Inspection on 01/11/07 for Hunters Lodge

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunters Lodge 30/10/08

Hunters Lodge 14/06/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hunters Lodge Hunters Lodge Bryngwym Manor Wormelow Hereford Herefordshire HR2 8EQ Lead Inspector Christina Lavelle Key Unannounced Inspection 1 & 9 November 2007 1.45-5.45&10.30st th Hunters Lodge DS0000065555.V349168.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 Hunters Lodge DS0000065555.V349168.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. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hunters Lodge Address 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) Hunters Lodge Bryngwym Manor Wormelow Hereford Herefordshire HR2 8EQ 01981 541352 01981 540762 hunterslodgehome@tiscali.co,.uk Voyage Ltd Mrs Karen Anne Hall Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may also have an acquired brain injury, some physical disabilities, a sensory impairment and/or associated mental health needs. Date of last inspection 14th June 2006 Brief Description of the Service: Voyage is the registered provider of Hunters Lodge and this company has run services and facilities for people with learning disabilities and accompanying challenging needs since 1997. The home provides accommodation and personal care for ten adults. Service users must require care due to learning disabilities and may also have an acquired brain injury, some physical disabilities and/or a sensory impairment. They may also have associated mental health issues, but not an enduring mental health condition. People living at the home are likely therefore to have complex needs and may also use challenging behaviours. The home is in the village of Wormelow, seven miles from Hereford city centre. There is a local shop, post office and pub within walking distance and the home has two vehicles for transport out into the community. The building is set in large grounds and also has an internal courtyard area. The accommodation is all ground floor and the premises has been adapted for people with physical disabilities who could be wheelchair users. All the bedrooms are single and have en-suite facilities that include a shower wet room or bath. One of them is self-contained flatlet that can offer a more independent living style to its occupant. The house has one large sitting room, a separate dining room, kitchen, lobby and utility room for everyone to use. On the first floor there is an office, staff sleeping in room, storage areas and a training/meeting room. Information about the home is provided in a Service User’s Guide, which is available from the home. This states the fee level and any extra costs are set out in individual Service Agreements that are discussed with each prospective service user and their advocate (if appropriate) before they move in. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided by Hunters Lodge. This means all the Standards that can be most important to adults who live in care homes were assessed. The first visit was made without telling anyone at the home beforehand. Time was spent talking with some of the people living there and staff. During the second visit the way the home is run was discussed with the deputy manager and a Voyage Operations Manager. A Commission pharmacist inspector also visited as part of this key inspection and carried out a specialist inspection of the arrangements for handling medicines, which took four hours. Surveys were left at the home for some staff and people who live there asking for their views of the service. Other surveys were sent to their families and to health and social care professionals who are involved with their care. Eleven surveys were completed and feedback received is referred to in this report. An annual quality self-assessment form was also completed before this visit. This asks managers to say what they think their home does well; what it could do better; what has improved and their plans to improve the service. It includes information about the people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All information received by the Commission about Hunters Lodge since the last inspection is also considered, such as events that affected people living there. What the service does well: Each person living at the home has a care plan. Plans show their needs and possible risks so that staff how best to support them and keep them safe. People living at the home say staff treat them well and they can express their views and concerns. They each have a keyworker allocated to them from the staff team who they like and they value the individual support they give them. Staff encourage and support the people who are living at the home to go out in the community and take part in activities they enjoy and could develop their skills. They also allow them to make choices in their daily lives and routines. Hunters Lodge offers people who live there a safe, well-kept and comfortable home. The accommodation is all on one level and is adapted and equipped to give good access and to help people with physical disabilities. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 6 Staff receive training about how to keep the home and people living there safe and to protect them and promote their welfare. Necessary checks are also taken up to help to ensure new staff are suitable to work in a care service. Hunters Lodge gives good individualised care to the people living there. This inspection confirms the view of one care manager that the home manages the support of people with complex needs in a positive way overall. The quality of the service is checked regularly and plans are made to keep on making improvements as the people living there wish and/or for their benefit. 