Inspection on 27/05/08 for Honeybrook House

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Honeybrook House Honeybrook Lane Kidderminster Worcestershire DY11 5QS Lead Inspector Jean Littler Key Unannounced Inspection 27th May and 10th June 2008 11:30 Honeybrook House DS0000071656.V366642.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 Honeybrook House DS0000071656.V366642.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. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honeybrook House Address Honeybrook Lane Kidderminster Worcestershire DY11 5QS 01562 748109 01562 750622 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) suehullin@tracscare.co.uk Tracscare Group Ltd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disabilities (LD) 10 The maximum number of service users to be accommodated is 10. This is the first inspection of the service since Tracscare Group Ltd. was registered. Date of last inspection Brief Description of the Service: Honeybrook House opened as a care home on the 15th April 2005. In April 2006 the service was purchased by the Tracscare Group who own a number of residential care homes in England and Wales. The group continued to operate the service under the company Honeybrook House Ltd. but introduced Tracscare policies and procedures. The company registered with the Commission later changed from Honeybrook House Ltd to Tracscare Group Ltd. in March 2008. Honeybrook House is situated in a residential area of Kidderminster that is close to the facilities in the town and to link roads to other towns in the region. The house is a converted nursing home with extensive private grounds. The service provides residential, personal and social care for up to ten adults who have a learning disability with a primary diagnosis of Autistic Spectrum Disorder. All service users are accommodated in single-occupancy rooms, and have access to large communal rooms. The manager has information about the Home that can be sent out to interested parties. The Tracscare Group also has a web site. The fees for the Home can vary depending upon the level of support needed. The current fees range between £1300 and £3000 a week. Additional charges are made for chiropody, some activities and any personal shopping or services. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission, carried out an inspection over two days. We looked around the house and spoke with the manager, Mr Cookson, the deputy and two of the staff. We spent some time with the people who live at Honeybrook House and saw some of their bedrooms. Some of the people at the home and their families or visitors completed surveys to give us their views. Some records were looked at such as care plans and medication. Mr Cookson sent extra information to us before the inspection. What the service does well: People have a clean and comfortable home. Some rooms and the garden are very large. The Home is near to the town’s facilities and also close to nice countryside. A new person can move in and try out the service before deciding if they want to live there permanently. People can move freely around most of their home and there is a relaxed atmosphere. Peoples’ daily routines are flexible and people usually go out every day. People are supported to stay healthy and their medication is looked after safely. People have their personal care needs met in the way they prefer. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 6 People enjoy the food and help with jobs around the house. People get on well with the staff. What has improved since the last inspection? What they could do better: The manager needs to make sure that people only move in if their needs can be met and they will get on with the people already living at Honeybrook House. People’s care plans need to be finished to show how all their needs will be met. People need to be confident that they will be safeguarded against known risks to their health and wellbeing. People should be helped more to communicate and make choices. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 7 People should be move involved in looking after their own money. The layout of the house should be changed so people have a choice of who to share their living space with and those with a physical disability have equal access. The staff should be better trained to help meet people’s needs. People should be consulted more and better informed about the plans for the home. 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. Honeybrook House DS0000071656.V366642.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 Honeybrook House DS0000071656.V366642.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): 2, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective new people are assessed to see if their needs can be met. They are also offered the opportunity to visit the Home and trial the service. However, people’s needs have not always been met by the Home because decisions to admit have not always taken into account all of the relevant information. EVIDENCE: There are currently two vacancies in the Home. The records of two of the four recently admitted service users were sampled. Detailed assessments had been completed by a senior worker in the organisation. Mr Cookson had also met both men and he said he was part of the decision to offer them a place. Assessment information had been obtained from previous placements, funding authorities and relatives in one case. All transitions have included the interested parties visiting the Home and people being given the opportunity to stay overnight before moving in on a three month trial basis. Two of those newly admitted have some physical disabilities. They have been given ground floor bedrooms but cannot access the first floor and much of the garden. They have to use an outside slope to get to the kitchen, laundry and one dining room in the basement. The assessment seen for one of these men did not address these issues. