Inspection on 30/05/06 for HMT Orchard House

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 10 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 24/01/06

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 Mrs Susan Hall Unannounced Inspection 30th May 2006 09:30 HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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.V298917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residential care for learning disability is restricted to one (1) person with a date of birth of 15.10.1961 24th January 2006 Date of last inspection Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with neurodisabilities, particularly Huntingtons Disease. There are two homes in the group. 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. The home is situated within easy walking distance of local shops and is near to the town and seafront. It can easily be accessed by rail, or by the M20/M2 motorways. Orchard House is a large, Edwardian, detached building, with 10 single bedrooms on 2 floors (ground and first floor). All bedrooms have en-suite toilet facilities, and some also have a shower or a bath. The home has a passenger lift for easy access between floors. The property has a garden at the front, and off-road parking for up to four vehicles. The access road is privately owned, and kerb-side parking is subject to wheel clamping and accompanying fines. There is an enclosed garden at the rear. Fees for service users range from £1280 - £1520 per week. The Providers supplied this information with pre- inspection information in May 2006. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report includes information gained since the last inspection in January, as well as the information gained from the site visit on the day. The information comprises survey forms and information from health professionals (including a GP), relatives, and service users; returned dependency tool assessments from care managers; a meeting with the Providers in April 2006; and the home’s record of complaints and notifications to CSCI. The site visit commenced at 09.30, and finished at 18.00. During this time, the Inspector was able to talk with 8 staff, the Manager, the Chief Executive Officer (CEO), 1 relative and 2 health professionals. She also met 5 service users, and was able to observe the care given to them and their interaction with staff and with each other. The Inspector was unable to converse at depth with any of the service users, but could see that there was a relaxed atmosphere, and that service users seemed content. Recently completed survey forms confirmed that they were happy living at Orchard House. The visit included reading documentation, checking medication, discussions with senior staff, a tour of the premises, and accessing staff files and training schedules. The Inspector was welcomed by the senior support staff on duty, who was most helpful in giving information and showing the Inspector round. There were two other support staff on duty during the morning, and they were joined later in the day by the Manager, the CEO, and the home’s Health and Safety Advisor. Three other support staff came on duty during the afternoon. The Inspector also met a relative, a cleaner, the cook, the maintenance man, and the contract gardeners. A Speech and Language Therapist spent several hours in the home, reviewing service users, advising staff, and carrying out two training sessions during the afternoon. The Inspector sat in for 20 minutes for one of these sessions. The Inspector also met a Physical Therapist, and was allowed to watch her teaching massage exercises to one of the staff, on one of the service users (who happily agreed). The Health and Safety Advisor showed the Inspector the gardens, and explained some planned improvements. What the service does well: The staff team work well together, and are ably led by the Manager, who has the necessary knowledge and experience to show staff how to carry out care practices. Staff showed an awareness of the specific needs for service users with Huntington’s Disease. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 6 Health care services were being managed well, with arrangements in place for regular visits from different health professionals. What has improved since the last inspection? What they could do better: Staffing levels need to be kept under review to ensure that all service users can be observed if other service users are receiving personal care; to ensure that service users can be taken out of the building; and to ensure that there are sufficient staff available to escort a service user in the case of an emergency. Current arrangements for activities and leisure pursuits are inadequate. The Manager had just appointed an Activities Co-ordinator, and it is to be hoped that this appointment will bring about an improvement. The company has not provided a company vehicle for taking service users out. One service user has his own car, but there are not enough registered drivers available, or enough staff to take him out much. Other service users rely on taxis/public transport. The Statement of Purpose and the Service Users’ Guide had not been finalised, although the required information had been collated. The premises still need attention to the rear garden to make it a safe environment, and accessible, for all service users. