Inspection on 03/05/06 for Hunters Moon

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunters Moon 21/04/09

Hunters Moon 24/04/08

Hunters Moon 05/12/06

Hunters Moon 21/10/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hunters Moon Grittleton Road Yatton Keynell Nr Chippenham Wiltshire Lead Inspector Mrs Jacqui Burvill Key Inspection 3rd May 2006 09:30 Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 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 Moon DS0000064634.V293550.R01.S.doc Version 5.1 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 Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hunters Moon Address Grittleton Road Yatton Keynell Nr Chippenham Wiltshire 01452 300025 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) info@holmleigh-care.co.uk Holmleigh Care Homes Ltd Cheryl Jane Beard Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st October 2005 Brief Description of the Service: Hunters Moon is one of a number of care homes owned by Holmleigh Care Homes Ltd, which operates homes in Gloucestershire and Wiltshire. This is a new service that opened in September 2005. Hunters Moon is in the village of Yatton Keynell, close to Chippenham. There is a pub and a shop in the village. The home has a vehicle for service users’ use. This was previously a family home, which has been adapted to include ensuite bathrooms with each bedroom. There are bedrooms on the ground and first floor. Access to the first floor is by stairs only. There is a large lounge, a conservatory, a dining room and separate kitchen and a separate utility area. There are large gardens to the rear of the home. There are at least four staff on duty each day and one staff member sleeping in and one waking night staff member. Fees range from £750 per week to £1,200 Information about the service is shared with service users’ relatives, and/or care managers. Service users are unable to access inspection reports in their current format, due to their communication needs. The service has been asked to consider how service users with communication needs air their views. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process, there were two visits; one unannounced on 3rd and one announced on 9th May 2006. There was an announced visit to the main office based in Gloucester on 19th May 2006. Surveys were sent to two of the service users’ relatives and one other relative was spoken to during the inspection. One response to the survey was received and the comments show that they believe the care of their relative to be ‘excellent’. None of the service users are able to use a survey form independently. Due to the service users’ needs, none of them are able to comment directly about the care they receive. All of the service users were spoken with and there was a period of 2 hours during lunch and early afternoon, where the inspector observed daily activity and care provided in the home. The following documents were looked at; admission and assessment records, care plans and risk assessments, daily notes, medication records and associated policies and procedures, staff training and recruitment records, fire safety records, accident and COSHH records. There was a tour of the premises. Five staff were spoken with in total, including the manager and deputy manager. What the service does well: Hunters Moon provides care that is individual to the person’s needs. Staff observe service users’ reactions to activities or outings and use this as a base to further explore interests or activities service users may like to try. This follows a very comprehensive assessment and ‘transition’ period, where service users are assessed and are able to try out a service by coming for days and building up to over night stays. There are positive consultations with families and care professionals to ensure that the admission process is individual to the service users’ needs. Care plans in place describe the range of needs service users have and how those needs are to be met. Daily records are very clear and objective and describe the care that has been provided and some of the choices made by service users. Service users receive personal care in a way that best meets their needs, with clear descriptions of their preferences. Staff support service users to make as many choices as possible, given their communication needs. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 6 The home is spacious and the enclosed garden provides a safe, clean and tidy environment for service users to walk and explore their own home. What has improved since the last inspection? What they could do better: Not all service users had up to date care plans in place. A requirement has been made regarding this. Risk assessments could be more detailed in describing the risks affecting service users with regard to radiators and a requirement has been set. One important piece of information about a particular way that medication is to be administered had been required at the last inspection. The manager stated this had been obtained by the home, but could not be found on the day of inspection. The home obtained this following the inspection. A requirement has been set. The conservatory area would benefit from some blinds so as to maximise the use of sensory light equipment in there and reduce the heat in the summer months. Service users who cannot express their views as they have non verbal skills need to have a method or support to enable them to do so. There are some issues regarding safe and robust recruitment; staff are not routinely checked against the Protection Of Vulnerable Adults list before employment is offered, neither is a Criminal Record Bureau check completed before a firm offer of employment is made. The CRB check is made once the member of staff has signed a contract and started work. They do not work unsupervised