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 Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 7 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 Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Good assessment and admission procedures are in place to help to ensure that the home would appropriately meet the needs of potential service users. EVIDENCE: The required information documents about the home are provided, including a Statement of Purpose and a Service Users’ Guide. The guide is available in a user-friendly format, including simple language and pictures. The fee level and extra charges are not specified in this guide but it states they are in a Service Agreement, as discussed with the individual and their advocate (if appropriate) before they move in. A contract is also agreed with their funding authority. Referrals for potential service users are made to Voyage which makes an initial assessment based on the information received. This is passed onto the home with a copy of a community care assessment made by the individual’s social worker from their funding authority. The home’s manager or deputy then arranges to visit them at their current residence to carry out their own needs assessment. They also obtain information from other people e.g. their family. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 9 Following this visits to the home are arranged for the prospective service user (and their social worker and relatives if appropriate). This could be for a meal and an overnight stay so that they can meet staff and people currently living at the home and look around the accommodation and bedrooms available. When necessary (and there is enough time) transition plans are then completed. A trial stay is next arranged for the individual, with a review meeting held at the end of this period involving this person, staff and relevant others, when the decision is made about the suitability and so continuation of the placement. The manager does not refer in the home’s self-assessment form to taking into account the views of people already living at the home about new people who want to move in. However it is presumed that they would be consulted and also their compatibility and the views of the staff team would be considered. Staff confirm they had usually received enough information about prospective service users, except when there was a short timescale between their referral before they needed to move in and/or they have no family involvement. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in these outcome areas is adequate. This judgement has been made using available evidence including these visits to this service. People living at the home have a plan showing their needs and support needed to meet them. Risk assessments are also carried out, with management plans in place, to minimise safety risks. Whilst they are able to make choices in their daily lives and routines, if when their plans and risk assessments are reviewed they focus more on identifying personal goals they could be better supported to achieve their goals and to develop skills for a more independent lifestyle. EVIDENCE: A sample of care records in respect of people living at the home was looked at. They include their photograph, background information and contacts details. Each person has a care plan, risk assessments, health related records and an activities schedule. Protocols are also in place to help staff manage challenging and self-injurious behaviours appropriately and consistently. The plans cover relevant areas of need that includes accommodation, health, personal hygiene, communication, social & developmental, relationships, family contact and diet. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 11 A suitably “person centred” approach to care planning has been adopted by the home. This means people living there are involved in drawing up their plans and take part in their care reviews. The input of other people e.g. relatives, is also sought. However some people had not signed their agreement to or have a copy of their plan. It is good therefore that one of the manager’s plans for improvements to the service is to provide everyone with their own plan in a format appropriate to their needs. Plans should also focus more on identifying their personal goals and how they could be achieved. Timescales should be set and their goals and any outcomes be reviewed more regularly. One relative comments that “I would like to see X involved more in setting targets for him/herself and more detailed planning around what was agreed at a review”. Everyone living at the home has a keyworker from the staff team who offers them some personal support. Staff are clear about their keyworker role, which includes helping them maintain links with families, arranging GP & health care appointments, activities, holidays, shopping, keeping their bedrooms tidy etc. Keyworkers can spend some one to one time with their allocated people and are involved in care planning and reviews and advocate for them if necessary. People spoken with clearly get on well and value their keyworker’s support. Care planning appropriately includes carrying out risk assessments. They relate mostly to minimising safety hazards, with detailed checklists that cover general safety areas. People living at the home do also have specific risk assessments about such as relationships, smoking and alcohol. Some can involve limitations to the individual’s choice, freedom or behaviour that are agreed with them when feasible and if not consent issues must be considered by relevant people. Risk management should also promote independence as far as possible, which includes self-administration of medication. One person who moved in months ago still had risk assessments in place from their former placement, although a review report dated last month stated new protocols should be set up to manage their behaviours and develop their independent living skills. Protocols in place for managing challenging behaviours are called “Restraint”, which is not now an acceptable term. Those seen do not involve physical interventions anyway (which must only ever be used in exceptional circumstances to protect that individual or other people), but techniques such as verbal de-escalation. Voyage is implementing a new methodology for behaviour management that will rectify this terminology and training sessions are arranged for all staff soon Regarding issues of equality and diversity the home’s philosophy and practice clearly focuses on individuals needs, as part of a person centred approach and staff allow people living at the home to make choices in their daily lives and routines. Relevant values and principles that should underlie the care provided are reflected in the staff induction programme and in policies & procedures, which the manager plans to update to include recent guidance and legislation e.g. The Mental Capacity Act. Some people living at the home have specific physical needs that have been assessed and specialist input sought and other issues in respect of such as ethnicity and gender have also been considered. . Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are enabled to participate in activities and go out in the community if they wish. Their family links and friendships are supported and staff encourage them to take responsibility for aspects of their daily lives. The home provides a healthy diet that people choose and meets their needs. EVIDENCE: Each person living at the home has an activities schedule with an attendance record kept. Although some people take part in few regular activities, staff continue to seek and offer them a range of opportunities for work placements, college courses, day services and/or leisure pursuits. Staff also support them to go shopping, walk to the local shop, pub etc. and are now deployed more flexibly at peak activity times to facilitate this. Outside the home some people go swimming, to a gym, horse riding and cookery classes etc. The home has two vehicles for outings and a budget for activities and fund a five-day holiday. In-house activities, such as crafts and massage sessions, are also arranged. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 13 People living at the home are expected to keep their bedrooms tidy and do their own laundry etc. although some apparently need a lot of persuasion and support from their keyworker to do these tasks. Involvement in cooking and household tasks should be included in their goals, with an action plan, as part of developing their independent life skills. It is recognised however that some people do lack motivation for activities and personal development due to their mental health and other difficulties. The evidence from this key inspection does concur with the view expressed by one social worker that overall the home manages the support of people with complex needs in a positive way. It is confirmed that families of people who live at the home are made welcome by staff. Relatives say that the home keeps in touch and they are always kept up to date about important issues. Staff help people to maintain their family links such as arranging and taking them on visits and they can telephone them whenever they want to. Friendships are also supported and it is good that external guidance has been sought for individuals when it is considered this could help them with their personal relationships. Regarding food provision there is a four-week menu made up that is discussed with and includes meals chosen by people living at the home. The daily menu for the main cooked meal is displayed on a notice board and breakfast and snack meals are chosen more flexibly. Meals seemed varied and wholesome, including fresh meat and fish and dishes such as pasta and vegetable stir fries. Staff say their aim is to promote healthier food options and there is always fresh fruit and vegetables, wholemeal bread etc. and they use few convenience foods. Food stocks were seen to include plenty of fruit and such as yoghurts, salads and high fibre cereals. One person has special dietary needs and due attention is given to providing them with a suitable diet. Staff received relevant training before this person moved into the home and a detailed record is kept of their food intake, with their full involvement and agreement. People living at the home are involved in meal preparation and shopping for provisions if they wish. Cooking is only with staff supervision and access to the kitchen has to be restricted by keypad locks. However those capable can make their own drinks and snacks. Mealtimes are considered as being part of the home’s social life and so staff encourage people who live at the home to eat main meals together with them. Hunters Lodge DS0000065555.V349168.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): 18, 19 & 20 Quality in these outcome areas is adequate. This judgement has been made using available evidence including these visits to this service. People living at the home are being supported to meet their personal care and health needs. Some of the arrangements in place for handling, administering and keeping records about medicines are not always sufficient, and more attention to detail is needed, to help to ensure that the health and well being of people living at the home is not at risk from the use of medicines. EVIDENCE: The care records and plans of people living at the home provide background information and details of their physical and mental health and a checklist of their medication. They show the support (if any) each person needs from staff to maintain good health and hygiene and their care and routines preferences. Everyone is registered with a local GP practice, as it is the only one covering the area. The manager previously confirmed that this practice is supportive to the home and people are enabled to visit the surgery whenever they wish and need to. They all also visit their GP when they first move in for a new patient initial review of their medical condition, health needs and medication etc. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 15 The home uses local services for health care check-ups, such as a Dentist and Optician, and keyworkers ensure that regular appointments are made and that people receive any input they need. Specialist health care is obtained by the home from a Consultant Psychiatrist and they can access other specialists e.g. a Behaviour Therapist employed by Voyage. Aids and equipment are provided in the environment e.g. ramps and rails, and from individual assessments if anyone has physical or sensory related needs. Staff make records of health care input people living at the home receive and any problems as they arise and are being monitored. Records are also kept of physical checks undertaken when people have particular health related issues, e.g. weight and fluid intake, and body charts are completed when they have injuries/marks etc. Everyone has a Health Action Plan (HAP) as recommended by the Department of Health for people with learning disabilities. HAPs include health related targets, actions needed and results and so should also provide a comprehensive picture of all their health care needs and preventative, routine and specialist input. HAPs should involve the person (to the extent possible) in managing their own health care, however the format is not very user friendly. A pharmacist inspector carried out the inspection of medication management by this home. Some stocks and storage arrangements for medicines and some medication records and procedures were looked at. The way medicines were given to some people in the home was seen. There were discussions with the deputy manager and two other members of staff, although nobody living at the home was able to talk about his or her medicines. The medicines needed for the people living at this home were in stock and securely stored. Staff who administer medicines have undertaken a formal training process about the care of medicines. A medication policy is also available so that staff have written direction as to how the home expects them to handle medicines safely. Some parts of the policy were not being followed and some amendments are needed to show what happens in the home. The list for homely remedy medicines that may be used needs reviewing as some products listed are not appropriate and could place people living in the home at risk of having unsuitable medicines. There are weekly audit sheets for medicines but the last sheet was completed 21/10/07. Some things found at this inspection did not agree with the last audit check sheet. For each person living at this home there are records kept of medicines received, administered and leaving the home or disposed of. This means there should be a complete audit trail for all medicines, which reduces the risk of mishandling. Some issues were found that needed attention to ensure that the records of medication are completely accurate in order to help to make sure people have the right amounts of medicines. These were all brought to the attention of the deputy manager to deal with as follows:• There was incomplete recording on some peoples records on a few days so this means they do not know whether medicines were given as prescribed. Records for creams, ointments and other medicines applied externally were sometimes poor. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 16 • • • • • • • Some medicines in stock were not included on the medicine chart in use. This risks missing prescribed treatments or not recording their use if given. We could not tell during the inspection if one person had been taken to the surgery for an injection treatment due every 3 months. There were protocols describing how to use some, but not all, medicines that are only needed on an “as required’ basis”. Some medicine charts did not include all these medicines and in one case the product was not in stock. In another case we could not tell if the protocol for one medicine was still relevant as there was no mention on the administration chart and that particular medicine is now administered regularly. Allergy information was often noted on medicine charts but for one person who has a protocol about using an emergency injection for a possible allergy, the treatment was not included on the medicine chart and the allergy section was left blank. Records for medicines returned to the pharmacy need completing fully so that it is clear exactly what medicine and quantity is involved, the date and person responsible. We found a medicine only used in an emergency that needed replacing as it was visibly unsuitable to use even though it was within its stated shelf life. The arrangements for taking medicines out of the home for trips were not adequate as the medicines were not properly labelled and better records are needed to give greater accountability of the medicines. Nobody is assessed at present as able to self-administer his or her medicines. Care plans need to reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff handle and administer their medicines. Two trained staff were seen to administer some medicines at lunchtime. Two staff always administer medicines and the second person signs a check sheet. This system helps to reduce risk of mistakes with medicines. It was discussed with the deputy manager ways to improve medicine administration because of risks with carrying medicines around the home in small cups rather than the labelled container from the pharmacy. Safe storage arrangements are provided for medicines, however to prevent contamination of medicines that are swallowed, storage needs arranging so that there is proper separation from medicines that are applied externally to the skin. Generally it was found staff do not write opening dates on containers when medicines are first opened to use. This would help to make sure that medicines are used within the recommended shelf life and provide a system to make audit checks that the amounts of medicines in stock agree with the records. There were no controlled medicines being used at the time of this inspection. A special cupboard is provided for these but it would need to be properly fixed in accord with the Misuse of Drugs (Safe Custody) Regulations 1973 should any of this class of medicines be used. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported to express their views. There are also systems in place to protect them and to manage complaints about the service. EVIDENCE: An appropriate complaints procedure is provided and a copy is given to people when they move in. Most of their relatives say they also know about these procedures and the home had always responded appropriately to issues they raised. People living at the home confirm they know how to make a complaint and feel they can talk to their keyworker or the manager if they have concerns and most say staff always listen and take action. Residents meetings are also held regularly, so giving them an opportunity to raise any matters they wish. There had not been any complaints made, or issues that may affect vulnerable adults, raised with the home or Commission since the last inspection. Policies and procedures are in place to help protect people living at the home. They include whistle blowing, how to identify and report suspicion or incidence of abuse and for managing service users’ finances. All staff receive training in respect of abuse and protection as part of their induction, as well as strategies and techniques to manage aggressive or self-harming behaviours positively. Staff are clear about their responsibility to ensure the safety and protection of people who are living at the home and would advocate for them if necessary. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The accommodation provided at Hunters Lodge offers people who live there a safe, comfortable and well-kept home. Arrangements are also in place to keep the house clean and fresh and so promote good hygiene and infection control. EVIDENCE: Hunters Lodge is located in a lovely rural setting, within extensive grounds. The village of Wormelow is in walking distance and has a shop, post office and pub and is on a bus route into Hereford. The home has two vehicles suitable for people with mobility difficulties and/or wheelchair users for outings etc.. The gardens around the house are accessible to wheelchair users and there are raised beds so people with physical disabilities could do some gardening if they wished. There is a large patio area and an enclosed courtyard with an aviary. The overall impression is of a comfortable and well-kept environment and the accommodation is decorated, furnished, fitted & equipped to a high standard. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 19 The house has one large sitting room, a hallway with additional seating and a separate dining room available for everyone living at the home to use. The home offers ten suitably sized bedrooms that are on the ground floor and so accessible to people with mobility difficulties. One of the bedrooms is a selfcontained flatlet that also has its own sitting room and kitchen facilities. All bedrooms have en-suite facilities including a bath or “wetroom” shower. Some people clearly choose to use their bedrooms a lot as their private space, rather than mix with others. Bedrooms are well personalised by their occupants and they can choose the colour of the décor etc and lock them if they want to. The premises were seen to be clean and reasonably tidy. Policies & procedures for good infection control are in place and staff provided with disposable gloves and aprons. Communal bathrooms have paper towels and liquid soap available and there are suitable arrangements made for the disposal of soiled waste. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in these outcome areas is good. This judgement has been made using available evidence including these visits to this service. Staffing levels and deployment are appropriate to meet the needs of people living at the home. Staff are trained to help them keep the home and people safe. Whilst most staff have achieved a care qualification if they also receive more training relating to the specialist needs of people living at the home this would increase their knowledge and skills so they could understand their needs and know how to support them better. Thorough recruitment procedures are now operated to check that new staff are suitable to care for vulnerable adults. EVIDENCE: It is confirmed staffing levels are normally sufficient and deployment is flexible to meet the personal and social needs of people living at the home. The staff team is now complete, with only one person leaving since the last inspection, which is good for consistency of care. There are two separate daytime staff teams who work ten-hour shifts on a four-day on and four-day off basis, which means activities are not affected by shift changes. Whilst in that respect this is positive, long shifts can be stressful and tiring which could affect the support they receive. There is also clearly some conflict between teams and different ways of working, so this arrangement should continue to be kept under review. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 21 Regarding the recruitment and selection of staff Voyage has robust policies & procedures in place and new staff are not confirmed in post until their Human Resource Team has checked to ensure the home followed them. Applicants are now expected to complete an application form including their full employment history, with any gaps explored and a satisfactory explanation obtained. They are asked to visit the home informally to meet staff and people living there and then attend a formal interview. Two written references (one from their most recent employer) and an enhanced Criminal Records Bureau (CRB) are taken up before they start a probationary period working at the home. Staff records seen included required documents, two suitable written references and a CRB. Voyage provides a comprehensive induction programme for new staff, which is appropriately accredited for people who work caring for people with learning disabilities. Their induction includes support from management and seniors to go through health & safety matters; all the home’s policies & procedures and care records. They also work alongside other staff until they are familiar with the home and their role and the needs of the people living at the home. Staff undertake the mandatory health & safety training i.e. fire safety, first aid, food hygiene, moving & handling and infection control. Relevant topics such as safe handling of medicines, abuse and