Inspection on 23/09/05 for HMT Orchard House

This inspection was carried out on 23rd 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

HMT Orchard House 21/05/08

HMT Orchard House 05/06/07

HMT Orchard House 30/05/06

HMT Orchard House 24/01/06

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

CARE HOME ADULTS 18-65 HMT Orchard House Underdown Lane Herne Bay Kent CT6 5UD Lead Inspector Jenny McGookin Announced 23 & 26/09/05 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service HMT Orchard House Address Underdown Lane, Herne Bay, Kent, CT6 5UD 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 373586 01227 749115 N/A HMT Care Ltd Ms Christine Bone Registered Care Home 10 Category(ies) of Care Home for Younger Adults (18-65) with a registration, with number Physical Disability of places HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A 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 cater for people of either sex, within the age range of 1865 years. Orchard House is registered to provide accommodation and personal care for ten adults, including one respite facility. It is a large Edwardian detached house. Its layout extends over two floors. There are 10 spacious single bedrooms, located on both floors, each with its own en-suite toilet and wash hand basin facilities. Six, including the respite unit, have full en-suite facilities. There is a 2-person passenger lift linking both floors. There is a specialist shower and toilet on the ground floor and a specialist bathroom and WC on the first floor. The kitchen, utility room and the main communal areas (dining room and two lounges) are all on the ground floor, and there is a kitchenette and more communal space on first floor. The property is enclosed on three sides, with an open aspect garden at the front and a fenced garden to the rear, which has a patio area, and discrete sections for herbs, flowers and vegetables. There is off road parking for up to four vehicles, but the access road is privately owned and kerb-side parking is subject to clamping and heavy fines without permits. The Home is situated within easy walking distance of a run of local shops and the amenities of Herne Bay. The Home can also be accessed from the M20/ M2 , or the Herne Bay British Rail station nearby. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was this home’s first inspection since its registration, which was intended to introduce the new inspector to the staff and residents; and to reach a preliminary view on the day-to day running of the home. The inspection process took just under fifteen and a half hours, and involved meetings with the proprietor, the registered responsible individual, a director, the risk assessment co-ordinator, a resident and her relative, two support staff, the cook, and a visiting psychiatrist. Feedback comments were also received from two relatives. The inspection also involved an examination of records and documents (most notably complaints management, staff induction and training) and one resident’s case file. One resident did not want the inspector to enter her bedroom, but seven other bedrooms were inspected for compliance with the National Minimum Standards, as well as the respite unit. And the inspector also checked the communal areas. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? What they could do better: The setting up of this home was not in the first place welcomed by the neighbourhood and there have been several complaints about noise, disturbance and its day to day running arrangements. Added to this have been concerns raised about the management of one resident’s complex needs in particular. The biggest challenge for this home will, therefore, be to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. HMT Care Ltd should look for opportunities to adapt the building further, so that it can pre-empt the residents’ changing needs, without detracting from its HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 6 homely setting. Adapted furniture is more readily available in discreet models nowadays. Notwithstanding HMT Care Ltd’s wish to keep the setting domestic, it has a duty of care to staff as well as the residents. Ceiling tracking should, for example, be considered to minimise the amount of hoisting equipment required otherwise, and the garden areas need to be made fully accessible. Other examples are commented on in this report. Care plans need to interact with risk assessments to ensure their take up by staff. Staff should certify having read / agreed to comply with care plans and risk assessments. The home needs to take a lead in the review of care plans with residents and other stakeholders, and should record each resident’s perspective and any unmet needs. A number of matters have been raised for attention in respect of staffing arrangements. The home’s capacity to robustly maintain baseline staffing levels or offer the level of flexibility required to enable more than one resident to be supported concurrently on or off site has come under scrutiny and needs to be more demonstrable. 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 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 and her 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. One resident and her relative confirmed having visited the home for an event before her admission. There is a trial period (usually a month, but this is interpreted flexibly and can extend to three months) before each admission is confirmed. Each placement is confirmed by a contract with the funding authority. Fees are set at a level to provide care that the Huntingdon’s Disease Association HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 10 (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. 