whilst a CRB check is being sought. A separate letter regarding Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 7 the recruitment process has been sent to the responsible individual, with a request for an action plan by 7th June 2006. Staff inductions have been introduced but not all of them have been completed. This is partly because there are newly employed staff in the home. Other aspects of paper recording such as fire safety checks had been recorded poorly as the incorrect sheets had been used. A similar issue had been raised at the previous inspection. As a result of these discrepancies, aspects of the Regulation 26 visits, which are made by the responsible individual and are unannounced and report on the conduct of the home should be looked at, so the registered person ensures that requirements are met and basic health and safety standards are properly maintained. 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 Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 8 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 Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 9 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): 2 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users have their needs assessed prior to admission and are they are able to ‘testdrive’ the service. EVIDENCE: Service users who have been admitted to Hunters Moon have benefited from comprehensive assessments prior to their admission. This includes assessments from health or social care professionals. The records for two service users were seen. The inspector spoke to one relative who was very impressed with the level of care provided by the organisation. When asked what it was about Hunters Moon that felt like it was good care, it was described as; ‘ a consistent approach with clear boundaries and the interests of service users at heart.’ Surveys were sent to two other families and only one response was received. There were positive comments about the home and that they felt their relative was very happy there. At this time, there are three service users in the home full time, and two service users are in ‘transition,’ as they are in the process of moving into the home. This transition period varies in length, depending on the needs of the service users and with involvement of family and social care professionals. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 10 After the admission, there is a three month trial period. In one case, there were records showing monthly meetings with a relative in order to smooth the admission process. Some of the information on one of the assessment documents shows that staff need additional training in ‘Total Communication’. This has been provided. The manager explained that compatibility of service users is as important as the assessment of their needs and aspirations. Arrangements have been made with some prospective service users and their families, so that service users are able to come to the home for day care or short term care, so they are able to ‘test drive’ the service and continuing observation and assessment of their needs can take place. The service user guide, statement of purpose and the complaint procedure is given to the service users’ relative on admission. It may be advisable to keep evidence of this. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected 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 was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Not all service users have up to date care plans and this could affect the way in care is delivered. Service users are supported to make decisions as best they can with staff knowledge about their preferences and interests. Risk assessments reflect some of the risks service users may be affected by. Clearer recording and storage of risk assessment records would improve the level of information available to staff and reduce the risk that may affect the service users. EVIDENCE: Two service user’s care plans were looked at. One was not in place, although the service user had been admitted a few weeks ago. Other information about Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 12 her care needs was in the file, but not a care plan written by the staff team at the home. The manager stated that it would be in place by the following week. Care plans describe the needs of service users. There is further scope for development here as there is a person centred approach in the home, although staff may not be fully aware of this. The manager plans to set up some training in this approach, so staff have knowledge to support their actions. Not all of the service users are able to communicate their needs clearly and staff have already started to gather information based on behavioural reactions to activities and events. Care plans need to be reviewed as they were written in August and should be reviewed at least once every six months. Staff write daily care records objectively. Where service users are unable to communicate, staff record ‘appeared happy’ for example and then described what they saw that made them interpret behaviour in this way. By responding to service users in this way, a profile can be built up of the types of activities and choices service users like to make. Risk assessments were in place, although not all risk assessments had been signed. Staff sign a document to say they have read and understood the risk assessment. One particular document with regard to the way a service user must have medication and the risks involved was incomplete, as a letter from a health care professional had gone missing. A request was made for this document and it was hoped it would be in place by the time of the second visit. Unfortunately, it was not. After the second visit, the inspector was informed that the letter was in place and clear instructions support the care plan detail. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users take part in activities that they enjoy. This includes facilities in the local village and nearby towns. Staff support service users in maintaining relationships with other service users, friends and family as this is part of a person centred approach. Service users’ rights and responsibilties are recognised by staff, who support them to make as many choices as possible and to have freedom around the home. In general, service users enjoy a varied and balanced diet. EVIDENCE: Evidence was gathered by looking at the records relating to how service users make choices and are enabled to do so and by observing interactions with staff and service users over a meal time and early afternoon. Staff spoke to service Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 14 users, offering them choices of meals and drinks and with most service users spoke about what was happening and what things were planned. This was a very busy time in the home, with lunch being served, service users coming back from trips out and plans in place to take other service users out, whilst another service user was not feeling very well. The entire staff approach was calm, relaxed and caring. All service users were having their needs met and no one was overlooked during this busy time. Staff were very supportive and aware of each of the service users’ needs. Service users were observed walking around all areas of the home and the garden. Only the laundry room and kitchen are inaccessible at all times, due to health and safety issues. Daily records show that staff record what emotion they think they have observed and what was happening at that time. This is especially good evidence as many service users are unable to directly communicate with the staff team to make them aware of their choices and preferences. Records are objective, signed and dated. These records describe the action taken with personal care, activities provided both inside and outside the home and meals. Service users take part in local community using the village shop and pub. Other facilities are being sourced within nearby towns and within Holmleigh Care. Family links are an important part of the care provision within Hunters Moon. Whilst relatives may choose not to visit, this is because of the transition period, or because service users are testing out their preference for the home by staying for respite care. There are real efforts made by the staff team, to support relatives with the changes they are faced with when a service user is admitted to the home. One relative spoke highly of how much this support meant at the time of admission. All service users have their own bedroom and full ensuite bathroom. Staff knock and ask permission to enter bedrooms, although service users tend to be with staff at all times. There are keys to the bedrooms doors, although none of the service users have keys at this time. Meals are recorded showing the menu plans and the actual meals that have been eaten on an individual day. One service user has an unusual diet and it continues to be a recommendation that advice is sought from a dietician or nutritionist. Service users have a choice of two options for lunch and a cooked meal is provided in the evening. Breakfast is toast or cereal. Hunters Moon is able to provide alternatives to meals as required. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 15 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 was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users receive personal care in a way that is appropriate to their needs. Service users physical and emotional health care needs are met and would be enhanced by completed or safely stored documents that relate to their need. Aspects of medication recording may put service users at risk, as some administration errors may occur as a result of a poor audit trail. EVIDENCE: The care plans in place describes how the service user likes to receive personal care. Each plan did describe this well. The plan includes a description of their daily routine, which helps with a consistent approach to providing care. One care plan describes the communication needs, which enables staff to interpret how a service user may be feeling and to take an alternative approach. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 16 There are details recorded of appointments to health care professionals. One service user had an incomplete epilepsy profile in place. This is a particular need and should have been completed by a community nurse. None of the service users are able to manage their own medication at this time, due to the nature of their care needs. It is possible that in the future, some service users may be supported to do this. The manager discussed various aspects, such as a lockable unit being provided. There are procedures that would enable service users to self medicate. Medication records and medication stocks were looked at and this showed a confusing audit trail for one service user’s medication. This had been further complicated by issues and errors from the supplying pharmacy. The home uses a monitored dosage system, which provides medication on a monthly basis is a blister pack. Medication records in one case were not clear in describing exactly what medication had to be administered and it was possible for errors to occur. A discussion was held with the manager and deputy manager about this and the CSCI pharmacy inspector was contacted, and a visit arranged, so that these issues could be addressed and rectified. Her report is in the paragraph below. “Medication, records and storage were inspected and discussions held with the deputy manager. All stocks of medicines had been checked and quantities recorded following the first inspection visit. Some medicines that were no