Inspection on 22/02/06 for The Hadlows

This inspection was carried out on 22nd February 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 8 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 18/05/06

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 Unannounced Inspection 22nd February 2006 02:00 The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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.V278755.R01.S.doc Version 5.1 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.V278755.R01.S.doc Version 5.1 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) Opus Living Miss Lisa Frances Bailey Care Home 10 Category(ies) of Physical disability (10) registration, with number of places The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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 21st September 2005 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 DS0000023879.V278755.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection conducted on 22nd February 2006 from 11.45 am to 16.20 pm. It was the second inspection for the year April 2005 to April 2006. The inspection was conducted by Maria Tucker. The home is under new ownership as from July 1st 2005. This home was overall found to be a failing service providing a poor quality of life for most service users who reside there. The home has declined rapidly since the last inspection. Both the internal and external management have failed to recognise fully or address adequately. It is acknowledged that there has been a new area manager recently appointed Mr Dion Allen. That a manager from a sister service, Mrs Lynda Wilson Smith has been requested to support the current manager in the management of the home. Including working at the home on a weekly basis to effect the changes urgently required. Some judgements about quality of life and choices were taken from direct conversation with service users individually, and collectively, as well as direct observation followed by discussion with staff. Information was gained through conducting case tracking exercises and document reading. Discussions were held with the Manager from another home Mrs Lynda Wilson Smith and staff. A partial tour of the premises was undertaken. It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected during the last inspection were not inspected during this inspection. This inspection focused on the areas found to be of serious concern and pose possible risks to service users. What the service does well: The care staff spoken with were aware that they were not meeting the service users needs or that they had the back up and management support to do so. Staff expressed that they are committed to improving the services and were open in voicing their concerns. Those service users who have been resident for a considerable period of time are settled and the staff are familiar with their needs. The menu reflects choice and service users particular preferences are catered for. Staff cook fresh home cooked meals. The area manager and manager from a sister home have been very quick to personally respond to a situation within the home. The responsible individual has made himself available to the manager and CSCI to discuss matters. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Staffing levels that reflect the needs of the service users and to ensure that care plans are carried out and service users are appropriately supported. Service users are admitted only if there is sufficient staffing and skills, and the assessed needs can be met. Leisure, recreation and day time occupation / activities to be increased with more opportunities for service users who require staff support to access the community. Risk assessments must be conducted on all activities and behaviours that may pose potential risks. Staff must have detailed information and advice / guidance on what action to take to deal with incidents and behaviours. Staff must receive induction training on adult protection within a reasonable period of time of being employed. Staff morale in relation to pay and changes of contract and terms and conditions needs to be addressed. Staff must be supported through effective management, and management structures and systems being put in place. A staff member commented, “It’s terrible down here, I used to love coming to work”. Adult protection alerts must be raised for all suspected adult protection incidents. The new providers have had a Statutory Requirement notice issued following a breech of notification of Regulation 37. The responsible individual Mr Tony Boyce responded on 5th December 2005 with details of procedures put in place The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 7 to ensure that are no further breaches. Evidence from the inspection concluded that these were not adequate or effective. The new owners must acknowledge that this is a specialist service, which relies on effective management and staffing arrangements. That decisions made at organisational level must be considered in the best interest of the service and for service users. The areas that are in need of being redecorated and refurbished for infection control and suitability to be considered as part of the homes ongoing improvements. The functions and tasks of the staff to be reviewed i.e. cleaning, shift running and senior responsibilities. The day-to-day management to be effective. 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.V278755.R01.S.doc Version 5.1 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.V278755.R01.S.doc Version 5.1 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, 3, Newly admitted service users cannot expect to have their specialist or assessed needs met. EVIDENCE: A revised copy of the statement of purpose was received by the CSCI on 9th January 2006. The statement of purpose listed music therapy and occupational therapy as included at present. A care plan viewed identified music therapy had not taken place or was there any staff identified on either rota as providing either of these therapies. Omitted from the statement of purpose was the relevant qualifications and experience of staff. A newly admitted service users file was inspected. The care plan did not follow the needs assessment in terms of activities or daily living needs. It did not specify restrictions on needing an escort when going out. There was no evidence that therapeutic or rehabilitation identified in the care plan i.e. music therapy had been assessed by a registered health professional. The service users personal health needs were not considered fully in terms of the location of the washing and toileting facility. There was not enough staff provided on the rota to meet the assessed needs. There was no evidence that relevant specialist and clinical guidance was adhered to for a service user admitted who required a specialist service. Staff spoken with whom had received specialist training stated this was a while ago. Another staff member had not received specific training to meet the specialist needs. The use of bank staff to cover shifts necessitates that these staff are all trained and familiar with the specialist service offered. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 10 Comments received by a service user recently admitted included “I was placed here” “I would rather go into a place where there are men and women” “I can’t stand this place”. Another service user commented, “I’m not getting on with anyone here”. A relative expressed their concerns of placing in an all male environment. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Some service users assessed and changing needs and personal goals are not met. EVIDENCE: A service users care plan did not contain details of how to manage identified difficult behaviours or provide specialist guidance and support. Staff detailed how a service user who had presented difficult behaviours had had a review and an agreement was seen and signed by the service user on proposed action if the behaviour continued. The behaviour continues. No action had been taken or subsequent arrangements made to review or amend the agreement. There was no evidence that specialist requirements for drug and alcohol misuse have been considered within the care plan. Five service users were identified as needing 1 to 1 support to go out. The restrictions and choice imposed through minimal staffing, poor structured activities and staff tasks, has led to service users sitting around. One service user could not remember when they last went out. Stating, “Sometimes go to The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 12 the shops with staff” expressing that they were lonely spending most of the time in the home. Risk assessments seen were very lengthy and complicated. They had not been reviewed nor had new risk assessments been conducted when events or incidents had occurred. Restrictions of choice and activities had been made as no risk assessments had been conducted. A service user expressed to the inspector that they did not want to be in the home, they wanted to live elsewhere with their own peer group. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 13 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, 17. Not all of the service users have the opportunity and support to enable them to have a reasonable standard of living or quality of life. The food is fresh and to individual taste. EVIDENCE: A care plan inspected focused on showering and getting up despite no formal activities following being supported to get ready. The care plan for a service user prior to moving into the home contained a range of activities and skills which were not continued with or where there opportunities to do so. There remained little evidence of structured activities within the home for leisure or recreation. The staffing levels and the support required to undertake activities did not match the needs. Staff were seen and heard to be respectful towards service users. Some service users were out during the inspection either at a day service or supported employment. Daily activities are recorded and planned. A service users occupation outside of the home was only for 1 day a week. A service The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 14 user detailed how they enjoyed football and had been to see their favourite team. The home has transport to enable service users to be taken out. Service users spoken with expressed that they wanted to mix with people who had the same interests and hobbies as they had. One service user did not have company of their own sex. There is male staff supporting service users in both houses. The service users meeting recorded food preferences that the service user confirmed had been provided. The food prepared by staff was fresh and home cooked. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 15 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 Service users regular routine health care needs are met. EVIDENCE: Evidence from the daily diary and service users notes confirmed that health and medical appointments continue to be undertaken. Staff were familiar with the individual support that service users needed. It was evident that staff did meet some of these needs and were aware that others were not met. A comment made by staff that due to the changes made by the new providers in reducing senior staff support and having minimal staffing on duty had resulted in a “lack of care”. There was evidence of external appointments for specialist therapeutic appointments for drug and alcohol services. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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): Service users cannot feel safe or that there complaints are acted upon. EVIDENCE: The service users minutes recorded the wishes of a service user not to have smoking at the dinner table during meals. This was not taken as a complaint or had it been resolved. The service user who raised this expressed that they understood that the person who did this was more disabled than they were but it was still “nasty”. The service is having difficulties at present with the behaviours of some service users. These have not been addressed adequately or have the staff or other service users been supported to manage this or protected from this. An adult protection alert has been raised. Evidence from document reading and discussions with staff and service users that an adult protection alert should have been raised earlier may have enabled action to have been taken to prevent possible abuse. The staffing levels are not adequate or the management action sufficient to protect service users or staff in incidents occurring. Staff discussed how service users were frightened to make complaints against other service users and how they had raised issues to the manager but these had not been taken seriously or dealt with. It is acknowledged that the support now being given by the manager from a sister home and the involvement of the new appointed area manager has had an immediate effect. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 17 A staff member had commenced working at the home prior their CRB having been returned. There was no evidence seen that the POVA checks had been done. A new staff member had been employed and had not had adult protection policies and procedures made available to them until several months after being employed. The induction format did not include adult protection. Staff were unfamiliar with the procedures of whom to contact and what action to take for outside agencies in relation to adult protection alerts. Staff were confident that there was always back up managers available. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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, 27, 28, 29, 30 Service users live in a generally comfortable and homely environment that has some areas, which need to be refurbished. EVIDENCE: During the inspection there were handy persons fitting a shelf over the washing machine for the tumble dryer to be sited and tiles laid in the utility room. The kitchen in one house is in need of refurbishment. It had areas around the sink and cooker, which had grime imbedded. A service user stated the kitchen “Draws a bit knackered” as things fall through, as it is broken. The utility rooms flooring and kitchen floors needs to be replaced. The back door has a glass panel that is not reinforced glass. The bathroom is in need of refurbishment. A service user, who for personal reasons needs to have their room close to the bathroom i.e. gets up at night to use the bathroom, is situated on the top floor. There was no evidence that another service user with mobility problems has had their needs assessed by an occupational therapist in terms of aids or adaptations. The minutes of a service user meeting detailed how a mirror lowered which had been done. The garden areas looked tidier. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 19 A copy of a letter sent to environmental health with infection control policies and procedures was received by the CSCI. It was not inspected if a visit had taken place or if any feedback had been received by the environmental health officer or fire authority. The washing machines are domestic in nature the home has to wash incontinence aids. One house was in a much better condition than the other. The carpets in one house were not clean and in need of hovering a service user pointed this out stating “look at the floor its dirty”. The radiators that have not been covered need to be risk assessed as to the potential danger. Both houses have smoking areas; ventilation in some areas was poor. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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 The home is not managed or has sufficient staffing to meet the needs of the service users. EVIDENCE: Staff were seen to be busy cleaning and cooking. Service users chatted to staff whilst they were undertaking tasks. At no time did the inspector see staff sit and spend time with service users in the lounge. In one house staff were supervising and supporting a service user with ironing and meal preparation. A copy of a contract was seen in a staff file. Staff were familiar with their support roles and had a good insight and understanding into the general needs of the service users. Staff expressed areas of their own knowledge and skill limitations. Staff who had worked at the home for a period of time had built up a good relationship with the service users as demonstrated by the interactions and in discussions of the specific needs. Training has improved with days identified on the rota and in the diary as having taken place or being planned. Not all staff have received the necessary training to enable them to provide a specialist service. Fire training has taken place and a day training on drug and alcohol misuse. Staff expressed dissatisfaction at the impact of the changes to the hours changed for handover to build up time for training. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 21 Evidence from the care plans, staff rota, staff tasks, skills and experience of staff, levels and frequency of incidences and recorded events indicated that the staffing ratios are not sufficient to meet the homes stated purpose and the needs of the service users. A staff meeting had been planned but had not taken place. Staff continued to express how they feel unsupported by the manger. A change in the staffing arrangements has led to only one senior staff and the manger to oversee the management and running of the home. The senior staff has no supernumerary hours to enable this role to be effective. Bank staff are used to cover shifts, there was no evidence that these staff had been inducted or updated as to the changing needs of the home and service users. A staff file inspected did not evidence that a thorough recruitment process had been followed. There was no evidence that a POVA check had been made and the CRB had not been received prior to commencing working at the home. Staff confirmed that regular supervision takes place. There was no evidence of procedures in place for dealing with physical aggression towards staff. Staffs described how some service users are verbally aggressive and abusive, but are not physically aggressive. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 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): The home is not managed effectively. EVIDENCE: The manager has not notified the CSCI if she has attained the NVQ level 4. The rota indicated that the manger provides support to both house as works identified days in both. Staff informed the inspector that this was not the case that the manager pops in for coffee and a chat. Fire safety training has taken place. PAT testing certificates were seen of electrical equipment. A company undertakes legionella tests. Standard 42 has not been fully inspected on this occasion. It has been addressed in other areas of the report. During the inspection there was nothing apparent that caused concern. The new providers have not submitted a business plan for the home. Due to the new ownership being under one year it is envisaged that this will be available from April 1st 2006 for the new inspection year. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 1 3 1 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 X 26 X 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 3 32 2 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 X 14 2 15 2 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X X X 2 X X X X X X The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 24 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 05/04/06 2 YA3YA2 3 YA23 4 YA32 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. 12(1)(a)(3)(4)(b) The registered person shall 05/04/06 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. So far as practicable ascertain and take into account their wishes. With due regard to the sex, background and disability. 13(7) The registered person shall 05/04/06 make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk or harm or abuse. 18(1)(c)(i) The registered person shall 05/04/06 having regard to the size of the care home, the statement of purpose and the needs of the service DS0000023879.V278755.R01.S.doc Version 5.1 Page 25 The Hadlows 5 YA33 18(1)(a)(b)(c) 6 YA34 19(1) 7 YA37 9(1)(I) 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 05/04/06 having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure 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. The registered person shall 05/04/06 not employ a person to work at the care home unless subject to paragraph (6), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 8 of Schedule 2. A person shall not manage 05/04/06 a home unless he had the qualifications necessary for managing the care home. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 26 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 8 9 Refer to Standard YA6 YA7 YA9 YA11 YA12 YA14 YA15 YA18 YA22 Good Practice Recommendations It is very strongly recommended that services and facilities provided and current and changing needs aspirations and goals are formally addressed, reviewed and met. It is very strongly recommended that limitations to choice be only made in the service users best interest. It is very strongly recommended that full risk assessments are conducted and reviewed. It is strongly recommended that service users have the opportunity to maintain and develop social, emotional and independent living skills. It is strongly recommended that planned daily activities outside of the home be increased. 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. It is recommended that service users receive personal support to match their needs. 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. It was not inspected in the homes complaints policy and procedure had been reviewed in the recording format as identified during the last inspection. 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. Those areas DS0000023879.V278755.R01.S.doc Version 5.1 Page 27 10 YA24 The Hadlows 11 YA27 12 YA29 13 YA30 14 YA35 15 YA36 where smoking occurs there is sufficient ventilation. That a response from the environmental health in respect of infection control policies and procedures are followed up. 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 with mobility problems in the bathroom and toilet. 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. 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. It is very strongly recommended that a full review of all staff training and development needs be made and arrangements made for these to take place. That staff induction training includes all mandatory training including adult protection to be undertaken within a reasonable time of having been employed. It is very strongly recommended that procedures be in place for dealing with physical aggression towards staff. The Hadlows DS0000023879.V278755.R01.S.doc Version 5.1 Page 28 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.V278755.R01.S.doc Version 5.1 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!