Inspection on 14/06/06 for Hunters Lodge

This inspection was carried out on 14th June 2006.

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

Other inspections for this house

Hunters Lodge 30/10/08

Hunters Lodge 01/11/07

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 REPORT: Unannounced Inspection 14th June 2006 (& additional inspection visits 16th & 20th June) 3:15 Hunters Lodge DS0000065555.V298857.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.V298857.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.V298857.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 01302 813100 01302 813101 Voyage Limited Mrs Karen Anne Hall Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 Service users may also have acquired brain injuries, some physical disabilities, a sensory impairment and associated mental health needs. Date of last inspection N/A Brief Description of the Service: The service provider Voyage is part of a much larger company, Paragon Health Care Group. Hunters Lodge was formerly a care home for older people and has undergone major alterations and refurbishment before being registered on the 8th of November 2005 to provide accommodation with personal care for up to ten younger adults (aged between 18 and 65), who can be men and women. Service users must require care due to learning disabilities and may also have an acquired brain injury, some physical disabilities and a sensory impairment. They may also have associated mental health issues, although not an enduring mental health condition. Most service users will therefore have complex needs and may use challenging behaviours. The principal value underlying the home is stated as being “to recognise that every person should have the opportunity to receive the support they need in order to reach their full potential in their chosen lifestyle”. 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 into the community. The building is set in four acres of lovely grounds and the accommodation is all ground floor. The inside and outside of the premises has been adapted and/or made suitable for people with physical disabilities and who may need to use wheelchairs. There are all single bedrooms with en-suite facilities, including a shower “wet room” or bath. There is also one self-contained flatlet offering a more independent living style. The home has a large sitting room, separate dining room, kitchen, lobby and utility room for everyone to use. For staff there is an office, storage areas and a large training/meeting room situated on the first floor. The current fee for the service is £1,216.14 per week, with an extra charge of £10.81 an hour when service users are assessed as needing 1 to 1 staffing. Other charges that can be made in addition to the fee are as follows: • Personal toiletries, clothing and electrical items (TV and music centre). • Activities not covered by the allowance made by the provider or in the funding authority contract. • Holidays other than the 7 days provided by the company. • Major extra outings, • Chiropody and hairdressing, • Damage and breakages deemed as being not accidental. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. These inspection visits are part of a key inspection of this service and is the home’s first inspection since it was registered. The first visit was carried out unannounced in about three hours on a Wednesday. The second visit was arranged at the first visit so the manager could be available to discuss how the service is developing and other relevant issues, and took place two days later over four and a half hours. The final visit was in another four days when two hours were spent talking with service users and interviewing two support staff. The main purpose of this inspection is to assess the service provided against key National Minimum Standards. Evidence obtained during these visits and from any other information received since the home opened are all considered. They include contacts between the Commission, home manager and provider, in particular the written notifications of events in the home that had affected service users. Also the monthly reports made by a representative of the provider following their required monthly visits to check how the home is being run and to talk with service users’ and staff about their experience of the home. The manager had also completed a questionnaire before the inspection visit, which provided further helpful information about the service. Various records kept by the home were checked and a tour was made of parts of the premises. Survey forms had been sent to the home before the inspection for the service users and their relatives asking for their views of the home. Five service users and two relative surveys were returned and their comments and feedback from talking with them are referred to in this report. What the service does well: A thorough assessment and admission process has ensured that only service users whose needs could be suitably met moved in and now live at the home. A service user’s guide with information about the home is provided and visits and trial stays are arranged to help new service users decide if they would like to live at Hunters Lodge. It is good that staff received training to help them understand and so be able to support service users with special needs better. Service users commented in their surveys and some also confirmed that they are happy living at Hunters Lodge and get on well with the manager and staff. They also said they are able to make choices in their daily lives and routines. Good care planning means staff know service users’ needs and how to meet them. Each service user is allocated a “keyworker” from the staff team who spends time getting to know them better to find out their individual needs, wishes and goals. They help service users to draw up a plan, which helps to make sure that all their personal, health and social care needs are being met properly and that they are able to develop their life skills and independence. