Inspection on 27/02/07 for The Hadlows

This inspection was carried out on 27th February 2007.

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 no outstanding requirements from the previous inspection report, but made 6 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 18/05/06

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 Lynnette Gajjar Key Unannounced Inspection 27th February 2007 09:30 The Hadlows DS0000023879.V325683.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.V325683.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.V325683.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 Post Vacant Care Home 10 Category(ies) of Physical disability (10) registration, with number of places The Hadlows DS0000023879.V325683.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 21st November 2006 Brief Description of the Service: 128 and 130 Hadlow Road comprises of two houses one of which is an end terrace property the second adjoining. It is registered for ten people who have a diagnosis of acquired brain injury and offers all single rooms; five rooms in each house. Facilities are in both houses and accommodation is spread over three floors. The homes are not suitable for people with significant mobility difficulties as there is no lift between floors. The two communal lounges are located on the first floor along with two bedrooms and bathroom/WC. The second floor has the staff office/ sleep in room and one further bedroom and bathroom facility. There are two bedrooms and a walk-in shower facility/WC on the ground floor with access to a linked walk through dining room. Small kitchen and laundry area. There is no separate visitors room or communal space located 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, a 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 £1177.00 per week as listed in the pre inspection questionnaire. A copy of the last inspection report is available at the home. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced key inspection in the year running from April 1st 2006 to March 31st 2007 and undertaken by Regulatory Inspector Lynnette Gajjar, who was at the home from 9.30am to 4.56pm. Included also in this report is evidence gathered during two random inspections carried out on 30th August 2006 and 21st November 2006 by Regulatory Inspector Maria Tucker, where in the latter, immediate requirements were issued for urgent action by the organisation to promote the safety of service users and staff and a warning letter was also issued as a result. The homes have undergone an organisational change and a significant number of home manager changes in the past 9 months. Evesleigh (Kent) Ltd has been acquired by the Independent Living Group but remain with the same limited company house number. They have recruited a new home manager Mr Douglas Laurie, who has been in post since 4th October 2006 but who has not yet registered with the Commission. There are plans in place for him to apply for registration for the two homes. This visit was spent talking directly with some service users, privately and collectively, visiting decorator and music therapist, care staff, deputy manager and manager. Information was gained through conducting case tracking exercises and document reading. Judgements about quality of life and choices were taken from direct conversation with service users, staff and observation followed by discussion with care staff, and evidencing records held at the home and the previous two random inspections. A tour of the premises was undertaken. Information was also gathered through a pre inspection questionnaire completed by the acting manager and ‘Have your say’ questionnaires received. The home currently has 8 people in residence and is running with 2 vacancies. The random inspection on 21st November 2006 identified serious concerns for the safety of service users and staff following an emergency admission. A full review of admission process has taken place and no new admissions have been made and this emergency placement has withdrawn. From this second key inspection it is evident that the new company has made some progress through the improvement plan since the random inspection on 21st November 2006 and the immediate requirements issued. However due to the scale of work required to improve the safety and well being of service users, many outcome areas remain only partially met. There is still work required to evidence that effective systems and practices are in place and that these are sustainable. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The serious concerns toward the health and welfare of service users and staff during the random inspection 21st November 2006 have been removed with this placement being withdrawn. No new admissions have occurred or are planned. The lounges, dining area and some bedrooms have been redecorated. New sofas purchased and some bedroom furniture replaced. Budget agreement has been made for new carpeting throughout, new kitchens, and redecoration of all remaining rooms, communal areas and bathrooms in both houses. Some radiators have been fitted with guards. The home has appointed a new manager who is beginning to work with staff, service users and senior management to work through the home’s improvement plan but who acknowledges many areas are still only partially met. The home has recruited three new care staff, offering a more stable staff team and reduced the heavy reliance on bank staff to cover the roster evidenced during the random inspections. Care plan and risk assessments have been reviewed and new formats implemented. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Hadlows DS0000023879.V325683.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.V325683.