CARE HOME ADULTS 18-65
Hulme Hall Close Hulme Hall Road Cheadle Hulme Stockport Cheshire SK8 6JZ Lead Inspector
Jackie Kelly Unannounced Inspection 9th August 2007 09:30 Hulme Hall Close DS0000034392.V344044.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.V344044.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.V344044.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.V344044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th July 2006 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 D Gale, the temporary manager was in the process of applying to the Commission for Social Care Inspection for registration. The home is divided into separate units, which are 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 has had a stair lift fitted. None of the single rooms, (which are 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 can accommodate a reasonable number of cars. The home is located in the Cheadle Hulme area of Stockport. Apart from the local pub/restaurant; the shops and other amenities are not accessible other than by car. Public transport is also not readily available. The current rate at the time of the July 2006 inspection was £737.10 per week with the residents contributing £61.75. 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.V344044.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over two days (one week apart). On the first day an “expert by experience” accompanied the inspector. An “expert by experience” is someone who has experience of using a care service either for themselves or a relative. They are not employed by the Commission For Social Care Inspection (CSCI) but are recruited by an outside organisation for use by the CSCI on inspections. Experts by experience are used on a number of inspections and their comments are included in this report. Time was spent talking with the manager Ms D Gale, support workers, residents and a relative. On the second day the inspector spoke with Barbara Mitchell the service manager and again with the home’s manager. The Health and Social care files, which included the care plans, were looked at along with a person centred plan. Other documents were seen such as drug sheets, the daily working file and supervision records. The Commission for Social Care Inspection sent the organisation an Annual Quality Assurance Assessment (AQAA) form to complete. The document was returned within the specified time and was completed satisfactorily with relevant information. Survey forms were sent to residents, relatives, GP and Consultant for Learning Disabilities. At the time of writing this report seven relative and nine resident forms had been returned. It should be noted that the majority of the resident forms had been completed with the support of the care workers. The majority of relatives who completed a survey form said that the care home usually met the needs the needs of the residents and gave the support or care expected and agreed. Comments included; ‘I am very satisfied with the care and attention my daughter receives’; ‘the staff involved at Hulme Hall Close show great kindness towards my daughter and other residents’; ‘the standard of hygiene is maintained’; ‘they listen to relatives concerns and take action where possible’; ‘Keeps the residents safe and cared for’; ‘communication has improved over the year’; are not afraid to voice our concerns to senior members of staff’. However there were also a number of negative comments from relatives particularly about staffing issues, lack of activities and communication problems. Comments received included; ‘we get information if requested but other than that we are not kept updated and the staff not either’; ‘recently I have been concerned with the staffing arrangements;’ ‘bank staff being used’; ‘insufficient cover’; ‘lack of communication and length of time it takes to deal with issues’; ‘the high use of temporary staff is of a great concern to us’;
Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 6 ‘sometimes complacent;’ does not have the opportunity to do the activities he enjoys’; ‘more activities’; brighter aspects both externally and internally’. Information and further feedback received from the above named sources has been included in the report. Due to the residents limited communication skills and understanding it was not possible for any meaningful discussions to take place. However the residents were appropriately dressed and looked cared for. No one had been admitted or discharged from the home for a number of years. Also no new staff had been appointed since the last inspection of January 2006. The Commission for Social Care Inspection had received no complaints or concerns since the last random inspection of January 2007 and there had been no safe guarding adult referrals. One complaint had been recorded by the manager and satisfactorily dealt with. What the service does well:
