Inspection on 05/12/06 for Hunters Moon

This inspection was carried out on 5th December 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 no outstanding requirements from the previous inspection report, but 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 03/05/06

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 SN14 7BH Lead Inspector Stuart Barnes Unannounced Inspection 5th December 2006 10:00 Hunters Moon DS0000064634.V313081.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 Moon DS0000064634.V313081.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 Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hunters Moon Address Grittleton Road Yatton Keynell Nr Chippenham Wiltshire SN14 7BH 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) www.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.V313081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2006 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. It accommodates seven people. The home is located in the village of Yatton Keynell, close to Chippenham. There is a pub and a shop in the village. Hunters Moon 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. Typically there are at least four staff on duty each day and one staff member sleeping in and one waking night staff member. The home provides has a vehicle to take service users out and about. Fees range from £750 to £1,200 per week depending on the assessed needs of care. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection visit took place over three days of which the first day was unannounced. In total 33 out of 43 relevant National Minimum Standards (NMS) were inspected. On the first day time was spent examining various policies and procedures including a raft of case documentation relating to 3 randomly selected service users, viewing part of the accommodation, observing staff engaging with some of the service users and spending time with the manager/ deputy manager. On the second day, time was spent talking with some of the staff on duty and talking to two service users about living at Hunters Moon. The inspector also attended a meeting under the local adult protection protocols where the needs of three service users were considered. On the third day time was spent talking to more staff, verifying staff recruitment procedures, speaking more informally to service users who were at home and giving feedback to the managers of the service. Additional to these visits we also required the home to provide us with information about the services. Fees range from £750 to £1,200 per week depending on the assessed needs of care. What the service does well: What has improved since the last inspection? Much progress has been made at addressing issues that were raised in the report of the previous inspection. As a consequence standards of recruitment have improved. Medication is being better managed. Risk assessments are more comprehensive. Fire safety has improved. There have been improvements in some record keeping Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 6 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 Moon DS0000064634.V313081.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 Moon DS0000064634.V313081.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. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The company provides quite good information about the service its provides but there is room to make these documents clearer and more user friendly for service users. Most assessments are well done but the service needs to ensure they capture the information they need and are clearer about any restriction, controls or therapeutic interventions that may be necessary. Most needs are being met to a good standard; but not all needs. EVIDENCE: There is a detailed statement of purpose and a service user guide that provides information about the company and the services provided at the home. These documents underpin the importance of respecting service users rights, their privacy and dignity and promoting their independence and choice. They also promote the realisation of any personal aspirations and the drawing on expert support with health care needs. As a stand alone document the service users guide is not formatted in a sufficiently user friendly style, though this is partially compensated by good pictorial presentation of three other documents; the complaints procedure, how to report maintenance breakdowns and the resident’s ‘life plan.’ Documentation in relation to three service users, selected at random where examined. There is evidence to show that the service obtains a lot of information about people who want to be considered for a place at the home. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 9 For two people there were examples of the home having obtained a comprehensive community care assessment detailing the support they need. However in one case the documentation gathered did not fully equate to obtaining a person centred assessment of need. This failing contributed to the person’s placement breaking down. While the service is good at collecting relevant information such as life histories, previous placements reports and educational attainment, it is not so good at using this information to draw up sufficiently detailed and comprehensive assessment of needs and written down behavioural strategies for those who challenge. This is especially so for those individuals whose behaviour has the potential to self-harm or who may harm others and whose care and management may require imposed restrictions. Because of the nature of these challenges the service needs to ensure that any such restrictions are assessed and approved of by a suitable, competent and qualified persons such as a behavioural therapist, or psychologist or psychiatrist and that such approval is signed and dated and documented in the person’s care plan and periodically reviewed. This