Inspecting for better lives Random inspection report
Care homes for adults (18-65 years)
Name: Address: Hothfield Manor Centre Church Lane Hothfield Ashford Kent TN26 1EL three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Montgomery Date: 0 2 0 3 2 0 0 9 Information about the care home
Name of care home: Address: Hothfield Manor Centre Church Lane Hothfield Ashford Kent TN26 1EL 01233643272 01233611433 hothfield.manor@fshc.co.uk www.huntercombe.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hothfield Manor Ltd care home 24 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 24 The maximum number of service users to be accommodated is 24 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the service are within the following category : Physical disability (PD) Date of last inspection Brief description of the care home Hothfield Manor Centre is a care facility registered to provide accommodation, personal care and support for up to 24 adults with a physical disability. The fees range from £900 - £1400 per week. The Centre specialises in the provision of care to people who have an acquired brain injury. The accommodation is in two specific areas, these being 12 single bedrooms in the Manor House and 12 single bedrooms in terraced chalet bungalows within the grounds. Some of the bedrooms have en-suite facilities. Five of the chalet bungalows are for 2 people and 1 bungalow has been constructed to enable 2 people to experience supported independent living. The Home has well maintained Care Homes for Adults (18-65 years)
Page 2 of 9 Brief description of the care home garden available for residents use, and adequate car parking space within the grounds. The Centre is located approximately 5 miles from the town of Ashford. The Home has its own transportation and there is a shop/post office within walking distance. Staffing comprises of a Registered Manager, Assistant Managers, support staff, a cook, domestic staff, gardeners and a administrator. Care Homes for Adults (18-65 years) Page 3 of 9 What we found:
This random inspection was conducted by Sarah Montgomery, Regulation Inspector, and Suni Chotai, Pharmacist Inspector. We arrived at Hothfield Manor at 7am. The inspection ended at 10.45am. The random inspection was conducted in response to concerns raised with the Commission regarding medication protocols and staff conduct at the home. We assessed information that told us how the home meets standards in relation to medication. This included gathering information from care plans, risk assessments, medication administration records, medication policies and procedures, speaking with staff, and observing medication being administered during the morning medication round. We also observed interactions between staff and residents. Our findings are as follows; Care Planning and Risk Assessments. Information gathered at this random inspection evidenced that documentation relating to care planning is poor. We looked at three health care plans. The care plans were all very basic, and did not contain sufficient information. Current care plans may put service users at risk of harm, as staff are not aware of the support needs of individuals. Of the care plans we inspected, two of the service users have epilepsy. Neither service user had a care plan about management and support of the epilepsy, nor were there any guidelines for staff concerning possible triggers for seizures. When questioned, staff did not have any knowledge about an individuals epilepsy, how it presented, or how it was managed. Staff confirmed they had never received any training on epilepsy. None of the care plans inspected contained any evidence that the service user had been consulted about their care or support needs. Nor had their wishes regarding how they would like to take their medication been sought. This is despite a pen picture of one service user stating is very able to be involved in all aspects of his care. No evidence could be found to suggest the home had information on the different types of medication individuals were taking or the side effects. There were no risk assessments pertaining to epileptic seizures, or any risk assessments should residents choose not to take their medication. This failure to properly care plan and risk assess for the identified health needs of service users is a significant shortfall, and may leave service users at risk of harm. It is imperative that the home revisit all care plans and risk assessment documentation for all service users, and ensure that all support needs, and all risks are adequately recorded. This review of care planning must be undertaken in consultation with individual residents so that their wishes and preferences can be listened to, recorded, and acted upon. Respect and Dignity of Service Users. Information gathered at this random inspection evidenced that outcomes for service users are poor in this area. During the inspection we observed a number of incidents in which a service user was spoken to in a harsh manner, without any regard for the persons respect, dignity or feelings. Examples of this are; get out of the office, dont run, walk; you go now, shave; you sit down and wait; do not touch; go to the smoking room. All of these examples were spoken harshly, in a telling off tone, and there was no warmth or kindness. We were shocked at this treatment of a service user. That these exchanges happened in front of inspectors suggests this is a recognised and acceptable way of speaking with service users at the home. The behaviour of the staff who made these comments is totally unacceptable. Their attitude towards the service user was dehumanising and Care Homes for Adults (18-65 years) Page 4 of 9 potentially abusive practice. These observations have been shared with Kent County Council. Medicine management The evidence looked at for staff training around medicines showed that this was lacking. Staff confirmed that there had been no such training in the past. The staff members on duty at night had no training in medicine management and would not be giving medicine. Many medicines were prescribed to be given at 10:00 p.m. the home was managing this by giving it early. The care plans around various aspects of medicine management were poor e.g there were no guidelines for the use of medicine to be given only when needed, and there was no procedure in the care plans on self administration of medicine for one person who managed their own medicines. There was a risk assessment for this action. One person was given medicines in food. There was evidence for why this was done but a multi disciplinary team had not been involved according to the documents. The medicines policies were generic [corporate ones] and did not cover the differences seen in this home. There was no provision to store controlled drugs in the required manner. It is noted that there were no controlled drugs in the home at the time. One person who visited the home regularly for respite had the medicines sent to the home prepared into a pill box by the relative. We were unable to to assess the safety of these medicines as these stays are usually at weekends. The staff need to make sure that these medicines are labelled. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 5 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 6 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person must develop care plans which fully record all assessed needs and personal goals and wishes of the service user. The care plans should cover aspects of medicine management such as medicine prescribed only when needed, giving medicines in food and proceudre for self managing medicines This will ensure residents are supported appropriately and are protected from harm. 01/04/2009 2 9 13 Have policies in the home that are relevant to the home so that a staff have guidance to work in a consistent manner 08/05/2009 3 9 13 The registered person must 01/04/2009 ensure risk assessments fully describe the identified risks and subsequent support needs for individual service users.
Page 7 of 9 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This will ensure service users are supported appropriately and are protected from harm. 4 20 13 The registered person must 01/04/2009 make sure that at all times there is at least one staff on duty appropriately trained in medicine management So that people in the home are not left without their medicines and are given their medicines at the prescribed times 5 32 12 The registered person must 12/03/2009 ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. This will ensure service users are treated with respect. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 9 of 9 - 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!
