Inspection on 23/05/05 for Hawthorns

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Hawthorns 05/07/07

Hawthorns 15/01/07

Hawthorns 14/06/06

Hawthorns 03/02/06

Hawthorns 02/09/04

Hawthorns 06/05/04

Hawthorns 13/10/03

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

CARE HOME ADULTS 18-65 Maytrees 2 Bushey Ground, Brize Norton Road Minster Lovell, Witney Oxfordshire OX29 0SW Lead Inspector Lilian Mackay Unannounced 23 May 2005 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 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 Stationary 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. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Maytrees Address 2 Bushey Ground, Brize Norton Road, Minster Lovell, Witney, Oxfordshire, OX29 0SW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01993 776336 01993 709056 Meriden Homes Limited Miss Jacqueline Godwin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 02 & 10 September 2004 Brief Description of the Service: Maytrees is a six-bedroomed bungalow situated in a quiet location in Minster Lovell, a village close to Witney, West Oxfordshire. The home is close to shops and other amenities, to include a post office, butchers and 2 general stores located within a 1/2 mile. Residents are taken out regularly in the home’s mini bus. The home provides residential care for up to six adults with a mild to moderate learning disability and associated challenging behaviour, under the age of 65. Residents can communicate verbally. The home is owned and managed by Meriden Homes Limited. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. These unannounced inspection visits took place over two days - between 5.15pm and 8.30 pm on Wednesday 23rd May 2005 and between 2.50 pm and 3.30 pm on Wednesday 6th June 2005. A feedback meeting took place on 13th June. The purpose of these visits was to see how the home is meeting the National Minimum Standards for care homes for adults 18-65. The first part of the inspection was undertaken by one inspector and the second by two. The inspectors spent time with the residents and the members of staff on duty. The inspectors observed staff interactions with those being supported and examined staff files, the staff rota, minutes of team meetings and two residents’ records. The home’s Certificate of Registration was displayed and indicates that the home is registered to provide care to six adults under 65 with a learning disability. The needs of residents at this time were described as mild to moderate learning disabilities and autistic spectrum disorder. The home is not registered to provide care for any other category and therefore has to consider the needs of its clients developing dementia. However, should they wish to change this, a variation application may be made accordingly. Residents’ mental health needs are met by the community mental health services. The home is well maintained and provides adequate space both inside and out for those being supported. One resident said, “I want to join a theatre group,” One resident said, “X does her job very well. She’s a nice person. She respects the clients. She makes the clients feel happier here. She helps the other staff as well. They are pretty good as well. I used to have really bad behaviour, swearing at X and calling her rude names. I’m on my last chance here. I used to smash windows and break stuff at my old school. I was on the wrong medication. My behaviour is much better now.” At a recent review one resident’s care manager and advocate were quoted as being “Very pleased with how well X is settling in and how happy and relaxed he appears.” One staff member said, ”It would have been nice to have had more of an insight into service users. We handle the guys well. I’d like more petty cash to do a planned event once a month”. On discussion, the proprietor confirmed that additional petty cash can be made available when required. One staff member said, “I wish I had had more information and guidelines on handling X. X really needs two and you need to know the moods. We need to work together more with X.” The home have since confirmed that all staff are met with prior to admission and sign to acknowledge receipt of service user Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 6 information. One staff member said, “The courses are better and the staff team are more relaxed. We get supervised monthly and bigger ones every three months.” One staff member said, “I would like five on the floor instead of four”. The inspector noted that the home was meeting its staffing obligations. One staff member said, “I wish they could go to more places where they can meet with others with a learning disability”. The proprietor confirmed that there is a club on Saturdays that residents can attend. The provider has since informed CSCI that the home tries to arrange a special trip for service users every month, in addition to other activities. The inspectors would like to thank the residents, staff and owners for their assistance, hospitality and courtesy during this inspection. What the service does well: Residents’ needs are fully assessed before they come to live at the home. There is a key worker system in operation where the care of each resident is the responsibility of a named member of staff. Residents have the opportunity to keep livestock. The house shopping is done more frequently and more use is made of fresh fruit and vegetables. A range of activities is provided for residents. Staff demonstrate competence to the pharmacist giving the training before they are designated to administer medications. Staff are interviewed by the manager and the deputy manager. Staff are well supervised. The key worker system and person-centred planning combine to provide a consistent approach. The company offers employee of the month awards. Management has remained constant since 2002. There is a person-centred approach to staff training. Both the manager and the deputy manager are doing the Registered Manager’s Award and the deputy manager is going on to do an NVQ level 4 in care. There is a commitment to NVQ level 2 training. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 7 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. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 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 standard(s) 2,4 and 5. Residents’ needs are assessed prior to admission. There is a three-month “trial” period. Each resident is given a contract. EVIDENCE: Assessment is done by care managers from health and social services and a copy of the care plan is obtained by the home. A care needs assessment is also done by the home. Evidence was seen of a three-monthly review of a new resident’s care needs. One of the two contracts requested was seen. It was reported that the other contract was kept by the resident in his room. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 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 standard(s) 6,7,9 and 10. The home ensures that care plans, containing the recommended aspects of personal and social support and healthcare are drawn up, when advised, which may not always be on admission. These are based on the care management assessment and the home’s own assessment. Limitations on human rights are not fully evidenced as being in the resident’s best interests. Risk assessments are undertaken but not dated. Residents’ records are not kept securely. EVIDENCE: A care plan was not devised on one resident’s admission to the home, but three months after admission, on psychiatric advice. Staff demonstrated sensitivity to and knowledge of ethnic needs as regards skin and hair care. Physical intervention was seen being used with one resident and evidence was seen in his care plan supporting this. This resident’s care plan should Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 11 document the circumstances under which this is permissible and the methods to be used. These should be reviewed at least six monthly as part of the care plan reviews. It was evidenced that residents’ care is reviewed at least six monthly, if not more frequently. Risk assessments are carried out for the use of knives, electrical appliances and absconding. These should be dated to help identify when review is due. Residents have access to residents’ personal files kept in the office. Management are going to address this issue by means of a risk assessment. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 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 standard(s) 11,13,14 and 17. Residents participate in a range of developmental activities. Residents are involved in the life of their local community. Residents engage in appropriate leisure activities. Residents have appropriate personal and family relationships. Residents are given a healthy diet. EVIDENCE: Residents make phone calls, wash up, lay tables, read for leisure, work on numbers and time, do the laundry, clean their rooms, cook, do the home’s shopping, do paperwork, write letters, watch DVDs and videos and spend time with the animals. In the community residents attend the gym, play pool, walk round Witney, go out in the home’s mini bus, go to the post office, attend college and the local library, go boating on the Thames, learn bus routes and go out for coffee. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 13 Residents have an annual holiday. Evidence was seen that residents are encouraged to maintain contact with parents and boyfriends by writing or telephoning or visiting. Residents are encouraged to eat together, separate from staff, to encourage them to socialise with each other. Evidence was seen that the house shopping is done more frequently and that more use is made of fresh fruit and vegetables. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 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 standard(s) 18,19, 20 Consistency is ensured by residents having designated key workers. Timely community health checks are undertaken. Medication is administered by competent staff. Homely remedies are not agreed in writing with residents’ GPs or pharmacists. EVIDENCE: There is a key worker system in operation where the care of each resident is the responsibility of a named member of staff. Records are kept of visits by community health workers such as GPs and psychiatrists. Homely remedies have been agreed verbally with residents’ GPs or pharmacists. Medication training is done by a well-known pharmacy and staff have to demonstrate their competence to the pharmacist giving the training before they are designated to administer medications. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22. The complaints procedure is not up to date. EVIDENCE: The existing complaints procedure, found in the Service Users Guide, indicates the regulatory body to be NCSC. A recommendation will be made to change this detail to the current regulator CSCI. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 16 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 standard(s) These standards will be assessed at the next inspection. EVIDENCE: Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34 and 36. Staff compliment on the day of inspection met the standards. Staff are encouraged and enabled to undertake NVQ training. Specific training has not been received by all staff in respect of all residents. Inconsistent responses are given when residents seek physical affection from staff. Whist staff receive two hours training in autism, staff informed the Inspector that training is not provided in mental disorders and infection control. Staff work 12 hour shifts to ensure there is no break in activities undertaken with residents, and satisfactory breaks are taken between shifts. Staff recruitment procedures need improving. The staff team had one vacancy. Staff recruitment procedures require improvement. All interviews are undertaken by two senior staff. Staff are well supervised. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 18 EVIDENCE: One staff member was not “signed off” as having been trained to meet one resident’s specific care needs. The inspector observed one resident being responded to differently by two members of staff when he sought physical affection from them. This issue is to be addressed through individual guidance in residents’ care plans. The staff sampled are either in the process of doing or have done NVQ 2 training and four staff have recently expressed an interest in doing so. Whilst the home is not registered to provide care to those with a mental disorder or dementia, care is at present provided to residents with early-onset dementia and with schizoaffective disorders. Staff receive no training on mental disorders but do receive two hours training on autism. No reference was seen in one member of staff’s training of how to respond to allegations by residents and psychotic behaviour. Training in infection control is not provided although double incontinence is an issue. Such training has been organised for July. Whilst staff work 12 hour shifts they have either three or four days off per week to recover. Such a shift pattern facilitates activities with residents, provides consistency and ensures there are not too many staff in the home at any one time to upset residents. There are either three or four staff on duty from 8am to 8pm. Night staffing consists of two members of staff awake on duty. The rota showed that in one week, six night shifts were done by agency staff. This was due to the need for the home to ensure no undue problems occurred during a new service user’s admission period. Two agency staff are never on duty together at night. Staff are sometimes employed before two written references are received; where references are received and it has been highlighted that disciplinary actions were taken, it should be documented why the decision to employ has been taken; the home should always obtain reasons why applicants left their previous employment working with vulnerable adults. The good practices observed in the home include taking prompt disciplinary action, when required, keeping photos and proof of identity of staff on file, interviewing in twos and following up written references with telephone calls. Six monthly staff performance reviews and bi-monthly staff supervisions are undertaken and recorded well. The home has two NVQ assessors. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 and 41, Management employed by the home are undergoing appropriate training. The required records in respect of Section 17 leave are held by the home. Application forms do not ask applicants to indicate any cautions received. EVIDENCE: The manager has been in post since 2002. Both the manager and the deputy manager are doing the Registered Manager’s Award and the deputy manager is going on to do an NVQ level 4 in care. Both are NVQ assessors. Staff reported having team meetings every 2-3 months. As good practice these minutes should record who is present. Evidence was seen of regular and well-recorded supervision sessions. Application forms, whilst asking applicants to list offences, does not currently ask them to also list any cautions received. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 20 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 x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 2 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Maytrees Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 x x H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 21 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. 2. 3. Standard 10 34 35 Regulation 17(1b) 19 18(1c) Requirement Timescale for action 31.08.05 Schedule 3 records must be kept securely. Schedule 2 records must be kept 31.08.05 of all staff working at the home. All staff must receive appropriate 31.10.05 training. 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 7 Good Practice Recommendations When physical intervention is required ensure care plans document the circumstances under which this is permissible and the methods to be used. Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South Cowley, Oxford OX4 2SU 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 Maytrees H57-H08 S28948 Maytrees V225857 230505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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