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 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. The preadmission assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. Residents are involved in these processes as far as they are able to be. 7. Residents were observed being supported to make decisions, and observed interactions between staff and residents were respectful during this inspection. 8. Residents have a number of opportunities to influence their care plans, daily routines and the running of the home, and their level of involvement is a matter of personal choice. 9. There are risk assessments to cover individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information is generally satisfactory, though some documents were not properly secured within files. EVIDENCE: HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 12 The format of the care plan, which follows on from the preadmission assessment process, is a comprehensive one, clearly designed to address the 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 this inspection 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 resident selected for care tracking, her interests, activities or any emerging unmet needs. The resident in question was aware that there was a care plan and was aware that there were meetings to check care plans out but her aspiration was to move onto supported independent living. The care planning documents did not, however, reflect this. The resident’s file, moreover, showed no formal inhouse review had been held. Her relative seemed to be more engaged in the process. 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 file selected for care tracking, was any evidence of practical interactions between the care plans and risk assessment processes thereon. 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 this is underpinned in the Code of Conduct outlined in the Service Users’ Guide. The residents’ right of access to their records is also summarised in the Charter of Rights in the Service Users’ Guide. However, there is no record of any take-up of any right of access to information or policies by residents or their HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 13 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 are easily portable and more secure provision needs to be arranged. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 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 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. 17. Meals are enjoyed, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. EVIDENCE: Abilities, activities and personal preferences are intended to be established as part of the preadmission assessment process, and confirmed by care plans and day-to-day consultation thereon. However, interests and activities were left blank in the case file selected for care tracking. Three relatives confirmed that HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 15 the home had been able to match their expectations, but the resident was intent on moving on. This home offers support to residents in maintaining their practical life skills, and this is underpinned by confidential counselling sessions provided by one of the proprietors and the specialist therapies it buys in (speech and language, 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, occasional theatre or concerts i.e. mainstream community activities not confined to or identifiable with disabilities. The immediate neighbourhood, however, has not welcomed the setting up this home, and there have been complaints about noise, disruption and aspects of the day to day running of the home. The challenge will be to restore confidence locally. 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. There are no pets in the home – their introduction would need to be risk assessed and subject to the consent of other residents. Each bedroom has a telephone point, though the installation of a telephone would be at the resident’s own expense. Residents can use the home’s cordless telephone upon request, subject to its availability. The cost of all calls will be charged directly to the SU or their financial representative. The use of mobile phones bought for the residents by the home is, as a condition, restricted to “pay as you go” to avoid large telephone bills accumulating. Dietary needs and preferences are also established as part of the preadmission assessment process, and confirmed by 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 HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 16 as a training need. The dining area is a congenial setting but residents can choose to eat in their rooms. 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 expect the home should 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 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 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. 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, and six (including the respite facility, have full en-suite facilities, so that the availability of these facilities is assured. 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. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 18 Each resident is registered with a GP but there has been no scope for personal choice in this matter locally. 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 extent to which one resident with complex needs has been able to refuse to co-operate with personal and health care has been the subject of complaint from one visiting healthcare professional and a neighbour over recent months. The challenge will be to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 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 22. The registered person has produced a complaints procedure, but needs to demonstrate its effectiveness 23. Staff expressed a commitment to protect residents from abuse but a balance still needs to be struck in respect of the rights and responsibilities of all parties involved in the care of one resident with complex needs, who has been refusing personal and health care. 