Inspection on 05/06/07 for HMT Orchard House

This inspection was carried out on 5th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 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 30/05/06

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 Key Unannounced Inspection 5th June 2007 09:50 HMT Orchard House DS0000061966.V340458.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.V340458.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.V340458.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 01227 749115 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 Position vacant Care Home 10 Category(ies) of Physical disability (10) registration, with number of places HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with Huntingtons Disease. There are two homes in the group. Both homes cater for people of either sex, and aged over 18 years of age. Orchard House is registered to provide accommodation and personal care for ten adults, and this includes 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 ten single bedrooms on two 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. Residents are carefully assessed for their compatibility with other residents in the home, in order to provide a settled and homely atmosphere. The property has a garden at the front, and off-road parking. 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. Fee levels are set at £1520.00 per week. Where residents have Local Authority funding, fees may be agreed at slightly different rates with each Authority. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which included assessing all key National Minimum Standards, and included many of the other standards. The inspection process includes assessing all information gained about the home since the last inspection in May 2006. This comprises formal notifications from the home, records of any concerns or complaints, and incoming information by letter or phone calls from stakeholders, relatives, staff etc. CSCI survey forms were sent out, and the Inspector had a good response to these. The Inspector visited the home for one day, and met residents, staff and management. The inspection visit included looking round the home, talking with staff and residents, reading documentation, and observing the general running of the home. The manager had recently left employment, and the home’s “Responsible Individual” (who is registered as the responsible person with CSCI), was currently acting as manager. She was in the home for part of the day, and assisted the Inspector with information. (She is referred to as the acting manager for the rest of this report). CSCI had received two complaints since the last inspection, and these were passed on to the Providers for internal investigation, in line with their own complaints procedures. Two referrals had been made to the Social Services Adult Protection (AP) team. The allegations were not substantiated. The management co-operated fully with the AP team throughout the process. Residents are enabled to carry out their own wishes in regards to getting up, going out and carrying out activities. Huntington’s Disease is a progressive illness, and residents are at different stages with this, so some have more mobility or cognitive awareness than others. The Inspector could see that they are well integrated with each other, and are generally very settled in the home. The Inspector received twelve completed survey forms - from residents, relatives and health professionals, - and these were all positive in their content. Residents’ survey forms included comments such as: “ the carers are very patient. I am happy at Orchard House”; and “I can still be independent to do most things e.g. shopping. The support staff help me to make decisions sometimes. I go out nearly every day, watch TV as I want, and see my family & friends.” Staff are friendly and approachable, and generally showed good knowledge of how to meet the needs of residents. They promote a relaxed atmosphere in the home. What the service does well: HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 6 The service provides good clear information for prospective residents who wish to move into residential care. There are good systems in place for carrying out pre-admission assessments, and trial visits to the home, when prospective residents can meet staff and join in with meals and activities. Residents are supported in making decisions, and carrying on with their lives in accordance with their preferences. The management ensures that there is good access to specific health care for Huntington’s Disease, and appropriately involves other health professionals. The service has developed excellent quality assurance and auditing procedures. What has improved since the last inspection? What they could do better: The main area of concern is that the service does not have consistent levels of sufficient staffing – with particular reference to support staff. This affects other areas in the home, as although good processes are in place, they cannot always be implemented without the necessary numbers of support staff. Staffing levels need to be constantly reviewed in relation to the assessed needs of residents, and as residents have unpredictable changes in association with their Huntington’s Disease, staffing ratios need to be managed in the light of the worst possible scenarios. Care planning does not clearly portray health needs in relation to Huntington’s Disease. The acting manager had already identified this, and is looking at revising the system to make it more specific. Some improvements are needed with medication management and administration. HMT Orchard House DS0000061966.V340458.