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 10 One man was admitted in 2007 from another home owned by Tracscare group following difficulties at that placement. His needs were well known to the organisation. There were some serious incidents that were reported to us during the initial few weeks of the placement at Honeybrook House. The staff team was not equipped to cope and respond appropriately to his behaviours. A member of staff said she felt he was inappropriately placed and said other service users initially spent a lot more time in their bedrooms because he was very noisy and challenging. He was transferred from the service six months later into another Tracscare home. As mentioned in the last inspection report for Honeybrook House, a new service user’s placement ended because his needs could not be met. It is essential that people in the company making decisions about admissions do so on a needs led basis alone with due consideration to the needs, preferences and views of the people who are already living at Honeybrook House. Honeybrook House DS0000071656.V366642.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, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People cannot yet be fully confident that all their support needs are reflected in their care plans. They are being assisted to make some decisions for themselves and take part in an independent lifestyle. The balance between people taking risks and being safeguarded has not yet been assessed in all areas. EVIDENCE: Each service user has a care plan folder. Two were sampled and found to contain relevant and helpful information for staff. The information was written in a respectful way and highlighted the personal preferences of each person in many areas such as personal care, activities and mealtimes. Several forms are being used to help monitor areas such as epilepsy, continence and personal care. One man had moved in November 07 but his plan was only just being finished, the other man was admitted in March 08 and his was not yet complete. These delays will not have assisted staff to work in a consistent way. Each person has a ‘reactive behaviour management plan’. A learning disability nurse, employed by the company to support on behavioural issues, helps to Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 12 develop this guidance. The one seen contained more positive information than the name indicates. It guided staff about how to avoid causing the young man any distress by them being aware of his preferences and how his Autism affects his ability to interpret information. It did go on to cover possible behaviours if an incident is not resolved quickly and his anxiety levels increase. It did not include clear instructions about what staff should do if his behaviours escalated e.g. if he ran out of the gate to the main road. People are being supported to take reasonable risk and partake in activities such as riding, golf or swimming. Risk assessment formats are in place and policies highlight the need for risks to be assessed. For one man the guidance mentioned the risk of choking while eating and of falling while doing activities. A dysphasia assessment and falls assessment were not found. Only two risk assessments had been completed for the more physically able man. They related to areas that his assessment showed had been risk areas in the past, yet they made no reference to this. They appeared to contain standard wording rather than being a genuine assessment of this individual. Other risk areas were not covered such as road safety and the activities he was attending. A quality assurance officer from the company had recently visited to check this care plan and it is concerning that these gaps had not been identified. Information was in place about people’s epilepsy, however in one case different frequencies for night staff checks were noted and there was no mention of specific safety arrangements for bathing and swimming. It was positive that Mr Cookson is exploring epilepsy night alarm equipment, as hourly visual checks by night staff cannot guarantee someone’s wellbeing. Mr Cookson was given feedback on areas to be further developed in care plans e.g. all gaps completed, risk assessing, goal planning and monitoring of progress; the information being in a more accessible format where appropriate; evidence of how people have been consulted about the plans and evidence of the decision making process (reference the Mental Capacity Act). Mr Cookson reported that he was promoting good keyworking and staff taking on this role were working more closely with their service users and representatives to help make the service person centred. Reviews have been held in line with the procedure e.g. after the trial period of three months and then at least every six months afterwards. Monthly progress summaries are being written by keyworkers but these could be better used to report on development progress towards the objectives of the placement. Information did show that both men were settling in well and that staff were striving to provide them with a personalised service. Each resident is being given opportunities to experience normal activities as part of an independent lifestyle. People are helping around the house with cleaning. One man vacuumed the lounge and was encouraged by staff, although the other service users were not consulted or asked if they wanted to leave the room because of the noise. People are buying their own clothes and toiletries in shops and some help with food shopping. Staff aim to take Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 13 each person out every day and those new to the area are getting to know the local community. Staff were observed to offer people a choice throughout the inspection e.g. activities, where to spend time, food and drink. Care plan guidance covered offering choices e.g. showing two outfits of clothes, always accept it if the person declines an activity. Some information is being presented in a visual format to support people to understand it and Mr Cookson said some objects of reference are also used. Speech and Language therapists are involved with two of the men. People are being supported to have life books that they keep in their bedrooms and add photographs to showing their activities and achievements. Communication is an area that could be further developed to better support all service users to make choices and demonstrate that the service is a specialist one. