Inspection on 24/01/06 for HMT Orchard House

This inspection was carried out on 24th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 23/09/05

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 Unannounced Inspection 24th January 2006 10:25 HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 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 Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 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 Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service HMT Orchard House Address Underdown Lane Herne Bay Kent CT6 5UD 01227 373586 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 Ltd Ms Christine Bone Care Home 10 Category(ies) of Physical disability (10) registration, with number of places HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd September 2005 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 DS0000061966.V279141.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was this home’s second inspection since its registration, which was intended to review key standards from the last inspection; assess some standards not inspected on the last occasion and to reach a view on the day-to day running of the home. The inspection process took seven and a half hours, and involved meetings with the proprietor, the registered manager, the risk assessment co-ordinator, a visiting physical therapist, two support staff, and the cook. The inspection also involved an examination of records and documents and one resident’s case file. Two bedroom doors were locked 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: As reported at the last inspection, the setting up of this home was not in the first place welcomed by the neighbourhood and there had been several HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 6 complaints about noise, disturbance and its day to day running arrangements. These complaints have to some extent abated. Added to this have been ongoing concerns raised about the management of one resident’s complex needs in particular, which is still currently under scrutiny, though the resident has been moved on. The biggest challenge for this home continues to be, therefore, to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. Medication administration records require further attention so that any irregularities are backed up with documented action. 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 continues to be at issue and needs to be more demonstrable. HMT Care Ltd will need to propose a replacement for the registered Responsible Individual, following the resignation of Linda Gilbert, so that lines of accountability are formalised. There is also a need to review the appropriateness of having one manager to manage both homes in the group. 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 DS0000061966.V279141.R01.S.doc Version 5.1 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 Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 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, 5 1. Not all the documentary information necessary for potential residents to make an informed choice is available, and some public information still 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 to meet the residents’ individual needs. Its capacity to cater for other coexisting diagnoses will require formal ratification by the Commission. 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 were raised at the last inspection for inclusion or amendment to obtain full compliance and found to be still outstanding. Taped and large print versions are said to be available now. See the last report (September 2005) for other matters raised for consideration in respect of these documents. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 9 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 or funding authority involved. However, one recent admission with more complex needs will require proper authorisation by the Commission. There is a trial period (usually a month, but this is interpreted flexibly and can extend to three months) before each admission is confirmed. Each placement is confirmed by a contract with the funding authority. Fees are set at a level to provide care that the Huntingdon’s Disease Association (HDA) requires. Any individual variations are to do with increases different boroughs are applying to the base level set by this home. Additional care needs are set six months later with the care manager. HDA provides training, advice and professional workshops to underpin practice at the home. Feedback from one visiting physical therapist confirmed her satisfaction with the care given by this home, but there have also been complaints. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 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 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: 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, but are now being gradually delegated to HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 11 support staff with training and support from the manager. The inspector met with one of the support staff, who confirmed the arrangement as described. The last inspection found that the care plans were being properly signed by the residents (where able) and / or their representative e.g. relative or care manager as evidence of their participation. This interest is not, however, sustained in all cases. Records, discussions with staff and observations confirmed residents are being accorded choices and control over day-to-day routines and interactions were judged respectful. Recent events have, however, indicated the need to strike a better balance between the interests of the residents, where they are likely to conflict. 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). The inspector met with the management team, who explained how they were trying to make the daily reporting, risk assessment and care planning processes more interactive. This is judged a promising development, but it was, however, too early to judge the effectiveness of this. 