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. The summary of this inspection report can be made available in other formats on request. HMT Orchard House DS0000061966.V340458.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.V340458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 People who use the service experience excellent quality outcomes in this area. The home provides good information for prospective residents, enabling them to make an informed choice about moving into the home. EVIDENCE: The statement of purpose has been revised, and is a clearly written document, containing all the required information. The service users’ guide has also been revised since the last inspection, and contains helpful information for new residents, relatives and enquirers. The acting manager was in the process of completing minor alterations to both documents, to indicate that the manager has left, and the home is currently in the process of recruiting a new manager. The Responsible Individual is acting as manager in the meantime, and has sufficient knowledge, training and experience to take on this role in the interim period. She has day to day involvement in the running of the home, and is covering other management responsibilities such as carrying out pre-admission assessments. These involve taking details of all aspects of the needs of the person concerned, including their medical history, social preferences, family background, and the stage of the development of Huntington’s Disease. The HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 10 assessor takes photographs of the home out with them, to provide more meaningful information. After the initial assessment, a senior support worker goes to visit. They then arrange a visit to the home, with the same senior on duty, so that there is a point of contact. Where possible, residents have trial visits to the home, or respite care, to enable them to find out what the home is like before moving into it on a permanent basis. The home has one room which is kept solely for respite care, and this provides the opportunity for prospective residents to have short stays, and become acquainted with the other residents and staff prior to deciding to stay permanently. One resident said that she had been able to visit for a few days before moving into the home permanently and “liked it very much”. The nature of Huntington’s Disease means that there are occasions when the progress of the illness produces sudden changes, with physical and/or mental conditions. This can be distressing for prospective residents and their families, and sometimes leads to the necessity for an emergency admission, where the illness causes undue pressure on a family situation. The management ensure that a detailed pre-admission assessment is still carried out, even if it is only a day or two before admission. Ongoing assessments, and contact with the family and care manager will determine if the emergency placement is satisfactory, and can lead to permanent residency. All residents are provided with a contract, which specifies the terms and conditions of residency, the room to be occupied, and a breakdown of the fees. HMT Orchard House DS0000061966.V340458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 People who use the service experience adequate quality outcomes in this area. Care plans contain some good information, but this is not always comprehensive, and is not in a format which is easy to follow. Care plans and risk assessments need to be revised, to ensure that they are working documents, with easily accessible information. EVIDENCE: The home has a commitment to ensuring that residents are enabled to express their individuality, make their own decisions as much as possible, and follow their preferred lifestyles. This is reflected in the care plans, which are drawn up after admission, with the involvement of the resident, and their family members/advocates where appropriate. Joint assessments are obtained from previous care management or hospitals, gaining as much initial information as possible. Each resident is allocated with a support worker as their key worker, and they work specifically with the resident to find out their individual needs and HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 12 choices. Residents are encouraged to take a full part in the life of the home, within the limits of their capabilities. This may include involvement such as picking and arranging flowers, choosing clothes or décor, or joining in with arranged entertainment. One survey from a relative stated: “They are very good at making sure we know everything that is happening. My relative likes to go out and about, and they are capable of giving her the independence she needs. She is able to do so much more now that she is given the correct help.” The inspector viewed three care plans. Residents are encouraged to participate in their care planning. The acting manager was aware of the need for some improvement with the format of care plans, and was currently working on a system to improve this. Care plans are reviewed at least monthly, and daily reports are completed after every shift. However, care plans do not clearly reflect that residents have Huntington’s Disease, and this is the reason for care plan targets, therapy sessions, and the need for a high calorie diet. Cognitive impairment due to Huntington’s is not clearly specified either, or how to recognise when this is deteriorating, or how staff should respond/react to developing situations brought about by cognitive impairment. One of the plans viewed was not easy to follow, and did not fully reflect this person’s preferences and daily living style. Risk assessments are stored in a separate file – with a separate section for each resident. These