CARE HOME ADULTS 18-65
Hylton Bank (28) South Hylton Sunderland SR4 0LL Lead Inspector
Sam Doku Unannounced Inspection 17 and 25 January 2006 13:30 Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 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 Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 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. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hylton Bank (28) Address South Hylton Sunderland SR4 0LL 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) 0191 534 1185 0191 534 2137 Northgate & Prudhoe NHS Trust Mr Gary Bridgewater Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: 28 Hylton Bank is a care home for eight people who have a learning disability and who have autism or behaviours associated with an ASD (Autistic Spectrum Disorder). Cheviot Housing Association owns the building and Northgate and Prudhoe Trust lease the property and delivers the service. The service accommodates male and female service users between the ages of 18 and 55 years. At present there are 8 men and women living at the home all who have varying abilities. All have difficulty in understanding their environment or communicating their needs. Consequently all of the people living at Hylton Bank have the potential of exhibiting challenging behaviours. There are 8 bedrooms and each service user occupies a single room, which complies with the National Minimum Standards. The design of the house with a North and South side gives the appearance of two separate houses, each accommodating 4 people. An area, which includes the activity room, the laundry and staff sleep over room, connects the 2 sides. Service users have access to all parts of the house with the exception of other peoples bedrooms unless invited. It is the aim of the home to develop activities, including daily life skills that are designed to reduce anxiety while creating personal security for the individual. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted over two days and involved two separate visits to the home. The first day of the inspection was mainly concerned with observing the interaction between the staff and the service users and inspection of the premises. The second visit was aimed at meeting with the manager and examining the relevant documents relating to the running of the home and the care. The inspection process involved talking to service users, sitting in the lounge and observing staff interaction with the service users, discussions with the manager and care staff, tour of the house, examination of health and safety records and service users’ personal file including care plans. What the service does well:
The staff are providing suitable support for two service users to transfer to a supportive living setting. Two service users are currently preparing towards opting out of residential care to live independently in the community with appropriate support. The service users have been proactive in the decision making process and have been involved at every stage of the arrangements. The home continues to deliver a high quality service to the service users. The care practices in the home allow the service users to be supported in exercising choices and making independent decisions. The staff are highly motivated and offer a service that is consistent with the wishes of the service users. The service users have very active and fulfilling lifestyles. There is evidence of service users engaging in social and recreational activities of their choice. The service users are supported to exercise as much choice as possible. Staff are at the forefront of preparing and supporting the service users to promote their independence. Risk assessments have been formulated for each individual, setting out the risks and the plans for dealing with those risks. All staff spoken with have good knowledge of the assessed risks and the plans for managing those risks. Staff feel well supported by their peer group thus ensuring high moral amongst the staff team. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 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 Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 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 systematic ways in which admissions are arranged enable service users to obtain sufficient information about the service before making up their mind. This ensured that the prospective service users and their families are confident that their needs and aspirations would be met at the home. EVIDENCE: There have been no new admissions to the home for some considerable time. However, the recent arrangements for admission to the sister-home that the staff have been involved with provided evidence of good practices relating to the home’s admissions policy. The manager described the home’s current admissions procedure, which would include receiving full and detailed assessment from the responsible social worker. He also stated that the home would carry out their own assessment to ensure that the needs of the prospective service user could be met. Gradual introduction to the home is an essential part of the admissions process. Two service users have recently been re-assessed with the view to providing them with independent living service in the community with staff support. The two service users have chosen to move out of residential care setting into a supported living accommodation. The service users were provided with sufficient information about the service and also supported by the staff to pursue their wish to move into supported living settings. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 9 Service users files were examined and these contained details of assessments carried out to identify their care needs, and care plans being formulated to address those needs. There was evidence of regular reviews and evaluation of care plans. This ensured that the care provided for the service users were relevant to their current needs, taking into consideration their own wishes and aspirations. There was evidence of service users being supported to take part in the formulation of their care plans, thus providing them with the opportunity to be involved in decisions about their care. In this way the individual’s wishes are established and provisions made in the care plans to meet those needs. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. The monthly review system, which involves the service users allow for the changing needs of each service user to be addressed through the care plans. This ensured active participation by the service users in the planning of their own care. Service users are regularly consulted about the their care needs and aspirations and these are reflected in the service users life plans. EVIDENCE: The files showed evidence of service users being involved in the formulation and review of their care plans. Staff who were spoken with confirmed that the process of involving service users in the planning of their care has the benefit of ensuring that the care and support that is provided is exactly what the service users require. One service user was spoken with at length and she indicated that the staff recognise her right to be involved in her own care. She indicated that the processes give them sense of empowerment and participation. The records of the service users provide further evidence of them making decisions and choices about their daily routines. Issues discussed included