longer required had been returned to the pharmacy and recorded. The records corresponded with the medicines held in the home. Medication administration records were completed. Staff had received training on the safe handling of medicines and specific training for one resident’s medication. Information was not available for all the medicines used in the home, patient information leaflets have been requested from the pharmacy. One resident takes medicines by crushing the tablets, this has been agreed with the doctor however discussions were had as to the best way to administer medicine to this resident.” Medication received as part of short term care did not have a clear record of what exactly had been received from the family and what had been returned. Only staff who have completed medication administration training as part of a distance learning course are able to administer medication. Their competency had not been assessed following the training and a form was found by the manager during the inspection for this purpose. Some staff who had completed the training did not have certificates in place, although they were not administering medication. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 17 Newly recruited staff should have some awareness of medication as part of their induction, before they take part in the distance learning training. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users who can express their views have them listened to and acted on. This would be enhanced by considering ways service users with non verbal skills have their views listened to. Service users will benefit from a staff team who have up to date knowledge and information about adult protection procedures and signs and symptoms of abuse. EVIDENCE: The complaint procedure is up to date and contains the details of the local CSCI office. One is on display in the hallway and there is also a pictorial version. The home does not have information about advocacy services in this area. Holmleigh Care has a ‘Service Users Action Group’. Although this is not an advocacy service, it enables service users to talk about their service and is chaired by a person independent of the care home. A leaflet is distributed that invites everyone. The manager stated that there may be one or two service users who may like to go in the future. Meeting minutes are kept. For those service users who can, it is a way of voicing their concerns. The inspector and manager discussed how service users without those skills would be able to voice concerns, or how staff could check out that service users are happy with the service that they receive. This promoted some discussion and Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 19 will enhance the current thinking that is taking place in the home, as the service develops. There have been no complaints since the home opened. The manager and deputy manager have arranged to take part in adult protection training provided by Wiltshire County Council. They then plan to cascade this training to the staff team. The updated ‘No Secrets’ booklet describing the Wiltshire and Swindon Vulnerable Adult procedure was given to the home by the CSCI. Abuse training has taken place in house and the manager has devised a training pack about this. It may be advisable to amend the pack, once the manager has attended the work shop on Vulnerable Adult training that she has booked a place on. This will provide more detail of the multi disciplinary approach to adult protection, which needs to be reflected in the organisation’s policy and procedure and the training pack. The abuse training pack did not accurately describe the point of consent when investigating adult abuse. This could potentially leave service users at further risk of abuse. This was discussed with the manager and is a point to raise for discussion in the Wiltshire training workshop. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 20 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, 30 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users benefit from a home that meets their needs, which is homely and comfortable. Service users have bedrooms that suit their needs and lifestyles. The home is clean and hygenic. EVIDENCE: Hunters Moon is in the village of Yatton Keynell, not far from Chippenham. The driveway and front door entrance to the home is secure, so service users are not at risk of inadvertently leaving the home. The home was renovated in 2005 and each bedroom has a full ensuite of either a bath or a shower. There is a bathroom on the ground floor with a Jacuzzi style bath. There is also a large lounge, separate dining room and an adjacent kitchen. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 21 The laundry room is next to the kitchen and there is also separate access to this room. The conservatory has been converted into a sensory room with specialist equipment, including Perspex mirrors and a bubble tube. Additional blinds would reduce heat in the summer and make the room more attractive to use if darkened. Each bedroom in use is furnished and service users are encouraged to make the space their own, reflecting their choice of activities, interests and colours in their own space. Some pictures have been put up in communal areas to add to the homely feel. The home was clean and tidy on both visits. Radiators are going to be covered, and risk assessments are in place. However these have not been dated and only mention one radiator with each risk assessment identical to the other. The manager and inspector discussed the doorway leading from the kitchen to the laundry room, where the wooden surround is pulling away from the wall. This has been reported and will be rectified. There are no fire extinguishers in the home, apart from the fire blanket. This is because no staff are expected to fight fires. After a discussion with the inspector, the manager stated that fire extinguishers will be installed. The garden is attractive and well maintained. The small decking area by the shed is too slippery for service users to use and has been safely restricted. The manager plans to improve this in the near future. This has not had an impact on access to service users as the garden is very large. There is a small area of fascia outside the dining room that needs to be repaired. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 22 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): 32, 34, 35 Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users benefit from a staff team whose skill mix and knowledge ensures their needs are met. Service users are at risk by serious deficits in the organisation’s recruitment policy and procedure. Staff inductions are not completed within a specified timescale, which may affect service users needs being met. Other staff have been appropriately trained in order to meet service users’ needs. EVIDENCE: Staff recruitment records were looked at in the home and in the head office on a separate date. Four staff records were sampled in the home and five in the head office. These records involved the same staff, plus one extra one in the head office. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 23 In the home, it was clear that staff had been recruited and offered contracts of employment before they had a Criminal Records Bureau check. Staff contracts showed that their first day of work coincided with the date of the contract and yet there were incomplete measures to ensure that staff had been recruited robustly. The recruitment records in the head office showed that staff do not routinely have a POVA First check, despite these need for these to be completed satisfactorily before staff are employed in the home. Such staff are supervised and never left to work unsupported, but without the proper checks. Not all staff had the same letter of offer of employment. Only one of the five letters specified that the offer of employment was subject to satisfactory references and a CRB check. Some application forms are completed on the day of interview. This may mean that a less than full picture of the person’s employment history is gathered. The application form does not specify that staff have to disclose any previous convictions. It reminds staff that nothing can be considered spent, and if they have any convictions, to list them. A separate letter was sent to the responsible individual about this, explaining in detail the gaps in the recruitment procedure and the breach of regulation. It is the responsible person and the registered person’s responsibility to ensure that staff who are acting on their behalf are fully aware of the legislation that may affect the way they carry out their role. Staff training records were looked at and discussions took place with two staff. One staff member is registered on the Learning Disability Award Framework. There is also pre NVQ training which is a foundation certificate for care workers. One senior member of staff has NVQ level 3. NVQ training will start for other staff in the near future. The deputy manager is doing NVQ level 4. Less than 50 of the staff team do not have an NVQ certificate. The manager explained that staff will be enrolled onto NVQ courses in the near future. Staff have a mix of skills and experience. Staff who have been employed since the last inspection have training sessions planned. There are staff on duty at all times with a current first aid certificate and all staff have completed manual handling training. Four of the eight staff records sampled have foundation food hygiene training. Staff are undergoing induction training. Not all of the inductions have been completed within the home’s specified timescale. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 24 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): Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home aims to provide a high quality care service by the manager and her team. Aspects of the organisation’s role would enhance the running of the home, ensuring the safety of service users through more robust checks in recruitment and other periodic record checks in the home. Service users views have not been gathered yet. Quality assurance will take place when the home has been in operation for one year. Aspects of the health and safety of service users would be better protected through more robust recording of the fire safety checks made. EVIDENCE: The manager is qualified and experienced to run the home. She has a deputy manager, who is currently doing NVQ level 4 in management. There is a senior staff member on duty at all times. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 25 The registered manager discussed her plans to further her training in order that she may cascade training to the staff team. The manager is competent in her role and ensures that the needs of service users are met in a person centred way. Aspects of delegated responsibilities should be regularly monitored. Quality assurance systems are in place ready to use, and will be put into operation when the service has been running for one year. This will be in August 2006. The quality assurance systems are based on the National Minimum Standards. A discussion took place about how these standards would be measured over a period of time and how results would be shown. This led onto a discussion about the Regulation 26 visits by the registered provider. These visits lack depth and the views of service users are not routinely sought. The involvement of the responsible individual is crucial to the development of the service and this means that they should be leading guidance and advice on issues such as recruitment and quality assurance. The fire log