identified risk areas such as leaving the house unattended, smoking, and use of stairs, but did not always show the details for how to manage, or prevent, the assessed risks. Residents sometimes display inappropriate or aggressive behaviour. This may be linked to brain changes brought about by the Huntington’s Disease. Methods for managing difficult behaviours was unclear, although some guidelines were seen for one aspect of behaviour management. Difficult behaviours need to be documented with more clarity, so that staff are sure about how to act in any situations, and what is appropriate for different residents. Some associated staff training was being carried out on the next day. Any restraint procedures (active or passive) should be very clearly specified, and the home must have appropriately trained staff in the home at all times if there are residents who may need restraint procedures. Storage of personal records is managed so as to retain confidentiality. New staff are informed of the importance of confidentiality at induction, and relevant policies and procedures are in place. HMT Orchard House DS0000061966.V340458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 People who use the service experience good quality outcomes in this area. The home has good processes in place to promote individual preferences in regards to personal lifestyles. EVIDENCE: Staff are trained to have an understanding of Huntington’s Disease, so that they can work with residents to help them maintain life skills, and encourage them to participate wherever possible. As Huntington’s is a progressive disease, the emphasis is mostly on maintaining skills, rather than developing new ones. Specialist therapists are brought into the home for physical therapy (massage, exercises etc.), physiotherapy, and speech therapy (which includes training in communication and swallowing difficulties), and these visit on a regular basis. Residents are no longer able to maintain paid employment, but are assisted to continue with occupations such as gardening/painting/car washing where they wish to do so. Staff were thinking of innovative ways to include these sort of HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 14 activities with outings in the community. For example, one resident was being enabled to take paints out for sketching. Outings include shopping, visits to pubs, restaurants, sea side walks, etc. but are limited by numbers of staff available to take people out, and lack of vehicles and drivers. The service is working towards having a vehicle that can be used to take out one to two residents and support staff at the same time, and fitted to take out wheelchair users as well as those who still have mobility. Residents are encouraged to pursue their hobbies, and to bring in items such as their own music centres and TVs. Entertainment is arranged in the home, and a singer was in on the day of the inspection visit. Residents were enjoying this, and some were joining in with singing and dancing. Other events include parties and barbecues etc., and relatives are invited to join in with these. Effort is made to enable residents to maintain family links, and to keep in touch with friends. Most residents have individual routines which help them to take part in the home, and the key workers help them to identify a structure which is suitable for their progress as individuals. Timetables are developed in line with care plan targets. However, some of these get missed due to shortfalls in the availability of sufficient staff. Daily routines provide the residents with the opportunity for being on their own or with other people, and their right to privacy is respected. They are offered the opportunity to keep their own door key - if they wish to do so, and if assessments show they have the ability to manage this. The home clearly recognises the importance of a highly nutritious and high calorie diet for residents with Huntington’s Disease. Involuntary limb movements, and agitation leads to using up many calories, and residents need ongoing food intake at regular intervals throughout the day. Most are prescribed with food supplements as well as main meals, and snacks are actively offered at frequent intervals. Residents are weighed monthly, and this is added to their monthly nutritional assessments. Residents tend to develop difficulties with eating and swallowing, and a Speech and Language Therapist regularly reviews their swallowing abilities, and gives advice on the correct consistency of food for each person. Home –made cakes, jellies, fortified custards and puddings are made nearly every day, ensuring that there are good quality high calorie snacks available. The cooks are familiar with the importance of providing the right amount and types of food, at the right times. Some items in the fridge were not labelled or dated, and this was brought to the attention of the chef and the acting manager. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. People who use the service experience adequate quality outcomes in this area. Personal support and healthcare is well managed in the home; medication management requires some additional attention to ensure that procedures all comply with the requirements. EVIDENCE: Staff support residents with the management of their personal care as needed. This is reflected in daily personal hygiene charts, care plans, and daily reports. Hygiene charts indicate if a resident has had a bath/shower/hair wash/shave etc. Residents are encouraged to choose their own clothes, hairstyles etc., and staff will guide them and give support where this is needed. Additional health care support is provided by visits from Speech and Language Therapist, Physical Therapist, Physiotherapist, GPs, dentist and chiropodist. District nurse support and advice is obtained where indicated. For example, a resident with diabetes needs daily insulin injections, and these are given by visiting District Nurses or appropriately trained visiting Healthcare Assistants, except where support staff have been trained and checked as competent by the District Nurses, and can carry this out themselves. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 16 Residents have out-patient appointments to monitor the progress of Huntington’s at specific hospitals – usually one of two in London with specialist units. Residents are escorted by staff for these visits, and are referred to neurology or psychiatric departments where indicated. One of the hospital Consultants who specialises in Huntington’s Disease, had recently written to the management, and arranged to bring a team from the clinic to visit the home. The team will be giving input and advice to staff, as well as monitoring the residents in the home. They work closely in liaison with the GPs. Although there are good support programmes in place, the health care needs are not (overall) well represented in the care plans which were viewed, and do not all evidence clear progressions for Huntington’s Disease. Nutritional needs and Physical Therapy are well reflected, but data showing the individual health progress or deterioration of residents is unclear in some plans. However, the acting manager is fully aware of this, and is working with staff to ensure that all care plans accurately portray health developments, and the action to be taken. Medication administration is limited to senior support staff, who have received in-house, and external, training. They have ongoing assessments for competency. The home has a small room on the first floor where the medication trolley could be stored, but it is usually kept on the ground floor for convenience. The Inspector noted that there was no facility to chain this to the wall on the ground floor, and so appropriate storage must be put in place if the staff intend to keep the trolley downstairs. The trolley is set out with a section for each resident. Storage was compromised by having some external medication stored adjacent to internal medication. Boxes of tablets included some where the tops had been ripped off, showing poor practice, as this indicates that staff are pulling strips of tablets from boxes without checking the box labels. Medication administration records (MAR charts) were well completed, and showed receipt of medication into the home. There are procedures in place for returning unused medication to the pharmacy. MAR charts had several handwritten entries, which had not been signed, and the Inspector highlighted the importance for two people to sign any handwritten entries, in order to prevent possible errors. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience good quality outcomes in this area. Residents know how to voice their concerns, and are supported in carrying this out. Staff are trained in the recognition and prevention of different types of abuse. EVIDENCE: The home keeps a clear and concise complaints log, and this showed that there had been nine concerns or complaints voiced to the home since the last inspection. Separate pages detailed the action taken and the timescales for completion, and confirmed that complaints are taken seriously, and are acted on appropriately. One recent complaint was still in the process of being resolved. Residents stated that they knew how to make complaints, and who they would talk to. Most indicated on survey forms that they do not usually need to complaint about anything, but voice any concerns to their key workers or the management. The complaints procedure has been revised to include required information, and is easily accessible. The home has had two referrals to the Social Services Adult Protection team in the last year. Neither of the allegations were substantiated. The management co-operated with other authorities throughout the process, and have taken their own disciplinary actions during the year where necessary. Staff training in regards to safeguarding adults is commenced during the induction process, and more detailed training is given during the first 6 months. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 People who use the service experience good quality outcomes in this area. The premises are suitable for their stated purpose. Some alterations and redecoration have provided ongoing improvements. EVIDENCE: The home has two floors, and single en-suite bedrooms for all residents. Easy access to both floors is facilitated by a passenger lift. Residents do not use this unaccompanied, unless their assessments indicate this is a safe practice. Bedrooms are decorated and personalised according to residents’ preferences. Any change of bedroom is in accordance with residents’ choice to do so, and the room would be checked for suitability in regards to any equipment needed prior to agreement to change the room. A list is kept of each resident’s personal property items. Rooms were clean and suitably furnished, and there was evidence of new carpets and furniture in some areas. One room was noted to have poor quality carpeting in the en-suite bathroom area. The Responsible Individual said that this had already been identified, and this bathroom is due for re-flooring. No changes had been made to the respite HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 19 room, and as this includes a small kitchenette area, its suitability is discussed during the pre-admission assessment process. Equipment is obtained as needed, and the Inspector noticed there were some new nursing beds, and new grab rails in place. The