CARE HOME ADULTS 18-65
Hulme Hall Close Hulme Hall Road Cheadle Hulme Stockport Cheshire SK8 6JZ Lead Inspector
Jackie Kelly Unannounced Inspection 17th January 2008 10:00 Hulme Hall Close DS0000034392.V358043.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 Hulme Hall Close DS0000034392.V358043.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. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hulme Hall Close Address Hulme Hall Road Cheadle Hulme Stockport Cheshire SK8 6JZ 0161 486 9783 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) Stockport MBC Adult and Community Directorate ** Post Vacant *** Care Home 15 Category(ies) of Learning disability (15), Physical disability (3), registration, with number Sensory impairment (1) of places Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A manager, working a minimum of 30 hours each week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home and who is registered with the Commission for Social Care Inspection. No more than two places can be used as respite/emergency/short term placements. 9th August 2007 2. Date of last inspection Brief Description of the Service: Hulme Hall Close is owned by Stockport Metropolitan Borough Council and is registered for 15 young people who have a learning difficulty. However the current number of residents living at the home was 10. The home is part of the Stockport Learning Disability Partnership, Adults and Communities Directorate. The responsible person for Hulme Hall Close is Mr T Dafter (Assistant Director Adults and Communities Directorate). Ms Haley Pendleton had been appointed as the manager and was to apply to the Commission for Social Care Inspection for registration. The home was divided into separate units, which were interconnecting on the ground floor only. To access the first floor, the young people must be able to climb the stairs apart from one unit that had a stair lift fitted. None of the single rooms, (which were below the National Minimum Standard of 10sq.m or 12sq.m for those service users who use a wheelchair), had an ensuite facility. The home had a large garden to the rear of the building and hard standing to the front, which could accommodate a reasonable number of cars. The home was located in the Cheadle Hulme area of Stockport. Apart from the local pub/restaurant, the shops and other amenities were not accessible other than by car. Public transport was also not readily available. The current rate was £737.10 per week with the residents contributing £61.75. The most up to date rates could be obtained from contacting the Stockport Learning Disability Partnership office at Regal House. There was a statement of purpose and ‘Tenants Pack’ which provided information about the home. The inspection reports were available on request.
Hulme Hall Close DS0000034392.V358043.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.
This was a key inspection which included an unannounced visit to the service, which took place over two days (one week apart). The first day was spent talking with the administrator and a small number of support workers. The second day we met the recently appointed manager Ms Haley Pendleton and the Quality Manager Ms Louise Machin. Other support workers were spoken with and we were able to meet a number of residents. No relatives were present at the home on either day of the inspection. No one had been admitted to or discharged from the home for a number of years. The Health and Social care files, which included the personal support plans and daily record file (grab file) were looked at along with the medication files. Due to the residents’ limited communication skills and understanding it was not possible for any meaningful discussions to take place. However we did observe that the residents were appropriately dressed and looked cared for. Staff personnel files and supervision files were also seen. The Commission for Social Care Inspection had received no complaints or concerns since the last key inspection of August 2007. As a result of an adult protection referral made by the Commission a strategy meeting took place on the 5th February 2008. It was agreed at the meeting that the senior managers be given the opportunity of putting in place the action plan that had been agreed. A further meeting took place in September 2008 when it was confirmed that improvements had been made and staffing concerns resolved. What the service does well:
Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 6 The information pack was presented in a format that was easy to read and understand. Some areas of the home were clean, reasonably decorated and furnished. All parts of the home were free from offensive odours. The health needs of the residents were well served through the consultant in learning disabilities who the residents visited on a regular basis to monitor their progress. The local medical practice also contributed to the general health of the residents. Stockport training and development offered a varied programme which all support workers were able to access. Family links were well maintained with relatives encouraged to visit and welcomed at the home. The Health and Social Care files, which included the personal support plan, had been introduced for ten residents. Daily record and medication files were also available. Some of the residents were supported to attend leisure activities outside of the home. The monthly, unannounced monitoring visits by a representative of the organisation (Quality Manager) had taken place regularly. We found the reports written to be comprehensive, informative and an honest appraisal of the home. What has improved since the last inspection?
The most outstanding improvement had been the progress made to resolve the staffing concerns. Ten new staff had been appointed which included a new permanent manager. Fourteen staff had been given thirty-seven hour contracts from the current twenty-nine. This increase in staffing levels had impacted on the staff teams enabling them to provide more support to residents out in the community. Staff moral had also increased and, with the new injection of staff, new ways of looking at the service had generated some new ideas. For instance the rota had been changed to enable the residents to go out in their cars more often. The communal area was to be used for a celebration where everyone was to be invited. Staff and residents from one of the flats had cleaned up the courtyards and parents were to donate plants to make them more inviting. Meetings were ongoing with relatives and staff to resolve specific problems.
Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 7 We were given a programme of work that was to commence February 2008. This entailed the whole of the building being decorated, repairs undertaken, new carpets fitted, new kitchen worktops and refurbishment to bathrooms. A working group had been appointed to look at restrictive practices and how risk assessments can sometimes influence and endorse this type of practice. A policy and procedure had been produced and would be distributed once senior managers had ratified it. The new manager, quality manager and service manager were all committed to continual improvement and to maintain the momentum that had been started by the previous manager of Hulme Hall Close. What they could do better:
Person Centred Plans should be produced in a format that is helpful to the resident. This was a recommendation at the previous inspection of August 2007. Not all the personal support plans and risk assessments had been reviewed and did not contain up to date information. Some of the information in the health and social care files would be better kept in the daily record file (known as a grab file). The medication files contained care plans that were not appropriate for individual residents. The ‘Health Action Plans’ should be introduced for everyone as soon as possible. This was a recommendation at the previous inspection of August 2007. The staff supervision files and staff personnel files, which were kept at the home, could be organised better and should contain more information. The fire awareness training should be implemented as soon as practicable. A quality assurance report for the year 2007/2008 which includes the results of any surveys undertaken by the management will be required by May 2008.The purpose of this report is to provide information to the Commission, relatives, and other interested parties, what the service provides, how it is provided and what changes can be made to improve the service. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 8 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. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 9 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 Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 10 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): Standard 2. Quality in this outcome area is good. Procedures and documentation for assessment prior to admission ensure the home can meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no new residents admitted since the previous inspection of August 2007 and there were no vacancies. Documentation and procedures were in place to undertake assessments should there be a vacancy. Hulme Hall Close DS0000034392.V358043.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): Standards 6,7,9. Quality in this outcome area is adequate. Personal Support Plans were written in a clear and concise manner to enable residents’ needs to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The personal support plans were written in a way that was clear and easy to read for the support worker and other professionals but were not available in a format that would help the service user to understand. This was a recommendation at the previous inspection of August 2007. The support plans and risk assessments did not have evidence of being reviewed regularly by the support worker team and indeed some of the information was out of date. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 12 Information contained in the health and social care files, for example the daily recording charts and weekly activities list, would be better kept in the daily record file (grab file). Any forms that were not being used should be removed from the file; they should only be in a file if they appertain to that person and are being completed. The new manager and the quality manager were aware of these shortfalls and would be addressing them as part of supervision and team meetings. Hulme Hall Close DS0000034392.V358043.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): Standards 12,13,15,16,17. Quality in this outcome area is adequate. Residents were supported to access services in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been an improvement in the activities residents were supported with outside of the home. Transport difficulties were being resolved which were essential due to the location of the home and lack of public transport. Family contact was good and parents were encouraged to visit and be part of their relatives’ lives. Daily activities that residents took part in within the home were limited and were to be looked at by the new manager with a view to enhancing residents’ involvement. There were no issues about the food or times meals were served.
Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 14 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): Standards 18,19,20 Quality in this outcome area is adequate. The service provided each resident with access to health care services to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The personal support plans, health and social care files and daily recordings showed that the residents were supported to access all the health care they required to meet their needs. The ‘Health Action Plans’ had not been introduced for all residents. This was a recommendation at the previous inspection of August 2007. The medication files were looked at for a small number of residents. We had some concerns regarding the care plans that had been written for different types of general medication. Any care plan must be written for the individual. All other forms of generic information should be for information only and this should be made clear. This was discussed with the new manager and the quality manager who said that the problems would be addressed. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 15 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): Standards 22,23 Quality in this outcome area is good. Residents were protected from abuse through training, records, policies and procedures and external monitoring. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no formal complaints made directly to us. The Commission had made a safeguarding referral after the last inspection, which took place in August 2008. The managers of Stockport Learning Disability Partnership had investigated the referral. The concerns had been addressed and measures put in place to ensure that residents were allowed to experience a better quality of life. The external quality manager checked the complaint logbooks during the monthly visits to the home to ensure that they were recorded appropriately and resolved. Financial records were kept in each of the flats; again the quality manager monitored these. Support workers had received training on safeguarding adults. All the new workers had this training as part of their induction. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 16 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): Standards 24,26,27,30 Quality in this outcome area is adequate. The work planned to upgrade the building and facilities will provide the residents and staff with a better environment to live and work in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building on the day of the inspection showed little improvement however a plan of work, which was to begin in February, was given to the inspector. The plan included painting and decorating, new carpets, general repairs, new kitchen worktops and bathrooms made good. Meetings had taken place about the bathroom, which was not adequate for assessed needs. It was hoped that the options available would be resolved soon and work would begin. The head of service and service manager were looking into issues surrounding the one particular bedroom, which was highlighted in the previous report of August 2008.
Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 17 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): Standards 32,33,34,35,36. Quality in this outcome area is adequate. The staff team was sufficient in size to ensure that the residents were supported to enjoy a better quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been a substantial increase in the staff team. Ten new workers including the manager had started over the past two months. Alongside this, fourteen workers had been given a formal contract for thirty-seven hours a week from the current twenty-nine hours. The impact these changes had made had improved staff moral, had brought about different ways of looking at day-to-day routines and had increased activities outside of the home for some people. Whilst it was ‘early days’ the management team were confident that this would continue. The recruitment and selection procedure was that of Stockport MBC and all new staff had received induction training before commencing at Hulme Hall Close. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 18 Training and personal development was ongoing. Core skills training courses were offered through the Local Authorities training division. The manager and quality manager during the second visit had discussed with us training on fire awareness (mandatory), person centred planning and values which was felt would benefit the staff team. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 19 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): Standards 37,39,41,42. Quality in this outcome area is adequate. Management involvement and quality monitoring ensured that the residents would have their health and personal care needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager had been appointed who was to apply for registration with the Commission. The quality manager for the Stockport Learning Disability Partnership visited the home monthly and produced a written report that was sent to the Commission and the service manager. The reports were comprehensive with the information written in a clear and concise manner. We found them to be an honest appraisal of the home. The quality manager had also written a separate
Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 20 report regarding the safeguarding referral made by us. Again this was written in same manner; it also stated where action was needed to build on the improvements that had been made since the previous inspection of August 2008. The staff personnel and supervision files that were kept at the home should contain more information and be better organised. This was discussed with the administration assistant, the quality manager and new manager. We left a sample format for basic staff information. There had been a visit from the fire prevention officer and the Partnership and the Commission had received a copy of his report. The immediate requirements of the report had been met. Training was to be devised and implemented as soon as practicable. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 21 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 3 3 X 4 X 5 X 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 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X 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 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X 2 2 X Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA38 Regulation 8 Requirement The new manager must register with the Commission. Timescale for action 30/03/08 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 YA6 Good Practice Recommendations The service user plans/person centred plans should be made available in a format they can understand. This was a recommendation at the previous inspection of August 2007. The personal support plans should be reviewed and amended without unnecessary delay to ensure that they contain the most up to date information. Some of the information contained in the health and social care files would be better kept in the daily record (grab file). Also forms, which are not being used for that particular resident, should not be in any of the files. Risk assessments need to be reviewed regularly and changes made as necessary to make sure that they contain the most up to date information. The improvements that had been made should continue so that residents can take part in fulfilling activities. The improvement to residents accessing community links
DS0000034392.V358043.R01.S.doc Version 5.2 Page 23 2. 3. YA6 YA6 4. 5. 6. YA9 YA12 YA13 Hulme Hall Close 7. 8. YA19 YA20 9. YA26 10. 11. 12. YA27 YA35 YA41 13. YA42 should be maintained to further enhance their quality of life. The ‘Health Action Plans’ should be introduced as soon as possible. This was a recommendation at the previous inspection of August 2007. The medication files contained care plans regarding the use of general medication or ‘homely remedies’. This needs to be looked at, as care plans should be specific to the person they relate to and the medication they are taking or may take as a homely remedy. Once the decoration of the bedrooms is completed this standard would have been partially met. Discussion and plans to implement strategies to improve other facilities in one particular bedroom should continue. Records should be kept of progress made and what has worked and what has not. The fitting of a hoist in one of the bathrooms is needed to meet the changed needs of the resident. This had not been done at the time of the inspection. To continue with encouraging the staff team to take training that is relevant to their work in order to improve the service to the residents. The staff personnel files and supervision files that are held at the home could be improved, as there was a lack of relevant information. A sample format of the information that is required by the Commission on the premises was given to the administration assistant. The requirements regarding staff training for fire awareness should be implemented as soon as possible. Hulme Hall Close DS0000034392.V358043.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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
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