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Inspection on 19/03/07 for Hunters Green

Also see our care home review for Hunters Green for more information

This inspection was carried out on 19th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Admissions to the home are handled well. This helps to ensure that the home can meet the needs of the people who move in. There is a good system for care planning in the home. Arrangements are also in place to ensure that service users access the healthcare services that they need and that medication is managed appropriately. Service users are treated individually and with respect. The quality of personal care support is high. Appropriate support is provided to enable service users to take part in activities which reflect their interests and needs. People living in the home are also enabled to stay in contact with family and friends. There is a culture of offering service users choice and responding to indications of preferences and wishes as far as possible. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 6A varied and healthy diet is offered along with appropriate support at mealtimes. Staff communicate effectively with, and respond to, service users. Staff are caring and skilled. Measures are in place which help to protect service users from the risk of harm and abuse. A clean, homely and well-adapted environment is provided. Service users have their own rooms, which are well decorated and personalised. Robust recruitment and selection procedures are in place, helping to protect service users. Staffing levels are sufficient to meet service users` needs. The home is very well run. Good systems are in place for monitoring and improving the quality of the service. Health and safety is well managed.

What has improved since the last inspection?

The previous report was issued when the service was run by a different provider. No specific improvements were noted during this visit, but the standard of care during this and previous inspections has been found to be consistently high.

What the care home could do better:

Systems are in place for identifying and managing significant risks, although some work is needed to improve aspects of this. Whilst staff generally receive the training they need, some areas require attention in order that staff are fully up to date with basic areas of training. Some recommendations are made for consideration.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hunters Green 12 Crifty Craft Lane Churchdown Gloucester Glos GL3 2LH Lead Inspector Mr Richard Leech Key Unannounced Inspection 19th & 20th March 2007 09:40 X10029.doc Version 1.40 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 Hunters Green DS0000066984.V333481.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 Older People and 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. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hunters Green Address 12 Crifty Craft Lane Churchdown Gloucester Glos GL3 2LH 01452 859096 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) www.brandontrust.org The Brandon Trust Mrs Jacqueline Susan John Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4), Physical disability over 65 of places years of age (4) Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/09/05 Brief Description of the Service: Hunters Green is a bungalow in a quiet residential area of Churchdown, Gloucestershire. The home provides care and accommodation for up to four service users with learning and physical disabilities. Service users are accommodated in single bedrooms. There is a lounge, dining room and adapted bathroom. The home also has a sensory room. A specialised vehicle is available for transportation. Prospective service users and people involved in their care are offered information about the service including copies of the Statement of Purpose and Service Users Guide. Up to date information about fees was not obtained during this inspection. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Monday morning, lasting until late afternoon. A second visit took place on the following day from about 10:00 to 14:00. Over the course of the inspection all of the service users were met with along with many of the staff team. The manager was present during the first day of the visit. Various records were examined during the inspection. These included samples of care plans, risk assessments, medication charts, staffing files and information about training. Some discussion took place with visitors to the home. Prior to the visit a pre-inspection questionnaire had been completed. Following the inspection some survey forms were sent out to various agencies who had involvement in service users’ care in order to provide additional feedback. In July 2006 some staff survey forms had been sent to the home. Although this was some time before the inspection, some of the feedback is still incorporated into this report. On the second day of the inspection some structured observation took place using a new tool (SOFI – Short Observational Framework for Inspection). This focused on the care and support offered to one person and the observation lasted for two hours. More general observation took place on both days of the inspection. What the service does well: Admissions to the home are handled well. This helps to ensure that the home can meet the needs of the people who move in. There is a good system for care planning in the home. Arrangements are also in place to ensure that service users access the healthcare services that they need and that medication is managed appropriately. Service users are treated individually and with respect. The quality of personal care support is high. Appropriate support is provided to enable service users to take part in activities which reflect their interests and needs. People living in the home are also enabled to stay in contact with family and friends. There is a culture of offering service users choice and responding to indications of preferences and wishes as far as possible. