Inspection on 21/09/05 for The Hadlows

This inspection was carried out on 21st September 2005.

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 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

The Hadlows 27/11/07

The Hadlows 27/02/07

The Hadlows 18/05/06

The Hadlows 22/02/06

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 Announced 21 September 2005 09:30 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. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Opus Living Miss Lisa Frances Bailey CRH Care Home 10 Category(ies) of PD Physical Disability (10) registration, with number of places The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 1 November 2004 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 Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 10.35am until 4.10pm. Time was spent meeting the manager and area manager going through various records and documentation. About one hour was spent meeting service users. Five staff on duty was spoken with. A partial tour of the premises was undertaken. Due to the nature of some of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussions with staff and evidencing records held in the home. No pre inspection documentations were received by the CSCI. Some comment cards were received from service users and their relatives. The home has had a variation made since the last inspection to combine both 128 and 130 into 1 home with 1 manager. The home is under new ownership as from the 1st July 2005. What the service does well: What has improved since the last inspection? As the home is under new ownership since the last inspection and has had a variation to combine both homes into one home this inspection this inspection is therefore treated as the first inspection with no requirements and recommendations carried over from the last inspections. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 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 standard(s) 1 Service users have a range of information to enable them to base the decision to move into the home. EVIDENCE: An updated version of the statement of purpose was given to the inspector during the inspection. A copy of the service users guide will be required to be forwarded to the CSCI. The statement of purpose has not been fully amended throughout to take account of the recent changes. It does not list a full schedule of accommodation provided or all items at listed in schedule 1. A copy of the service users guide, which is kept in the home for the service users, was seen briefly. It contained a lot of information for service users to refer to about the local area; opportunities for leisure and recreation and day time activities There have been no new service users admitted since the new company took over and the variation approved. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 9 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, 10. Overall service users can feel secure that their individual needs are met. EVIDENCE: A service user spoken with described how they were being supported with meeting their own goals and aspirations stating, “all staff are really helping me to meet my goal”. Evidence from the care plans and reviews that service users are being supported on an individual basis in identifying and meeting their care plan goals and needs. Service users spoken with were familiar with their key worker, care plans and their reviews. One service user stated “I do have a care plan and meetings with my key worker absolutely brilliant”. The service users have comprehensive pictorial information which they complete with the support of their key workers if necessary that details personal information; likes / dislikes; abilities and assistance needed. This does need to be filled in completely and taken into consideration i.e. preferences. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 10 The care plans were not updated from the review although there was evidence that they were being carried through. Risk assessments had not been conducted for activities such as self-medicating. A letter requesting permission for information to be shared was seen to be signed by a service user in their file. From discussions with staff and observations made confidentiality is respected. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 11 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, 12, 13, 14, 15, 16, 17 Service users have choice and opportunity to maintain and fulfil a lifestyle that is flexible and individual. EVIDENCE: Service users have daily activities and plans that they undertake which provide a structure and a means of achieving personal goals. A service user spoken with said, “life is wonderful, everything is”. Daily activities were individual with the weekends generally being free for personal leisure time. There was little evidence of structured activities within the home for leisure and recreation. Staff stated that service users tended to spend time in their rooms or those that were able went out and about on their own. Service users were enthusiastic about a recent holiday. Throughout the inspection all staff were seen and heard to be respectful towards the service users making time to listen to them and gently guiding and supporting them with daily activities. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 12 Service users spoke of how they visited relatives regularly. Some service users stay with family and friends for visits and holidays. The routine of the day is based around what each service user has planned and their respective commitments. Meals were said to be eaten at various times depending on who is around and who is doing the cooking. Some service users do their own cooking and shopping as well as having a budget where they can choose to eat out. Given that the service users plan and prepare the meals for each other in a group living shared way the personal preferences and mealtime arrangements should be considered. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 13 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, Service users have their medical and health needs promoted. EVIDENCE: Staff were familiar with the individual personal support that service users needed and described how they undertook these in a sensitive and discrete way. The staffing in one of the houses did not allow for a male staff to provide personal support if needed or requested. Evidence in the care plans and document reading that routine and specific medical and professional support and appointments are made. It was discussed that service users who are diabetic would have the procedure for managing and recording their food intake reviewed as currently the system only records meals taken at home. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 14 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, Service users have the opportunity to raise any issues and concerns. EVIDENCE: The home currently has a duplicate book for service users to complete should they wish to make a complaint. It was recommended that any complaints be made into a hard leaf book and the recording be made to mirror the complaints policy and procedure. There have been no complaints made and service users spoken with did not raise any complaints or issues of concern. Service users meet regularly with their key workers, this provides an opportunity to air any concerns. The comment cards received suggested that not everyone was aware of the homes complaint procedure and that a complaints had not been made. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 15 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) 24, 25, 27, 28, 30 Service users live in a homely atmosphere that is in need of a general clean and maintenance to make it as comfortable as it could be. EVIDENCE: One of the houses was found to be clean and tidy and generally well kept. The other house was not clean; the bathroom floor was in need of a wash and the bath mat and wicker chair in need of replacing for infection control; some of the areas in the kitchen such as the cupboard handles had grime imbedded in them and the carpets in need of vacuuming. The laundry room is situated at the back of the house, again one house was found to have limited space for sorting laundry; items stored inappropriately such as continence aids on the side; the dinning room table was dirty and would need to be cleaned before meals were eaten. The home has smoking areas in one house this was seen to be in every room except the service users bedroom and bathrooms. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 16 Overall although both houses provided a homely atmosphere with domestic fixture and furnishings they are in need of a general tidy and in some areas redecorating and renewal of old worn out furniture and fittings. The washing machine in one of the houses where incontinence aids are washed does not have a sluicing facility and there was no evidence of infection control policy or procedures. The service users have their own rooms which they are able to lock and can be viewed by invitation only. The garden areas were well used but require to be maintained so be fully safe and a place where service users can maximise fully. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 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, 35, 36 Service users are supported by staff in a positive way, which would be more constructive if staff received training and support. EVIDENCE: The home has a management structure consisting of a manager, seniors carers and carers. There is a maintenance person for odd jobs who visits when required. Each house has a minimum of 2 staff on duty at all times with a sleep in staff at night. The manager is supernumerary working 9 to 5pm Monday to Friday. The staffing rota provides staff from 7 to 3pm and 2 to 10pm, with extra bank staff covering extra shifts to support service users when needed. A service user spoken with stated that they have a key and if out late they let themselves in. From observations and discussions with and between staff and service users the support required was understood and provided in a way that was seen to be mutually respectful and enjoyable with positive interactions. The staff-training matrix indicated that not all staff received the mandatory training within a reasonable time period. The rota did not highlight any training for some time. Staff spoken with expressed that they would like more The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 18 training. Some staff are currently undertaking the NVQ award to work towards meeting the target of 50 of care staff with NVQ level 2. Staff spoken with stated that they did not receive regular supervision. Two staff stated that they had not had supervision for over a year. The senior carer of each house undertakes the supervision of care staff. Seniors receive supervision from the manager. The rota did not contain full details of the staff working or the exact hours. This was an omission, which had been made during printing the rotas and would be rectified. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 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, 40, 42 The service users do not have the benefits from a manager who provides clear leadership and direction in the running of the service. EVIDENCE: The manager continues to work towards attaining the NVQ level 4 award. Staff spoken with stated that they did not feel the manager gave them the support they required. Comments received from staff included “would like more direction and a more assertive approach” “I feel undirected” “manager does well promoting service users wishes and supporting individuals.” There was no evidence that both houses received support by the manager the visitors book in one house recorded that the area manager had visited on 3 occasions since the beginning of December 2004. Service users spoke positively about the home and the input that the manager provided to them. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 20 The home has policies and procedures that require to be updated and reviewed to take into account the changes in the home and ensure safe working practices and in line with the new ownership, for example infection control. During the inspection fire safety precautions were not adhered to in that the staff room is used for smoking by staff with no metal container for placing cigarettes in. Staff were unfamiliar with the fire drills and could not remember tests taking place. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 21 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 2 x x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 2 x 1 Standard No 11 12 13 14 15 16 17 3 4 3 2 3 3 2 Standard No 31 32 33 34 35 36 Score 3 2 x x 1 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Hadlows Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x 1 x H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 22 NA 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 YA 1 Regulation 4 (1) (c) schedule 1 Requirement The registered person shall compile in relation to the care home a written statement referred to as the statement of purpose. It must include all items listed in schedule 1 The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall, having regard to the size of the care home, the statement of purpose and the needs of 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. The registered person shall, having regard to the size of the care home, the statement of purpose and the needs of 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. A person shall not manage a care home unless he has the Timescale for action To be forwarded to the CSCI once completed. Action plan to be received by the CSCI by 5/11/05 Action plan to be received by the CSCI by 5/11/05 2. YA YA YA YA 30.1 30.4 30.5 30.8 13 (3) 3. YA 32.6 18 (1) (C) (i) 4. YA 35 18 (1) (C) (i) Action plan to be received by the CSCI by 5/11/05 5. YA 37.2 9 (1) (I) To complete Page 23 The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 qualifications necessary for managing the care home. 6. YA 42 23 (4) (a) The registered person shall after (c) (V) (d) consultation with the fire (e) authority take adequate precautions against the risk of fire, including the provision of suitable fire equipment; make suitable arrangements for reviewing fire precautions, and testing fire equipment, at suitable intervals; make arrangements for persons working at the care home to receive suitable training in fire prevention and to ensure, by means of fire drills and practices at suitable intervals. award by 1st January 2006 Action plan to be received by the CSCI by 5/11/05 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. 7. Refer to Standard YA 6 YA 9 YA 14.1, 3 YA 17.2 YA 18 YA 22 YA YA YA YA 24.1 24.6 24.11 24.12 Good Practice Recommendations It is recommended that the care plans are updated following a review or as the needs change. It is strongly recommended that full risk assessments are conducted in relation to independence training skills and activities. It is recommended that leisure and recreational time and activities are developed within the home. It is recommended that food preferences are considered when choosing meals and menu planning. It is recommended that a male staff is provided for both houses if requested or needed. It is recommended that the homes complaints policy and procedure be reviewed in the recording format. It is very strongly recommended that the a review of the premesis is undertaken so that the areas and equipment in need of replacing or redecorating are identified and that a planned maintenance and renewal programme can be made. Also that in areas where smoking occurs there is sufficient ventilation. It is strongly recommended that the H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 24 The Hadlows 8. 9. 10. YA 28.2 YA 36.1 YA 38.1 YA 38.2 enviornmental health is consulted regarding policies and procedures for infection control and current practices. It is strongly recommended that the home seeks advice in respect of the siting of the tumble dryer and the homes policy and procedures for fire prevention. It is strongly recommended that the garden areas are tidied and maintained. It is very strongly recommended that regular supervision takes place for all staff. It is recommended that the manager supports both houses and staff providing a clear leadership and direction. The Hadlows H56-H06 S23879 The Hadlows V238598 210905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent 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. 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