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 6 The manager, staff and service users discussed the variety of activities that are now taking place regularly, both within the home and wider community. It is evident the home has made good efforts to seek out opportunities to enable service users’ personal development and to increase their participation in social and leisure activities. These include a gardening and a smallholding projects, horse riding and swimming and keep fit and arts & crafts sessions held weekly at the home. The home has two vehicles and staff time is arranged flexibly so service users can go out when and where they wish, as often as is feasible. Hunters Lodge is set in lovely, large and private grounds in walking distance of the shop, post office and pub in Wormelow village. The house is very well furnished, decorated and equipped and offers service users a very comfortable home. Service users are encouraged to make their bedrooms more personal and they can choose to use them as their private space, or to mix with others. There is an open and positive approach in the home and the manager and staff team are working well together and clearly put the needs of service users first. All new staff have received a lot of training to help them to meet service users’ needs properly and keep them and the home safe. Staff feel well supported by management and the home also receives good support from the provider. It is ensured that only suitable people are employed at the home by using thorough recruitment procedures and taking up necessary checks before appointing staff 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. Hunters Lodge DS0000065555.V298857.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.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence, including these visits to the service. Detailed information is provided for prospective service users to help them (with their families and/or representatives) decide if Hunters lodge is where they may like to live and whether the home would suitably meet their needs. Thorough assessment and admission procedures ensure that the home could appropriately meet prospective service users’ needs. EVIDENCE: Information documents are provided for the home, including a statement of purpose, service users’ guide and a terms & conditions of residence. Service users’ funding authorities had also agreed charges in respect of the placement including for any additional costs such as staffing. It is confirmed service users had been given copies of the relevant information before moving to the home. There were six service users living at the home and one person being assessed with a view to move in currently. Service users have a wide range of complex needs and it is good that the manager and staff are very aware that the group must be compatible to also ensure some people would not be put at any risk from others. The manager appropriately takes full responsibility for taking the decisions as to whether the home could suitably meet a prospective resident’s needs and also that they would “fit in” with those people already living there. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 9 The manager, staff and service users’ care records confirmed it is always ensured the home receives full information about prospective service users background and needs when they are referred for a placement. The manager, deputy manager had visited the most recently admitted person at their former care home to assess their needs. Two support staff from Hunters Lodge had also worked alongside the staff team at this care home to get to know the prospective service user and their needs better. Whenever possible, due to distance and as suits individuals, introductory visits and stays are arranged at the home prior to admission for a trial stay. In any event service users confirmed they were given a copy of the service users guide and photographs of the home and their families had been encouraged to visit to look around before their trial stay was arranged. Prospective service users’ families and social workers had appropriately been fully involved in the assessment and admission process. There had been a review meeting held after the trial stay to decide about the suitability of the placement, including the service user, their relatives and relevant other people Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including these visits to the service. There is a thorough care planning system in place, which is person centred and ensures staff know service users’ assessed needs and goals and how to meet them. Risks are assessed so any risks that could affect service users’ safety are minimised whilst staff also aim to encourage independence. Service users are enabled to make choices and decisions in their daily lives and routines. EVIDENCE: A sample of service users’ care records was looked at. They appropriately include each person’s photograph with details of their personal and medical history. There are information and protocols in respect of their personal care needs showing how staff can help to meet individual needs and reflecting their preferred daily routines. Staff also make daily reports for each person that cover events, activities, their mood, health and behaviour and so provide very helpful information about their daily lives, welfare and progress. Care plans had been drawn up detailing service users’ assessed needs in all relevant physical, emotional and social areas. They include communication Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 11 and behaviour difficulties, with management plans for staff to follow showing targets, resources needed and possible risks. Plans appropriately include how staff can promote service users’ choices and involvement in making decisions. A “person centred” approach is followed and the care-planning format shows service users are appropriately involved in planning and reviewing their own care and are enabled to express their wishes and goals. Each