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems in place have not been followed to ensure that service users care and health needs have been adequately assessed and can be met by the home. Information provided to service users and contracts supplied by the organisation do not include accurate information about fees charged and responsibilities for payment. EVIDENCE: The home’s statement of purpose (SOP) has been reviewed and rewritten with some typing errors identified and needing amendment. The new manager stated that the service user guide (SUG) was being updated to incorporate more pictures and both will be made available in communal areas for service users. Neither document includes the range of fees, breakdown of fees, explaining who is responsible for payment of fees as required by new regulations from June 2006. The home has a documented admission policy and process. The random inspection undertaken on 21st November 2006 identified poor emergency admission practice that put existing service users, staff and the new service user at risk, through inadequate information, inadequate staffing levels and health care needs not being met, no consultation with service user or staff at The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 10 the home. Resulting in an immediate requirement and the first stage of enforcement action by the Commission to protect the health and welfare of service users and staff requiring urgent action within 48 hours. Due to the nature of the service and specialising in brain-acquired injuries and behaviours that may challenge the service and tenants; admissions must be well prepared, planned and undertaken over a specified period of time assessed as suitable to all of those involved. It is highly questionable if emergency admissions should be considered within this service. A comment from a service user stated, “ As the last question I don’t think I was given enough information” Staff expressed how they did not feel they were involved in new admissions process until the day the person arrived at the home. Staff did not feel their views had been listened to in previous admissions and concerns over compatibility with current tenants and their support needs. Following the random inspection, the organisation has reviewed their procedures to offer a more robust process to be followed. However, no new admissions have occurred to assess its effectiveness. The new manager expressed a clear understanding of current needs of those in residence and stated to have undertaken two pre-assessments but these have not been pursued as felt inappropriate. The manager stated senior managers and the new providers were aware of the need for compatibility and the needs of current tenants have a major impact on any new admission particularly in the home with current vacancies. Due to the nature of service trial visits and preparation work must be followed by all concerned. The case file tracked evidenced a copy of SOP contract / terms and conditions of residence. One from the previous owners and another issued 24th July 2006 by Evesleigh Kent Ltd. However sections were incomplete. An additional page had been added relating to interaction with fellow tenants this had been signed by staff and service user but is not dated. Neither the manager or Area Manager were aware of the Office of fair trading guidance for contracts in care homes issued in 2004 and were advised where to obtain this, along with the revised Care Home Regulations June 2006 pertaining to the SUG and fees. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have care plans in place to identifying personal aspirations and goals. Behaviour management strategies should be undertaken as part of a multi-disciplinary process where human rights and choice are affected. Some service users’ assessed and changing needs are not currently being met. EVIDENCE: Each service users has a large case file. Of the one case tracked it has been reviewed and update 14th and 27th January 2007. There are clear identified goals as well as risk assessment and lengthy but detailed behaviour management strategies in place for community activities, contact with family, motivation, daily living activities and chores. It was noted that care staff had written the strategies and there was no reference to involvement of other professionals in the individual’s care and agreement to strategies being followed particularly where personal choice and human rights may be affected. The service user had been involved and signed each document and agreement to this. The file is large and cumbersome to negotiate and as a new member The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 12 of staff or bank staff it would be difficult to read, understand and follow immediately. Key information could be reviewed into alternative formats for easier access and usability, to ensure consistent support by carers and ensure safe working practice with individuals. Service users have planned 1:1 time twice a day with staff. Referrals to local drugs and substance misuse counselling centres have been made. One house has five longer-term tenants who have developed a routine and structure that meets their collective and individual care and support needs. There is an acceptance of each other with an understanding of personal space and respecting personal traits. However the other home has tenants who do find shared living difficult, leading to confrontation and conflict between individuals. This requires behaviour management programmes and a higher staff presence to diffuse situations. Service users are at risk in this home of physical and psychological harm due to this conflict. Incident and accident records evidence this resulting in an adult protection strategy meeting being set up to look at this in more detail. A Service user questionnaire states, “Basically I do not feel happy at (Name of home), I would appreciate a move. The staff are my only friends in here.” Due to different levels of physical and psychological disability following brainacquired injury each service user requires different levels of support, motivation and prompting with everyday living and leisure skills. Memory retention can fluctuate and requires special support and skills from staff in maintaining personal dignity and respect of individuals and managing behaviours that may challenge the service, fellow tenants and local community. Other comment received included: “ I am very happy here, staff help me when I need it and support me to do things I want to” “It’s alright, I go to work and staff remind me of things I need to do, as I have short term memory.” Staff numbers do restrict activities with 2 staff to five service users. Activities are planned on a roster basis, which limits impromptu and spontaneous activities, especially where personal motivation hinders interaction and completion of a task at set times. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are now being encouraged to make some choices and take responsibility about their daily lives and activities. With personal programmes of internal and external activities to meet personal interests, motivation and work experience. Service users have variety, choice and wholesome food. The layout and size of the kitchen and dining room as a walk through area can compromise safe food preparation. EVIDENCE: Service users are benefiting from revised activity plans and recent improved staffing. As stated earlier one home service user have been living locally for a number of years and has well established links in the local community and work experience and planned sessions such as work at local Sainsbury’s, attending Headway day service. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 14 Leisure opportunities include accessing local amenities, shops, restaurants, cafes, and swimming pool. One service user attended regular football matches of their favourite team. Another described attending local assembly hall to see a comedian and show the last weekend and how much they had enjoyed this. A local musician comes weekly to the home on Tuesday to do guitar and music session with a small group in one home. Activities are planned on a rota basis to enable all service users to have 1:1 time with key staff and access the local community. There is two staff in each house with a floating member to cover both. Obviously supporting and transporting one from each house does restrict spontaneity of activities/appointment. It can also restrict opportunities when a service user’s motivation is good and they are in good spirits, to go out on a specific activity of choice. The homes have access to games, DVD’S, TV etc but in one unit, a service user’s personal TV is being used communally whilst the home waits funding approval to purchase a new TV. The service user was in agreement with this. The home’s lounges are located on the first floor of each home. All service users must be able to manage stairs to access this communal facility or else can be isolated from their peers. There is no separate visitor’s room or quiet room other than private bedrooms in the home. This is of particular concern in one home where personal conflict between tenants does require access to other communal space other than their bedroom. The daily routines are as flexible as possible with service users getting up at their preferred times, even if this meant them missing their planned activity. Constant staff support and reminders are made. Meals are varied and personal choice. Menus are discussed with service users and shopping purchased around this. One service user was about to review their planned menus due to activities and time to prepare and cook food better suited to the time they have allocated. Service users were observed to make themselves beverages and snacks throughout the day. The kitchen facilities in both homes are very small and will only allow two people in the area safely at any one time. The dining room also is small, with the table positioned against the wall but pulled about at mealtimes. This is also the walk through the ground floor WC, shower room and laundry and observed to be in constant use. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this 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 continues to visit the home for individual and group sessions on a weekly basis. Through observation and discussion the service user enjoys this with a good relationship developed with the therapist. The care plan tracked showed an occupational therapist assessment and 1 to 1 sessions and advice. Referrals to physiotherapists continue to be made via the General Practitioner, drugs and alcohol counselling, 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. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 16 Various health and specialist consultancy appointments were arranged and in the diary and records kept of the outcome of the appointment. Most service users are ‘out of county’ placements and working with community mental health team has been limited due to travelling. It was noted that one area discharged service users from their books and have written to the local GP for a local referral to Community mental health team as living in this area. Better support and working from local mental health/substance misuse teams should be explored for individuals on a regular basis, especially in developing behaviour management strategies and to assist with medication reviews. It was noted that a service user has had a high number of medication reviews in the past 2 months with medication changes at each appointment. Due to the individual needs of service users and mental illness, support from specialist teams would be exceptionally beneficial to the staff, G.P and service user. Overall the medical and health needs are recognised and the home are pro active in seeking specialist referrals. Medication storage, ordering administration and disposal is well managed. MAR sheets seen held no gaps but do require further chasing with GP to remove medication no longer used being printed every time a new medication order is made. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those living here feel confident to raise concerns or complain with staff at the home and senior managers directly. Service users in one home and staff are at risk of potential physical and verbal aggression due to current conflicts between tenants and personal mental well being. Formal accredited training in non-abusive physical/psychological intervention techniques is needed for all staff. EVIDENCE: The home has a complaint procedure. Of those spoken with, and responded to questionnaires, they felt their concerns are openly discussed with the staff and if needed by a senior manager. The home has received one complaint and this has been processed appropriately. “I feel happy that I can talk to any staff and the big boss.” “ Staff are very good, they listen, even if I say red is red and they say white is white.” “ I am very happy here” “Yeah they listen, might not agree with me but they listen” Restrictions on freedom of movement are in place for service users due to individual behaviour management, cognitive ability and brain-acquired injury. This does affect personal choices and human rights. Risk assessments and The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 18 strategies have been reviewed and amended. As stated earlier in the report, a multi disciplinary approach and recorded agreement of strategies should be in place. Following recent incidences and conflicts experienced in one house. Service users and staff are at potential risk of physical and verbal aggression. That has resulted in hospital treatment. The home has been proactive in raising an adult protection alert with Social Service to investigate strategies and systems in place and explore resolutions to protect tenants and placements. Guidelines and strategies have been put into place but not agreed by a multi disciplinary team. The home’s training matrix shows the majority of staff have undertaken Adult Protection training with three new staff requiring to undertake this with in their induction period. Information supplied to the commission with the pre inspection questionnaire indicated no staff has undertaken formal behavioural management/ non abusive physical/psychological intervention techniques. Subsequent information supplied in response the draft report response indicated that 10 of the 19 staff have undertaken this training last year. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and on the assurance that the outstanding work needed will be completed. Service users live in two homes where maintenance is improving. They will benefit further and be safer through the completion of the environmental design and equipment proposed to promote their personal independence, safe freedom of movement and orientation around the home and safe access. EVIDENCE: The two homes are situated next door to each other and symmetrical in design and layout. There is a ground floor comprising of two bedrooms, corridor leading to a small dining room, which you have to walk through to get to the very small kitchen, leading to the WC, shower room and laundry. Thus walking through a food preparation and eating area to get to laundry and personal care bathrooms. Financial agreement has been obtained to replace kitchens in both homes. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 20 The first floor has the lounge, further two bedrooms and bathroom. With the second floor housing the last service users bedroom, staff sleeping in room/office and bathroom. Although there are bedroom located on the ground floor, service users are required to be ambulant to access the communal lounges located on the fist floor, as stairways are narrow and steep. Neither home has a lift. The home was found to be tidy and clean with the exception of the areas that were identified in need of being refurbished, as they are difficult to thoroughly clean. The infection control nurse has visited the home and conducted an assessment on June 30th. A new washing machine has been purchased and is in place in one unit. It was discussed that due to the expense of these machines and the need to prioritise other items of furniture that need replacing and upgrading such as the kitchen and bathroom, then it could be spaced out so that at least one house where there is the most need has a washing machine and a second is purchased in the new financial year. The home have a maintenance book that identifies things that require doing and a plan for proposed refurbishments. The maintenance schedule identifies action to take when something requires doing detailing whom to contact. The handy man was on site repairing fire stripes to a service user’s bedroom door and trying to solve the non-working tumble dryer. It was acknowledged that communal areas had begun to be upgraded with redecoration and new furnishings in one unit. The decorator was on site in the other, who confirmed they had been requested to quote redecoration for other remaining areas of the home including the shower and bathrooms. Funding to replace all carpets has also been approved and awaiting fitting. Service users are to be consulted on personal choices and references particularly in their personal rooms. A service user was receiving new bedroom furniture delivery during this visit and was very pleased with the choice they had made. This included a lockable facility. Due to conflicts currently being experienced, additional communal space should be considered to allow recreational space safely other than in personal bedrooms. There is no separate quiet area, or visitor’s room; there is a small office (which can be busy and the only staff space) for 1:1s. Meetings often have to be held in a service user’s room. The recommendation that the glass in back door windows and doors is replaced or reinforced has not occurred, this has been identified in previous inspections as a security and safety risk. Following an incident in the past few The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 21 weeks where a service user suffered injury requiring hospital treatment this must be given priority to be addressed in both units. It was noticed that some radiators remain uncovered, not all windows are fitted with restrictors especially on first and second floors. Windows particularly on the front of the house are not double glazed and the noise and rattling frames was quite noticeable throughout the day from the busy main road outside. Serious consideration should be given to planning their replacement over the coming budget year. Staff have no lockable facilities at the home, which is of concern for safe keeping of personal belongings, monies and /or medication, particularly where they ware required to stay overnight at the home covering sleeping duties. Sleep in arrangements is on a sofa bed, which has generated a number of complaints from staff re health and safety. Alternatives should be explored. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,24,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Formal recruitment processes and checks assessed have been satisfactory. Service users are beginning to benefit from the stabilising of staff and improved staffing on shifts. Lack of specialised training, place service users and staff at potential risk and does not allow for the safe or effective support in brain acquired injury and non-abusive physical and psychological intervention techniques. EVIDENCE: The home has recruited two new permanent care staff and one bank staff since the last inspection. The home is running with two further vacancies that are covered by regular bank staff. During the random visit of 21st November 2006 it was deemed that there was inadequate staff on duty with a new admission to safely meet their health and care needs as well as other service users in residence. Immediate notices were issued for inadequate staffing putting service user and staff at serious risk and potential harm. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 23 During this visit records showed each house having 2 staff on each shift with one sleep over and the manager being on a supernumerary shift. If appointments and activities are not planned well, this can impact on service users’ activities. Staff undertaking induction have received the company induction package but records tracked have not been competed as required in timescales set. Many core areas remained in complete. One staff member now in their third month has not completed first two weeks of induction booklet. They had not been on any formal mandatory training but believed this has been requested but no dates have yet been set. The home’s training matrix information supplied to the commission with the pre inspection questionnaire indicated no staff has undertaken formal behavioural management/ non abusive physical/psychological intervention techniques. Subsequent information supplied in response the draft report response indicated that 10 of the 19 staff have undertaken this training last year. Subsequent information supplied indicated that 6 of the 19 staff have undertaken training related to brain acquired injury. However staff who had attended the Acquired brain injury training felt this was very useful but would benefit from updated and refresher session in new information, research and support network available to them and their service users. Staff records tracked evidence supervision agreements, and a record of supervision now being implemented and carried through. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and on the assurance that the outstanding work needed will be completed. Residents at The Hadlows have experienced the lack of leadership and commitment from the management team over the past 9 months. However following the transfer of the company, new structures and appointment of manager; service user are benefiting from stabilising of the management team, that is concentrating on developing better safeguards and resident’s best interests. EVIDENCE: Evesleigh (Kent) Ltd has been acquired by the Independent Living Group but remain with the same limited company house number. The homes have experienced a number of home manager changes over the past 12 months that has not offered service users neither staff the stability, The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 25 nor leadership required to manage this service effectively, resulting in immediate requirements at the last random inspection on 21st November 2006. Senior management have engaged with the Commission in developing an improvement plan required after the random inspection 21st November 2006 and steady progress has been assessed during this visit but acknowledgment that a number of areas remain only partially met. A new home manager Mr Douglas Laurie took up post on 4th October 2006 and is a registered nurse in mental health has over 40 years experience in nursing and residential care as well as care management. Application to register is being compiled at present. The manager has concentrated on developing team working, recruitment and environmental works require as part of the improvement plan. Of those spoken with staff felt well supported by the manager and deputy manager but often felt senior managers have made decisions without consulting service users or staff in the past that have had a detrimental effect on the service. Staff did feel things have begun to improve since Christmas and more investment into the home and environment now being made was having a positive impact on service user quality if life as well as activities. 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. Staff meetings take place regularly. Service users have daily 1:1 meetings with staff that are recorded. House meetings take place to plan weekly routines and menus. The manager was unaware of any formal quality assurance processtaking place, however subsequent information supplied by the organisation to the draft report indicates a quality audit was undertaken and report was completed in September 2006. The manager acknowledge that more internal monitoring and auditing systems would identify deficits in administration and records found during this visit. 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. 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 has been completed and work has begun to address areas recommended for action. As identified under the environment standards there are a number of health and safety issues still requiring action and completion to ensure safety and well being of service users and staff. This area remains partially met. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 26 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 X 4 1 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 3 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 2 2 2 X X 2 X The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 Requirement Timescale for action 06/04/07 5(b,ba,bb,bc,bd) The Service user guide: Is amended to include areas required by this regulation from June 2006. Pertaining to terms and conditions, details of total fees payable in respect of services, arrangements for charging and paying for additional services and statements where this may be different such as where service are whole or part funded by persons other than the service user. Improvement plan to be submitted to the Commission by the timescale date. 2. YA9 12(1) (b) The registered person shall 06/04/07 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 risk assessments must be adhered to and followed. DS0000023879.V325683.R01.S.doc Version 5.2 Page 28 The Hadlows The support and intervention of staff with challenging or difficult behaviours must be more detailed for staff to follow and staff must be consistent. This requirement remains ongoing and assessed as partially met with some progress being made since the last visit. Improvement plan to be submitted to the Commission by the timescale date. 3. YA24 23(3) (a)(ii) The registered person shall provide for staff suitable facilities and accommodation including storage facilities that is lockable for personal belongings and medication. Improvement plan to be submitted to the Commission by the timescale date. 4. YA32 18(1)(c)(i) The registered person shall 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 within agreed timescales; The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 29 06/04/07 30/04/07 50 of care staff to hold the NVQ level 2 or above. This requirement remains ongoing and assessed as partially met with some progress being made since the last visit. All staff undertakes formal accredited training specialising in Brain Acquired Injury with regular updates as new legislation and practice occurs. Staff undertake formal accredited training in non abusive physical/psychological interventions Improvement plan to be submitted to the Commission by the timescale date. 5 YA35 18(1)(c)(i)(ii) The registered person shall 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 including a structured induction programme, with suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to the work 06/04/07 The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 30 In that: i) New staff is scheduled to complete their induction programme as detailed in the homes induction procedure, timescales and workbook as required. Senior staff is scheduled time to work alongside new staff to assist with their induction and complete workbooks to aide supervision and appraisal for their probation period. ii) New staff should complete all mandatory induction training and external courses within their 6-month probation period. Reasons where this is not possible should be recorded with dates for completion expected. Improvement plan to be submitted to the Commission by the timescale date. 6 YA42 13(4)( c) The registered person shall ensure that unnecessary risk to the health and welfare of service users are identified and so far as possible eliminated. In that window restrictors are risk assessed and installed as required, glass in external and internal doors are replace with toughened safety glass. All radiators are covered. Improvement plan to be submitted to the The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 31 06/04/07 Commission by the timescale date. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations It is strongly recommended that the home obtain a copy of the Office of Fair Trading Fair contracts in care homes guidance and latest amended miscellaneous care home regulations June 2006 for reference and contracts are reviewed in line with these documents. It is very strongly recommended that limitations to choice be only made in the service users best interest ad are agreed through a multi disciplinary process. 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. The home has begun to address this. It is recommended that this progress be made in a timely fashion with proposed dates for completion. 4. YA26 Service users whose bedrooms are facing the main road would benefit from their windows being double glazed/ replaced to offer better soundproofing and noise reduction. 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. An assessment was undertaken in September 2006 however recommendations are still in hand to be completed. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 32 2. YA9 3. YA24 5. YA27 6. YA29 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. 7. YA30 It is very strongly recommended that the washing machines have the specified programming ability to meet disinfection standards. Partially met; one machine purchased in one unit other to follow. 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. But evidence of budget agreement shared and work to commence in coming weeks It is strongly recommended that this be addressed within a timely fashion. 8 YA31 That staff are provided with ID badges. This was assessed as partially met during May 2006 as equipment has been provided to the home for issue but Id Badges have not been issued to all staff. This remains the same with no further progress. 9 YA39 It is strongly recommend a formal quality audit be undertaken by the company to ascertain service users, relatives and visiting professional’s views about the home and current service provided. The Hadlows DS0000023879.V325683.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V325683.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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