (5) registration, with number of places HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with neurodisabilities, particularly Huntingtons Disease. There are two homes in the group and they are sited near to each other. Both homes cater for people of either sex, within the age range of 18-65 years. 48, Albany Drive, is a large Victorian detached house. It is situated on a corner of two side roads, in a residential area of Herne Bay. It is near to local shops, the seafront, and other facilities, and can be easily reached via rail, or by road – using the M2 or M20 motorways. There are three floors (ground, first and second), with bedrooms on the ground and first floors. All bedrooms are for single use, and include en-suite toilets and wash basins. The home has several communal areas, including a lounge/dining room on the first floor, and a smoking room on the second floor. The property has an enclosed garden to the rear, with a patio area, and front and side gardens with flower borders. There are small gardens to the front and side, laid to lawn with rose borders. There is off road parking for two vehicles, and unrestricted kerb-side parking. Fees for service users are set at £1310 per week. This information was supplied by the providers in pre-inspection documentation, in May 2006. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection includes information gained since the last inspection in September 2005, as well as information gained from the site visit on the day. The Inspector received feedback from 3 service users currently in residence; from a G.P; and from a care manager for one of the service users. She also met 2 health professionals (a Speech and Language Therapist, and a Physical Therapist) at the other HMT home – Orchard House – and these both work with service users at Albany Drive as well. A meeting was held with the Providers in April 2006, and this included sharing information about the Providers’ plan for internal alterations to the building. This was specifically in regards to installing a passenger lift – creating easy access to all floors; and altering the ground floor layout so that service users do not have to go through the kitchen to access a ground floor bathroom, and the rear garden. The site visit commenced at 10.30 and finished at 4pm. During this time, the Inspector met and chatted with the 3 service users, and 7 staff (as well as the Manager and the Chief Executive Officer). The Inspector was not able to converse at depth with service users, as there was some difficulty with communication. However, one service user said that he was “looked after well”, and liked the staff. The staff team were seen to be working well together. One support staff said he was grateful for the way in which other staff worked alongside him. The Inspector was shown around every area of the home, and read documentation including care plans, staff files, medication charts, some policies and procedures, staff training schedules, complaints log, accident records and minutes for staff meetings. CSCI survey forms received back from health professionals all contained positive comments. One of these stated that “ I always find that the carers for (person’s name) have an excellent rapport, and are knowledgeable about the problems”. What the service does well: Staff give good personal support and health care to the service users. Evidence was seen of detailed, individualised support, and an understanding of the specific needs of service users with Huntington’s Disease. There is an effective staff training programme in place, which includes a Skills for Care induction programme; ongoing internal staff training; external training for mandatory subjects; NVQ 2 and 3 training; and additional training for specific subjects relevant to the care of these service users. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 6 There is a good understanding of the high nutritional needs for service users with Huntington’s Disease, and the Manager and cook work together to ensure these needs are met. 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 Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The quality in this outcome area is adequate. Prospective service users are supplied with sufficient information to make a choice about the home. Good processes are in place to check the suitability of the placement. EVIDENCE: The Statement of Purpose and Service Users’ Guide are in the process of being reviewed and amended by the Chief Executive Officer. She wants to be sure that these are in the best possible format to enable these documents to be properly used. The documents are currently available to enquirers in the previous format, and the alteration process is nearly completed. The Inspector recommended that the Service Users’ Guide should also be produced in a simplified format for some service users to understand more easily (photos/pictures etc.). The complaints procedure is inadequate, and as this forms part of these documents, will also need to be updated. (See further comments in the section Concerns, Complaints, and Protection.) Contracts for service users are provided by the funding authorities. The Inspector viewed copies of these, which are retained on the service users’ files. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 9 Extra payments are specified. Service users are not currently given Terms and Conditions between HMT and themselves, but the aims and objectives of the home are included in the Service Users’ Guide. Pre-admission assessments are carried out by the Manager, using a preprinted format. She visits service users in their home or previous placements prior to agreeing the suitability of the home to meet the service users’ needs. Information is gained from GPs, home carers, relatives and health professionals. Consideration is given to the room available, and if the service user needs any specialist equipment. Assessments include checking the use of stairs; bathing/showering needs; if the person is a wheelchair user; any aggressive behaviour which could impact on other service users; and any specialist health and dietary needs. Service users are able to visit the home prior to moving in, and have a trial period of one month. This can be extended if indicated. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 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 the following standard(s): 6,7,8,9,10 The quality in this outcome area is good. Staff enable service users to remain in control of their lives where possible, and to support them as needed. EVIDENCE: Service users have care plans which are drawn up with their involvement, and with input from relatives and care managers. These are discussed by the Manager and senior support staff each week, and reviewed on a monthly basis. Reviews with care managers, keyworkers and relatives were evidenced in the accompanying documentation, and provided detailed, ongoing care needs. A member of staff was able to show a good understanding of the keyworker system. A new system of care planning had been implemented by the Manager, and although this was not complete, the care plans reflected good practice. This “standex” system was working better than the previous care planning, as it has different records filed together, and this prompts staff to complete those details (e.g. monthly weights, daily personal care). HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 11 Service users are able to make choices about their daily lifestyles. They get up and go to bed at their preferred times, and are able to choose when to go out, and how to spend their personal finances. They are supported by staff in making their decisions with explanations such as “ the rain is very heavy today, and you don’t like to get wet” (as seen in one report). Another service user told the Inspector that he does not like to go out in cold weather as has a tendency to chest infections. The staff know this, and they encourage the service user to go out more in mild and warm weather. None of the service users currently in residence required advocacy services, but the Manager would access these if needed. Service users are assisted with their personal finances by their keyworker, and each one has a Bank, Building Society or Post Office account. Small amounts of personal monies are stored individually in safe locked areas. Paper proof is retained for each transaction. Staff and service users discuss things about the home together on a day to day basis, often informally round the lunch table. There are also more formal meetings. Discussions include changes to the home, and staff and service users had been consulted on the colour of the new carpet ordered for the hallway and stairs. Service users have their choice of furnishings in their own rooms – varying from soft lilac to Arsenal red. There had been recent discussions about holidays, and the service users have elected to go on holiday together this year, and have chosen the venue. Good risk assessments are in place for individual service users. These include items such as: trips out; management of finances; use of bedside table/lamp; supported meal assistance; taking medication; moving and handling assessment; and use of stairs. Risks associated with unacceptable behaviour were clearly identified, and behavioural guidelines had been added where appropriate. The staff recognise that aggressive behaviour may be linked to frustration with the illness, and it is important to look at ways to minimise the frustration. Incident reports are completed in detail, and include body maps for any injury/bruising. Details include a record of the service user’s behaviour before, during and after the incident, the action taken and the response obtained. The importance of confidentiality is included in the staff induction programme, and then in ongoing training. Staff understand the times when a disclosure may need to be shared. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 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 the following standard(s): 11,12,13,14,15,16,17 The quality in this outcome area is good. Service users are enabled to take part in appropriate activities and are supported in maintaining friendships and relationships. The home provides a healthy and nutritious diet, and the required support for service users at mealtimes. EVIDENCE: As service users have a degenerative disease, most emphasis is placed on maintaining existing skills, rather than developing new skills. However, there may be times when service users wish to develop skills, and they will be supported in this if it is feasible. An example of this was a service user who wanted to develop computer skills as he was losing the co-ordination skills for hand writing. College placements would be accessed in situations such as this. Counselling and therapy sessions are arranged individually as needed. One service user had been having counselling sessions with a trained counsellor. Ongoing Speech and Language Therapy (SALT), and Physical Therapy, are incorporated into the life of the home. These professionals visit the home every 4 – 6 weeks, or more often if indicated. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 13 Service users are able to fulfil their spiritual needs. This was evidenced by one who is a Christian being able to attend church if wanted; and by another service user of the Jewish faith having specific directions given in the event of death. Service users have easy access to the local town facilities and the seafront. This is accessible whether walking, or in a wheelchair. Service users regularly visit shops, Post Office, tea-rooms, pubs, sea-front, theatre, parks and the library (especially for DVDs). The home has records of visits to places of interest such as theme parks, garden centres and wildlife parks. One had recently been able to visit family in London, and was escorted by a support staff. All aspects of the visit had been risk assessed before proceeding. There is also a Huntington’s Disease (HD) support group that some attend. Activities in the home include watching TV; listening to music; going in the garden; playing games such as monopoly; reading - or being read to by staff. Service users can go where they want to in the home, and risk assessments include supervision needs for different areas. The service users have chosen to go away on holiday together this year, to the Isle of Wight. A senior support staff said that they access details of the suitability of hiring premises, by obtaining details from the National Trust. The inspection took place on a warm day, and the service users chose to have lunch in the garden together. The Inspector noticed that the cook carefully served up different amounts on to individualised special plates. Plate guards and special cutlery are available. All of the current service users needed soft foods – but not liquidised. The cook takes this into account, and provides items such as crumpets in place of toast, and lots of fruit smoothies. Menus are discussed with the Manager, and the cook works to a 4 –weekly planner. This is flexible for service users who change their minds. The kitchen was clean and well organised. Fridge, freezer and food temperatures are recorded every day. All of the staff are trained in basic food hygiene, and the staff are working through a “Safer Food Manual” recommended by the Environmental Health officer when he visited in March 2006. Support and training with food and assisted eating is given by the Speech and Language Therapist, and this is an important aspect of caring for service users. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 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 the following standard(s): 18,19,20,21 The quality in this outcome area is good. The home has good systems in place to promote service users’ health needs, and to ensure ongoing advice and support for their specific condition of HD. EVIDENCE: There are clear records in care plans to show that staff give daily, practical support to service users with personal cleansing needs. Charts specify when a bath, shower, hair wash, shave etc. have been given. Service users are enabled to carry out tasks (such as cleaning teeth) on their own, for as long as possible, and with appropriate supervision. The Speech and Language Therapist gives good advice and support for all service users re speech, language, feeding and swallowing, and ensures that staff understand how to manage this aspect of care. All of the current service users needed thickened drinks, and all staff were familiar with this. The Physical Therapist visits every few weeks, and these visits include relaxation therapy, and exercises for maintenance of muscle tone. Staff are taught how to carry out passive exercises for service users, on a daily basis. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 15 Service users have appointments with their GPs as indicated, and are referred to other health professionals as needed. Recent examples include a dietician, and a psychiatrist. Service users are supported with visits to the dentist, optician, and foot-care specialist. The Manager has established good links with the specialist HD unit at Guy’s Hospital. A service user had sustained a fall in the early morning, and the Inspector noted that as well as checking his physical condition, the staff had immediately carried out a risk assessment for the cause of the fall, and had taken action to deal with it. This had been recorded on the accident and incident forms. Documentation includes dependency scores, moving and handling assessments, social activity records, therapy records, and monthly weight records. Medication is stored in a small, locked, storage room on the second floor, in a locked metal cabinet. Administration is via the Boots Monitored Dosage System. Drugs are administered individually, as service users mostly have medication given after getting up, or before bedtime – and they get up and go to bed at different times. Only senior support staff who have been checked for competency administer medication. No out of date medication was found, and there was no overstocking. Medication Administration Records (MAR charts) included a photograph of the service user, and a detailed sheet about each type of their medication. These reminded staff of side effects to look out for. MAR charts had been neatly and accurately completed. Service users had signed written agreements in respect of allowing staff to give them their medication. The storage room is at the top of the building, and gets very hot. An airconditioning unit had been purchased and was in use. The temperatures of the room and drugs fridge are recorded daily. In regards to death, and dying – service users have entries at the front of their standex sheets indicating if they have any special preferences or cultural/religious needs. Staff have some training in the ongoing training programme for this, but it was noted in an internal audit that staff would benefit from additional training for helping service users through death/bereavement. This was being accessed. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 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 the following standard(s): 22,23. The quality for this outcome area is good. Service users, relatives and staff are informed about how to make complaints, but the procedure needs amending to include all the required details. Good training programmes help to protect service users from different forms of abuse. EVIDENCE: The complaints log itemises details of who has made the complaint and the content. Records are kept of all investigative processes, letters, meetings, and outcomes, and showed that complaints are handled appropriately. CSCI were informed of two Adult Protection alerts (raised by social services) since the last inspection. One of these related to an inability to meet a service user’s needs. The alert was upheld. The service user was transferred elsewhere. It was felt that this person should not have had a placement at this home, as the needs were very complex, and needed a different placement to meet this person’s needs. The management have taken steps to improve the pre-admission assessment process; and to access further training on managing service users with difficult behavioural needs. Another Adult Protection alert was raised over an alleged theft of a service user’s money. No evidence was found to support this claim, and the allegation was not upheld. Service users had recently completed CSCI surveys, and internal questionnaires. These showed that they know who to go to if they have any concerns/complaints. The complaints procedure has been put into a simplified HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 17 format to promote understanding. The complaints procedure does not contain the names and addresses of people/organisations to contact (e.g. social services; CSCI), and there is a requirement to amend this. Disciplinary proceedings are used for staff if indicated, and they have access to a grievance procedure. The staff induction includes recognition of different types of abuse, and action to take in the event of any suspicion of abuse. The company carries out further internal training on this, and there was a training session on whistle-blowing during the afternoon of the inspection visit. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26,27,28,29,30. The quality for this outcome area is adequate. The premises are generally well maintained, and provide a homely environment. The Providers are pursuing plans for making the house more fit for purpose. EVIDENCE: The Inspector was shown around every part of the home, and saw that it was clean throughout, and that general maintenance was satisfactory. There are outstanding requirements to install a passenger lift and to install an adapted bath. The Providers have had plans drawn up for the necessary alterations, but these need to be amended, and so the work has not yet commenced. Consideration is being given to any prospective new service users, to check that the home will meet their needs in it’s current state. The existing service users feel very much at home in this building, but lack of a passenger lift prevents easy access to all floors. All bedrooms were viewed, are spacious, and have been personalised according to service user’s preferences. Some of them (including vacant bedrooms) HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 19 contained old furniture in not very good condition, and the Inspector recommends that furniture items are kept under review. Each bedroom includes an en-suite toilet and washbasin. These have been completed with partitioning which does not reach to the ceiling, so would not afford much privacy if service users had a relative/friend visiting in their bedroom. However, service users expressed their satisfaction with their own rooms, and were pleased they could choose the décor. Colour coded towels are purchased to match the décor. The Inspector noted a stained area of carpet by one washbasin (which is outside the en-suite area in this room), and asked about the possibility of laminate or linoleum flooring for this area. She was informed that some service users do not want to wear shoes in their rooms, and it is recognised that the combination of bare feet and unsteady walking on a laminate or linoleum floor could contribute to falls. So carpeting has been chosen as a result of the risk assessment. It was pointed out to the Inspector that the cleaner had not yet been into this room, and would clean this area of carpet when she cleaned the room. Carpeting on the hallway, stairs, and landing was very worn. New carpeting had been chosen and ordered, and was due for fitting in the next 2 weeks. Carpeting of en-suite areas and bathrooms is not ideal for hygiene management, and could be replaced in due course by non-slip flooring which is easier to clean. However, apart from the identified area in one of the bedrooms, all carpets were reasonable, and there were no offensive smells. There are 2 communal bathrooms – one on the ground floor, and one on the first floor. These both