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 still no record of any take-up of any right of access to information or policies by residents or their representatives, nor of their involvement in the development of policy or practice. The home keeps hard copy and electronic records. Cabinets, computers and office facilities are all properly secured. Each resident has a lockable cash tin to store money and valuables in, and these were in the process of being replaced with more secure provision as required. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 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, 17 11,12. There is some choice and control over most aspects of daily routines. Some sources, however, (professional, familial and neighbour) need to have their loss of confidence restored and maintained. 13, 14. This home offers a limited range of activities inside and outside the home, and records activities 15. There are open visiting arrangements, and the home is well placed for access to local community resources. 17. The residents’ health and wellbeing is being better catered for since the cook’s training needs have been addressed. Staff are readily available to assist residents. The setting is congenial. EVIDENCE: The arrangements as described at the last inspection were generally confirmed by this inspection. Abilities, activities and personal preferences are identified as part of the preadmission assessment process, and confirmed by care plans and day-to-day consultation thereon. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 13 This home offers support to residents in maintaining some practical life skills, and this is underpinned by the specialist therapies it buys in (speech and language, physical and physio therapy). 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 occasional opportunities to access local resources such as shops, seafront, cafes and pubs, theatre or concerts i.e. mainstream community activities not confined to or identifiable with disabilities. Records are being maintained in each case. The immediate neighbourhood, however, has not welcomed the setting up this home, and there have been on going complaints about aspects of the day-today running of the home, though the number has abated since the last inspection. The challenge will always be to restore and maintain confidence locally. There is no company vehicle but one resident has access to a car purchased for him by his funding authority, which staff will be able to use once the insurance arrangements have been finalised. The inspector was assured that the other residents are able to use taxis or public transport, and that the large bulk of the cost of this is borne by HMT Care Ltd. Some transport costs would still fall to the resident or their funding authority. A dedicated adapted vehicle is, therefore, recommended, so that access to the community is not frustrated by their inevitable increasing mobility impairment or funding issues. 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 – but records and anecdotal information confirm their introduction by residents has been facilitated subject always to risk assessment and the consent of other residents. One respite placement brought a parrot with him, and one resident kept a pet rabbit for a while. 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. HMT Care Ltd. pays £10 for the first instalment. Dietary needs and preferences are also established as part of the preadmission assessment process, and confirmed by input from a speech and language HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 14 therapist and dietician, in the care plan and day-to-day consultation. The arrangements are described in more detail in the last inspection. This inspection was used to follow up the inspector’s meeting with the cook at the last inspection. The cook described the direct training, reading material and training videos she’d had in catering for people with Huntingdon’s Disease since the last inspection, where this was identified as a training need. The owner said that the plan is to recruit a cook for Sundays and to increase the number of catering hours to meet identified needs. 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. At the last inspection, the inspector judged prospective residents should expect the home should have a sound knowledge of local religious resources and events 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. There had been no progress with this, but the manager undertook to follow this up. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 15 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 18. En-suite facilities guarantee some measure of availability and privacy. Staff are available on a 24 hour basis to assist residents, and provide sensitive and personalised support. 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 some healthcare professionals will need to be restored 20. Medication arrangements are subject to risk assessment and individual contracts, so that residents have as much choice and control as possible. 21. There is a policy and procedure on ageing and death, to ensure a personalised approach, though some matters are raised for inclusion to en sure full compliance with regulatory responsibilities. 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. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 16 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. There is access to the community dietician. Each resident is registered with a GP but there has been no scope for personal choice in this matter locally. However, HMT Care Ltd is now more readily able to register new admissions with a local practice, rather than wait for the Primary Care Trust to make the allocation. Records have confirmed that the residents’ ability to manage their own medication is being risk assessed and subject to contract. The medication storage arrangements are secure and access to medication is restricted. HMT Care Ltd has a summary policy on the management of medication, which is underpinned by training by the manager and by Boots The Chemist. This arrangement was confirmed by a support worker. An examination of medication administration records showed that each resident’s charts had a cover sheet usefully identifying side effects or contra indications. However, only one set of records had a photograph of the resident concerned, and there was no information about the implications of missed dosages, their relationship to food or drink intake, or the action to take in each case. This is strongly recommended, to ensure a timely and co-ordinated approach. The extent to which one former resident with complex needs has been able to refuse to co-operate with personal and health care has been the subject of complaint from healthcare and social care professionals 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 DS0000061966.V279141.R01.S.doc Version 5.1 Page 17 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 22. The registered person has produced a complaints procedure, but needs to demonstrate its effectiveness in respect of residents’ issues. 23. Staff continue to express a commitment to protect residents from abuse but lessons need to be learned about the balance which needs to be struck in respect of the rights and responsibilities of all parties involved in the care of this group of residents. EVIDENCE: The Statement of Purpose and Service Users’ Guide both need to be amended 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 has a complaints register but there were no complaints in the register from any of the residents. The inspector understands that day-to-day issues are still being recorded in the homes Cardex system or incident reports. The challenge will continue to be, therefore, for this home to demonstrate that it can translate any expressions of satisfaction into recordable events; so that anyone authorised to inspect the register can assess the extent to which residents feel able to speak up and the home is taking their views seriously. The home does not use independent advocacy services but the manager said she had been making some enquiries about this. This option should be more actively promoted. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 18 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. Both said this had never occurred in this home. However, one former resident had for some time been refusing personal and healthcare, and causing distress to other residents until her discharge. The home’s management of this has been the subject of a conflict of professional and non-professional opinion, which culminated in an adult protection alert and is currently undergoing resolution. The challenge will always be to strike a better balance between the rights and responsibilities of all parties concerned, to restore confidence overall. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 19 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, 27, 28, 29, 30 24, 28. Residents have a choice of communal areas and the furniture is a mix of domestic and specialist, and comfortable. There are homely touches throughout. 25, 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 significantly more equipment and adaptations in evidence, but the home / site is still 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, and the recent removal of parking restrictions (imposed by the private owner of the road) is likely to have a positive impact on access in future e.g. for visitors and socially inclusive events. However, the access road surface is deeply pitted and will require attention as a precaution against the risk of accident. The owner described how she had already been trying to establish who had responsibility for its maintenance, to address this matter. The HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 20 junction between this access road and the main road is, moreover, reported to be hazardous, as views are obscured by hedging. There has been one near miss since the last inspection. The owner said she had taken this up with the local council, with a view to having traffic warning signs erected. Almost 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, and since the last inspection, HMT Care Ltd had purchased fans to further meet the residents’ personal requirements. Since the last inspection, HMT Care Ltd has obtained a significantly better mix of specialist and domestic furniture. There was also more evidence of adaptation of the building, so that it is now better placed to pre-empt the residents’ changing needs, rather than react to them, without detracting from its homely setting. Examples include more banisters and grab rails, ceiling tracking in one bedroom for hoisting equipment, adapted beds (one of which has an integral hoist) and comfy wheelchairs, an adapted shower chair, slide sheets, and a lifting belt. There are door holders on some internal doors, linked to the fire alarm system and power sources, which enable residents and staff to leave doors ajar but which would slam shut in the event of fire alarms being activated or power cuts. More equipment and adaptation is on order or planned. This effectively means that notwithstanding HMT Care Ltd’s wish to keep the setting as domestic as possible, it is striking a better balance between this principle and its duty of care to staff as well as the residents. Periodic audits of the premises by Occupational Therapists would ensure it can maintain its capacity to meet changing needs of its residents. Particular areas for further attention include: - the respite facility access to kitchen and shower room - the uneven surfaces in the rear garden - the provision and siting of other handrails and grab rails 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 (matter raised by the last inspection). The home has a smoking policy, which allows residents to smoke in one 1st floor communal area, and this facility has been made available to staff (who were previously required to take their smoking breaks outside - this was a source of complaint by immediate neighbours. This arrangement has been further improved by staff taking staggered work breaks. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 21 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) tended to be uniform in style but some residents now have comfy wheelchairs and a greater range of chairs (e.g. some with arms, or set at different heights) is said to be on order, which will give residents more choice. There are more safeguards and adaptations in place. There is a call bell system – which has a hands-free facility. All radiators have decorative guards, though some require firmer securing. Hot water taps have thermostatic mixers concealed behind panels – 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 had arranged for an inspection visit by the local fire officer to advise on whether to install window restrictors, and other fire safety matters. 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. HMT Care Ltd is looking to swap their functions so that the 1st floor facility would become the main kitchen, subject to the advice of the Environmental Health Officers. 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 still needs to be reassessed in respect of the respite facility (matter raised by the last inspection). Both communal bath / shower rooms have terracotta tiled flooring. This is not judged easily cleanable or comfortable to stand on, but the owner agreed to submit documented advice to the contrary from the Environmental Health Officers. 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 were originally provided with lockable cash tins but these were easily portable. These are in the process of being replaced by more secure facilities. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 22 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 continue to look for opportunities to re-site them at a more accessible height e.g. when re-wiring work is carried out. 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. One has an adapted shower seat. However, where these en-suite facilities are not completely enclosed, the inspector judged they may have implications for the safety of meals the residents may decide to take in their bedrooms. The owner had previously agreed to submit documented advice to the contrary from the Environmental Health Officers, but this matter was found to be still outstanding. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 23 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): 33 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. EVIDENCE: The staffing arrangements as described at the last inspection were confirmed as still applicable. 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 Tuesdays, Thursdays and for half a day on Fridays – and is on duty at the other home in this group on the other days of the week. She shares the on-call arrangement with her senior support worker and, as a back up, the directors. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 24 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 10 hours a week (covering both homes in the group). Some more complex building projects are covered by outside contractors. The staffing level on the day of this inspection exceeded these baseline staffing levels, and the inspector was assured that this was representative, but staffing levels have been the subject of complaint and staffing rotas were requested for the past month for further consideration. At the last inspection, the responsible individual was asked to apply the Residential Forum formula and to report back to the inspector on the staffing arrangement it indicated. This matter was still outstanding. See the previous inspection report for findings in respect of the Statement of Purpose and service User Guide on staffing levels. This is a staff group, which continues to identify flexible working and team working as its strengths. Each member of staff the inspector spoke to confirmed information received at the last inspection, specifically 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 was shown evidence of a structured induction checklist and staff confirmed having received a range of mandatory training (e.g. manual handling, fire safety, adult protection, health and safety). The Risk Assessment Co-ordinator gets involved in staff induction e.g. H&S, fire safety. The home also uses distant learning e.g. for manual handling. Both staff who met with the inspector, confirmed that they had regular supervision sessions every six weeks, which generally exceeded the National Minimum Standards, and one confirmed information from the manager that annual appraisals were almost complete. None of the staff had been issued with their own copies of the General Social Care Council Code of Practice, but there are said to reference copies available. The manager undertook to address this. There are no volunteers. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 25 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. The Manager’s qualifications and experience as described are appropriate to her role as registered manager, subject to the submission of documentation to confirm her completion of NVQ4 accreditation. 38, 43. HMT Care Ltd will need to propose a replacement for the registered Responsible Individual, following the resignation of Linda Gilbert, so that lines of accountability are formalised. 39. Feedback questionnaires need to be systematically introduced to measure the home’s success in meetings its own aims and objectives as well as the expectations of residents and/or their representatives. 