home has a Parker bath on the first floor, and the residents like this, as it is easier to access. This lacks ventilation, and there is a recommendation to consider this. There is a separate shower room, and this includes a shower chair for easy use. Communal facilities include a sitting room on the ground floor – which has an adjoining kitchenette where drinks can be made; a separate dining area on the ground floor; and a sitting room on the first floor, which has been designated as the smoking room. The main kitchen is on the first floor, and was seen to be generally in good order. There are satisfactory cleaning programmes in place. The laundry room is on the ground floor, and has a washing machine with a sluice facility, and tumble dryer. A red alginate bag system is used for laundering soiled items of clothing. The premises were clean throughout, and generally well maintained. The home employs a cleaner five days per week, and the home looked clean and airy. Alterations have been made to the front and rear gardens, with new fencing for areas at the front and side of the property. This includes a space for the clinical waste bin, which is less obvious than previously, and makes the premises more homely. It has also made more space at the front for car parking. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 People who use the service experience adequate quality outcomes in this area. The home has good staff in place, who are familiar with their roles, and provide effective support to residents. Low numbers of support staff have affected ongoing care planning targets, and meeting other needs such as numbers of outings and support with activities. The overall outcome can only therefore be described as adequate. EVIDENCE: Staffing levels were reviewed and improved as a result of a requirement at the last inspection, but need constant reviewing in order to ensure that staffing levels are sufficient for effective care. The home currently had eight residents, who are all assessed as having high dependency levels for varying reasons. Some need increased assistance with mobility or moving and handling; while others need monitoring due to the fact that they are still very mobile, but are constantly on the move. All need assistance with personal care, and most need assistance with feeding. Some residents wish to go out every day – or most days, and this is reflected in some of the care plan targets. Most have been risk assessed as unsafe to leave HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 21 the home unsupervised, so this places an additional responsibility on support workers. Current rotas showed that staffing levels are for three support workers in the mornings, three support workers in the afternoons, and two at night. This means that there are three support workers throughout the day to carry out all personal care, feeding, activities, and outings. The Inspector noted that there had been times on the rota where there had only been two support staff due to sickness at short notice. Residents have frequent changes in the course of their illness, which means that they may have good days and bad days. This may entail some residents needing two staff to manage personal care at times. If one staff member has taken a resident out, this only leaves two – who may be attending to one resident and not able to supervise/monitor the others. It also means that only one resident can go out at any one time, and this is not consistent with some of the care planning targets – where residents need to be able to go out on a more frequent basis. There may also be occasions where two staff are needed for giving passive restraint. The Inspector noted there had also been some shortfalls at night – with only one support worker on duty at times. As there have been shortfalls in terms of sufficient staff, there is a requirement for the Providers to ensure that there are sufficient numbers of support workers on duty at all times to meet the assessed needs of residents. Systems must be put in place to ensure that there are still sufficient numbers of support workers in the event of staff sickness, training, or holidays. The staff have clearly defined job roles, and residents have confidence in their ability, their skills, and their commitment to providing for their needs. Most support staff work overtime hours if needed, to try and meet gaps in the staffing rotas. Over 50 are trained to NVQ level 2, and many have NVQ level 3. There is an expectation for new staff to commence NVQ 2 after the first 6 months, and this is discussed at interviews. Ancillary staff include a cook on duty for all meal preparation, a cleaner five days per week, a facilities manager who oversees health and safety and maintenance management, and a maintenance man. Recruitment procedures are well managed, and staff files showed that items such as POVA first checks, CRB checks, proof of identity, and written references are reliably carried out. Interview notes are retained, and copies of any recent relevant training certificates. The Inspector noted that the application form did not clearly specify that a full employment history is now required. The acting manager said that she would amend this, and there is a recommendation to ensure this is put in place before any further recruitment is carried out. The home has a detailed induction programme based on Skills for Care, and new staff are required to attend for a pre-employment induction day. The HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 22 induction training then continues, and includes all mandatory training within the first 6 months. The Inspector noted that new support staff were commencing employment as part of the normal rota of staff, and