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 7 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.V298917.R01.S.doc Version 5.2 Page 8 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.V298917.R01.S.doc Version 5.2 Page 9 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 The Inspector has assessed quality in this outcome area as adequate. There is detailed information available in order for service users to make a decision about being admitted to the home, but this has not been compiled into a satisfactory framework. Prospective new service users have a thorough pre-admission assessment to ensure that the service will be able to meet their needs. EVIDENCE: The Chief Executive Officer (CEO) has been working to amend the Statement of Purpose and the Service Users’ Guide. These seem to include all the required information, but are lengthy documents which are not easily readable. The Inspector pointed out the requirements in Standard 1 and in Schedule 1 of the Regulations, so that this may provide a more straightforward format for the Statement of Purpose. The Service Users’ Guide is detailed, and contains the relevant information. This would be improved by amending the contents to make the document into a better working tool. It has been produced in large print, but should also be produced in a simplified format suitable for some of the service users (e.g. a photographic or picture symbol format). The CEO stated that the Manager already takes photographs of the home with her when she carries out preadmission assessments. Permission must be gained for any photographs which include service users. The accompanying complaints procedure is inadequate, HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 10 as it does not contain the names and addresses of persons to apply to outside of the home (e.g: Social Services, CSCI, Ombudsman). It is a requirement to include the details of CSCI. Contracts include fee details and a breakdown of the costs. The Inspector viewed two contracts from funding authorities, and these contained the correct details. Extra costs are clearly specified. The most recently admitted service user had been visited by the Manager and CEO together as part of the pre-admission assessment. HMT use a pre-printed pre-admission assessment form, and this had been well completed. Details included: Background, family and social history; Life history; A description of interests and a typical day in his life; Preferred activities such as swimming, going out for a drive, watching/playing football; Management of personal finances; A tick box assessment form for carrying out household tasks (he is unable to do any); Attitude to being in care, and the attitude of relatives and friends; Personal care needs – including washing, dressing, nutritional needs, mobility, medication and sleep pattern. Additional information had been gained from health professionals, including a Speech Therapist, a Physiotherapist and a Psychiatrist. There was a proposed care plan, and a joint assessment from his previous placement. The information is checked against the room available in the home, and the Manager ensures that the home has any specific equipment needed, and that staff are trained appropriately. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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 the following standard(s): 6-10 The Inspector has assessed the quality in this outcome area as adequate. Care plans include detailed information, but were not completed into a format which enabled easy access of the information. Significant improvements had been made in developing risk assessments. EVIDENCE: The Manager had commenced a new “standex” system in place of the original care plans. This makes it easier to cross reference different information, but is difficult to maintain such a wealth of information as in the previous care plans. The standex system was up and running, but was not completed in all aspects at this time. Staff had been familiarised with the new system, and were completing daily reports well. These are completed for morning, evening, and night shifts, and were properly signed and dated. The Inspector read 2 care plans/standex records. The information was detailed, and showed the commitment of the staff team to giving good care to the service users. Standex records included details for personal cleansing, dressing, management of anxiety, sleeping routines, nutritional care, and HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 12 weight records, a clothes inventory, bowel care, medication, social activity, dependency charts and incident records. There are additional records for GP visits, and for visits from health professionals. Service users are allocated with keyworkers. Care plans are discussed with next of kin/relatives where appropriate, and signed where possible. The Inspector saw that service users are encouraged in making their own decisions about where they want to go, or what they want to do. This is not straightforward, as the nature of Huntington’s Disease means that service users have varying associated memory loss, and impaired communication. One service user wanted to go to the hairdressers, and this was arranged for that day. However, the arrangements had to be altered due to insufficient staff available to enable her to be accompanied. This was mainly due to training sessions in the afternoon. The arrangements were deferred until the next afternoon, with the service user’s agreement. Management of personal finances is discussed prior to admission, and monthly payments of their allowances are paid into individual accounts. Service users are assisted in accessing their own accounts, and records are maintained of personal financial transactions. Service users currently in the home did not have the ability to manage participation in day to day procedures such as handling laundry or meal preparation. The emphasis on care is on maintaining the skills which service users still have – not on developing new ones. This is in keeping with the specific nature of Huntington’s Disease. Risk assessments had been much improved. The company have employed a Health and Safety Advisor, who carries out risk assessments for the building, and generic risk assessments relative to all service users (e.g. access to the gardens, hot water temperatures). Specific risk assessments for individual service users are drawn up in association with the Registered Manager, except for risk assessments dealing directly with care issues (moving and handling, management of difficult behaviours). These are developed by the Manager after discussions with key workers, and other relevant people such as relatives or care managers. Behaviour guidelines provide a consistency from the staff in managing these aspects of care. Records are stored in locked filing cabinets to retain confidentiality, and the staff showed an awareness of retaining confidentiality of information. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16, 17. The Inspector has assessed the quality in this outcome area as adequate. The home does not supply adequate facilities for providing a full range of activities and outings, and this does not indicate good value for money from the fees paid for by the funding authorities. Service users nutritional needs are being met, and staff are trained to assist them. EVIDENCE: The emphasis on care is in maintaining current life skills. It is not applicable to be trying to develop new practical life skills for service users who have a degenerative disease. Maintenance of communication skills is assisted by a skilled Speech and Language Therapist. She concentrates on teaching staff and service users how to maintain speech and swallowing skills. Standard 12 is not applicable in this home, as service users are unable to develop educational or occupational activities. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 14 The Manager is working with staff to build up better programmes of activities for service users, and this will include individualised weekly programmes. Activities are currently limited by lack of available staff, and insufficient transport. The Inspector was concerned to find that the home relies solely on taxis and public transport for shopping, outings etc. This is costly for service users, who should be able to spend their personal finances on specific items/places to visit, rather than the means to get there. Taxis for wheelchair users are very expensive, and it is discriminatory to wheelchair users to reduce their options on going out of the building. Some staff have asked permission to take service users out in their own cars, but this is not a serious option, as most have moving and handling assessments which would preclude them from travelling in normal cars. Service users’ needs are not being met in respect of everyday outings, and the home lacks the ability to take service users out as a group. Activities records were noted in the care plans/standex records for one service user. These were incomplete, having been completed in December 2005, and then not again until March 2006. Items mostly included reading newspapers with the service user, or taking him for walks outside. The Manager had drawn up new care plan targets for him for the next month, to include specific choices – e.g. playing football in the park, a weekly Macdonald’s visit, shopping for clothes and DVDs. There was evidence that some items were being met. The Manager was in the process of employing an Activities Co-ordinator during weekdays, to ensure that service users are assisted in carrying out their choices of activities where possible. This may be dependent on the service users’ physical or mental state on the day, and there is therefore the need to remain flexible according to each service user’s capacity. Holidays are arranged on an individual basis, and care managers discuss the payments and the proposed places prior to agreements. Records were seen in service users’ folders (retained in the office), regarding specific agreements with service users about managing their own door keys; supervision for bath/shower/hairwash; and for supervision with smoking/use of lighter. Nutritional management was generally good. The Speech and Language Therapist gives detailed teaching and advice about ensuring that service users have the correct posture at mealtimes to facilitate their swallowing ability; how to assist service users with feeding and with thickened drinks; giving supplements to service users; risks of aspiration pneumonia; and the importance of a calm and unrushed atmosphere. Menus are drawn up by the CEO, and the Inspector would have liked to have seen more evidence of menus being discussed with the cook, the Registered HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 15 Manager and with keyworkers, to confirm that service users are having the widest choices possible. The cook was currently working 6 days per week, while the company advertises for a weekend cook. The 7th day is covered by support staff, (who have completed food and hygiene training). The main kitchen is on the first floor, and there is a separate kitchenette on the ground floor. This is used by staff for making drinks and snacks for service users. Both areas were clean and had satisfactory equipment – including a hot trolley for keeping food at the right temperature if service users are not immediately ready for it. Fridge, freezer and food temperatures are checked daily, and food delivery vans have the temperature checked. Opened items in the fridge had been covered and dated. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 16 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 The Inspector has assessed the quality in this outcome area as good. Service users have good access to health care, and their health is monitored appropriately. Additional professional advice is sought for meeting the specific needs of service users with Huntington’s Disease. EVIDENCE: Care plans included clear details for personal care and support of service users. Personal cleansing needs specified if a bath or shower is preferred, and the amount of help needed with hair washing, shaving, dressing and toileting. Nail care, foot care and dental care were all specified. Attention is paid to the importance of good oral hygiene and dental care. Service users go out of the home for health care visits where possible, in order to keep their lifestyles as normal as possible. If their erratic movements or difficult behaviour make it difficult for practitioners to carry out care, arrangements are made for practitioners to visit the service users at the home. Service users are encouraged to make their own decisions about when to get up or go to bed, but there may be health reasons for encouraging them to get up each day, or carry out some activity. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 17 Good health care support is carried out by visiting health professionals, including a Speech and Language Therapist, a Physical Therapist, and a Physiotherapist. The Inspector met the first two of these in the home on the day of the inspection. Both of them stated that the staff take their advice and training seriously, and ensure that their recommendations are included in the service users’ care plans. The home accesses GPs and Psychiatrist as needed. The Inspector viewed the medication storage cupboard on the first floor, which is mostly used for storing supplements, and is kept locked. It includes storage of a domestic fridge, which is solely used for storing medicines which require low temperatures. The staff check the fridge temperature twice daily. Daily medication is administered via the Monitored Dosage System, and is stored in a medicine trolley which is kept locked in the first floor office. The storage cupboard does not have sufficient space for 2 people to check drugs together, and so the trolley is sited in the office. A wash hand basin is available in the office. The medication trolley could not be used at lunchtime, as the passenger lift was broken. The staff member correctly took the rack of medication downstairs in order to administer the lunchtime medicines. The medication trolley was in good order, and no out of date medicines were seen. The Inspector pointed out that the trolley contained named medicine pots with lids on them, and enquired the reason. The Manager said that staff like to use the same pot when giving medicines out – but they are not “potted up” before hand. The Inspector stated that if medicine pots are properly washed, there is no need to use the same pot, and this practice should stop, as it could encourage the potting up of medicines. Senior support staff are trained by an external company in administration of medicines, and the Manager carries out competency checks. She is looking for further training herself in order to ensure that the competency checks are suitably detailed. Medicine Administration Records were examined, and had been neatly and accurately completed. Each chart included a photograph of the service user, and an accompanying sheet with details of each type of medication, what it is for, and what side effects to look out for. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The Inspector has assessed the quality in this outcome area as adequate. Staff demonstrated an understanding of the complaints procedure, and of recognising signs of abuse, and how to deal with these situations. EVIDENCE: The Inspector viewed the complaints log, which had been compiled since the last inspection. There was a brief outline of each complaint, and further evidence in the folder to show how the complaints had been dealt with. The Inspector could not locate the information for all the complaints, and was informed that the CEO had handled these, and had some details stored elsewhere. Where details were available, they showed that complaints had been properly handled and appropriate action taken. The complaints procedure is on display on a notice board on the ground floor. It is inadequate, as it does not comply with regulation 22. Names and addresses of people who can be contacted have not been included, (e.g. social services, CSCI, ombudsman); and it is a requirement to include the details of CSCI. A simplified format of how to make a complaint is available for service users. They would usually need to be assisted by a support staff in order to make a complaint. The home had recently carried out a service users’ questionnaire, which would assist service users with stating any aspects of their care with which they are unhappy. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 19 No complaints or allegations have been received by CSCI since the last inspection. A concern raised by a visiting professional was followed through by the Inspector, and was found to be groundless, and due to a misunderstanding. Staff showed understanding of different types of abuse, and there was information in evidence on a staff notice board. The home includes recognition of abuse in the induction training programme, and how to act if there is any suspicion of abuse. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 20 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 - 30 The Inspector has assessed the quality in this outcome area as adequate. Adaptations have been made to the home in some areas, but there are still aspects of the environment which need to be dealt with. EVIDENCE: The Inspector viewed all areas of the home. All bedrooms are for single use, and those occupied had satisfactory furniture and furnishings, and were personalised to each service user. Some vacant bedrooms - and the bedroom usually designated for respite care - did not contain adequate furniture, or contained old, unsatisfactory furniture. The Inspector was informed that bedrooms are always set up according to the choice and needs of individual service users, and so would be decorated and furnished according to their needs and wishes. All bedrooms have en-suite toilet facilities, although some are quite cramped, and not large enough for wheelchair users. Some contain a bath or shower as well. Most of the en-suite areas are carpeted, and the Inspector suggested it would be better for management of infection control to replace these with HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 21 flooring which can be more easily cleaned. However, the carpets were in reasonable condition, and did not smell offensive. The home has an assisted “Parker” bath on the first floor, and an assisted shower on the ground floor. It was