does not appear to be happening. This is not to say that any such restrictions are not appropriate to the circumstances; they may well be. Such restrictions include restriction of liberty and free movement, handling other people’s financial affairs, any specific programmes to modify behaviour and the disguising of medication. A feature of this inspection is that the evidence points both ways in respect of how well the service is able to meet assessed needs. It shows that, for example, one person was assessed as being suitably placed but the placement broke down in a matter of weeks but for other service users the home is currently being very successful at meeting complex and challenging needs. Such success is voiced by care managers, health care workers, agency staff, the manager and acting manager and verified in case documentation and periodic placement or medical reviews. It can be concluded that part of the reason for the relatively sudden breakdown of the placement referred to above indicates the service did not have sufficient understanding of the needs of younger people with autism and were not sufficiently guided by previous carers and the people who were involved in the placement decision that the service user needed many months rather than weeks to adjust to their new setting. Neither did the home understand that in such circumstances it was likely the challenges would increase rather than decrease during the period of transition. Examination of this person’s case documentation shows that it was also evident that care workers may not have been as objective as they should have been when assessing behaviours using a ‘traffic light’ system of red, amber and green to indicate severity. Service users are supported to access a range of specialised services such as those providing medical care. One care manager described the service as being a very good quality service with competent staff – where service users are well matched. Another health care worker also highly praised the service for the way it works with persistent and demanding challenges. Various comments in one service user case file indicates good progress and good partnership Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 10 working with the family. However another feature of this inspection was the report by managers of the home and by one social worker of difficulties experienced in the sharing information including challenges and incidents. Such difficulties suggest there has been some misunderstanding as to what information should be passed on by others, including any reports of serious incidents. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 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. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. The service is achieving good results at managing changing needs and in the planning of care which includes offering person centred ‘life style’ planning. However some inherent risks arising from the nature of the service need more consideration. EVIDENCE: The service uses an ‘essential life style plan’ to provide ‘a brief overview of the persons world.’ Two examples seen show that these plans use coloured ink, large letters and pictures or symbols to aid understanding. They remind the reader that some of the information is opinion and subjective where for example the person is not able to speak for him or herself. These documents are used by care workers as a guide, as well as a plan. They include likes, dislikes, habits and ways in which successful communication can take place. They also detail preferred routines on waking up and throughout the rest of the day (and night) indicating where necessary interventions in a sequential order if this is considered important to the service user. A feature Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 12 of these documents is the attention to small detail and reminders, which affirm dignity by comments such as, “not to eat with my fingers.” Other comments aid or promote independence, e.g. “remember to pull my chair out before sitting on it.” Others indicate respect such as, “please gesture please or thank you.” Consideration is also given in the Essential Life Plans (and other care plans) to aspects of general safety such as, “ I may become agitated when out so please stay alert if my rhythm is disturbed.” The life plan also incorporates photographs considered important to the person such as pictures of their family or previous home or school. As reported elsewhere care plans provide insufficient information about the reasons for any imposed restrictions that are considered necessary and who decided such restrictions and why? It can also be seen from the life style plan that the service is good at supporting service users to make decisions when and where it is safe for them to do so. Pictures and symbols are used to promote knowledge and understanding. Three service users reported that the service obtained things they wanted for their comfort such as a television in their bedroom, music equipment and specialist relaxation equipment. Two service users were able to say that they liked living at Hunters Moon. One person confirmed that that they sometimes go to the pub and that at breakfast they get a cup of tea. They both said they have made a friend at the house. While one person said that they spend a lot of time in their room listening to their favourite music the other spoke more about liking their room because it was newly decorated. One person said that they get bored sometimes and that while they had a nice room the bed was a bit hard for their liking. They made a comment that one of the resident’s who was being disruptive could not help behaving in the way he was; thus conveying a degree of understanding and compassion, typical of the service. Records show service users can determine bed times, food preferences, and activities. The company will