service user is allocated particular support staff to oversee their care (keyworkers) who try to build a closer relationship with them so they know their needs, goals and wishes better. Plans are being reviewed regularly and as any changes in need occur. Reviews involve keyworkers, service users and significant other people. Staff interviewed were fully aware of the plans and clearly used them to guide their practice. Service users spoken with also knew who their keyworkers are and clearly valued their input. Risk assessments had been carried out whenever necessary to promote service users’ safety and minimise any risks to themselves and others, including using challenging and/or self-harming behaviours. Intervention policies had been put in place and any incidents are recorded and analysed appropriately. Two service users use a special form of communication and some staff were doing a British Sign Language course and the staff team had attended a day training session on hearing impairment. It is very positive that training for staff has been arranged in respect of service users’ special needs, such as autism awareness and for managing challenging behaviours in a positive way, (called Crisis and aggression Limitation management (CALM)). Further training was planned in respect of epilepsy and diabetes. The home has also obtained appropriate support from relevant professionals to help them meet individuals’ care needs e.g. the Acquired Brain Injuries social work team, the Deaf club, and Prada Willi association. This all provides evidence of how the home responds to the diverse needs of service users. Thus ensuring staff have the information and input they need to provide quality care to service users with special health and disabilities needs and so who require particular and greater support from the staff team. Service users who agreed to speak with the inspector confirmed they like living at Hunters Lodge, and that the home was much better than where they had lived previously. They said the house and gardens are very nice and they are able to choose when to get up, what activities to take part in and as long as staff are available can go where they want in the community. It was good that the manager and staff talked about how most service users had settled in well; had become more independent and now used less challenging behaviours. Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, & 17 Quality in these outcome areas is good. This judgement has been made using available evidence, including these visits to the service. Service users receive help and encouragement to lead active and interesting lives and to mix within the wider community, to the extent they are able and wish. They are also supported to maintain links with their families and develop friendships and to make choices and decisions in their daily lives and routines. It is being ensured that wholesome and healthy meals are provided for service users’, which they like and also meet any special dietary needs. EVIDENCE: Service users’ plans include an assessment of their social, cultural and spiritual needs and any goals in respect of their education and training. Each person has an activity plan including development of their life skills and issues relating to community access. Records are kept of all activities, outings etc they have actually participated in. It is good the manager and staff have clearly made a great effort to seek training and development opportunities and social/leisure activities for service users both within the local community and in the home. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 13 A masseur visits Hunters Lodge and arts & crafts and keep fit sessions are held weekly. A craft session was taking place during one of these visits and it was nice to see several service users were really enjoying it and the tutor, service users and staff were getting on well and working together. They are also supported to mix in the local community by going to the village shop and pub. Outside the home some service users use a gym and go swimming and horse riding. Other activities include a gardening group at a local college, going to the ECHO drop in centre, doing a Gateway Award, and attending a day service in Ross involving community work. Some people take part in a smallholding project and the provider would like to develop the concept of a smallholding on site at the home in the future. Several service users had been on holiday and outings are arranged daily, depending on the availability of staff and vehicles. Staff and service users confirmed service users’ relatives are made welcome and staff support service users to maintain contact with them, if they wish. The development of outside friendships is also supported and one person had made a new friend who is invited to spend the day with them at the home. Service users are encouraged to do as much for themselves as they can and help with household tasks, such as cooking and doing their laundry, to develop their independence and life skills. One service user is very involved in working in the garden and helps the home’s gardener produce vegetables and fruit. Service users spoken said they can choose when to get up and go to bed, whether to spend time alone in their bedroom or with other people. Service users’ meetings are held monthly, chaired by one service user and facilitated by a staff member. These meetings have an agenda, are minuted and any issues raised by service users are noted in a communication book. Subjects covered include food provision, holidays and other aspects of life in the home. Regarding food provision the manager draws up a weekly menu that includes meals based on service users’ preferences. More healthy food options such as fresh fruit, vegetables and wholemeal bread are included. Food stocks were seen and plenty of fruit, yoghurts, salads and such as high fibre cereals were available. One person has special dietary needs and it is good that due attention is given to provide a suitable diet. Staff received training before their admission and a detailed record is kept of food intake, with this service user’s full involvement and agreement. Service users said they like their meals. Although the kitchen has to be kept locked it was confirmed that service users capable are able to access it to make their own drinks and snacks. Staff encourage service users to help with food preparation and cooking to develop their life skills. Currently support staff prepare all meals but consideration was being given to allocating particular staff to cook the main meal. Mealtimes are considered to be part of the home’s social life, when staff and service users meet and eat the main meal of the day together in the dining room or garden. Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including these visits to the service. Service users are appropriately supported by staff to meet their personal and health care needs, with their involvement and preferences taken into account. Medicines kept in the home for service users are managed safely and securely. EVIDENCE: Service users’ care records and plans provide detailed information about their physical and mental health and of any support they need from staff to maintain good hygiene and health. Staff discussed how one service user prefers to receive personal care from certain staff members and how this is respected. Staff keep records of any physical checks undertaken when service users have particular health related issues e.g. weight and fluid intake. In this way they are able to monitor their condition closely and take any action and/or obtain appropriate medical input whenever necessary. All the service users are registered with the local GP practice, which is the only one covering the area. The manager said this practice is supportive to the home and service users are enabled to visit the surgery when they need to. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 15 The home also uses local services for health care check-ups such as Dentist and Optician, and keyworkers ensure that regular appointment are made and that service users receive the input they need. Staff are in the process of setting up Health Action Plans for each service user. This should be completed as soon as possible and will provide a comprehensive checklist of how service users health care needs are being addressed and preventative measures taken to identify health care issues as they arise. The manager is very aware of the specialist services that could be needed to support service users and how to access them. Input is obtained by the home from a private Consultant Psychiatrist engaged by the provider and they can also access other specialists such as an Occupational and Speech Therapist if local services are not available for service users funded from outside this PCT. Regarding medicines in the home staff designated to administer medication had undertaken safe handling of medicines training as is expected. There was also a sample of all their signatures and medicines administered are always witnessed by a second person. The home provides policies & procedures on medication management and there are also protocols for homely remedies, when drugs are recalled and are taken out of the home with service users taking part in community activities. Relevant information leaflets and a guidance book on drugs are also available. Medicines are suitably and safely stored and there is also storage for controlled drugs, should they be required. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in these outcome areas is good. This judgement has been made using available evidence, including these visits to the service. Systems are in place to manage complaints and for the protection of service users. Service users are enabled by staff to express their views and concerns. EVIDENCE: The home provides an appropriate written complaints procedure which service users are given during their admission. It is good the manager intends to produce this procedure in a format that should be easier for service users to understand. Service users’ meetings are held monthly, which give them an opportunity to raise any issues and make suggestions to improve the service. One important part of the keyworker role is also to help service users express their views and concerns and to advocate on their behalf if necessary. The home provides relevant policies for service users’ protection. Staff spoken with were aware of their responsibility to protect service users and to “whistle blow” if necessary. Staff undertake training in relation to abuse and service users’ protection from the provider’s trainer during their induction. However it is recommended staff also receive instruction from the Herefordshire multiagency co-ordinator for Protection of Vulnerable Adults (POVA)to ensure they know where and how to refer any incidence or suspicion of abuse/neglect of service users. A copy of the POVA procedures was sent to the home for staff. There are detailed behaviour management plans in place for service users who may use challenging behaviours that could harm themselves or others. Staff have to undertake training so they know strategies to intervene and so prevent and/or deal positively with aggressive or self-harming behaviour. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 17 The provider is appointee for four service users’ financial affairs, although each person has their own savings account and they have access to cash from their personal allowance. Records are kept in the home of all monies paid in and spent by service users and receipts are also kept and cross-referenced. One service user’s accounts were checked and found to be appropriately kept and their cash balance reconciled. Only senior staff have access to service users’ accounts and the manager or deputy manager check them monthly. Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including these visits to the service. Hunters Lodge provides accommodation for service users that suitably meets their needs and offers them a safe, spacious and very comfortable home. The home is kept clean which ensures that good hygiene and infection control is maintained for the benefit of service users. EVIDENCE: A detailed site visit was undertaken just before the home was registered when it was confirmed that the accommodation would be suitable for service users’ needs. It was also confirmed that the premises complied with all the National Minimum Standards and requirements of other Regulators i.e. Building Control, Planning Department, the Fire Authority and Environmental Health. Hunters Lodge is located in a lovely rural setting, within extensive grounds of about four and a half acres. The village of Wormelow is within walking distance and has a shop, post office and pub and is on a bus route into Hereford city. The home has two vehicles to provide transport further afield that are suitable for people with mobility difficulties and/or use wheelchairs. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 19 Most of the premises were seen during these visits and reaffirmed the home has been furnished, decorated, fitted and equipped to a high standard. Any redecoration or replacement of carpeting, and furnishings that is needed will be included in the home’s annual development plan. The home also employs a handyperson and gardener to undertake repairs and the grounds upkeep. There is a large sitting room, a hallway with additional seating and a separate dining room available to service users as communal space. All the rooms have been sympathetically furnished to maintain their period features. Much work had already been done to the gardens, including areas planted with vegetables and fruit. There is a large patio area with a marquee and furniture and an enclosed courtyard, which has an aviary. All the gardens around the house are accessible to wheelchairs and there are also some raised beds so that people with physical disabilities could reach to do some gardening if they wanted to. The home provides ten suitably sized, furnished and fitted bedrooms that are all located on the ground floor and so accessible to people with mobility difficulties. One of these bedrooms is a self-contained flatlet and has its own sitting room and kitchen facilities. All bedrooms have en-suite facilities, which include a bath or “wetroom” shower and so afford service users greater privacy and independence. Service users clearly choose to use their bedrooms as their private space and for when they do not wish to mix with others and see their visitors. Two bedrooms viewed had been personalised by their occupants and new service users can choose the colour of the décor etc in their bedroom. The premises were seen to be clean and tidy. Policies & procedures for infection control are in place and staff are 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 clinical waste. Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in these outcome areas is good. This judgement has been made using available evidence, including these visits to the service. Suitable staffing levels are being maintained and staff have received relevant training to help them meet service users’ needs and keep them and the home safe. NVQ training is underway so the team will become appropriately qualified The staff team understand their responsibilities and are committed to their role. They are well supported and work together to provide service users with consistent and good quality care. Thorough recruitment procedures are in place to ensure that only suitable staff are employed to work with service users, for their protection. EVIDENCE: Staffing issues were discussed with the manager, staff and service users and staffing rotas looked at. Staffing levels are being gradually increased as new service users are admitted. This is also dependant on individual service user’s assessed needs for specific staff supervision. Staff interviewed considered that a sufficient number of care staff are deployed for them to meet service users needs, although some felt it would be better to have a staff member either designated as cook or allocated to cooking the main meal on a daily basis. The manager is already considering whether this option could be of benefit. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 21 The home has two staff teams who work during the daytime on a four-day on four-day off basis, on ten hour shifts. This does mean service users activities are not affected by shift changes, and staff also report they are able to take breaks and the hours suit them. However it is good the manager said this shift pattern was being kept under review, as especially in view of service users’ complex needs, long shifts can be stressful and tiring and so could affect staff approach and consistency and the support that service users receive. Staff are expected by the provider to undertake all the mandatory health & safety training i.e. fire safety, first aid, food hygiene, moving & handling and infection control. As well as other topics that relate to service users’ care and special needs such as safe handling of medicines, abuse, autism and managing challenging behaviour. Other areas such as epilepsy are being arranged. The staff team are all relatively new and so only two of them currently have an NVQ qualification in social care. However it is good that another six are now doing NVQ level 2 and five NVQ level 3, which has followed completion of their induction. At least half the team should therefore achieve this qualification in due course as the Standards specify. The induction programme appropriately is accredited for people working in care services with people who have learning disabilities (LDAF). Induction also includes new staff being supported by senior staff to familiarise themselves with the home, service users and safety matters Three staff were asked individually about their appointment and induction and a sample of staff records was looked at. It was confirmed all prospective staff complete an appropriate application form and when being interviewed are expected to spend time with service users so their feedback can be obtained. Necessary checks are always taken up by the home, including two written references (one from their most recent employer) and an enhanced CRB/POVA (police) check, before their appointment is confirmed. They also have to work a probationary period at the home before an employment contract is agreed. Staff consider their team works well together and they are supported and kept informed about the running of the home and service users by management. They all receive individual supervision and communication in the home is good, including the information given them during shift handovers. Staff meetings are held, although some felt these could be arranged more often. Hunters Lodge DS0000065555.V298857.