Inspection on 18/05/06 for The Hadlows

This inspection was carried out on 18th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hadlows 27/11/07

The Hadlows 27/02/07

The Hadlows 22/02/06

The Hadlows 21/09/05

The Hadlows 01/11/04

The Hadlows 16/06/04

The Hadlows 22/11/03

The Hadlows 03/06/03

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

CARE HOME ADULTS 18-65 The Hadlows 128 - 130 Hadlow Road Tonbridge Kent TN9 1PA Lead Inspector Maria Tucker Key Unannounced Inspection 18th May 2006 09:30 The Hadlows DS0000023879.V294113.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 The Hadlows DS0000023879.V294113.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. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hadlows Address 128 - 130 Hadlow Road Tonbridge Kent TN9 1PA 01732 355646 01732 359527 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) Evesleigh (Kent) Limited Vacant Care Home 10 Category(ies) of Physical disability (10) registration, with number of places The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users accommodated will have been assessed as having an acquired brain injury. To accommodate one service user whose date of birth is 19 July 1939. Date of last inspection 22nd February 2006 Brief Description of the Service: 128 and 130 Hadlow Road are two houses one an end terrace property the second adjoining. Both houses have three floors. It is registered for ten people with a diagnosis of acquired brain injury and offers all single rooms, five rooms in each house. The homes are not suitable for people with significant mobility difficulties as there is no lift between floors. Communal facilities include 2 lounges and 2 dining rooms on the ground floor. The home is located approximately 1½ miles from the centre of Tonbridge where there are all the facilities of a town including shops, eating places, pubs, churches, Post Office and banks. The nearest main line station is approximately 2 miles away and the nearest bus stop 50 yards away. The home has limited car-parking facilities to the front of the building and on street parking to the side of the property. There is a garden to the rear of each house which service users are able to use. The fees are £1112.00 per week as listed in the pre inspection questionnaire. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first key inspection in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 08.40am until 17.00pm. The regulatory inspector was accompanied for part of the inspection by the Team Leader Adult Services Kent Social services. The visit was spent talking directly with two service users, 3 care staff, the deputy manager, a manager from a sister home and the area director. Some judgements about quality of life and choices were taken from direct conversation with service users followed by discussion with care staff and evidencing from records held at the home. A partial tour of part of the premises was undertaken. The pre inspection questionnaire has been received. Comment cards have been received comments included: • “Sometimes there is not enough staff to take me out”. • “I can usually do what I want but has not always been possible due to how many staff are here”. • “Sometimes not enough staff to do what I want”. The manager has left since the last inspection the manager appointed to replace her has also left. A new manager is due to commence shortly. A number of concerns raised in previous inspections have been pertaining to the previous leadership and management of the home and it was acknowledge from this visit there have been movement in a positive direction from February to address the lack of management. The home continues to have support from the manager and senior staff from a sister home and regular active support from the area director. The home is under new ownership as from July 1st 2005. This home continues to be a failing service with poor inconsistent outcomes for the service users. It is acknowledged that although many things have been put into place to improve the home, the low staffing levels has resulted in this being an impossible task for staff to achieve given the high needs of the service users and the specialist service required. As stated in the last report the external management has failed to fully recognise or address this adequately. The continued commitment from the staff at the home and the support from the area manager and manager from a sister home has enabled improvements to be made and the recourses maximised. There have been two adult protection alerts raised on the home since the last inspection. Both are currently on going. Following this key inspection enforcement notice have been issued in relation to inadequate staff, which will require a follow up visit to ensure compliance, if The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 6 non-compliance is assessed then further legal enforcement action will be taken by the commission. What the service does well: What has improved since the last inspection? The statement of purpose and service users guide has been amended and is in the process of being further updated due to changes. The level of support from the area manager and manager from a sister home has led to more formalised leadership, direction and management. Systems and procedures have been put into place such as formalised hand over, communication recording and daily service users notes. The care plans have been improved upon with the formats having changed to allow for transparency and a more service user focused plan of care. Risk assessments have been undertaken. Training has been increased with further training identified and booked. An administration support staff has been working in the home to assist with the management paperwork. Staff meetings and service users meeting are taking place. Regular Regulation 26 visits are undertaken. The mixing and socialising of service users from both houses has increased, as has the working in both houses of staff. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 7 Adult protection alerts have been raised for suspected adult protection issues and Regulation 37 notifications made to the CSCI. Service users now take an active role in the daily running of the home such as cooking and cleaning tasks. 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. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has formats and systems in place for perspective service users should a vacancy arise. EVIDENCE: The statement of purpose and service users guide have been updated and amended. Due to recent changes these documents are currently again in the process of being revised. There have been 2 service users admitted in the last 12 months and 2 discharges. No new service users have been admitted since the last inspection. Music therapy has commenced on a weekly basis. There was no evidence that occupational therapy is provided. Signed contracts ‘placement agreements’ were contained in service users files, as were details of the services provided. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users have inconsistent care and support that does not meet their needs or aspirations. EVIDENCE: As identified in the last inspection report a service user has been admitted without their personal health needs being fully considered in terms of the location of the washing and toileting facility and peer group. A comment made by a health and social care professional in a comment card stated “I have 1 client at this residential home previously, staff have been helpful and used initiative in a difficult case. They were aware that the placement was perhaps inappropriate for this client, but worked well to overcome difficulties”. There was not enough staff in one of the units to meet the service users assessed needs. This remains unresolved despite the efforts of the home to hold a review with the placing authority. The care plans have been improved upon and are now based on individual lifestyle planning. Four of the service users in one unit have been assessed as The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 11 requiring 1 to 1 support. The limited staffing arrangements has resulted in a care plan that is clear and detailed but inconsistent in being followed. Four service users require escorts when accessing the community. The care plans detailed individual support is required for daily living tasks and independence skills training. Of the nine comment cards received from service users 1 had ticked to say they always make decisions about what they did each day, 6 usually did and 2 sometimes did. The individual choice and decisions for service users are compromised due to the low staffing arrangements. A recent review held for a newly admitted service user was very positive and indicated that the staff had made great efforts with the limited recourses in meeting the needs and planning for future needs to be met. Service users have identified key workers and expressed who they were and how well they were supported by them. There are risk assessments contained in the care plans. These are comprehensive and informative detailing what action is needed to minimise risk. A risk assessment conducted in relation to an adult protection issue was not followed during the time of the inspection. The risk assessments identify that 1 to 1 staffing support is required. The staffing arrangements in one of the units does not allow for this. The care plans contained information relating to difficult or challenging behaviours. One professional assessment detailed action to be taken in relation to a particular behaviour. It was noted in the daily records that this had been implemented effectively on this occasion. The care plans were not detailed enough for staff to follow and a consistent approach to be taken by all staff. Evidence from staff records and meetings that staff are reminded / instructed to take a consistent approach and to follow the care plan. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 16, 17 Quality on this outcome area is Poor. This judgement has been made using available evidence including a visit to the service Not all of the service users who require 1 to 1 support with leisure and occupation can expect / or be enabled to have regular meaningful activities other than household chores. Specialist treatment appointments are kept when staffing arrangements are sufficient. EVIDENCE: The pre inspection questionnaire states that breakfast and lunch vary in the times they are taken as service users are supported and encouraged to prepare these meals for themselves. Service users on a 1 to 1 basis with staff prepare the evening meal. Snacks and drinks are available for service users to help themselves as they choose. Service users choose and plan the weekly menu. The pre inspection questionnaire lists various activities including day services; college; adult education; shopping; visiting areas of interest. The in house activities included cooking on a 1 to 1 basis quiz nights, socialising with peers The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 13 and every Tuesday afternoon a music therapist visits the home for group and 1 to 1 sessions. The home provides restricted opportunities for service users to go out due to limited staff available. Staff spoke at how