offer to be an appointee should no one else be able to undertake this work. Proper systems are in place to account for any financial transactions. Care managers also report effective exchange of relevant information. (except for the one example previously referred to) Key workers undertake a monthly review of each resident but this well intentioned system is considered ineffective and too limited for persons with such complex needs. As written these reviews do not always provide evidence for some of the comments made in them such as; “improving this month” or “communication improving” or “ has had good month.” Statements such as; “less seizures are not backed up with evidence.” These monthly reviews would have more value if they where less subjective and included data to verify the conclusions reached, including such things as the number and range of activities undertaken. They need to measure success more than they do and to look forward as well as backwards. This is a service where there are inherent risks because of the nature of the service some of which are not sufficiently identified (see below). There is a detailed risk assessment, risk management and risk taking policy, which Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 13 together combine to promote, as much autonomy as is possible and give service users freedom to choose what is both safe and free from any significant harm. This is a service where the staff group understand the importance of ensuring safety and the need to protect service users from harm. Many, many staff interventions were observed of care workers taking action to prevent accidents, injury, assaults and damage to property while carrying out their routine duties. Such interventions always appeared to be a managed response, using distraction, prompts, gesture or the use of a leading arm to direct people to place where they would be safer. Most noticeably they appeared to be responses that were caring and protective and were by care workers who assumed a quiet, confident demeanour, in sometimes exceptionally difficult circumstances. However such good intentions by these caring and dedicated staff were partly compromised by a lack of ‘worse case scenarios’ assessment of risk. The two following examples illustrate this. There were no risk assessments where it is known that a service user may pull down pendant lights hanging from the ceiling or where a locking mechanism on bedroom doors means that some service users were unable to exit their room without staff support. Other areas of risk assessment and risk management were much better including; • Road safety. • Community access. • Safety in the garden • Medication • Specific risks for individuals including those associated with health care issues such as epilepsy. • Fire prevention. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 13. 14. 15. 16. 17. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. This is the weakest area of the service, despite some good endeavors. There is a lack of clarity about the purpose of daytime activities as well as a lack of opportunity to undertake meaningful activities locally or further a field. There is a lack of sufficient resources. Service users appear to enjoy the food offered and eat well. EVIDENCE: Evidence was gathered by looking at the records. A feature of this service is the efforts put in by care workers and the company to support service users to maximise their personal development. This is achieved in a variety of ways and includes sensitive life planning and care planning that is person centred. Comments by care managers and health care staff report progress. Case documentation indicates that the service works consistently hard to support parents to share care and work in partnership with the service where this is desired. It can also be seen that where contact Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 15 between families is less strong the service also works hard to maintain links and keep family members in touch. The service has a specialised vehicle (people carrier) so it can take people out and about. It was said that service users take part in the local community by using the village shop, pubs and other resources, including a local ‘Gateway’ club – a club that provides a discrete social opportunity for people who have developmental needs. However recent challenges and inclement weather has been a barrier to regular community access with the manager admitting that certain individuals have not been able to follow their life plan/care plan. The number of activities falls short of what would be expected in a good service. Outings such as ‘feeding the ducks’ or a ‘car ride’ though enjoyable do not fully meet the criteria of sufficient inclusion in the wider community. The manager reported that the service has wanted to access a suitable horse riding resource but has been hampered by difficulties in getting adequate insurance cover. To illustrate the level of community involvement, records for week commencing 4 September shows that one service user spent her mornings by;1. Going out for a few hours one day. 2. Going grocery shopping another day. 3. Doing some craft work for a short period. And in the afternoons the same person; 1. Played in the garden 3 days for short periods and went for a drive in the car/van. 2. On another afternoon they went bowling and did some craft work. Another service user for the same week;1. Went out 3 mornings for a car ride. 2. Had two morning sessions in the relaxation room and 1 short spell in the garden. And in the afternoons; 1. Went for a ride in the car, spent time in the relaxation room and in the garden. Another service users’ experience for this week was four drives out in the car and two sessions doing puzzles or craft. However this person’s activities were curtailed due to illness. What part activities play in a person’s life is not clear to see. It is not clear whether they are used merely as time fillers to break up boredom and daily routines, or whether they serve as value based occupation to be ‘usefully occupied’ or whether they have the purpose of being the avenue by which people can progress life skills or maintain and develop their social circle or whether they are activities to promote good health and well being. The absence of clarity in care plans and in the minds of staff may be factors that lower expectations regarding leisure and activity, as may be the absence of drivers on some shifts. Such factors need to be guarded against. One care manager also expressed the view that activities for her two clients were somewhat limited. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 16 At the same time care workers were seen to explain expected routines as a way of preparing service users to know and better understand what will happen next and what is expected of them. While some service users were observed walking around the home/house freely it was evident that restrictions were being placed on some people to limit where they went. Such restrictions were also evident as a means of protecting people from potential harm when there was disruption during episodes when one person was challenging in a critical way. Restrictions are in place that prevents service users from freely accessing the laundry room and kitchen areas for reasons of health and safety. It was noted there was further restriction on one resident accessing her bathroom unsupervised. Such environmental restrictions appear appropriate to the circumstances at the time. Daily records show that staff record what emotion they think they have observed and what was happening at that time, as many service users are unable to directly communicate with the staff team to make them aware of their choices and preferences. Records describe the action taken with people’s personal care and any activities that are provided both inside and outside the home. Care workers were observed to offer service users different meal options and choices of drinks. A feature of this service is just how much effort staff make to deliver a good meal experience for everyone; doing all they can to provide pleasurable meal times and good food each day. A record is kept showing the menu plans and the actual meals that have been eaten. Menus include provision of a diet for one person that respects religious customs and family preferences. 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. Where appropriate care plans and case documentation highlights any ‘triggers’ that may arise at meal times that can cause or indicate distress. However information did not sufficiently detail whether eating separately from other people might better assist the person in such circumstances. All service users have their own bedroom and an ensuite bathroom. Staff knock and ask permission to enter bedrooms; a further indication of being respectful and considerate. There are keys to the bedrooms doors, although none of the service users retain their keys at this time. The locking mechanisms that are in use for some service users prevent them being able to freely leave their bedroom. According to the manager the locks fitted were ones recommended by the regulatory body at the time. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 17 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. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. Service users are supported to access a range of health care services. They also greatly benefit from a service where the staff have good working relationship with heath care professionals that attend to them. There are two areas where there is scope to further improve this aspect of care; such as the use of dedicated health care action plans or similar working tools to aid assessment and more active involvement of behavioral specialist including psychologists to monitor any restrictive interventions that may be necessary. EVIDENCE: The care plans in place describe how each service user likes to receive their personal care. Each plan describes this very well and in a manner that affirms respect for the individual and supports the service aims of ensuring dignity and showing respect. A clean, pleasant environment and ensuite facilities furthers this aim as does the employment of staff who show respect, speak quietly, exercise due discretion and proper consideration for privacy – even in circumstances that can be very challenging at times. To ensure a consistent approach to providing personal care, care plans/life plans include a description of daily routines. Less well done is the ability of the Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 18 staff team to assess behaviours, in a consistent manner, using a traffic light system. Service users are supported to access a wide range of primary and specialist health care services. It is apparent that the home benefits from an outstandingly good relationship with the local GP surgery. It is also evident that service users are supported to access a wide range of preventative services such as optician, dentist, dietician, as well as psychiatric services and community nursing services. One service user is supported to access a GP chosen for by the family. Entries in the daily log book show that when a medical practitioner changes medication or a treatment schedule such changes are flagged up for staff attention. Details of appointments to health care professionals are recorded in case documentation. It was noted that the manager/deputy manager had a good rapport with a visiting psychiatrist, which was user focussed. We have received comments from the local community nurse, a consultant psychiatrist, and another consultant about how positive they view this service. Less evident was the involvement of any behavioural therapist or/and psychologist in determining any therapeutic restrictions or control measures, which are used. This includes the use of ‘time out’. One review reported good attention to health care, including some welcomed weight gain. For another service it was also noted there was a welcome weight gain (evidence of happy eating experiences!), and better promotion of continence. In another case file there was evidence to show staff were closely monitoring aspects of poor health such as epilepsy including resultant injury. One of the challenges in the service is dealing with epileptic episodes. There was evidence of appropriate record keeping as well as an ‘epileptic profile.’ Staff conveyed understanding of the condition and compassion about the effects it has on those people who experience it. The medication policy was examined. It affirms service users right to keep and administer their own medication but in this service this does not happen due to proper concerns about safety. The policy would be strengthened if it gave more emphasis to the importance of assessing a person’s competency to administer medication, as the method for doing so appears vague. The storage of medication was checked and was found to be satisfactory. Medication records were examined in relation to two service users. These records appeared to be in good order. Discussion took place about the practice of disguising medication in peanut butter for one person so as to ensure it was swallowed. The manager was able to produce supporting documentation from the prescribing doctor to say such practice was essential to show ‘due diligence’ so as to ensure the person welfare. However such practices ought to be periodically reviewed and the decisions confirmed in writing. A relative raised a concern that their family member was prescribed medication, which they were not informed about by the home. There is evidence that shows any unused or unwanted drugs are periodically returned to the prescribing chemist. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 19 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. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. This appears to be a service which is open, honest and transparent about incidents that occur in the home and where staff take seriously their responsibility to ensure service users are kept as safe as is possible. EVIDENCE: The service has a detailed complaints procedure but the most protective element of this service is not this procedure. It is the caring, compassionate and dedicated staff that work hard to ensure service users are safe and well kept. The complaint’s procedure includes a pictorial version designed to inform service users of the system. Staff report that they are provided with details of the local No Secrets’ policy guide and the General Social Care Council code of practice (G.S.C.C) – spare copies were available in the office. They also reported that they have had abuse awareness training or are booked to receive it. There have been no complaints since the home opened. Discussion took place about the need for and the use of advocates. No one in the home has an appointed advocate though the majority have family members who will represent their best interests. According to the deputy manager one of the reasons for not being able to obtain an advocate for those who need one is partly due to geography and partly due to a reduction of services as a result of local authority funding. The failure to find an advocate is not due to any service deficits; however for one individual having an advocate is a more pressing need which now requires more formal representations to be Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 20 made to the placing authorities so they can review the situation and hopefully find a suitable resource. Holmleigh Care has a ‘Service Users Action Group’ that is chaired by a person independent of the care home. Membership of this group enables service users to talk or communicate about the situation and the service they receive. The manager is keen to increase the homes representation on this group and is looking at ways to achieve this. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 21 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. 25. 29. 30 The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. The provision of ensuite bedrooms in an ‘ordinary’ house that is comfortable, and clean marks this service out as having generally good standards. However there are some design deficits that need addressing if the service is to continue to provide for people who have the kind of challenges evident on this inspection. EVIDENCE: Overall the standard of accommodation is good. It provides a secure large garden area and electronic gate so service users are prevented from running into the road. Purchased in 2005 and renovated the house was a former family home. All bedrooms provide ensuite facilities and there is a large lounge area plus a separate dining area. The conservatory is equipped as a relaxation room with specialist sensory equipment including perspex mirrors and a bubble tube. Bedroom are personalised to reflect the preferences and needs of those who sleep in them. One service users showed the inspector their newly decorated room with a colour scheme and furnishings that she said she chose. It was evident from her smiles that she liked the room a lot. The home was found to Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 22 be clean and tidy throughout out and appropriately decorated for the Christmas festival. However despite these good standards there is scope for further improvement. There are some design limitations in the dining room as it includes an arch with a working surface fixed to it where it is possible for service users to crawl through and access the kitchen area. An extra room would help reduce the impact of disruption and challenges, which service users may have to endure if