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 & 43 Quality in this outcome area is good. This judgement has been made using available evidence, including these visits to the service. The home is being well run by a suitably qualified and experienced manager and with a supportive and responsive provider. There is an open and positive management approach and the staff team are receiving appropriate direction and support to help them to understand and meet service users needs better. Systems are in place so the service will continue to develop as service users want and to ensure the home is kept safe to safeguard service users and staff. EVIDENCE: The manager (Karen Hall) has extensive experience in residential care having previously worked in a care home for older people for ten years. Following this she worked for about four years in three care services for people with learning disabilities, employed first as a team leader, then a deputy manager and up to obtaining this post as a Unit Team manager. Mrs Hall has achieved NVQ qualifications in social care at levels 2, 3 & 4 and the Registered Manager’s Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 23 Award. She has undertaken a wide range of other training relevant to service users’ needs, such as autism, epilepsy, Makaton and positive interventions for aggressive behaviour. It is evident she is knowledgeable about learning disabilities and their implications for service users themselves and their care. Management responsibilities in the home are also appropriately delegated to the deputy manager and seniors. They are all involved in organising day-today activities, health & safety promotion, staff supervision and induction. Senior staff had undertaken training in supervisory skills and the manager had also received training relating to recruitment and disciplinary procedures. Staff confirmed the home’s managers are approachable and said that service users are always put first. They feel the staff team work closely together to help new service users settle into their new home and to ensure all their needs and wishes are met to the extent possible. Service users were seen to get on well with managers and said they liked them and other staff. In respect of management support from the provider, Voyage have a Training and Human Resource Officers who are always available to advise and support the home. An Operational Manager regularly visits the home and provides supervision for the manager. Service manager meetings are held monthly and the manager confirmed her view that she and the home are well supported. The provider’s monthly visits are one of the ways they monitor the service and check how the home is being run. These visits appropriately include interviews with staff and service users and an audit of all relevant aspects of the service, including records, environment, complaints received, finance and safety. Any action that may be needed to address shortfalls are specified. The resulting reports are also part of the home’s quality assurance and monitoring system and should result in an annual development plan for the service. This must be based on service users’ and other stakeholders’ views and the service users’ meetings and questionnaires are being used to collect their feedback. It was confirmed when the home was registered and in the pre-inspection questionnaire that Voyage provide a full range of polices & procedures to inform the working practices of the staff team. Staff are expected to read all these documents and sign a checklist that they have understood and will work in accordance with them. Staff interviewed were familiar with these policies. Regarding the promotion of health & safety the manager indicated in the preinspection questionnaire that regular safety checks are carried out and relevant risk assessments are in place. Records seen showed monthly checks of the fire safety system & equipment, water temperature & storage, fridge, freezers and electrical appliances. Staff undertake all mandatory health & safety training topics and staff said they had recently participated in a fire drill. The manager was advised to keep a record of staff taking part in fire drills to ensure they do so at least annually. No safety hazards were identified during inspection visits. Hunters Lodge DS0000065555.V298857.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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 4 28 4 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 N/A 3 3 3 3 3 3 3 Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA23 YA32 Good Practice Recommendations Staff should receive instruction relating to the protection of service users from the Herefordshire co-ordinator for the Protection of Vulnerable Adults. The programme of NVQ training for staff should continue so that at least half the staff team achieve this qualification as soon as possible. Hunters Lodge DS0000065555.V298857.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 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.V298857.R01.S.doc Version 5.2 Page 27 - 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. 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