40. Staff have access to policies and procedures and records but the range is still not comprehensive EVIDENCE: Chris Bone has been the registered manager for both homes in the group since their registration, and has several years’ experience in the care sector. After HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 26 problems with the accreditation agency, and the inspector understands considerable progress has been made with her Registered Managers’ Award (NVQ4 accreditation), but the CSCI is still awaiting documentation to confirm her certification. There is a need to review the appropriateness of having one manager covering both homes. There are clear lines of accountability within the home and all members of the board have regular contact with each home in the group, though this still needs to be better documented on rotas. There was also good evidence of Regulation 26 reports on monthly visits carried out by one of the directors. However, since the last inspection the registered Responsible Individual has resigned and a replacement has not be proposed. This gap must be addressed. There have, moreover, been a number of complaints raised against both homes in the group since their registration, all of which has indicated the need to fundamentally review provision. This process is ongoing and HMT Care Ltd have been making progress with matters raised for attention. This property is now being significantly equipped and adapted to make it more readily suited to the changing needs of the residents. The Risk Assessment Co-ordinator is proactively involved in regular audits of the premises and practices, and he also gets involved in health and safety training. At the last inspection all the maintenance records seen were up to date, in good order and backed up with periodic environmental risk assessments. There needs to be a firmer commitment to a baseline staffing statement, and a concerted effort needs to be made to restore the confidence of staff and residents’ relatives and representatives (healthcare and social care). There were still, disappointingly, no questionnaires for the funding authorities, the Huntingdon’s Disease association or other stakeholders, and the inspector was advised that no input from any independent advocacy services was planned unless called in to address specific issues. At the last inspection, 11/42 policies listed as required were not in place. These included key issues raised by complainants, though some progress has been made with this. The arrangements for business planning and managing residents’ finances were not inspected on this occasion. HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 27 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 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 3 LIFESTYLES Standard No Score 11 2 12 N/A 13 2 14 2 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 2 2 3 1 1 2 1 X HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4(1)© & Schedule 1 Requirement The Statement of Purpose must be checked against all the elements of this standard and regulation, to obtain full compliance. Original timesframe – 31/12/05 The Service User Guide must be checked against all the elements of this standard and regulation, to obtain full compliance. Original timesframe – 31/12/05 The registered person must ensure that medication administration is robustly recorded and that records demonstrate that missed dosages or other irregularities acted upon, in compliance with accredited standards. 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 DS0000061966.V279141.R01.S.doc Timescale for action 28/02/06 2 YA1 5(1) 28/02/06 3 YA20 13(2) 31/01/06 4 YA24, YA29 23(2)(n) 31/03/06 HMT Orchard House Version 5.1 Page 29 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. Original timesframe – 31/12/05 The registered manager needs to submit certification of her NVQ4 accreditation There need to be effective quality assurance systems in place based on the views of stakeholders to measure the home’s effectivess in meeting its stated aims and objectives. HMT Care Ltd needs to ensure that all the policies listed by the CSCI are in place and available to staff The following matters are raised for attention: - Abuse. HMT Care Ltds should obtain a copy of the Kent and Medway Guidance and check its own policy for compatibility - Care of the Dying and Bereavement. This should also address the retention of records and medication after death - Medication. HMT Care Ltds should obtain a copy of the Royal Pharmaceutical Guidance on medication standards and check its own policy for compatibility - Code of Practice. HMT Care Ltds should obtain copies of the GSCC Code of Practice, supply each member of staff with a copy and check its own statements for compatibility - Complaints. This policy needs to fully comply with Reg 22 HMT Care Ltd will need to propose a replacement for the registered Responsible Individual, following the resignation of Linda Gilbert, so DS0000061966.V279141.R01.S.doc 31/01/06 6 7 YA37 YA39 9 24 31/01/06 31/03/06 8 YA40 18 31/03/05 9 YA43 7 31/01/06 HMT Orchard House Version 5.1 Page 30 10 YA43 8 that lines of accountability are formalised. There is a need to review the appropriateness of having one manager covering both homes. 31/03/06 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 3 Refer to Standard YA13 YA13 YA13 Good Practice Recommendations The challenge continues to be to restore and maintain confidence locally A dedicated adapted vehicle is recommended, so that access to the community is not frustrated by mobility impairment or funding arrangements. 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. The home’s policy on death should include the home’s duties in respect of the retention of records and medication; and its duty to notify the CSCI of all deaths, to ensure compliance. 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 challenge will be to strike a better balance between the rights and responsibilities of all parties concerned in the care of the residents, to restore confidence overall. The home should actively promote the use of independent advocacy services. The responsible individual is asked to apply the Residential Forum formula and to report back to the inspector on the staffing arrangement it indicated. Staff should be given their own copies of the General Social Care Council Code of Conduct. 4 YA21 5 YA22 6 7 8 9 YA23 YA23 YA33 YA34 HMT Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 31 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 Orchard House DS0000061966.V279141.R01.S.doc Version 5.1 Page 32 - 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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