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. People are being given the opportunity for personal development. They are being supported to partake in leisure activities that they enjoy, however for some new people these need to be further developed. All are accessing the local community facilities. Staff are respecting people’s rights and do support them to take responsibility for themselves. They are being supported to maintain links with their families and friends. They are being provided with a balanced diet and they enjoy their meals. EVIDENCE: Mr Cookson reported that work has been ongoing to develop personalised activity timetables for each person. Those for the two newest people are still being worked on as staff increase their knowledge of what the men enjoy. During both days of the inspection people were seen to go out in small groups to either prearranged activities or on leisure trips such as meals out. Two vehicles are provided to help facilitate outings. A handrail has been fitted on the people carrier to help a new service user access this. The care plans and records sampled showed that the service users were going out regularly. Staff Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 15 confirmed that people usually go out daily and that activities were now planned ahead rather than this being left to each shift to decide. Examples of regular activities include walks, swimming, shopping and aquarium trips. A worker said a monthly theme is given for the arts and crafts to provide a focus. One man wants to improve his golf game and is being supported with this. He and another man have an interest in gardening and both are being supported to attend work experience at a nursery/small holding. Another still works in a charity shop when they need him. Areas of the garden have been designated to the service users who have an interest and they are planting these areas and growing flowers from seed. The deputy said there are also plans for raised beds. The activity timetables incorporate tasks where people can develop independent living skills e.g. cleaning their own bathrooms and meal preparation. The sample of goals seen were also about self help skills. One member of staff was able to give several examples of how service users have developed over the last year. Mr Cookson plans for keyworkers to give briefings in staff meetings in the near future. This should help ensure all staff are aware of the progress people are making towards their personal goals. Staff reported that the daily routines are flexible depending on preferred routines and planned activities e.g. one person often likes a nap in the afternoon. Some people relax in their bedrooms and pass the time with their hobbies e.g. making models. One man was seen in his room taping from his CD collection. He was clearly doing this by choice and was enjoying himself. Staff knock on doors before entering and respect people’s wishes if they do not want to be disturbed. Some are able to manage their own keys. People’s rights seem to be respected, however, recording of decision making processes should be further developed in light of the Mental capacity Act. Mr Cookson confirmed in the AQAA that links with families are being maintained. One visitor said she is appropriately informed about important issues and most of the time her friend is supported to keep in touch with her. She does feel that the service always meets his needs. One man can communicate with his family by email. A wireless router is being installed so he can use his own laptop rather than the office computer. The staff cook the meals and shop locally with the service users. The four weekly menus have been designed with people’s preferences in mind. They contained a good variety of balanced meals with fresh fruit and vegetables. Staff said choices are offered and another option is provided if someone does not like the meal. Mr Cookson plans to employ a cook as catering is taking staff away from support duties. Several of the service users help in the kitchen. A lunchtime meal was observed to be calm with staff eating with and assisting people as required. The man who has a bed-sit chooses if he wants to eat in his room or with the group. There are two dining rooms so people have a choice where to sit. Honeybrook House DS0000071656.V366642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are being well supported with their personal care in a manner they prefer. Most of their health needs are being met but improved recording, care planning and staff training would help to assure this. Medication is generally being managed safely. Independence in these areas is being encouraged. EVIDENCE: The deputy reported that the daily routines are flexible and said one man had got up late that morning by choice. The staffing levels allow each person to be supported with their physical care needs in a personalised manner. Care plans seen contained clear details of how the person prefers to be supported and how staff can promote their independence. Each person has their own toiletries, bedding and towels. Records showed that people were bathing daily and everyone looked well presented. A staff induction booklet included information on privacy and dignity and staff were observed to interact with people in a sensitive and respectful manner. Some of the staff had not had experience of supporting people as physically dependant as two of the newer service users. A worker reported that some staff had found this a challenge. No specific training was provided to support them with this role change. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 17 Health information is included in the care plans and health action plans have been introduced. Some entries need clarifying e.g. one plan indicated the man could not self-check for testicular cancer but ‘not applicable’ was written against the action section. General health checks are being carried out by a GP so this should be included in the check-up. One new man’s plan referred to two health conditions and it was not clear if he suffered from both or if staff had confused the two. The deputy talked about a special diet in relation to one of these, but Mr Cookson was unaware of this. He agreed to clarify the issue with the GP and make the records and arrangements clear. Monthly records showed weights were being monitored. A new person had not been weighed since his admission in March 08. The deputy thought this might be because he could not stand on the scales. No arrangements had been made for him to access seated scales. One young man has some complex health needs and these were explained in his care plan. Records showed he had attended health appointments and the outcomes had been recorded. Four of the service users have epilepsy however only seven of the nineteen members of the team have received training in this area. The providers employ a learning disability nurse and have access to external health consultants; however, evidence was not seen to show how the service users are benefiting from this other than the input into their behaviour management plans. Specialist support is being provided by local professionals for specific individuals e.g. Speech and Language Therapy. The service advertises itself as a specialist resource for people with Autism. The providers should consider how they could further demonstrate this. The medication procedures were being followed. The records sampled were clear and showed quantities are checked in and tracked including when taken in and out of the building. Suitable storage for medication that needs to be kept in the fridge should be arranged e.g. a lockable tin. Currently a plastic food container is used when needed. Two of the service users are being supported to self medicate, which is very positive. A system is in place to allow staff to monitor unobtrusively to ensure compliance. Medication profiles are in place, however, more could be recorded to demonstrate how the requirements of the Mental Capacity Act are being met in regard to decision making about medication. Some clarification is needed about homely medication arrangements. The GP has signed a document but this was before the new men moved in. Two men want to take Lemsips when unwell but this was not on the GPs’ list. Their ‘as required’ protocols made no reference to Lemsip or to how it should be used in conjunction with paracetamol. One man, admitted in March 2008, is prescribed an emergency medication for epilepsy. Mr Cookson had been unaware that staff would require training to administer this. The consultant mentioned this after the man had arrived and training was then arranged. Fortunately, the man did not need the medication during this eightweek period. Mr Cookson was made aware on the first day of the inspection that this medicine is a Schedule 3 controlled drug (CD). A CD register was being set up at the time of the second visit and storage was being improved. Honeybrook House DS0000071656.V366642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ views and concerns are being listened to. Systems are in place to help to protect the service users from abuse. Some areas of risk have not been identified and therefore people are potentially at risk. EVIDENCE: The Home has a complaints procedure that includes the required information. A version of this is available in a format for people with a learning disability. Some of the service users seemed confident to come into the office and engage with Mr Cookson. No complaints have been received by the home since Mr Cookson took over. Care reviews are now being held six monthly to help ensure issues are addressed pro-actively. He reported that he communicates well with the service users and their representatives and that many compliments have been received about the service. Mr Cookson hopes to involve external independent advocates in the service. Feedback from surveys indicated that people felt able to raise issues and that they are usually responded to appropriately. We have received no complaints and we have not been made aware of any adult protection issues. There is a policy regarding abuse and staff reporting any concerns. Staff are being made aware of these in their induction and given copies of the General Social Care Council Staff Code of Conduct. Staff are being offered bi-monthly supervision and those spoken with said they would report concerns promptly. Mr Cookson reported that all staff cover protection in their induction. He held a training session on Protection, in August 2007, that all staff employed at that time attended. Several of the current team have not attended more in depth training. After this was raised on the first day of the inspection Mr Cookson Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 19 reported that a one-day course is due to be held in June and July 08. Adult Protection is also covered in the NVQ awards. It is positive that service users are not being physically restrained. Staff are being provided with a three day course about how to respond to behaviours that they may find challenging. The manager and a member of staff reported that a