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 a loose-leaf file with pre-numbered pages and an index, and is largely being used in practice to detail complaints from neighbours (noise, disturbances and operational matters) and one or two issues raised by visiting professionals. Records generally indicate that action was taken in each case, but one record was missing and the level of detail was not always robust and required tracking through other information sources. 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 HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 20 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. Each member of staff who met with the inspector was separately asked what they would do if they encountered any adult protection issues and each expressed a commitment to challenge and report them. They each showed an adequate understanding of the role of the CSCI in such matters and all knew how to contact the CSCI. All said this had never occurred in this home. However, one resident has for some been refusing personal and healthcare, and the home’s management of this has been the subject of a conflict of professional and non-professional opinion. The challenge will be to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 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 and the furniture is generally domestic in style, and comfortable. There are homely touches throughout. 27. Each bedroom has an en-suite WC and wash basin cubicles, and six have full en-suite facilities, so that their availability and privacy is assured. Communal bath, shower and WC facilities are accessible to communal areas. 29. There is some equipment and adaptations but it is only partially adapted / wheelchair accessible. 30. The home is well maintained, clean and free of offensive odours. EVIDENCE: The location of this home is judged generally suitable for its stated purpose, but the recent imposition of parking restriction to permit holders by the owner of the access road may have some impact on access in future e.g. for visitors and socially inclusive events. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 22 All areas of the home were inspected and found to be homely, comfortable and clean. Comfortable temperatures were maintained throughout the inspection. There is an air exchange system in operation. The inspector was surprised to read that the provision of any extra facilities (heating, cooling devices and air conditioning) to meet the residents’ personal requirements would be at their own expense. Some matters were raised for attention. See Schedules. The furniture tends to be domestic in style, and this has been the subject of complaint. 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, 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. Ceiling tracking could, for example, be considered to minimise the amount of hoisting equipment otherwise required. The garden areas, fully enclosed at the rear, provide pleasant discrete focal points and private areas to walk or sit in. But the ground surfaces are very uneven and likely to present trip or slip hazards and must be attended to. The home has a smoking policy, which allows residents to smoke in one 1st floor communal area, but staff are required to take their smoking breaks outside and this has been a source of complaint by immediate neighbours (noise, litter and invasion of privacy). Although this has been improved by staggered work breaks, a more suitable arrangement needs to be made, particularly in respect of seasonal changes. Communal Areas The main lounge and dining areas are on the ground floor, but there is additional communal space on the first floor. All the chairs (dining and lounge) are uniform in style – a range of chairs (e.g. some with arms, or set at different heights) would give residents more choice. 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. One resident has done so. The inspector would expect the home’s own provision to be based on assessed individual need (current and predictive). There are some safeguards and adaptations in place, but these are not universally applied. Some areas have handrails either side, others don’t. There is a call bell system – which has a hands-free facility. HMT Care Ltd is looking to introduce piston-operated door openers, linked to the fire alarm system, which means doors can ordinarily be left open at the desired gap but would slam shut when the fire alarm is activated. All radiators have decorative guards. Hot water taps have thermostatic mixers concealed behind panels – HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 23 and there are weekly checks of room, water temperatures as well as of the fire safety arrangements. The upper story windows are all openable at the top half. The home needs to take advice on whether to install window restrictors. Kitchens There are two kitchen facilities (the main kitchen is on the ground floor and there is a kitchenette on the first floor), both of which were found to be clean and well maintained. Communal Bathroom / WCs There is one adapted shower room/WC on the ground floor and an adapted Parker bathroom / WC on the first floor i.e. reasonably accessible to bedrooms and communal areas. Six of the ten bedrooms (including the respite facility), moreover, have full en-suite facilities. However, access needs to be reassessed in respect of the respite facility. Both communal bath / shower rooms have terracotta tiled flooring. This is not judged easily cleaned nor comfortable to stand on. Bedrooms All the bedrooms are spacious and single occupancy. Each occupied bedroom is reasonably personalised, and the doors can be snib-locked as well