they have few staff that can drive the house care but they did “try to get everyone out when they were on at the weekend and Hastings was a particular favourite”. Staff spend much of the time escorting service users to their respective activities and picking them up again. It is acknowledged that some service users who have established activities or regular routines are supported by staff to maintain these. Those service users who require extra support or who have not got identified day services or activities tend not to be supported with activities other than daily household tasks. One service user has no peer group of their gender or activities to support this need despite expressing a desire for this. One service user who is a football supporter has been to see every home game with staff. Service users are escorted to visit relatives. Staff have made a file available of local activities. A service user is receiving specialist support to overcome an addiction problem. It was noted that one appointment was missed and no further appointments have been made despite notes in the communication book for this to be done and an entry made describing the service users anxiety at having no appointment. The daily routines are as flexible as possible with service users getting up at their preferred times. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Service users can expect to have their health and medical needs identified and appropriate referrals made. Some health appointments are dependent on staffing to ensure they are kept. EVIDENCE: A music therapist visits the home for individual and group sessions on a weekly basis. The pre inspection questionnaire lists an occupational therapist is available for 1 to 1 sessions and advice. Referrals to physiotherapists are made via the General Practitioner, as has a chiropodist referral. The care plans indicated specific support that service users needed. Staff were aware of individual preferences and through observations of interactions between staff and service users support was tailored to preferences. Various health and specialist consultancy appointments were arranged and in the diary. Four appointments had been missed / cancelled including a doctors appointment and an outreach appointment. Overall the medical and health needs are recognised and the home are pro active in seeking specialist referrals. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 15 The guidance for PRN medication needs to be recorded in the care plan / medication policy and procedures with specific details of when; how many and what medication is given for. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users cannot expect to be protected. EVIDENCE: The pre inspection questionnaire states 2 complaints have been made and both have been substantiated. A service user who had made a complaint regarding smoking while eating informed the inspector that this had not been resolved so they now choose to eat all their meals in their room. An incident form has been received regarding an altercation between 2 service users when one service user objected to another service users behaviour. There have been 4 admissions to accident and emergency. The pre inspection questionnaire lists that 3 service users maintain their own benefit books. Following an adult protection alert and investigation by the police and social services appropriate measures to minimise the risk have not been followed through to ensure the safety and welfare of service users involved. This was observed during the inspection, as one staff was unable while undertaking personal care support with another service user to monitor as per guidelines identified in a risk assessment. The petty cash tin that contained service users money did not balance a receipt for petrol was noted to have been paid by a service user; another service user had many cheques that had not been paid as an account for them has still not The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 17 been opened. The inspector discussed with a service user how they were being supported by staff who kept their money for them as agreed in their care plan. They commented that they “not often have a chance to spend money”. The team leader from Kent social services department was present for part of the inspection to follow up on a current adult protection alert. The home has been very pro active in reporting possible allegations of abuse and in attending multi agency meetings. Due to the complex nature of the service users and the staffing levels service users are placed at risk. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Service users live in a generally comfortable and homely environment that has some areas, which need to be refurbished. EVIDENCE: The environmental health officer visited the home on 16th May 2006. Legionella tested on 12/10/05. There have been vast improvements made to the cleanliness of one unit. The inspector found the unit to be fresh and clean with service users being supported to maintain all communal areas of the home. The kitchen in one house remains in need of refurbishment and no identified timescales have been given to undertake refurbishments and replacements as identified during the last inspection. Work needed includes the bathroom that has a broken sink and flooring and walls that cannot be suitably cleaned; the kitchen cupboards and units fixed or replaced; the dinning room chairs replaced; the utility room flooring and kitchen floor replaced; the back door glass panel having reinforced glass. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 19 There remains no evidence that service users with mobility problems have had their needs assessed by an occupational therapist in terms of aids or adaptations. The washing machine is domestic in nature the home has incontinence aids. The individual rooms seen were well equipped to personal taste. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality on this outcome area is Poor. This judgement has been made using available evidence including a visit to the service The low staffing levels; lack of senior support or specialised training, place service users and staff at risk and does not allow for the safe or effective running of the home. EVIDENCE: The staff rota was not complete it did not identify times staff were on duty; the capacity of staff or exact hours worked. The staffing levels were not adequate to meet the service users assessed care plan needs, the risk assessments or to complete the daily tasks and routines of the home. It was discussed that the levels are 2 per unit and staff are supposed to support the other house. The senior staff on duty expressed that this is not possible, as 2 staff are needed in each unit. There is not sufficient senior staff to provide an overall management at the home for day to day running. Evidence from document reading and discussions with staff that the roles and responsibilities of staff are not clear or do staff follow them. During the inspection the morning shift was so busy that 1 staff remained on their own in 1 of the units while the other staff was driving service users to services and shopping. There have been 37 shifts covered by bank staff in the last 8 weeks according to the pre inspection questionnaire. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 21 The staffing levels in accordance to the Department of Health residential forum for physical disabilities with 10 service users with low needs (as stated in the pre inspection questionnaire) comes out as 431.63 for learning disabilities this figure is 433.00. There are 12 staff employed. Evidence seen during the inspection that staff are in the process of being recruited. As stated in the last inspection report ‘evidence from the care plans, staff rota, staff tasks, skills and experience of staff, and staffing ratios are not sufficient to meet the homes stated purpose and the needs of the service users’. Two care staff have the NVQ level 2 or above award. The staff training matrix indicates training that has taken place there has been an increase in the training however due to staff shortages and availability of training dates some mandatory training is still needed. Staff do not have identity badges to support them in their roles if needed when out in the community supporting service users. Staff on the on call rota are sleeping in and on shift while on call. A staff from a sister home had no details held within the home or evidence of an induction into the home; this was identified during the last inspection. Some shifts on the rota had 3 staff on duty. The statement of purpose identifies that a minimum of 4.2 staff will be on duty form 7am to 10pm. Staff files did not contain records that supervision for all staff takes place. A list of who is to be supervised by whom is on the wall. There was no evidence on the rota of extra staffing to permit supervision. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service There are policies and procedures in place to protect service users and staff, with the limited staffing arrangements these may at times be compromised. EVIDENCE: The pre inspection questionnaire lists a record of maintenance and associated records; listed policies and procedures all of which had been reviewed either January or February 2006. The current management for the home consists of 1 deputy manager and 1 senior support worker a senior support worker from a sister home covering shifts for support. The home has no current manager this position has been filled very quickly by the home with a new manager due to take up post soon. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 23 The home is very open and transparent where staff are confident in speaking openly to the inspector and other staff members. Staff are encouraged to express their views and opinions in staff meetings and through the Regulation 26 visits. It is acknowledged that there is no manager at present and a lack of direct leadership although measures have been taken and put in place through the area manager and manager from a sister home to provide a clear sense of leadership and direction. This is an area that has improved. As the home has not been owned for a year as yet a full quality assurance of the home is not expected to have been fully completed. There are some systems in place such as service users meetings to seek feedback. Good links with relatives provides feedback on an individual basis. The pre inspection questionnaire lists policies and procedures detailing when they have been reviewed. A referral has been made by the inspector for the infection control nurse to visit the home to give guidance and advice in this area. The filing cabinet containing staff personal records was not locked at the time of the inspection. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 2 32 2 33 1 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 3 1 X LIFESTYLES Standard No Score 11 1 12 2 13 X 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X X 3 3 3 2 3 X The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4(1)(c)Schedule 1 Requirement Timescale for action 29/06/06 2 YA6 15(2)(b) 3 YA7 12(2) 4 YA9 12(1) (b) The registered person shall compile in relation to the care home a written statement of purpose. It must include all items listed in Schedule 1. The registered person shall 29/06/06 keep the service users plan under review. In that care plans must be followed and formally reviewed by placing authorities. The registered person shall 29/06/06 so far as it is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. In that service users choices and opportunities are not restricted by staffing arrangements. The registered person shall 29/06/06 ensure that the care home is conducted so as to make proper provision for the care and where appropriate treatment, and supervision of service users. In that Version 5.2 Page 26 The Hadlows DS0000023879.V294113.R01.S.doc 5 YA11YA19 13(1)(b) 6 YA32 18(1)(c)(i) 7 YA33 18(1)(a)(b)(c) risk assessments must be adhered to and followed. The support and intervention of staff with challenging or difficult behaviours must be more detailed for staff to follow and staff must be consistent. The registered person shall 29/06/06 make arrangements for service users to receive where necessary treatment, advice and other services from any health care professional. In that appointments that are made are kept and medical and health needs followed through. The registered person shall 29/06/06 having regard to the size of the care home, the statement of purpose and the needs of the service users, ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform. In that mandatory training must continue to take place; 50 of care staff to hold the NVQ level 2 or above; specialist training for this service users group is undertaken; staff in senior roles receive training in the areas of management that they perform i.e. supervision. The registered person shall 29/06/06 having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure Version 5.2 Page 27 The Hadlows DS0000023879.V294113.R01.S.doc 8 YA33 17(2) 9 YA36 18(1)(b)(2) that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to met their needs; training appropriate to the woke they perform; suitable assistance, including time off, for the purpose of obtaining suitable qualifications appropriate to such work. This remains outstanding from the last inspection subsequent action will now be taken by the CSCI. The home shall keep and 29/06/06 maintain a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. Schedule 4 7 The registered person shall 29/06/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs. The registered DS0000023879.V294113.R01.S.doc Version 5.2 Page 28 The Hadlows person shall ensure that persons working at the care home are appropriately supervised, in that regular supervision takes place; senior staff provide support to staff; the on call is firmed up so that staff on duty have back up. 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 5 6 Refer to Standard YA12 YA13 YA14 YA15 YA20 YA22 Good Practice Recommendations It is strongly recommended that all service users be supported to take part in valued and fulfilling activities. It is very strongly recommended that those service users who require support to participate in the local community have the opportunity and are encouraged to do so. It is recommended that service users have a range of leisure and recreation activities. It is recommended that service users have the opportunity to develop friendships with their peers of the same gender. It is strongly recommended that the PRN policy and procedure be firmed up as identified in the text. It is very strongly recommended that complaints made by service users are acted upon and that support is given to enable service users to raise complaints. This is in relation to a complaint that had previously been made and remains unresolved. It is strongly recommended that a review of the premises is undertaken so that the areas and equipment in need of replacing or redecorating are identified and that a time scale with planned refurbishments is made. This remains outstanding from the last inspection. It is very strongly recommended that a review be made as to the suitability of the location of the bathroom to meet the needs of a service user. That an assessment be undertaken as to any specialist needs for a service user DS0000023879.V294113.R01.S.doc Version 5.2 Page 29 7 YA24 8 YA27 The Hadlows 9 YA29 10 YA30 11 12 13 14 YA31 YA34 YA36 YA1 with mobility problems in the bathroom and toilet. This remains outstanding from the last inspection. It is strongly recommended that a review be made of the premises and equipment by a suitably qualified person to ensure that service users who have mobility or other physical needs are catered for. This remains outstanding from the last inspection. It is very strongly recommended that the washing machines have the specified programming ability to meet disinfection standards. That the utility rooms, bathrooms and kitchen are in a condition that enables them to be kept clean and hygienic. This remains outstanding from the last inspection. It is very strongly recommended that staff are clear about their roles and responsibilities and these are adhered to. That staff are provided with ID badges. It is strongly recommended that some details of staff working as bank staff from sister houses are kept and held within the home. It is very strongly recommended that procedures be in place for dealing with physical aggression towards staff. Training for this has been identified. It is very strongly recommended that the staff files are kept secure in that the cabinet is kept locked. The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Hadlows DS0000023879.V294113.R01.S.doc Version 5.2 Page 31 - 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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