consistent approach has resulted in three service users behaviours becoming more settled over the last year. Records confirmed that very few incidents were taking place. As mentioned under ‘Individual Needs and Choices’ many areas of risk had not been identified and addressed in the care planning process and this could mean that people were potentially put at risk. Honeybrook House DS0000071656.V366642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a clean, safe and comfortable home that is being well maintained. They have personalised bedrooms that assist them to be independent. The house is large and close to amenities, but the layout is not ideal for ten people with Autism some of whom have physical disabilities. EVIDENCE: The house is an attractive large detached property, which is in good condition externally. It is set in its own secluded grounds that are being maintained by a part-time worker. The interior of the house is in good condition and the communal areas and sample of bedrooms seen are all comfortably furnished and personalised. The communal rooms consist of a large lounge, a conservatory with seating, two dining rooms and a sensory room. The gardens are large but only parts are used as some areas are less accessible. Since the last inspection more seating, smart lounge blinds and new TV storage furniture have been provided. The overall impression is modern and attractive. Some of the service users seem very proud of their bedrooms. One explained he was going to buy a new bed and television. The bedrooms of the four new men have been fitted out with their personal possessions. All the bedrooms have Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 21 en-suite facilities. One man’s physical needs meant his en-suite bath was unsuitable so this has been replaced with a wet room shower. The door was changed to improve access, handrails added and a shower seat provided. These adaptations were made without the input of an Occupational Therapist (OT). Dr Cookson is going to request input now, as other aides may be needed and the man’s wheelchair used for outings needs reviewing. On the advice of his previous placement this man’s mattress is being propped up along one side so if he has a seizure he is less likely to roll out. The OT should be consulted about this, as a larger bed may be more suitable and comfortable. Service users’ bedroom doors lock as they shut. The deputy explained that most people have their own keys and for the three who do not the auto-lock is latched during the day to give people free access to their bedrooms and belongings. The kitchen and laundry are kept locked but service users do access these areas with staff support. One man uses his bedroom as a bed-sit. He has a breakfast bar and some kitchen equipment fitted. The plan to also make the adjoining two bedrooms bed-sits and provide a separate lounge for these three service users cannot now be implemented. The two most recently admitted men are less mobile and so they have taken these two ground floor bedrooms. This means that when the last two places are filled ten service users will be sharing the same communal areas. This is not ideal, as people with autism often prefer a quiet and predictable environment. One service user’s family expressed their concerns about this change and what affect this will have on their son. They had not been consulted about the change of plans. As plans are being drawn up consideration should be given to how additional communal living space could be provided such as a second lounge or a separate lounge/diner for the quieter or more able men. Two of the communal bathrooms were not used. One has been refitted as a shower room; the other has been turned into a small quiet room. There are still plans to move the kitchen from the basement to the ground floor where the office and sensory room currently are. The sensory room will be reprovided in the basement along with space for activities and a Jacuzzi. Mr Cookson said work is due to start soon. Two new service users cannot manage stairs. They are currently accessing the basement by an outside slope. While plans are being drawn up consideration should be given to internal access so they are not discriminated against because of their physical disability. The care staff are responsible for cleaning the Home. Arrangements appeared to be effective and the chemicals were being stored safely. New laundry equipment has been provided and the deputy reported that this is sufficient to meet the increased demand created by the increased number of service users. She said infection control arrangements are in place such as the use of protective clothing and laundry sluice cycles. The deputy has attended an advanced food hygiene course. There are gaps in staff training for basic food hygiene and infection control that should be addressed. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 22 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): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are being supported by a staff team who are being well supported and managed. Training is not being provided quickly enough to ensure staff, particularly the new ones, have the skills and knowledge they need to do their jobs well. The service users are being protected by the recruitment procedures. EVIDENCE: Staffing levels have been increased now there are eight service users. The rota seen confirmed that six staff are on each shift. Two staff were spoken with and both reported that this level was appropriate although mornings are busy when everyone needs staff input. New staff are being recruited ready for the last two service users to be admitted. All service users are male but less than half the staff are male so focused recruitment could be considered. The night arrangements are changing and instead of having one waking night worker with a sleeping-in person on call there are going to be two waking staff. Mr Cookson also plans to employ a cook to free up care staff from preparing food for up to eighteen people. Support staff will continue to be responsible for the cleaning but the night staff do a significant amount of this. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 23 The staff said the shifts are well planned and activities are now prioritised. They said there is always a senior person on duty and often two. They were receiving bi-monthly supervision, attending staff meetings and felt well supported. Both were positive about the service and their role. The worker who had been in post for longer felt the team was supporting people more consistently and behaviours were improving as a result. The deputy works on shift more often now and morale has improved. The staff on duty were seen to interact with the service users in an appropriate and friendly manner. Staff turnover has slowed slightly. Seven staff have left since the last inspection in comparison to nine the previous year. Mr Cookson is aware that a stable team is important for the service users and he feels now the service is more settled turnover will reduce. Feedback from surveys was positive about the staff team. One visitor reported, ‘Staff usually have the right skills and they have been eager to learn about my friend and have always treated him with dignity. I always feel welcome when I visit’. A nurse who had provided medication training said she found staff professional and interested and able to take on new information. One recruitment file was seen as a sample. The person had been interviewed at a different service and so Mr Cookson had not met her before she started. This approach is part of the organisations equal opportunities policy. There are positive elements to this practice, however, the manager should be ensuring new staff are suitable for the service users at Honeybrook and this approach would not enable service users to take part in choosing who supports them. Mr Cookson said he had approved the recruitment but could not find a record of this. All appropriate checks had been carried out such as references and a CRB. A ‘Buddy Booklet’ had been completed to show the worker had been given initial important information. She had her induction folder at home and was still working through this despite being in post for eight months. The owners say the induction includes all the required information including the Common Induction Standards. They have recently taken the decision not to support staff to gain the new Learning Disability Qualification as they feel all the content is included in their own induction. After the induction, staff are going to move straight onto the NVQ 2 programme. This is unfortunate, as having staff with a specific learning disability qualification would be considered an asset. The number of staff with an NVQ has risen from four to thirteen in the last year. The training matrix showed that a range of training is being provided that includes Fire Awareness, First Aid and Food Hygiene. Some of this is provided in-house through work-books. Significant gaps in training were noted e.g. Infection Control training had not been provided since November 07 and Understanding the Clients Perspective had not been provided since December 06. Staff who administer medication had completed the company’s own training, however the majority had not had accredited training. This is now Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 24 being provided and nine staff are on the course. Mr Cookson tries to access local courses for some training but places are limited. A worker spoken with had been in post for eight months but was only due to attend an Autism Awareness course in July. She had attended a course on Responding to Behaviours that are Challenging. She had been given a leaflet about epilepsy but had found it shocking when she first saw one man’s severe seizures. Epilepsy training has just been arranged. No Person Centred Planning or Total Communication training is provided. For a specialised service, training on these essential areas should be given a higher priority by the organisation in line with the Statement of Purpose for the service. Honeybrook House DS0000071656.V366642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service users are benefiting from the changes the new manager has introduced such as better activities planning. They and their representatives are being consulted but the process for this needs to be developed. Suitable policies and record keeping systems are in place to help safeguard people’s best interests. Health, safety and welfare are being promoted in many ways but there are some potential risks to people that have not been adequately addressed. EVIDENCE: The ownership of the service changed when the Tracscare Group Ltd. were registered as the providers in March 08 instead of Honeybrook House Ltd. Although the directors of both companies are the same the service is new and this is, therefore, being treated as the first inspection of this service. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 26 Mr Cookson took over as manager in April 07, however, he has only recently applied to become registered. An interview date is set for mid June. He has relevant experience and has a degree in psychology. He has submitted his NVQ 4 for verification and now plans to start the Registered Managers Award. Feedback received from service users, visitors and staff was positive with people reporting that Mr Cookson is a good leader, approachable and keen to help. Good progress has been made towards improving the outcomes for service users e.g. by providing a more effective staff team and improving care planning and activities. The service is more financially viable now because of increased occupancy. The Annual Quality Assurance Assessment submitted prior to the inspection was very brief. Mr Cookson had been given a draft corporate version and had added very little. It did not reflect the improvements in the service that he was informing us about verbally nor did it highlight how shortfalls such as training gaps were going to be addressed. He said he was not aware of the importance of the AQAA in the inspection process. The ‘Personal and Health Care’ section in this report highlights that Mr Cookson did not have all the information required to take the right management decisions about a new person’s medication. He is clearly enthusiastic and committed but needs to keep himself better informed and seek advice appropriately. Mr Cookson has successfully implemented the Tracscare policies and procedures into the daily running of the service. The recording systems are linked to each other and relate to the procedures. Audits are being carried out regularly by quality assurance staff and a line manager. The financial records for one man were seen. These were up to date and linked to the receipts. The balance of cash was being checked daily. In a couple of cases the information was not enough to explain what had been purchased, so recording may need to be expanded to provide clarity. Suitable arrangements are in place for the use of bankcards. Most service users’ money is kept in the office. This is not person centred or enabling and the practise should be reviewed. The provider’s reported in the AQAA that the quality assurance programme includes annual questionnaires to service users and their representatives. Mr Cookson was not clear what action had come from this process or when it was last carried out. He said he does consult people at review meetings but it seems consultation could be further improved. Some development plans are known but there is no business plan in place for stakeholders to see. As mentioned one family were concerned that plans to separate the living areas that they had been informed about when their son was admitted had been changed without consultation. Systems are in place to help promote the Health and Safety of service users e.g. daily checks on fridge temperatures. Mr Cookson reported in the AQAA that all equipment had been serviced. As mentioned some guidance did not cover all known risks to service users. A lack of planning about training have meant new staff have not been given essential knowledge in some areas in Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 27 their induction period. A visit from the fire officer in May 08 had resulted in three recommendations. Mr Cookson had followed these up and had agreed with the officer that no action was necessary at the moment. Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x 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 3 3 2 3 3 2 x Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NA 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 YA9 YA23 YA42 Regulation 13 (4) (b) (c) Requirement Known risks associated with peoples’ behaviours or health must be assessed and suitable arrangements put in place to safeguard them and maintain their wellbeing. Timescale for action 31/07/08 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 YA2 YA3 Good Practice Recommendations Ensure people are not admitted into the home unless they are compatible with current service users and preadmission plans clearly demonstrate that their needs will be fully met. Care plans must contain clear guidance for staff about what actions to take if a service user becomes distressed and shows known behaviours as a result e.g. at what point if any can physical restraint be used to safeguard them. There should be evidence that service users have been consulted about behaviour support plans, or their representatives, if they lack the capacity to understand the Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 30 2 YA6 3 YA6 safety issues. Complete each person’s care plan in a timely manner and show how people and their representatives have been consulted about the content. Activities that service users are participating in should be risk assessed and guidance given to staff about how to promote their independence while avoiding unnecessary hazards. Review the practise of keeping cash tins in the office. Consider how people can be supported with their spending money in a more person centred and enabling manner. Ensure health information is recorded accurately and health action plans are comprehensive. Ensure all service users are enabled to monitor their weight. 4 YA9 5 YA16 6 YA19 7 YA20 Securely bolt the controlled drug cabinet to an outside wall. Homely medication protocols should include all items that are being held in the home. 8 YA24 YA29 While plans are being drawn up consideration should be given to internal disabled access to the basement rooms and to how a second lounge could be created so people can choose whom they share their living space with. Staff training on specialist areas such as Autism, Total Communication, Epilepsy and Person centred Planning should be given a higher priority and all new staff should receive this training in their induction period. The manager should develop systems to aid planning and support him to keep an overview of all areas of the service. Some administrative support may be helpful to free up his time to focus on priorities. The service should be further developed to better demonstrate that it is a specialist service for people with Autism Spectrum Disorder. 9 YA32 YA35 10 YA37 11 YA39 The consultation processes should be further developed so they are more transparent and so stakeholders can see what the developments plans for the service are. DS0000071656.V366642.R01.S.doc Version 5.2 Page 31 Honeybrook House Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Honeybrook House DS0000071656.V366642.R01.S.doc Version 5.2 Page 33 - 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!