have a portable chair fitting, and the first floor bath has a shower attachment to the taps. The Providers have previously supplied an action plan to fit an adapted bath. Plans have had to be amended, and so the Inspector has given this again as a requirement. Access to the ground floor bathroom is through the kitchen, which is unsatisfactory. The Providers intend to have separate access to this bathroom when alterations are made to the property. The alterations should also improve wheelchair access to all areas. There are different sitting areas for service users, including a large lounge/dining room on the first floor, and a smoking room on the second floor. A wrought iron safety gate has been fitted at the top of the first floor stairs, and this has a keypad lock to open it. This is to prevent falls down the stairs. Additional equipment was in place, such as grab rails, toilet surrounds, fire alarm system, and a call alarm system. Service users are assessed individually for specific equipment needs (such as specialist seating), according to their physical condition. The rear garden is fairly small, but pleasantly set out with a patio area, lawns and flower beds. Unfortunately, it does not provide a safe area, as paving/concrete areas are uneven and unsafe. There are plans to alter this HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 20 area. In the meantime, service users are closely supervised when they wish to go outside. Laundry facilities are adequate, with a room on the second floor containing the washing machine, and a utility room on the first floor which has a tumble dryer. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36. The quality for this outcome area is good. The staff team interact well with service users, and support each other in their different roles. The staffing level needs to be kept under review, due to the changing needs of service users. EVIDENCE: The staff team have an awareness of their different roles and responsibilities, and were seen to be working well together to care for service users effectively. Main aims and values of the home are stressed at initial interviews, in the induction programme, and in ongoing training. The home uses the Skills for Care induction training, and this is an effective tool. The Manager oversees the induction of new staff, and the process takes 3-4 months to complete. Detailed records are kept of the different subjects covered. This includes mandatory training, and specific training for understanding HD. Volunteers are not permitted to work at the home, as staff need detailed understanding of this condition. Recruitment procedures are well managed. The Inspector picked out 2 staff files, which contained the required documentation. (CRB check; 2 written references – with one from the previous employer; a record of any gaps in employment and why; a medical questionnaire; confirmation of identity, and HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 22 POVA check). All staff are given a GSCC code of conduct, and receive terms and conditions of employment. The company expect all support staff to work towards NVQ 2 and/or 3. At this time, 3 staff were working for level 3, and 2 staff were working for level 2. The Registered Manager is an NVQ Assessor. She has established links with Learn to Care and Business Link for training programmes. The staff training matrix showed that mandatory training was up to date, and that ongoing training was booked for staff where updates were needed. The home has implemented a detailed internal training programme, which links into Skills for Care. The home had an internal training session on “whistleblowing” during the afternoon of the inspection visit, and this was led by the CEO, who is closely involved in the running of both HMT homes. The internal training programme includes four overall sections: understanding principles of care; maintaining safe working practices; HMT Care – understanding your role; understanding the needs of the service users. Staff meetings are held monthly, and the Manager often attends staff handovers. The Inspector read the minutes for 2 staff meetings. They showed that staff have the opportunity to discuss any issues in the home. Staff are individually supported by supervision, and yearly appraisals. There is a good supervision format. The staff team on the day comprised 2 support staff for mornings and afternoons, and a senior support staff from 9-5 pm. Extra hours have been agreed for senior support staff to work 9-5, (approximately once per week each), so that by having an extra person on duty, they can spend time updating documentation. This a step forwards, as it enables the other 2 staff on duty to concentrate on caring fully for the service users. The home had 3 service users in residence, and usually has 2 support staff for mornings and afternoons, and 1 support staff at night. These are assisted by a cook 5 days per week, a cleaner 2 days per week (when every area of the home is cleaned), and additional help from the maintenance man and the health and safety advisor. Most of the Manager’s hours are supernumerary to this. The service users need constant supervision when they are not resting, and this number is just adequate for most of the time. However, the home quite often has service users for respite care, and this can stretch staff too far in terms of taking service users out, escorting them to appointments and emergency cover. As service users have a degenerative condition, they may need additional care, and therefore higher staffing levels, in the future. The staffing rota was viewed. It did not show any evidence of staff working a long day, followed by a night duty and then a morning shift – as previously reported. This would be unsafe practice. The support staff were busy all day, but managed to attend the training session in the afternoon when service users were resting. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 - 43 The quality for this outcome area is good. There have been considerable management improvements, showing the commitment of the Providers to raising the standard of the home. EVIDENCE: The Registered Manager has completed NVQ 4 and RMA training, and is waiting for accreditation. She is also an NVQ Assessor. She is looking to further increase her knowledge with a course to understand management of behavioural difficulties. The Manager clearly gives a lead in the home to staff, and assists them with understanding how to carry out hands-on care. She oversees all induction and mandatory training; and carries out staff meetings, and individual staff supervision. The previous Responsible Individual for the home (who has left that post, but knows the home well), has been employed to oversee quality assurance, and the staff training programme. She has put together a very detailed audit plan, HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 24 with different senior management responsible for different roles. Internal audits are included for: staffing, training, records and documentation, catering, housekeeping and décor, care, environment, drug storage and administration, security, safety, social needs and care plans. These have all been carried out in May 2006, with their own report based on the National Minimum Standards, and how the home is meeting these. Monthly Regulation 26 visits are carried out, and a copy is sent to CSCI. A quality assurance programme for service users, relatives and visitors had just been completed, within the previous 2 weeks. In respect of this, the Inspector did not send out the CSCI survey to relatives and friends, but relied on those produced in the home. Each of the service users completed a CSCI survey, and these contained positive feedback. They showed that service users feel at home; are satisfied with their care; feel well looked after by staff, and are able to pursue their own lifestyles. New policies and procedures had been implemented which had previously been omitted. These are available to staff, and form part of the induction training programme. Record keeping was seen to be generally acceptable. Daily reports were suitably detailed. MAR charts were accurate, and charts had been signed to show that personal care had been given. Some forms were still in the process of being brought up to date in the care plans (e.g. activity records, property lists). The health and safety advisor oversees all aspects of safe working practices. Pre-inspection information confirmed that maintenance checks (e.g. gas, electricity, water temperatures) were all up to date, and any requirements had been complied with. Fire drills have been added to the ongoing training programme. Fire extinguishers were seen to be in date. In March 2006, a service user fell downstairs, and sustained a shoulder fracture. The stairway was risk assessed, and a stair gate was placed at the top to prevent any further falls occurring. The gate has a keypad system. The Inspector did not ask to view the business plan, but the CEO said that the plans for alterations to the building were a major concern, and the company expects to go ahead with these. The insurance certificate was on display, and up to date. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 2 28 2 29 1 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 26 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 2 3 Standard YA1 YA1 YA22 Regulation 4 and Schedule 1 5 (1) 22 Requirement To complete the Statement of Purpose in the amended format. To complete the Service Users’ Guide in the amended format. To alter the complaints procedure, so that it includes details of organisations to apply to, including CSCI. To supply CSCI with an action plan, showing how the company will make alterations to the rear garden, so that it is as safe as possible for service users. (Further to the altered plans for the building being completed). To supply CSCI with an action plan, showing how the company intend to alter access to the ground floor bathroom and rear garden without going through the main kitchen. (Further to the altered plans being completed). To install an adapted bath suitable for meeting the needs of service users. DS0000047536.V297199.R01.S.doc Timescale for action 31/07/06 31/07/06 31/07/06 4 YA24 23 (2) (o) 31/08/06 5 YA24 23 (2) (a) 31/08/06 6 YA27 23 (2) (n) 30/09/06 HMT Care Limited Version 5.2 Page 27 7 YA29 23 (2) (n) To supply CSCI with an action 31/08/06 plan for installing a passenger lift to meet the needs of access for service users. (Further to the altered plans being completed). 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 2 Refer to Standard YA1 YA26 Good Practice Recommendations To produce the Service Users’ Guide in a simplified format (e.g. photographs, pictures etc.) To review the suitability of old bedroom furniture, replacing items as needed. HMT Care Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 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 Limited DS0000047536.V297199.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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