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 11 social activities, holiday arrangements and meals. Staff confirmed that consultation with the service users allow them to decide on activities of their choice and as a result they feel they have control over their lives and that the staff and the routines in the home had not taken over their lives. Contained in the service users’ files are individual risk assessments, which have been carried out by the staff. The risk assessments cover areas such as assistance with domestic chores, transport journeys, eating out, kitchen safety, shopping trips, pub visits, and bus journeys. The process ensured the safety and wellbeing of the of each service user, both within the home and outside the home, while at the same time enabling them to lead independent life as much as possible. Records relating to the service users and the day to day management of the home are kept securely and in line with the provider’s policies on record keeping. This ensured that information about the individuals are safe from public access. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15. Practices ensure that the service users participate in all aspects of daily living activities including involvement in their personal care and in social and recreational activities, thus promoting their self-esteem, health and wellbeing. Staff support the service users in making decisions for themselves, thus promoting their independence and right to make choices. EVIDENCE: Three service users were spoken with about the various social activities that they are involved in, including visits to local pubs, cinema, shopping, attending discos, theatres, horse riding, college courses and other community facilities which they found useful. There are also arrangements for indoor activities such as board games, video films and watching TV. These are documented in care plans and in daily activities record showing how these activities had benefited the service users. Some of the service users use public transport and taxi services to access community facilities and to visit places of interest. Entries in the daily
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 13 activities files showed that service users enjoy these activities and always look forward to them. The staff team support and promote family links with the service users. Two staff members confirmed that service users are reminded of important events such as birthdays for relatives and friends. This ensured that service users, who wished, are able to send good wishes cards to their friends and families, thus maintaining contacts with them. Practices observed indicate that staff enable and support service users to make independent decisions for themselves. Staff were asking service users what activities they would like to engage in. Service users were supported to make choices about meals and other activities. This created an atmosphere of independence, respect and empowerment amongst the service users. Past menus indicated that service users receive homely and nutritious meals. There is also evidence of service users going out for meals, thus ensuring their involvement in community activities. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Service users health care needs are identified and arrangements are made to promote these, including good arrangements that ensured the safe administration of medicines, which promotes service users health and wellbeing. EVIDENCE: A number of care plans and risk assessments were examined. These clearly identify specific care needs and the ensuing care programme is the result of consultation with service users and other professionals. Records show that agreed care plans are followed by all staff and these are reviewed regularly to ensure that the care provided is current and relevant to the service users needs. The service users have input in reviewing their care, thus promoting their right and involvement in the own care. Service users are supported to attend GP service and other health related appointments such as out patient appointments, district nursing support, appointments with dentists, opticians and chiropodists. These visits are recorded in the individual life plans and in daily report books as evidence of the health care they have received. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 15 Service users have access to psychiatric and behaviour psychology services thus promoting their psychological and emotional wellbeing. Service users files indicate regular access to such specialist medical services. There is no service user who currently manages their own medication. The drugs administration system was inspected and found to be well maintained and there was no discrepancies found in the system. All staff have who are responsible for administering medicines have had suitable training in the handling of medication. Detailed written policies on medicines were also available for inspection. These measures ensured that the healthcare needs of the service users were maintained. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: The standards relating to this part of the section had not been assessed on this occasion. These standards were examined at the last unannounced inspection of the 23 June 2005. All the standards were met and at this inspection it was observed that the standards have been maintained and remain satisfactory. Readers wishing to read about these standards should refer to the last inspection report of 23 June 2005. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30. The home provides comfortable accommodation for each individual, including single rooms and facilities that promote independence. The home is clean, well maintained, which enhance the self-esteem and meets each person’s needs. EVIDENCE: The home is designed to meet the needs of people with a wide range of physical disabilities. The corridors and doorways are wide enough to allow easy access and comfortable movement of people. All rooms are single occupancy. The generous room sizes allow individual service users to furnish their rooms with personal items while leaving sufficient spaces for movement within their rooms. The home continues to maintain good standard of hygiene. On the day of the inspection the home was clean and maintained to a good standard. Antibacterial hand washing facilities were available in the toilets. The kitchen, lounge and bedrooms were all noted to be clean and in good order. Laundry machines have programme facilities to meet disinfecting standards, thus ensuring good control of infection practices.