record book was seen and although it was possible to determine that the fire alarm had been tested weekly, it had not been recorded on the appropriate form. A similar issue over recording tests and checks had been raised at the last inspection and it was thought to have been resolved. Not all staff had received fire safety training, or had drills. On the second visit to the home, these records were further checked and it was clear that there were still some misunderstandings about the test of the fire alarm and a fire drill. This was pointed out to the manager, who planned to rectify this. This issue should have been picked up as part of the regulation 26 visits by the responsible individual. The manager plans to laminate the diagram showing the fire zones and evacuation procedure. The training pack devised by the Wiltshire Fire Brigade will be used to train staff in house. The accident book had been appropriately recorded and acted upon. Safety data sheets are in place for all the cleaning products in use in the home. All of the products are held safely away from service users. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 26 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X X X X 2 X Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) (2) Requirement All service users must have a care plan in place that describes their needs and how they are to be met. Until radiators are covered, all radiators must be risk assessed, based on the individual risk to service users. (Carried forward from the last inspection. Each risk assessment is identical and only specifies one radiator. Due to be met by 30/12/05.) There must be a clear protocol from a healthcare professional with regard to the way medication is being administered for a particular service user. (Carried forward from the last inspection due to be met by 30/12/05. A letter had been received, but was not in the care plan during the inspection) Medication administration sheets must accurately describe the dose, and the number of tablets to be taken. DS0000064634.V293550.R01.S.doc Timescale for action 30/05/06 2. YA9 13 (4) (b) (c) 30/06/06 3. YA20 13(2) (4) (c) 30/05/06 4. YA20 13 (2) 30/05/06 Hunters Moon Version 5.1 Page 28 5. YA20 13(2) 6. YA23 13 (6) 7. YA34 8. YA39 17(4) 18 19(1) b c (4)a b c (9) (10) a b (11) a b c 26 (4) (b) All medication received into the 30/05/06 home must be accurately accounted for and recorded, so that a clear audit trail can be followed. The registered manager must 30/08/06 receive adult protection training in order to cascade this training to the staff team. (Carried forward from the last inspection. Due to be met by 30/03/06. External training is to be confirmed) Newly recruited staff must have 30/05/06 a POVA First check whilst a CRB check is being sought before they are offered employment. 9. 10. 11. YA42 YA42 YA42 23 (4) (d) 23 (4) (a) 23 (4) (e) The responsible individual must ensure that appropriate records are checked and service users are consulted when regulation 26 visits take place and are recorded. All staff must receive fire safety training at least once every three months. The fire procedure must be detailed in the front of the fire safety log book. All staff must take part in a fire drill at least once every three months. 30/06/06 30/06/06 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations Care plans should be reviewed at least once every six months. DS0000064634.V293550.R01.S.doc Version 5.1 Page 29 Hunters Moon 2. 3. YA7 YA9 3. 4. 5. 6. 7. 8. YA17 YA19 YA20 YA20 YA20 YA20 9. 10. 11. 12. 13. 14. 15. YA23 YA23 YA32 YA34 YA34 YA34 YA42 The manager should provide training and awareness of ‘person centred approach’ for staff. Risk assessments should be clearly recorded, dated and signed, reflecting the range of risks that may affect service users, including the number and location of uncovered radiators they may be affected by. Where a service user may have a poor or unusual diet, advice should be sought from a nutritionist or dietician. (Carried forward from the last inspection) The epilepsy profile for one service user should be completed by healthcare professionals. Medication policies and procedures should be amended to reflect any local practices. (Carried forward from the last inspection) Newly recruited staff should have some awareness of medication and the practice of administering medication in the home as part of their induction. Staff who have completed medication distance learning training should have their competency to administer medication assessed by the registered person. Information about medications used in the home should be in place. This should include the inserts in packets of medication about directions and contraindications, which can be obtained from the pharmacy and a BNF or a MIMS, which details the medication in use the home and possible side effects. The registered person should obtain information about advocacy services that are available in Wiltshire. The Registered person should consider ways in which service users who cannot express their views except in a non verbal way and supported to do so. Staff should be enrolled onto the appropriate NVQ training course. The application form should contain clear information about whether the applicant has any convictions that are regarded as spent. The registered person should ensure there is a policy and procedure about the recruitment of ex – offenders. Guidance can be found on the CRB website. The organisation’s recruitment policy and procedure should be reviewed and amended in order that no breaches of regulation occur when new staff are employed. The fire safety checks should be recorded on the correct sheet describing the test that has taken place. Hunters Moon DS0000064634.V293550.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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