they occur in the lounge area. It is noted that bathroom doors open inwards and are used by people who may experience an epileptic seizure. It was also noted that a side exit door adjacent to a bedroom area leading into the garden did not have an alarm fitted; leading to the possibility that a service user might exit it during night time. Since the last inspection fire extinguishers have been provided and are in situ. Some fittings such as pendant lights, certain locks and taps need to be more appropriate to the challenges evident in the service. Staff expressed irritation how loud some fire doors bang – something that service users may also find annoying but not articulate. This problem needs to be a remedied. The patio area, which is currently fenced off, would benefit from upgrading in ready for being used in the spring. The use of the relaxation room for time out has been recognised as not being very appropriate so now ‘timeout’ occurs on the top landing: also not a very appropriate place, but better than the conservatory area. All areas seen were found to be clean and tidy. To supplement general standards of cleanliness and hygiene staff report they are provided with necessary protective clothing and barrier creams when needed and that they receive training in infection control. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 23 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. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Staff demonstrate good personal and professional qualities but there are not enough permanent staff in post. As a result the staffing of the home is a bit fragile. Delays in ensuring sufficient staff have successfully completed a relevant national vocational qualification (NVQ) and insufficient training behavioral techniques are two areas where there is need for improvement. EVIDENCE: The home is dependant on the use of agency staff due to the current shortage of permanent staff. The acting manager said there were two full time staff vacancies prior to Christamas 2006. According to the manager the reason for the shortage of staff mostly reflects the geographical isolation of the service and the company’s desire to choose very carefully those it employs in the home. The use of agency staff enables adequate staffing levels to be maintained but it also risks maintaining continuity of care; a factor most important for service users who challenge or who experience autisism. One of the agency staff was interviewed. This person said they had been deployed at the home for over 3 months. They impressed as having excellent personal and professional qualities including skills in communicating with people who lack speech. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 24 Records also show that the home benefits from having another agency worker deployed at the home on a long term contract. Staff also raised a concern that the lack of drivers sometimes affects consitency in planning care, though this was said not to be a very frequent problem. According to the staff interviewed the service works hard at ensuring a consistency of approach through effective communication systems such as staff meetings (usually every 6 weeks), handover meetings between shift changes, the use of an informal communication book and most of all clearly defined programmes and daily plans for each service user. Continuity of care is also helped by the company arranging for all permament staff to attend a ‘positive behaviour management’ course’ – a 3 day course that promotes understanding of behaviour, consistency of approach and good outcomes for service users. Observation at the time of the inspection shows that the staff team demonstrate a range of personal and professional qualities; qualities that were also noticed on a previous inspection. However for such a specialist service it lacks staff in sufficient numbers who have a recognised qualification in understanding challenging behaviour and in using behavioural techiques to modify behaviour. The acting manager plans to undertake a training in conflict management which will help but by itself is considered insufficient. Staff report that the company is “brilliant” at providing them with learning opportunities. One care worker articulated what others have implied – “we respect each other – so communication between us is good.” Records show that staff receive training in key areas such as first aid, health and safety, safe medication, infection control, moving and handling and awareness training in preventing abuse and in understanding epilepsy. The other area where there is insufficient progress is the successful completion of any relevant National Vocational Qualification training by at least 50 of those working at the home. While all permanaent staff have now enrolled to commence such training, they have yet to complete it. Two care workers staff records were checked. Recruitment checks appeared to be in order. Successfully applicants complete a pre-employment health assessment and a detailed job application form. There was evidence of satisafactory references having been obtained, including references from previous employers, as well as a satisfactory criminal record bureau (CRB) check and a protection of vulnerable adults (POVA 1st) check prior to their commencment of work. Rotas show that at busy times there are typically 5 staff on duty. It is evident that the home is able to respond to changing circumstances and bring in extra staff when required. The system of supervising staff relies too heavily on written instructions in the communication book such as, “X is not to be showered in the mornings routines are set for a reason” or or discussions in team meetings or the general oversight by shift leaders. One to one supervision is inconsistently done with two staff saying they have not had any in recent months. Neither does there seem to be a system where agency staff