as keylocked. Residents are asked if they would like a key and their ability to manage a key is also subject to a risk assessment. In terms of their furniture and fittings, the bedrooms inspected were generally compliant with the provisions of the National Minimum Standards, except in respect of the provision of bedside lights, tables and two comfortable chairs. The inspector was assured that the provision of bedside tables and lights was risk assessed in each case. All the residents have been provided with lockable cash tins but these are easily portable. These tins need to be secured against a firm immoveable surface or replaced by more secure facilities. All the bedrooms have at least two double electrical sockets, but these are all sited at skirting board height, which means residents have to stoop or ask staff to help them to operate them. The home should look for opportunities to resite them at a more accessible height. Each bedroom has a telephone point for private landline or Internet, though this would be at the resident’s own expense. Where the home has bought residents mobile phones, these are “pay as you go” to prevent bills mounting up. Every bedroom also has a TV point – though the provision of personal TVs is also at the resident’s own expense. The provision of en-suite WCs and hand-basins clearly ensures these facilities are readily accessible to the residents and that their privacy is assured. However, where these en-suite facilities are not completely enclosed, they may have implications for the safety of meals the residents may decide to take in their bedrooms. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 24 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: The working day is interpreted in terms of at least 14 hours and is intended to be staffed accordingly i.e. from 7.15am till 9.45pm. • The morning shift is from 7.15am till 3.15pm; • The afternoon shift is from 3pm till 9.45pm. In each case there should be at least two care staff on duty. At night time there is one waking duty member of staff. The registered manager works at this home on Mondays, Wednesdays and Fridays – from 8am till 5-6pm and at the other home in this group on the other days of the week. She shares the on-call arrangement with her deputy and, as a back up, the directors. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 25 The proprietor, registered responsible individual and other directors are said to visit regularly, and there is also regular input from the risk assessment coordinator. There are dedicated staff to do the cooking and cleaning during the weekdays. And there is a maintenance man who works 20 hours a week (covering both homes in the group). The rotas supplied for September 2005 indicated compliance with these baseline staffing levels as described on the days of this inspection, but never once exceeded them. This was judged surprising given the likelihood of outings being requested while the weather was good. The manager was previously advised to include a legend on staffing rotas to explain any codes used – this matter was found to be outstanding in respect of three codes used. 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 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 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 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. When questioned directly, staff confirmed that the staffing levels did, on occasion, drop to just one. Without proof of intervention by any of the directors, this is judged unacceptable, given the level of assistance required by individual service users. The responsible individual was asked to apply the Residential Forum formula and to report back to the inspector on the staffing HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 26 arrangement it indicated. At the point of issuing this draft, this matter was still outstanding. This is a staff group, which identifies flexible working and team working as its strengths. Each member of staff confirmed that the recruitment process was systematic and thorough – that it systematically required two references, and that satisfactory checks were carried out, including CRB checks. A contract is issued following a satisfactory probationary period. The inspector understands that probationary periods are not confirmed if staff refuse to do the mandatory training. There is evidence of induction and mandatory training (e.g. manual handling, fire safety, adult protection, health and safety). The Risk Assessment Coordinator gets involved in staff induction e.g. H&S, fire safety. The home also uses distant learning e.g. for manual handling. An examination of staff induction records for staff, however, indicated that only two staff induction checklists were completely signed off, and the number of gaps was surprising given the staff members’ roles (examples include: assessing residents / care planning / reviews, medical consent, safe bathing, notifications to CSCI, abuse). The manager retains the original training certificates, wherever practicable, and where photocopies are kept, they are signed / dated by the manager to confirm her having seen the originals. Staff identified further Huntingdon’s Disease specific training needs e.g. behaviour management and nutrition, which the manager should follow through. The manager 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. All the staff who met with the inspector, confirmed that they had regular supervision sessions every six weeks, and records indicated a generally diligent approach, which generally exceeded the National Minimum Standards. The use of supervision target sheets is judged good practice but these are not applied robustly. And there has been no training in giving supervision; and supervision needs to be rolled forward into formal annual appraisals. These gaps must be addressed. None of the staff had been issued with copies of the General Social Care Council Code of Practice, but 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this occasion, except that all maintenance records were found to be up to date, systematically updated and recorded. Preliminary findings are made in respect of policies. EVIDENCE: The Pre-Inspection Questionnaire requires homes to confirm whether listed policies are in place and whether reviewed. 