management of challenging behaviours are also completed. They go on to do NVQ training (a qualification in social care) and it is good that all staff are qualified or working towards NVQ. Some staff had received training relating to the special needs of people who may use the service e.g. autism. It is considered however that further training in areas relating to such as mental health, epilepsy and dependencies would give them more knowledge and skills to help them understand and so be able to support people living at the home better. There is a training matrix kept for the staff team showing the core and specialist training the team and each staff member has done and requires with dates for refreshers. This needs to be updated and a schedule set up to address training shortfalls. This was recognised by the deputy manager who expressed the intent to address this as a priority. It is apparent the staff team are well motivated and committed to providing a good individualised service for the people living at the home. They say they receive good support and supervision from managers and that communication within the home is generally good. Some say however that it can be difficult to arrange regular staff meetings and that they are not always constructive. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Suitable management arrangements are in place on a short-term basis to run the home if the absence of the registered manager continues. Service quality is monitored and reviewed so the home should develop and improve as people living there wish it to and/or for their benefit. Policies, procedures and staff practices protect and promote the safety of people living and working there. EVIDENCE: The manager is suitably experienced and qualified and the previous inspection confirmed the home was being well run with an open, positive management approach. Responsibilities were appropriately delegated to the deputy manager and other senior staff. The manager has been absent from the home several times since July however and whilst the deputy manager has taken day-to-day responsibility for the home during this time he clearly cannot continue to do so Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 23 effectively for an extended period, as this could impact on the running of the home. It is good therefore that he and Voyage recognise this and additional support would be offered and one support staff member is acting up as senior. Voyage operate a formal system to monitor, review and assure service quality. This includes the required monthly visits from a representative of the provider when relevant aspects are checked and/or audited and staff and people living at the home are interviewed. An annual service review is also carried out and overseen by a regional Quality Assurance (QA) manager. This all results in a development plan to improve the service with any actions needed specified. The views of people living at the home must be reflected in the annual plan and their feedback is obtained from questionnaires and their meetings. Regarding health & safety in the home as previously discussed all staff receive mandatory training. Voyage also provide comprehensive policies & procedures on all relevant aspects to help to ensure that the home and staff meet their responsibility to comply with legislative and currently accepted good practice guidance. The following was also confirmed:• Electrical circuits are regularly checked and PAT test are carried out. • The fire safety system and equipment are checked/tested at the specified intervals. • The central heating system is serviced regularly. • Risk assessments are carried out with COSHH risk assessments in place. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 24 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 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 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 25 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard 1 YA20 Regulation 13(2) Requirement When medication is administered to people who live at the home it must be completely and accurately recorded. There must be up to date medicine care plans to clearly describe how to use any medicines prescribed to use ‘as required’. This will help to make sure that people receive the correct levels of medication. When medication is administered to people living at the home and whilst people are away from the home, safe practices must always be followed in accordance with a proper risk assessment. This will help to ensure that each person receives their correct medicines. Timescale for action 31/12/07 2 YA20 13(2) 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Plans and risk assessments of people living in the home should be reviewed to focus more on their personal goals to show how they can be supported to achieve their goals and develop skills as part of a more independent lifestyle. DS0000065555.V349168.R01.S.doc Version 5.2 Page 26 Hunters Lodge 3 YA20 4 5 YA20 YA20 6 7 YA20 YA35 Care plans should reflect what choices people who live at the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. The home should review and update the policy and list for using homely remedy medicines to ensure that all these medicines are suitable for each person living at the home. Staff should write the date on all containers of medicines when they are first opened to use to help with good stock rotation and allow audit checks that the right amount of medicines are in stock. The home should store medicines that are swallowed properly separated in the medicine cupboard from medicines that are applied externally. More training relating to the specialist needs of people living at the home should be arranged for staff to increase their knowledge and skills so they can understand people’s needs and know how to support them better. The home’s training matrix and schedule should also be updated. Hunters Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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 Lodge DS0000065555.V349168.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!