unfortunate that while the passenger lift was out of order, this precluded some service users from accessing the Parker bath, and they could only have a shower or a strip wash. The “respite” bedroom has 2 steps down leading to a kitchenette area, which in turn leads to a toilet and shower room. This is unsatisfactory for hygiene purposes. As there is no need for a kitchenette, and many service users would be unable to use it, it would seem more sensible if this area was redesigned into a small sitting area – or if the toilet/shower room was increased in size. This bedroom had a broken wardrobe which needs repairing/replacing, and was not a well presented room for a respite facility. One bedroom has had overhead tracking fitted for hoisting purposes, and the Providers may need to consider this for other rooms as service users’ conditions deteriorate. Additional grab rails have been fitted on the stairs and in some rooms. A specialist bed has been purchased for one service user. All rooms are fitted with a call bell, and the call bell units run on a battery system, enabling them to be fitted where service users can reach them. Staff carry portable monitors, so they know when anyone is calling for help. The passenger lift had broken down approximately 10 days previously, and the Providers had ordered a new motor for it. The Manager informed the Inspector 5 days after the inspection that a temporary repair had been effected while they were waiting for the new motor. Lack of access between floors restricts service users’ lifestyles, and so this must be regarded as a priority. Communal areas include a sitting/dining area on the ground floor, two other ground floor sitting areas, and a sitting room on the first floor. This is also the designated smoking area. A concrete ramp (and handrails) had been built in since the last visit. This gives access to the front door. There is a ramp at the rear from one bedroom via patio doors. The front garden was neat and tidy, and there is off- road parking at the front. A separate area is being designed for the domestic refuse bin, so that it is less obvious for neighbours. The rear garden is unsafe in some areas, with uneven paving surfaces, concrete edges jutting out, uneven grassed areas, and a manhole cover sticking out. It is possible to use the rear garden in a limited fashion for some service users under careful supervision, but it is unsafe in many areas. The Providers have plans in place to improve this, enabling access for all service users, including those who are wheelchair bound. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 22 The laundry room contains a washing machine and a tumble dryer. A red bag system is used for soiled items. The washing machine includes a sluice facility. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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): 31-36 The Inspector has assessed the quality in this outcome area as adequate. Staffing levels are insufficient to give the care needed to highly dependent service users. The company are beginning to address this issue with an agreement for minimum staffing levels, and the recruitment of an activities coordinator. EVIDENCE: The staffing rotas show 3 support staff for morning shifts (07.15 – 3.15); 2 for afternoon/evening shifts (3pm – 9.45), and 2 for night shifts (9.30 – 7.30). This allows sufficient time for handovers. All service users are considered as high dependency. Some are more mobile and need mostly constant supervision when moving around the home because of unsteady gait. Those who are less mobile have deteriorating physical conditions, and need 2 staff to give personal care, and assistance with moving and handling. The numbers of staff on duty are therefore barely adequate, especially as most service users need to be fed, and cannot be rushed with their meals. There is very little opportunity for staff to carry out stimulating activities, take service users out, or to manage any crises/emergency which may arise. The Manager had just recruited an activities co-ordinator, and this should enable some improvements. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 24 A cleaner is employed 3 days per week and cleans every area in the home on those days. The home was seen to be clean and tidy. A cook is currently employed for 6 days per week, while the home is recruiting a weekend cook. On Saturdays, the cooking is carried out by a support staff, who also carries out care duties. There is only 1 other support staff on during the afternoon/evening, and this is unsatisfactory. There should be sufficient support staff on duty, who are not side-tracked by other responsibilities, but are available to service users. The Inspector was pleased to see that there is good training taking place in respect of Huntington’s Disease; there is specific reference to diet, nutrition, posture, feeding, and involuntary movements. The Inspector was informed that mandatory training is in place for all staff, and the induction programme is now based on the “Skills For Care” programme. One of the support staff had just completed NVQ 2, and intends to study for NVQ 3 in due course. A list of mandatory training showed that all subjects are covered (basic food hygiene, first aid, infection control, fire safety, moving and handling, and POVA). The Home has a high commitment to staff training, and support staff are all encouraged to complete NVQ 2 and/or 3. Most support staff had completed, or were in the process of completing, this training. Support staff were seen to interact well together, and spoke highly of the Manager. They did not seem to have sufficient time to take the proper breaks, and this is very important when dealing with highly dependent service users. The Manager pointed out that some choose to take a higher number of shorter breaks for smoking. When there are only 2 staff on duty, this also precludes staff from taking proper breaks, as there needs to be 2 staff available for some service users. There is a recommendation to ensure that all aspects of Employment Law are complied with. The Inspector examined 2 staff files for recruitment procedures, and discussed the process of recruitment with a fairly new staff member. Good recruitment procedures are in place, and staff files were in good order. One did not contain the employee’s details of health/medical history, but the files were otherwise complete. Staff supervision sessions are carried out 2 monthly, and there are good records to show the content of supervision. They showed that training needs are considered and discussed, and that staff have sufficient opportunity to raise ideas and concerns. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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 - 42 The Inspector has assessed the quality in this outcome area as good. The Manager shows effective running of the home, and has the experience and skills to demonstrate hands-on care to support staff. EVIDENCE: The Manager was on duty in the home from mid-morning onwards, and conversation with her clarified some issues for the Inspector. She clearly has the respect and support of the staff, who spoke highly of her abilities, and her involvement with their training. She carries out most of this with a person to person hand-on approach, so that staff can see how to interact with service users, and how to give personal care. She stated that her training has come about through years of experience, and she is looking for ways to gain accreditation to show she can pass on training to other staff. She has increased one to one supervision sessions where needed, and records the reason for any supervision to be deferred. One of the support staff stated HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 26 that there are regular staff meetings, and all staff are able to voice their feelings, and share ideas. There are separate meetings for senior staff, and for night staff. The home had just completed their own quality assurance survey, giving service users and relatives the opportunity to share their feelings. The surveys were sufficiently detailed to give a clear response to how service users viewed their care. The evidence showed that service users are generally happy living in the home, and feel cared for. Visiting professionals and a relative spoke well of the staff, and said they are friendly, have a good attitude to caring and work hard. The CEO and the Manager have ensured that previously omitted policies and procedures are now in place, and others have been renewed and developed. Records were generally well maintained, confidentially stored, and up to date. The Manager supplied the dates for recent system checks (e.g. fire alarm systems, electrical certificate, hoisting checks). The Health and Safety Advisor checked all water temperatures on the day of the inspection – these are done weekly. Checks for legionella are carried out, and building risk assessments. The cleaner showed an understanding of COSHH, and knew where the leaflets were for the cleaning products. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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 1 2 3 3 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 N/A 13 1 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 X HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 Page 28 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 completed, with all points compiled into a satisfactory format. The Service User Guide must be completed with all the required information, and so that the information is easily accessible. The Manager must ensure that care plans are complete for all service users. To consider the purchase of a company vehicle, to enable service users to access the community more easily. To amend the complaints procedure, so that it includes the names and contact details showing where complaints can be made. This must include the details for CSCI. To ensure that all bedrooms are supplied with adequate furniture; and to replace or repair the broken wardrobe in the respite bedroom. To implement the planned improvements for the rear DS0000061966.V298917.R01.S.doc Timescale for action 31/07/06 2. YA1 31/07/06 3. 4. YA6 YA14 15 (2) 16 (2) (m) 22 (7) 31/07/06 30/08/06 5. YA22 31/07/06 6. YA26 16 (2) (c) 30/08/06 7. YA24 23 (2) (o) 30/09/06 HMT Orchard House Version 5.2 Page 29 8. YA33 18 (1) (a) 9. YA37 9 garden, ensuring that the external grounds are suitable for, and safe for use, by all service users. To ensure that sufficient support staff are available at all times to meet the needs of service users. Staffing levels should be further reviewed since the action plan was sent to CSCI in May 2006. The Registered Manager needs to submit certification of her NVQ4 accreditation. Previous timescale for 31/01/06 has not been met.) 31/07/06 30/09/06 10. YA43 7 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. (Previous timescale for 31/01/06 has not been met.) 01/08/06 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 4 Refer to Standard YA14 YA20 YA24 YA27 Good Practice Recommendations To maintain a daily and up to date record of activities for each individual service user. For the Manager to ensure she has sufficient, up-dated training for overseeing the competency of medication storage and administration. To review the respite room arrangements, considering alterations to the kitchenette and bathroom areas, so that they are no longer adjacent. To consider altering the carpeting on floors in en-suite DS0000061966.V298917.R01.S.doc Version 5.2 Page 30 HMT Orchard House 5 YA36 areas to flooring which is more easily cleaned – when the carpets are due for replacement. To ensure that staff receive the necessary support to carry out their jobs effectively; ensuring that all aspects of Employment Law are complied with. HMT Orchard House DS0000061966.V298917.R01.S.doc Version 5.2 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.V298917.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!