11/42 listed policies were found to be not in place. These included key issues raised by complainants: continence management, nutrition; harassment, sexuality, record keeping. HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 28 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 x Standard No 22 23 ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 2 1 3 Standard No 11 12 13 14 15 16 17 2 N/A 2 2 x 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 HMT Orchard House Score 2 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x 1 x x x H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 29 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Periodic audits of the premises are required to ensure it can maintain its capacity to meet changing needs of its residents. Particular areas for attention include: - the respite facility access to kitchen and shower room - the uneven surfaces in the rear garden - the provision and siting of Timescale for action 31 12 05 2. YA1 31 12 05 3. YA1 22 31 12 05 4. YA24, YA29 23(2)(n) Immediate and ongoing HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 30 handrails and grab rails 5. YA24 23(4) The home needs to take advice on whether to install window restrictors on upper storey windows, as a precaution against risk of accidents Staffing Rotas. The following matters are raised for attention: - The manager must include a legend on staffing rotas to explain all the codes used. The manager is required to detail the on-site hours of the directors and ancillary hours (cooking and cleaning) separately, particularly where staff duties are 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. HMT Care Ltd must ensure that all the policies identified by the regulatory framework are in place 31 12 05 6. YA33 Schedule 4(7) Immediate and ongoing 7. YA40 18 31 12 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care plans shoul document the extent to which residents are actively engaged in this process i.e. at reviews, and how the home established the resident’s own perspective and any emerging unmet needs. care planning documentation needs to better reflect the practical steps required to address individual needs, and should be reviewed monthly Each residents lockable cash tin should be secured against a fixed surface or alternative provision made Care plans should better reflect the extent to which residents can participate in domestic tasks The challenge will be to restore confidence locally H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 31 2. 3. 4. 5. YA6 YA10 YA11 YA13 HMT Orchard House 6. 7. YA13 YA13 8. 9. YA17 YA20 10. YA22 11. 12. YA23 YA26 13. YA27 14. 15. 16. 17. 18. YA28 YA30 YA30 YA30 YA33 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 extent to which one resident with complex needs has been able to refuse to co-operate with personal and health care has been the subject of complaint from one visiting healthcare professional and a neighbour over recent months. The challenge will be to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. The challenge will 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 should actively promote the use of independent advocacy services. ·All bedrooms must be assessed against the elements of the NMS and non-provision must be justified by properly consulted or negotiated risk assessment. Lockable cash tins need to be secured against a firm immoveable surface or replaced by more secure facilities. The Parker bathroom and shower room should have comfortable non-slip floor covering – terracotta tiled flooring is not judged either The Parker bathroom should have also provision for clothing and personal effects Communal areas should be provided with a variety of chairs (differing heights and styles, some with arms – dining and lounge) to suit individual needs Kitchen facilities should have flyscreens on external windows or insectocutors The main kitchen should have a separate handwash basin and cleaning materials should be stored in a lockable cupboard The kitchenette should have lidded rubbish bin. Its 1st Aid kit requires blue plasters and scissors. A checklist should be maintained of contents to ensure its upkeep The Statement of Purpose should commit the home to a statement of minimum staffing levels, and prospective H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 32 HMT Orchard House 19. 20. 21. YA33 YA34.5 YA35 22. 23. YA36.6 resident should have the right to expect contingency arrangements to address stated variables in staffing arrangements. The responsible individual is asked to apply the Residential Forum formula and to report back to the inspector on the staffing arrangement it indicated. Each member of staff should be given a copy of the GSCC Code of Practice Induction checklists need to be more robustly applied and the following training needs have been identified: - behaviour management - nutrition - the management of aggression, self-harm, - fluctuating needs, - professional relationships - supervision. Staff supervision needs to be rolled forward into formal annual appraisals HMT Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 33 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 Orchard House H56-H05 S61966 HMT Orchard House V240999 Stage 4.doc Version 1.40 Page 34 - 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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