who have long term Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 25 contracts are getting one to one supervision – something workers needs in a service as complex as this. However there were records to confirm that some staff were getting such supervision. It is also noticed that the policy on supervision gives scant attention to the importance of it being a process of accountability though it does state it is a process for supporting staff, promoting their development and the quality of care. Induction of staff also appears under developed as it does not follow the relevant skills council specification. However staff do confirm that when they start their employment they get a lot of help and support from the manager as well as their colleagues and describe the manager/acting manager as being very supportive. They also state that they undertake a three day orientation programme which they value; but which falls short of being a sufficiently detailed induction. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 26 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. 42. 43. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. This is a home where there is a strong ethos and where managers have good leadership qualities. Aspects of quality assurance have improved but to reach excellence the company need to be more robust in its own monitoring, evaluation and resourcing of the service. EVIDENCE: Since the last inspection aspects of quality assurance have progressed. The company has successfully obtained the ‘Investors in People’ accreditation and its most recent assessment confirms the company meets the standards required. It praises the company for the clarity of its policies and procedures, states that people understand what care standards need to be delivered and that those who work for the company feel highly supported and valued for the work they do. A feature of the inspection was the espoused ethos of the service and how those working in it were able to positively identify with the Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 27 homes main function of caring for some of the most vulnerable members of society. The investors in people assesment also suggests supervision and appraisal systems could be further improved and some aspects of training developed. It also reflects a concern that on occasions some service users cannot do what they want to do because of staff shortages – a view concurred with by this inspection. Directors of the company are fulfilling their statutory obligation to visit the home at least monthly to report on the conduct of the home. These reports could be further improved if they were fully dated, properly signed and had more analysis and data on key issues of concern. There is scope to further improve aspects of quality assurance by ensuring that the audit process gives better feedback to the manager of the home and a more detailed action plan is drawn up scheduled completion dates for any necessary corrective actions. The service is good at reporting incidents, accidents and other significant occurrences to the Commission, as they are required to do so. However to make sure care managers know about such events communication with them needs to be more effective. The current registered manager is considered by the Commission to be a fit person to manage such a service. The manager is supported by a deputy manager who has recently made an application be registered by the Commission and if deemed fit to do so will assume this role. (The current registered a manager who will assume a wider role within the company.) This report highlights a challenging service at a critical stage in its development. It can be seen that those working in the home are highly committed to providing service users with the best care they possible can. They succeed in many ways, though currently the service is relying too much on the personal commitment and dedication of a relatively small number of individuals to achieve this objective. Consequently there is fragility about his service that needs further consideration. In particular the manager needs extra support and extra resources to enable her to carry out her main function. As well as additional permanent staff, such resources may need to include additional staff, access to information technology (a computer and a fax machine), administrative support and some specialist training in managing challenges. The service as a whole works hard to ensure the safety of those who live at the home and also those employed in it. However behaviours and challenges were seen which threaten aspects of general wellbeing and personal safety of other users and staff. There were critical incidents arising from deterioration in health and behaviours that impacted on others (service users and staff), which frightened or alarmed people. While these were managed, people were at constant risk and extra staff were required. Personal risk to service users appears to be well managed and well documented such as the use of harness, protective headgear, certain behaviours including restrictions and individual factors arising from health care needs. Since the last inspection fire extinguishers have been obtained. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 1 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 1 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 2 X X 2 2 Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1) Requirement When any assessment of need is carried out the registered persons must ensure that such assessments include the reasons for any proposed restrictions of liberty, freedom of choice or power to make decisions including any decision that the service will manage the person’s money and/or medication. The registered manager must ensure that each service users daytime needs are fully assessed and that they are recorded in their care plan. Such an assessment must include suitable educational opportunities. The registered manager must ensure that each service users daytime needs are fully assessed and that they are recorded in their care plan. Such an assessment must include their social needs, well as ensuring a community presence. The registered manager must ensure that each service users daytime needs are fully assessed and that they are recorded in DS0000064634.V313081.R01.S.doc Timescale for action 05/03/07 2 YA12 12(1)(a) 05/03/07 3 YA13 12(1)(a) 05/03/07 4 YA14 12(1)(a) 05/03/07 Hunters Moon Version 5.2 Page 30 5 YA3 14(2) 6 YA2 12(1)(b) 7 YA42 13(4)(a) 8 YA24 13(4)(a) 9 YA33 18(1)(a) 10 YA35 18(2) 11 YA39 26(4) their care plan. Such an assessment must include suitable leisure activities. Before a service user is placed in the home and following an assessment of their needs the company must write to the service user and confirm the extent to which the home can or cannot meet the persons needs. or discussion in team meetings. Any restrictions of liberty, freedom of choice or power to make decisions including any behavioural interventions for the purpose of managing challenges, must be agreed as part of a multi disciplinary assessment including, where relevant, by a competent behavioural specialist and/or psychologist or psychiatrist and recorded on the persons care plan. The manager of the home must undertake a risk assessment in relation to the provision of pendant lights. Where practicable to do so all bathroom doors and toilet doors used by people who experience epilepsy must open outwards The company must ensure that a suitable member of staff is identified for additional training in behavioural management and that such training be provided to them. The company must ensure that all care workers in the home staff who have been appointed after September 1st 2006 have an induction that is fully complaint with the standards laid down by the relevant skills council i.e. Skills for Care. Those undertaking monthly management reports as to the conduct of the home must DS0000064634.V313081.R01.S.doc 05/02/07 05/03/07 05/02/07 05/03/07 05/06/07 05/02/07 05/02/07 Hunters Moon Version 5.2 Page 31 ensure such reports are dated and signed by the person undertaking such reports. 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 YA1 Good Practice Recommendations Consideration should be given to the service user guide being in an audio and in a pictorial format that is suited to the needs of current service users. When reporting incidents under Regulation 37 of the Care Homes Regulations 2001 copies of such incidents affecting serving users should be copied to the service users care manager. It is strongly recommended that the current system of monthly reviews that is undertaken by key workers is changed to include wider participation of other staff and records measurable achievements, progress, frequency of occurrences and goals for the next month. It is recommended that pendant lighting in areas where services users can grab are changed to recessed lights. It is strongly recommended that the mechanism used on service users bedroom doors be of a type that allows the occupant to get out of the room using one hand. In consultation with service users or their representatives and those working in the home the company urgently reviews the purpose of day time activities, ensuring that activities provided meet the needs of service users. It is recommended that key workers undertake a monthly audit of the activities that users of the service take part in which also shows what they do, how often and who with. It is recommended that the exit door near the laundry area be alarmed in case service users are tempted to use it during night time hours. It is strongly recommended the home obtains and uses a dedicated ‘health action assesment tool’ so that information about health care needs can more easily be separated from other information kept at the home. Any potential dangers from using the dining room should be further risk assessed and if appropriate any corrective actions must be taken to eliminate any such risks. DS0000064634.V313081.R01.S.doc Version 5.2 Page 32 YA2 3. YA6 4. 5. 6. YA24 YA24 YA12 7. 8. 9. YA12 YA24 YA19 10. YA42 Hunters Moon 11. 12. YA24 YA35 13. YA36 14. YA36 15. YA41 16. 17 18 YA31 YA37 YA37 Measures should be taken, without negating any fire safety measures, to reduce the noise levels arising from fire doors closing. The company should inform the Commission how it intends, and within what timescales, to train at least 50 of care workers including agency staff in a relevant National Vocational Qualification at level 2 or above. It is recommended that agency staff that work at the home for longer than two consecutive months are provided with one to one supervision by a person competent to undertake such a task. The manager should carry out an audit of which staff have had one to one supervisions meetings with their supervisors and if such an audit shows any gaps such supervision should be provided with out further delay and at least every 2 months thereafter. It is recommended that monthly managements reports as to the conduct of the home include more narrative and include both critical comments as well as identify matters considered to be satisfactory. The company should take full recognisance of the comments in this report concerning the lack of resources available to the manager. Consideration should be given to providing the home with suitable information technology equipment for the benefit of the staff and service users. Additional administrative support should be provided to the manager including provision of suitable information technology to further the service aims. Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Hunters Moon DS0000064634.V313081.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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