there is a recommendation to enable new staff to work as additional staff for a few shifts, as they are dealing with highly dependent residents, and need some knowledge of the care needs prior to taking their place on the allocated staff team. There are good training programmes in place, using a mixture of internal and external trainers. Staff training files confirmed that statutory training is in place. However, there is no training matrix, and without this, it is not possible to confirm to authorised people that all training is up to date (without going through all staff files). There is therefore a recommendation to implement a staff training matrix to clarify this. Formal one to one supervision has been implemented and is ongoing. This is carried out using the same format for everyone, and provides opportunity to discuss changes in the home, training needs and any other issues. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37-42 People who use the service experience good quality outcomes in this area. Overall management is being satisfactorily maintained in the absence of a registered manager. EVIDENCE: The manager left the home approximately two months before the day of the inspection visit, and the Responsible Individual is now acting as manager while recruitment is taking place. As the home is registered for the specialist needs of residents with Huntington’s Disease, recruitment includes the necessity of a manager who is familiar with this illness (or associated relevant training). The acting manager is knowledgeable about Huntington’s, and has skills consistent with overseeing the home at this time. Support staff have become aware of areas where they can take more responsibility, and are working towards this. Staff said that the management HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 24 enable an atmosphere where they can raise concerns, and can discuss new ideas. Staff meetings are held every month, and there are senior support staff meetings and management meetings held intermittently. The home has excellent quality assurance procedures in place, enabling residents, relatives and health professionals to feed back on a regular basis. This includes the home’s own survey forms, as well as using CSCI survey forms. Key workers or relatives assist residents where necessary with completing surveys, trying to accurately represent their feelings. The home also has detailed internal auditing procedures in place, and these are clearly documented. Monthly Provider visits are carried out, and record details in regards to items such as conversations with staff/residents etc., how to meet new requests from residents, and any environmental changes that are needed (e.g. new furniture or carpeting). Policies and procedures are in place and are accessible to staff at all times. These are reviewed at least annually, or if changes are indicated. Specific policies (such as whistle-blowing and confidentiality) are stressed during the induction period, and staff must be able to show they are familiar with these. Record keeping is generally well maintained (such as MAR charts, and servicing records), but the Inspector has already noted some discrepancies with care plans and risk assessments. Residents know that they can have access to personal records at any time. Staff are trained in safe working practices – but, as previously recorded – mandatory training could not easily be verified for all staff. Maintenance records are neatly and accurately recorded, and the Inspector viewed a sample of these which included: water temperature records, fire extinguisher checks, emergency alarm checks and fire drills. Notifications are sent to CSCI in accordance with requirements, and accidents are recorded using HSE forms, and in compliance with the Data Protection Act. HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 4 3 2 3 X HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 YA6 Regulation 15 Timescale for action Care plans must be appropriately 05/09/07 revised, so that they are kept up to date, and clearly reflect the needs of residents. Risk assessments must be in place for all assessed risks, and accompanied by behaviour guidelines if applicable. Medication administration and storage must comply with the guidelines laid down by the Royal Pharmaceutical Society; in respect of The administration trolley should be fixed to the wall when not in use; External medication should not be stored with internal medication; Handwritten entries must be signed by two staff. Numbers of support workers must be sufficient at all times as are appropriate for the health and welfare of residents. This means that there must be DS0000061966.V340458.R01.S.doc Requirement 2 YA9 13 (4) 31/07/07 3 YA20 13 (2) 05/07/07 4 YA33 18 (1) (a) 05/07/07 HMT Orchard House Version 5.2 Page 27 sufficient support workers to meet their needs for all aspects of daily living, including supervision, mobility needs, outings and activities. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations Care plans should more accurately portray health needs in regards to Huntington’s Disease, and any specific action to be taken. To provide ventilation in the Parker bathroom. To ensure that the recruitment application clearly specifies that a full employment history is required. Where new staff are in the initial days of their induction, they are in addition to full staffing numbers. To implement a staff training matrix so that mandatory training can be easily evidenced for all staff. 2 3 4. 5 YA24 YA34 YA35 YA35 HMT Orchard House DS0000061966.V340458.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V340458.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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