Some areas of the home were clean, reasonably decorated and furnished. All parts of the home were free from offensive odours. Supervision and staff meetings took place on a regular basis and were recorded. These were particularly important to pass on information to support workers, to obtain their views and opinions, to assess their quality of work and to look at training needs. 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. There was a varied training programme in place for support workers to access. Eleven of the nineteen support workers employed at Hulme Hall Close had completed a National Vocational Qualification Level 2 and/or Level 3. Family links were maintained. Each flat had a menu and the support workers were encouraged to cook meals from fresh ingredients and not rely on fast foods etc. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The two residents who did not have a health and social care file should have one implemented as soon as possible. The previous files, which were now obsolete, should be removed from the flats and archived in the main office. This will avoid any confusion by the staff team as to which file and information they are working with. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 8 Person Centred Plans should be produced in a format that is helpful to the resident and should be used by the support workers as a tool to assist the resident to achieve their full potential and be aware of changing needs. The senior management should deal with the issues around implementation of person centred plans in order that progression can be made for the benefit of the residents. Not all the risk assessments had been reviewed on time, which has health and safety implications. The Learning Disability Community Team had not started the annual reviews for the residents, which could mean that the residents are not receiving what they are entitled to. It had been planned that after the reviews which had taken place last year a ‘Health Action Plan’ would be introduced; this has not happened. These should be implemented as soon as possible. The manager had been looking at ways in which the resident’s quality of life by accessing activities, which the residents enjoyed, could be introduced. However health and safety issues together with a lack of co-operation and reluctance of staff to change working patterns were making this difficult and was not in the best interests of the residents. During the visit to the home both the expert by experience and the inspector saw little interaction between the support workers and the residents. The main activity seemed to be watching television. As well as activities outside of the home activities within the home should also be considered. There were occasions when male support workers were caring for female residents with no female presence in the flat. This has been raised at previous inspections and is not respectful of the female residents rights to privacy and dignity. Two of the medication cupboards were looked at during the inspection one was clean and tidy however the second was not. This should be monitored as this could result in incorrect medication being given. The building, furnishings and fittings were not of a consistently good standard. At least two bathrooms were in need of repair with one requiring a hoist to be fitted due to the changing needs of the resident. Not all the bedrooms were of the same standard either. Whilst the inspector recognises that there were some problems these should be addressed to try and introduce better living conditions rather than accept the situation as it is. The expert by experience and the inspector, from discussions with the support workers and feedback from relatives, were of the opinion that there was low staff moral, a lack of motivation, and a failure to embrace new practices and move forward. Until the senior management overcome these issues (which they are trying to do) residents will not receive the service they should.
Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 9 The home at the time of the inspection had thirteen staff vacancies. Whilst the inspector is aware that other staff had filled these hours and a recruitment drive had recently taken place it was not acceptable that the organisations managers had not addressed this before. 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. 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.V344044.R01.S.doc Version 5.2 Page 10 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.V344044.R01.S.doc Version 5.2 Page 11 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 1,2. Quality in this outcome area is good. Information about the home and procedures for assessment are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had been issued with a ‘Tenants Pack’ which contained information in a suitable format about the home and who to contact. There had been no new residents admitted and there were no vacancies. However documentation and procedures were in place to undertake assessments should anyone be referred for a place at the home. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 12 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 was poor. Whilst there had been some improvement to the care plans and some person focused planning had taken place; there was still a lot of work to be done to ensure that all the residents were being given the same opportunities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files, which all but two residents had in place. Each resident also had a working file for daily recordings etc. The previous files, which are now obsolete, should be removed from the flats and the information archived as necessary. The remaining two files should be implemented as soon as possible. One person had a person centred plan however this had not been written in a format that was suitable for the resident and did not appear to have been used by the staff team as a working tool. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 13 A person-focused plan to meet the changing needs of one individual had been done in conjunction with relatives and advocate. Another is planned for a second resident, which will also involve an advocate. A small number of staff had received training on person centred planning but there were some concerns about ability to implement them. The senior management in order for the service to make progress speedily and for the benefit of the residents should address these matters without further delay. The Learning Disability Community team had not yet started the annual reviews, the first one should have taken place in November 2006 therefore some of the residents were now nine months behind. The financial system within the home had improved and there was now in place a suitable recording system, which offered greater transparency and control for the staff team. Risk assessments were in place but its was reported by the quality manager in their report of July 2007 that all had not been reviewed. At the time of the inspection the position was still the same. Hulme Hall Close DS0000034392.V344044.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): Standards 12,13,15,16,17. Quality in this outcome area is poor. Resistance from the staff team to any change in rotas and practice was not helping to improve the quality of life for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Apart from one of the residents (who attended a gardening scheme one day a week) the remainder did not have the ability to take part in either paid or voluntary employment. All required assistance to access social and leisure services within the community. All the residents had access to a car, which had been purchased by the individual residents under the mobility scheme. However due to restrictions regarding health and safety issues and lack of co-operation from the staff team
Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 15 not all the cars were being used to there full potential. This deprived the residents of a meaningful and enjoyable activity. Much of the service provided was no different (there had been a slight improvement) from that which was in place at previous inspections. The amount of day services and leisure activities attended differed widely between residents. The resident’s circle was restricted to family, support workers and carers. The small number of the residents, who regularly attended a disco night or day service, extended their circle of acquaintances albeit with people of a similar disability. One resident had a support worker from a private agency one day a week (for which he was paying for out of his allowances) to accompany him and a support worker from the home on bike rides. Other residents attended a resource centre, discos in the evenings, and hydrotherapy pool or go shopping. Since the introduction of the new financial system the staff team from one flat had started to go out for meals and go to the cinema. A sensory room had been provided which the staff team were gradually building up with assistance from the sensory team according to the needs of the resident. Regular family visits were maintained for all the residents from once a month to two or three times a week. The manager had been looking at the hours worked in each of the flats and how these could be managed more creatively to give the support workers the opportunity to take residents out and access suitable activities in the community. This was being met with resistance from the staff team who had worked the same way for many years. Their reluctance to change was not working for the best interests of the residents. During the visit to the home there seemed to be little interaction between the residents and support workers. The main activity appeared to be watching television. Each unit planned the menus and shopped accordingly. The majority of the residents required assistance to eat their meals. Hulme Hall Close DS0000034392.V344044.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): Standards 18,19,20,21 Quality in this outcome area was adequate. For most of the time the service provided each resident with access to health care services and provided personal support in the residents own private surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents received personal support and care from a staff group; many of whom had worked at Hulme Hall Close for many years. Bureau staff was used to supplement the staffing in times of staff shortages through holidays, sickness or staff vacancies. Agency staff were used when there was no alternative but these occasions were kept to a minimum. Each ‘flat’ housed two residents both of whom had their own bedroom, which provided them with privacy for personal care. There was also a lounge/dining room, kitchen and bathroom in each flat. However the building was not suitable to accommodate all individual health care needs within their flat. The bathrooms and toilets were not originally designed for people whose health could deteriorate with age or illness, which would require the use of a hoist or a wheelchair.
Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 17 The residents who were seen during the visit were dressed appropriately and were clean and tidy. The female residents in respect of their privacy and dignity should not have a male support worker without a female presence. Residents visited the consultant for learning disabilities for regular check ups. The local health centre was used for the residents’ day-to-day needs. Other services had been obtained, such as dentist and opticians as was necessary. Residents are required to have an annual statutory review to identify changes in need or support required. Those that took place in late 2005 and early 2006 included residents and their relatives/representatives. The inspector was informed that once the reviews had been completed a ‘Health Action Plan’, would be implemented. However at the time of the inspection the ‘Health Action Plans had not been implemented. The next round of the annual statutory reviews, which the Community Disability Team should have started November 2006 have not commenced. None of the current group of residents was capable of managing their own medication. All medication was kept in a locked cupboard within each of the flats and a record was kept. One of the cupboards that was looked at was not very clean; this was pointed out to the support worker on duty. Support workers had received training on safe handling of medicines. As the home originally accommodated very young people ageing and associated illness and death were not looked at. Now that the residents have reached maturity these issues will become more appropriate. The manager has recognised this and was looking at future planning with families regarding growing older, to ensure the preferences and wishes of individuals will be considered. Hulme Hall Close DS0000034392.V344044.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): Standards 22,23 Quality in this outcome area is adequate. There were complaints and financial recording procedures in place to protect the residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident’s rights and responsibilities information, which had been produced in an assessable format, outlined how they could complain. All complaints, comments etc. were recorded in each flat with an explanation of action taken. A central complaints log was kept in the office to ensure that they were responded to and tracked. There had been no complaints or safeguarding adult referrals made directly to the Commission for Social Care Inspection since the previous inspection of January 2007. The home had received one complaint, which had been dealt with in a satisfactory manner and recorded. A financial audit done by the finance department of Stockport MBC had been completed and the findings implemented. Staff had attended the alerter training course for Safe Guarding Adults. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 19 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 poor. Some areas of the home are in need of upgrading with suitable furnishings, fittings and equipment to improve the residents’ quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was originally purpose built to house twenty-one children with a learning disability and is set in the grounds of a supported tenancy, which is owned and administered by Stockport MBC. The number of residents has over the years reduced to ten whose ages range from twenty’s to early forty’s. It is not situated on a main bus route nor does it have easy access to train station, shops or other amenities. The home does not meet the national minimum standard of 10sq.m with regard to bedroom sizes. However those care homes that did not provide this amount of space before the 1st April 2002 was able to continue using these rooms. The room sizes were defined in the statement of purpose and resident guide.
Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 20 The inspector and the expert by experience looked round the home and visited all the ‘flats’. The standard of furnishings were adequate in some flats but in others were shabby and worn out requiring new carpets, sofa’s and decoration. Again some flats were clean, tidy and well presented whilst others were less so. The manager had recently had discussions with Stockport Homes who are responsible for the building and furnishings about what is required. The manager had also commissioned the contract cleaner to deep clean all the carpets. One resident’s bedroom had no furniture other than a bed and mattress and with the high window first impressions were of a prison cell. The inspector was also told that the resident spent a lot of time in this room. Whilst it is recognised that there are difficulties the inspector would like to see more done by the staff team to try and improve the situation of the bedroom and to offer a more stimulating environment in order to overcome the problems. The bathroom in one of the flats was no longer suitable for the needs of the resident living there; the person had to use a bathroom in one of the other flats. A second bathroom has tiles missing which need replacing. The two courtyards in the centre of the building were a disgrace in that there were weeds surfacing through the paving stones. However the manager said that the gardening contract had been renewed and the weeds had been treated. May be the support workers could consider involving themselves and the residents in a meaningful activity by taking responsibility for the courtyards. The introduction of some plants and seating may prove beneficial for all. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 21 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 poor. The high vacancy rate, low moral and resistance to change by the staff team was having a detrimental effect on the day to day running of the home and the residents’ quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of the support workers had been employed at Hulme Hall close for many years with no new staff having been employed at the home since the last inspection of January 2006. The feedback from people who had completed questionnaires or were spoken with indicated that there was a lack of motivation, low staff moral and a failure to embrace new practices and move forward. The lack of recruitment had meant that the home was carrying thirteen staff vacancies at the time of the inspection. The permanent staff team and Learning Disability Team’s own bureau staff had been maintaining adequate staffing levels. Agency staff had been used on some occasions but only as a last resort. However the Local Authority had recently organised a recruitment drive. Interviews had taken place and an initial six had been identified to Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 22 commence at Hulme Hall Close as soon as the required checks had taken place. The training and development section of the Local Authority organise training on all mandatory subjects such as; health and safety, moving and handling, fire safety, first aid, food hygiene, safe handling of medicines and safe guarding adults. Eleven of the nineteen staff had a National Vocational Qualification (NVQ) Level 2 or above with a further two staff currently completing the training. The manager had been working with support workers on their Personal Development Reviews, which will take place annually and reflect personal training needs and objectives. Formal supervision and group meetings had taken place. The impact of this has yet to be seen in the changing of staff practice. The management team had set up two training days for the staff based around Hulme Hall Closes values. This needs to be done to improve the quality of life for the people living at the home. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39,42. Quality in this outcome area is poor. The service has not been well managed for some years, and staff practice has been allowed to be restrictive to the detriment of the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hulme Hall Close has not had a stable permanent manager for many years, which has had an impact on the delivery of service to the people living at the home. The time between management appointments being made has often left the home with no manager on site to supervise the staff team and provide leadership in the day-to-day running of the home. Whilst we have seen some improvements over the years, these have been shortlived and not sustained. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 24 The fact that the organisation has allowed this to happen over the years has resulted in a team of support workers being stagnant and inward looking which will require a strong management presence to reverse their attitude and outlook. The Commission recognises that the acting manager and the current organisational management team are fully aware of the issues and have been putting in place strategies to improve the service and the quality of life of the residents. One major area that the management have addressed is the rota system and how the hours can be best used which should have a positive impact for the residents. Improvement need to continue and be sustained. The organisation is hoping to appointment a permanent manager within the next few months with a commitment given to the Commission that the acting manager will not be moved until the appointment has been made and an induction period undertaken. The visits required under regulation 26 were now being carried out on a regular basis. The reports that were sent to the service manager and also to the inspector were comprehensive and informative, and demonstrate that the current senior management of the service have an understanding of what needs to be addressed. A quality assurance report and annual development plan which includes results of surveys with residents, relatives, and other representatives for 2007/2008 will be due April/May 2008. The manager ensured as far as possible that the health and safety of the residents and staff was promoted and protected through compliance with legislation. However there are some health and safety issues regarding the general state of repair of the bathrooms. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 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 1 25 x 26 2 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 1 x LIFESTYLES Standard No Score 11 x 12 1 13 1 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 1 x 2 x x 2 x Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA12 Regulation 12 Requirement The restrictive practices and lack of co-operation from the staff team to allow residents to reach their full potential and access activities outside to the home must continue to be addressed ensuring that their wishes and feelings are taken into account in the provision of care. Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA7 Good Practice Recommendations The obsolete files should be removed from the flats to avoid confusion as to which files should be used. The person centred plans should be written in a format, which the service user can understand. The support workers should use them as a working tool on a day-today basis. All residents should have one. The Learning Disability Team should complete the annual reviews and the risk assessment reviews should be reviewed on time. 3. YA9 Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 27 4. YA13 5. 6. 7. 8. 9. 10. 11. YA16 YA18 YA19 YA20 YA24 YA26 YA27 12. 13. 14. YA30 YA32 YA33 The home is not within easy reach of local amenities therefore the use of cars is essential. The current lack of co-operation by staff regarding the vehicles needs to be resolved to ensure that residents can access community facilities without difficulty. Interaction between staff and residents could be improved. There was little activity going on during the inspection apart from watching television. All female residents should have a choice and not be restricted to an all male staff team in their flat which has happened on a small number of occasions. The ‘Health Action Plans’ should be introduced as soon as possible. The medication cabinets must be kept clean and tidy at all times. The premises are in need of refurbishment in a number of areas. The bedrooms need to be looked at and appropriate action taken to improve the décor and furnishings. At least two of the bathrooms need refurbishment. The fitting of a hoist in one of the bathrooms was required to meet the changed needs of the resident. This had not been done. The cleanliness in a small number of flats could be better. The motivation of the staff team was not good and this reflected in general appearance of the home and the work that was being done. The number of vacancies and the use of bureau and agency staff had not been good for the home. This number of vacancies should not be allowed to accumulate again. Hulme Hall Close DS0000034392.V344044.R01.S.doc Version 5.2 Page 28 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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