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 18 Some parts of the home had benefited from a recent re-decoration programme. The furnishing and soft furnishing in the lounges have been coordinated to provide a pleasant environment, thus enhancing the selfesteem of the service users. There are policies and procedures in place regarding safe handling and disposal of clinical waste, dealing spillage, the provision of protective clothing and hand washing. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 19 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. There are sufficient staff in numbers and appropriately trained to meet the needs of service users. Staff understand their role and responsibilities which ensured that the care needs of the service users are met. EVIDENCE: Examination of past rotas showed that the home consistently maintains adequate staffing levels to meet the needs of the service users. The manager confirmed that the Trust adheres to proper employment policies in recruiting staff. It was evident from discussions with staff that the proper recruitment procedures have been followed by the manager. This included completion of application form, job description, contract of employment, two satisfactory references, interviews, and Criminal Records Bureau checks. The Trust has a comprehensive induction plan for all newly appointed staff. The manager confirmed that all new staff are provided with an induction programme and later followed by LADAF training. All staff have been provided with statutory training and other training such as anger management and autism awareness. However, the induction details for one staff member indicated that a substantial part of the six-week induction programme took place on the same day, although the manager indicated that was an administrative error. The manager was asked to review this to ensure that the
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 20 dates correspond with the actual days when the instructions were given to the new employee. The staff training log contained details of the training provided for the staff which included moving and handling, first aid, fire safety training, food hygiene, challenging behaviour management, protection of vulnerable adults awareness training, management and prevention of anger management and conflict resolution. Autism workshop had been provided recently for all staff thus providing greater understanding of the care needs of people with the condition. A number of staff were spoken with during the inspection. They all confirmed that they have been issued with individual job description and terms and conditions of employment. The staff confirmed that they have all received copies of the General Social Care Council code of conduct. In discussions with one staff member, she described the recruitment and selection process and this was in line with the Trust’s written policies. She confirmed that references were taken by the Trust and CRB enhanced check was done for her before she commenced work. It was evident from discussions with staff and the manager that the Trust follows it strict recruitment guidelines and in so doing ensures that the service users are safeguarded from any form of abuse. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 21 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, 40, 41, 42. The manager is appropriately qualified and experienced which, ensured that service users benefit from a well run home that promotes their health, safety and welfare. EVIDENCE: The standards relating to this section of the report have been largely maintained. The positive comments and views expressed in the last inspection report still apply. These comments and views have therefore been re-stated here as confirmation of the standards being maintained. The manager is a trained nurse and has NVQ level 4 in management. He has considerable experience working in the healthcare setting and in managing a care home. Such training and experience has been beneficial to the service and the service users. The staff who were spoken with indicated that the manager runs the service for the benefit of the service users and has positive relations with the staff. However, some staff expressed concerns about the level of management
Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 22 support that they would require in situations, which at times could be very stressful. Action must be taken to address these issues as failure to do so may lead to low staff moral and a negative impact on the care provided. The Trust has produced detailed Health and Safety policies and copies of these were made available for inspection. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). The manager stated that all staff have had training in food hygiene, fire precaution and first aid. Records relating to fire instructions had not been maintained. Record need to be maintained showing which staff members have received fire instructions. All portable appliances have been tested. A record is maintained of monthly water temperature tests in the home. There is evidence of regular servicing of fire equipment, gas and electrical appliances. All the servicing records that were examined were up to date. These included fire fighting equipments, water treatment, electrical installation and gas servicing. Up to date servicing and maintenance of these services and equipments ensure a safe environment for the service users and the staff who work there. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hylton Bank (28) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 3 X DS0000015740.V254175.R01.S.doc Version 5.0 Page 24 No 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 YA1 Regulation 5(1)(f) 4(1)(c) Requirement The statement of purpose and service user guide should be reviewed to include name of Commission for Social Care Inspection and not social services inspection unit. All staff must receive regular supervision and suitable arrangements for identifying individual support needs and arrangements made to address them. Timescale for action 01/06/06 2 YA36 18(2) 01/04/06 Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA24 YA33 YA35 YA39 Good Practice Recommendations A record of fire instructions should be kept indicating which staff members have received fire instructions. Regular staff meetings should be undertaken. The staff induction programme should be dated to correspond with the dates that the employee received the instructions. The service user survey should be complied into a report format for easier access. Hylton Bank (28) DS0000015740.V254175.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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