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 6 A varied and healthy diet is offered along with appropriate support at mealtimes. Staff communicate effectively with, and respond to, service users. Staff are caring and skilled. Measures are in place which help to protect service users from the risk of harm and abuse. A clean, homely and well-adapted environment is provided. Service users have their own rooms, which are well decorated and personalised. Robust recruitment and selection procedures are in place, helping to protect service users. Staffing levels are sufficient to meet service users’ needs. The home is very well run. Good systems are in place for monitoring and improving the quality of the service. Health and safety is well managed. What has improved since the last inspection? What they could do better: 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. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Older People) & 2 (Adults 18-65). Standard 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough approach to admissions means that service users moving into the home and others involved in their care can be confident that their needs will be fully assessed and met. EVIDENCE: One person moved into the home in October 2006. Documentation in respect of this admission included care plans and other material from the person’s previous home, assessments from specialists and an assessment by staff at Hunters Green. In addition, there was an assessment of the environment at Hunters Green by members of the Community Learning Disability Team, which Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 9 concluded that the home was physically suitable for meeting the person’s needs. There was documentary evidence that the person made several visits to the home before moving in. These had been written up. Staff confirmed that they had met the person before they moved in, and that the service users had all been introduced several times before the admission. Staff spoken with also felt that they had been given sufficient information to appropriately support the person from when they moved in, as well as any necessary ongoing external support. A write up of a discharge meeting was seen which included detailed actions and agreements relating to the transition to Hunters Green. In previous reports for other Brandon Trust homes it has been recommended that the admissions policy dating from 2000 be reviewed and updated. The policy in place in the home was not checked on this occasion. The Trust has indicated that a full review of policies and procedures will take place, to be completed by September 2007 at the latest, with reviews then taking place annually. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 (Older People) and 6, 9, 16, 18, 19 & 20 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A thorough care planning system operates in the home, promoting the consistency and quality of care. Systems are also in place for identifying and managing significant risks, although there is scope for improvements in this area to further protect service users. Arrangements are in place to ensure that service users access healthcare services as necessary, promoting their wellbeing. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 11 The systems in the home for the handling of medication are robust, helping to keep service users safe and well. Service users are treated individually and with great respect, promoting their dignity and self-esteem. EVIDENCE: Examples of care plans for two service users were checked. These covered appropriate areas, provided clear guidance for staff and had been regularly reviewed. Those viewed had a clear aim/rationale for the intervention described. Work had been undertaken about service users’ ability to input to the care planning process. This was documented on a best-interests format. Examples of Essential Lifestyle Plans (a form of person-centred planning) were seen. Whilst there was evidence of review, some of the documentation was several years old. A training day about person-centred planning had been arranged for the staff team on April 3rd 2007. This should provide a good basis for undertaking a more thorough review of person-centred planning in the service. The Trust was in the process of refining a person-centred careplanning tool which was likely to be rolled out later in the year. Daily reports and handover sheets for each shift were sampled. These gave detailed information about areas such as diet, personal care and activities. Staff spoken with were able to describe the care planning process and how changes to care plans were communicated. This provided further evidence that they were ‘live’ documents. Care plans referred to healthcare issues as necessary, including advice from specialists such as members of the Community Learning Disability Team. Care planning files and other records provided evidence of significant input from healthcare professionals in the community, and of their recommendations being communicated throughout the team. Some reviews and assessments involving the Community Learning Disability Team took place during the inspection. Staff spoken with demonstrated good awareness of service users’ conditions and of issues such as pressure care. Healthcare notes included documentation of best-interests work, such as for considering whether a person should have a flu immunisation. General healthcare notes along with discussion with staff provided evidence that service users were receiving necessary support to access routine and specialist healthcare services. There was evidence of annual healthcare checks taking place. One outcome as recorded by the healthcare professional was, ‘to maintain the excellent care [service user] is receiving’. The Trust has a format for health action planning, although this had not yet been fully implemented. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 12 Some work was seen to have taken place about health action planning. In some cases this would benefit from being reviewed. Medication administration records and storage appeared to be in order. Some administration was observed. The medication policy was seen, dating from 2000. Local procedures and an approved staff list were on file. The home also had copies of local and national guidance about the administration of medication in care homes, as well as a copy of the BNF (a reference manual about medications) from March 2006. Staff spoken with confirmed that they receive two-part in-house training about the handling of medication and also undertake an external training course before they are permitted to administer medication to service users. One person was noted as having an allergy to penicillin although this was not printed on the allergies section of their MAR chart. Staff spoken with were aware of this allergy and it was clearly marked on file. The manager said that it had previously been recorded on the MAR chart but that a recent IT issue at the pharmacy had resulted in it being deleted. This should be reinstated on the MAR chart. Care plans referred to respecting service users’ privacy and dignity, and provided guidance about people’s personal care needs and preferences. Staff spoken with demonstrated a very clear understanding of the principles and practices around respecting people’s privacy and dignity. Observation throughout the inspection confirmed that these were adhered to. For example, doors and curtains were closed as necessary and staff were heard explaining to service users what they were doing/about to do in a courteous and respectful manner. Service users were individually and smartly dressed, wearing accessories. During the inspection one person had their hair styled by staff. Records and discussion indicated that staff support service users to access hairdressing facilities in the community and also provide manicures for service users. Observation and discussion with staff provided evidence of flexible and relaxed routines based on service users’ needs, preferences and choices as far as possible. Where able, service users were invited to assist in day-to-day life in the home, such as feeding the cat and helping in the kitchen. Care plans made reference to significant risks and how these were managed. Files also included risk assessments covering specific areas. In some cases these had been written many years prior (e.g. 1998) and handwritten additions/review notes were reducing their clarity. Such risk assessments should be rewritten/retyped. Risk assessments for the service user who had recently moved in had not yet been written. These need to be put in place. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 (Older People) and 12, 13, 15 & 17 (Adults 18-65). Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided to enable service users to take part in activities which reflect their interests and needs. People living in the home are also enabled to stay in contact with family and friends, enhancing their quality of life. There is a culture of offering service users choice and responding to indications of preference and wishes, which may help the people living in the home to feel valued and empowered. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 14 A varied and healthy diet is offered which responds to people’s needs and preferences, promoting their wellbeing. EVIDENCE: Daily records for two service users were looked at to check their activities over a ten-day period. These provided evidence of service users being supported to take part in a variety of activities in the home and community including attending day centres, having reflexology, watching TV, listening to music and going for walks in the local area. During the two days of the inspection service users’ activities included going out for lunch, shopping with staff, attending a day centre, doing art and craft in the home, having reflexology sessions, having their hair styled, listening to music and using the sensory room. A volunteer visited the home to meet with one person and to engage them in conversation and activities. As noted, where able service users are encouraged to take part in domestic activities. Staff spoken with felt that service users’ activity needs were generally met. Some people felt that there should be a new vehicle to make it easier for all of the service users to go out together (the current one can only accommodate one wheelchair, although some of the service users are able to transfer into seats). Staff added that some of the service users preferred not to go out very often or became tired if their activity schedule was too hectic. Care plans referred to activities and also to people’s relationships with family and friends. Records and discussion with staff provided evidence of the team actively supporting people to stay in contact with family, and of there being appropriate communication between staff and relatives. Three relatives/visitors to the home completed survey forms, providing very positive feedback. Comments included, ‘I…am very satisfied…the staff appear to be very dedicated and caring’ and ‘I am very impressed by the care shown to service users’. Staff were observed and heard offering people choices, for example about food, clothes and activities and also about which staff provided personal care support. Care plans made reference to the importance of offering choice and of trying to establish people’s preferences and wishes. Staff spoken with described the challenges of offering choices and ascertaining people’s wishes, and how they tried to go about this. As noted, best interests work is taking place where appropriate, for example around signing of the licensing agreements from the Housing Association. Two mealtimes were observed, along with breakfasts and snacks throughout the day. The atmosphere was calm and congenial. Service users were seen being offered appropriate support and food was presented in a form suitable for each person. Alternatives were offered where a person appeared to indicate Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 15 that they would prefer something else. The service users appeared to be enjoying their food. One person went out for lunch to a café on the first day of the inspection. Observation, food records and menus provided evidence of a varied and balanced diet being provided. There was reference to a menu review taking place with staff being invited to comment, for example in terms of their knowledge of service users’ preferences. The manager said that there were plans to create a pictorial menu as part of improving accessibility. This should be done as part of broadening the approach to total communication in the home. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 (Older People) and 22 & 23 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are aware of individual signs of discomfort and distress and of how to respond, helping service users to feel listened to and respected. Measures are in place which help to protect service users from the risk of harm and abuse. EVIDENCE: The Trust has a complaints procedure. It is understood that this is to be reviewed and should then become more accessible/user-friendly. Relatives/visitors completing survey forms indicated that they were aware of the procedure but had not had to make any complaints. The pre-inspection questionnaire indicated that there had been no complaints in the last 12 months. Staff spoken with were able to describe how different service users expressed discontent and how they responded to this. In some cases this was through an assessment of the context and a process of elimination about what may be causing unhappiness and distress. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 17 The manager said that all staff had undertaken training about adult protection in the last 12 months. Staff spoken with confirmed this and demonstrated understanding of adult protection and abuse. They described the safeguards in place in the home, and expressed confidence that if they did raise a concern it would be taken seriously and acted upon. The LDAF accredited induction offered by the Trust includes a module about adult protection and abuse. Records of service users’ finances were sampled and appeared to be fully in order. The manager said that there is a balance check every day at handover. The service has a whistle blowing procedure, as well as a policy about safeguarding adults dated December 2005. This included reference to the ‘No Secrets’ document. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 (Older People) and 24 & 30 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and well-adapted environment is provided, promoting service users’ safety and comfort. EVIDENCE: All areas of the home were checked. The building was well maintained, clean and free from offensive odours. Some redecoration had taken place since the Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 19 previous inspection related to the needs of a person who had recently moved in. Bedrooms were seen to be bright, well decorated and personalised. Written and verbal feedback from people who regularly visit included that there was a homely atmosphere and that the building was always clean and fresh. It was noted that the extractor fan/vent in the separate toilet would benefit from being cleaned. Also, some of the handles on the furniture in the lounge were broken, in some cases resulting in fairly sharp edges. These should be replaced. The manager reported that the Housing Association had not always been very responsive when issues were raised. The uneven car park was causing particular concern in terms of service users getting in and out of the vehicle as safely and comfortably as possible. However, on the second day of the inspection a survey was due to take place resulting in a quote. This levelling work should be taken forward. Staff spoken with confirmed that the equipment in use in the home was well maintained and suitable for meeting the needs of the service users. The building is a bungalow providing level access to all bedrooms and communal areas (besides the sensory room in the adjacent garage). Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 (Older People) and 32, 34 & 35 (Adults 18-65). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to meet service users’ needs. Staff are caring and skilled, helping to ensure that the standard of support is high. Robust recruitment and selection procedures are in place, helping to protect service users. Whilst staff generally receive the training they need, some areas require attention in order to promote service users’ safety. EVIDENCE: Staff spoken with reported that staffing levels were appropriate to meet service users needs. This was backed up by general observation throughout the inspection and by external feedback. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 21 Observation using the framework tool, as well as general observation and external feedback provided evidence that staff were caring, attentive and committed. Interactions were seen to be positive and supportive. According to information from the manager about half of the staff team had achieved a relevant NVQ qualification or were working towards this, with plans for more staff to take NVQ courses. The Trust offers an induction package which incorporates the LDAF induction modules. The Trust has a policy about recruitment and selection from April 2004. Consequently some important information is not covered such as about the PoVA scheme and certain requirements about reference sourcing. This should be addressed as part of the full review of policies and procedures reported to be taking place. The manager described the approach to recruitment. There were plans to include service users more in this process, through gauging their responses when candidates visit the home. Staffing files checked included necessary information and appeared to be fully in order. CRB forms were sent through without the section describing any convictions. The manager said that she assumes this means that they are clear. It was suggested that the HR section could accompany the document with written confirmation that this is the case. Following the inspection the manager described the checks that had taken place in respect of the volunteer, indicating that correct procedures had been followed. It was suggested that the role of the volunteer could be more closely defined and documented in order to ensure that the person does not undertake tasks that are the responsibility of paid staff (see Standard 31.7 (Adults 1865)). The manager was clear that the volunteer did not undertake activities such as personal care support. The manager described training that had taken place recently, as well as planned training. As noted, staff had received training about adult protection in the last 12 months. Other training such as infection control had also been provided. A day about person-centred planning was arranged for early April 2007. Staff spoken with were generally satisfied with the training provided. Training records indicated that whilst much mandatory training was up to date there were also areas which had slipped and where training was overdue such as for first aid. The system of having an in-house keyworker for moving and handling had also changed, and staff now needed to have training in this area. Newer staff spoken with were satisfied with their inductions. Minutes were seen of staff meetings which take place about every two months. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 (Older People) and 37, 39 & 42 (Adults 18-65). Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 23 The home is very well run, promoting positive outcomes for service users. Systems are in place for monitoring the quality of the service, helping to maintain and improve the standards of care in the home. Arrangements for handling service users’ money help to protect them from the risk of financial abuse. A range of systems in the home and Trust help to ensure that the health and safety of service users and staff is promoted. EVIDENCE: The manager is a registered nurse who keeps a portfolio as part of maintaining this registration. She has completed the NVQ level 4 Registered Managers Award. Staff reported that the manager was approachable and that the home was well run. Comments included that the manager was very hands-on, caring and hard-working. They described the high standards expected and the support that they received to achieve these. As noted elsewhere in the report outcomes for the people using the service were found to be very positive. The manager reported that the deputy role was being replaced by two seniors. Arrangements were being made to recruit the second senior care worker. Systems for checking and improving the quality of care were considered. There were four principal tools in operation: • In 2006 managers of the Trust’s homes completed a self-audit based on internally devised core standards covering areas such as choice, communication and person-centred planning. Line managers then reviewed the outcome. The resulting action plan for Hunters Green was seen. This included clear objectives and timescales. Discussion/records provided evidence of actions being taken forward. Staff were asked to complete a detailed survey of their opinions about the standard of care for each person living in the home, with comments and suggestions invited. The manager said that keyworkers would then analyse the results and establish whether there were any actions arising. Examples of the forms were seen. Staff spoken with said that they felt able to be honest in their responses. Visits under Regulation 26 are taking place each month. Copies of the reports are forwarded to CSCI. • • Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 24 • Surveys were being sent out to other people involved in service users’ care. Two responses had been received at the time of the inspection, providing very positive feedback. As noted, many of the Trust’s policies and procedures need review and update, and work is planned to address this during 2007. The home’s response to previous CSCI requirements and recommendations has been good. As described, the systems in place for handling service users’ finances were found to be appropriate and in order. Records provided evidence of regular input about fire safety, for example during staff meetings. There were also records of fire drills, the two most recent having been on 21/12/06 and 12/03/07, and of weekly fire alarm testing and emergency lighting tests every month. A fire risk assessment had been completed in May 2006. The manager reported that a visit was due from the estates manager, who would go through this assessment. There was written evidence of gas safety and portable appliances being checked in September 2006. Routine testing of some equipment in use in the home was due in March 2007. The manager said that some of the certificates relating to routine maintenance were sent direct to the Housing Association and that it could therefore be hard to track what was due when. In some cases it was also proving necessary to prompt the Housing Association in order that maintenance did not become overdue. This situation will need to be monitored. The manager described other internal health and safety checks such as those for the vehicle, bed rails, slings, fridges/freezers and hot water temperatures. Some records were seen evidencing these. Managers of each home in the Trust undertake an annual health and safety audit, a copy of which is forwarded to head office. This had last been undertaken in July 2006. Some environmental risk assessments were in place, located in a health and safety file. The Trust has a health and safety policy dating from September 2005. It has been reported that a full revision of the Trust’s health and safety manual is underway, due for completion at the end of March 2007. Examples of accident records were seen. Hunters Green DS0000066984.V333481.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 Older People 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 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 x 33 4 34 x 35 3 36 x 37 x 38 3 Hunters Green DS0000066984.V333481.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 YA9 Regulation 13 (4) Requirement Ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated: Undertake risk assessments as appropriate in respect of the service user who has most recently moved in. Staff must receive training appropriate to the work performed, such as training in first aid and moving & handling. Timescale for action 31/05/07 2 OP30 13 (4) & (5). 18 (1) c (i) 31/07/07 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 3 4 Refer to Standard OP8 OP9 YA9 OP12 Good Practice Recommendations Keep existing health action plans under regular review. Make arrangements for one person’s allergy to penicillin to be recorded in the relevant section of the MAR chart again. Where risk assessments have handwritten additions which reduce their clarity these should be rewritten/retyped. Consider whether it may be beneficial to service users to obtain a replacement vehicle which is able to carry more than one wheelchair at a time. DS0000066984.V333481.R01.S.doc Version 5.2 Page 27 Hunters Green 5 6 OP15 OP19 Take forward plans to create a pictorial menu. Progress the plans to make the car park more even. The extractor fan/vent in the toilet should be cleaned. Replace the broken handles/knobs on some of the furniture in the lounge. The HR section forwarding part of the CRB certificate could accompany the document with written confirmation that the check is clear. The role of the volunteer could be documented in order that it is clearly defined. 7 8 OP29 YA31 Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Hunters Green DS0000066984.V333481.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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