Inspection on 15/05/06 for The Hall

This inspection was carried out on 15th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hall 10/08/07

The Hall 09/01/06

The Hall 27/06/05

The Hall 25/02/05

The Hall 20/09/04

The Hall 01/02/04

The Hall 24/06/03

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

CARE HOME ADULTS 18-65 The Hall The Hall Ashford Road Hamstreet Ashford Kent TN26 2EW Lead Inspector Lois Tozer Key Unannounced Inspection 15th May 2006 09:50 The Hall DS0000023574.V292774.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 Hall DS0000023574.V292774.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 Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Hall Address 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) The Hall Ashford Road Hamstreet Ashford Kent TN26 2EW 01233 732036 Mr Michael John Rogers Mrs Sylvia Margaret Rogers Mr Robert Andrew Mycroft Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Provide residential care to not more than nine (9) people with Learning disabilities. Not more than three (3) people with physical disabilities The residents shall be sixteen (16) years and over The three (3) residents with physical disabilities must also have a learning disability 9th January 2006 Date of last inspection Brief Description of the Service: The Hall is situated in the village of Hamstreet, Kent and is placed a short distance from the railway station and is on a public bus route. Access to local amenities, shop and recreation facilities can be easily reached on foot. The home is registered to provide care and accommodation for a maximum of 9 people aged between 16 and 65. The target age range of people using the service is 16 to 25 years who have a learning disability. The service is set up to be of benefit to young people who wish to move into greater independence, and therefore the aims of the service are to provide a great deal of opportunities for responsibility taking and personal development. The home is a spacious building with lots of character. Bedrooms are situated on the ground and first floor and are all single occupancy. A large lounge has been split in two to giving a greater range of communal space. The kitchen / diner has a small computer area off the dining room end. There are two bathrooms (one ground, the other first floor), both with toilets and one separate toilet in a central, ground floor location. The home maintains a smoke free environment within the home, but supplies separate covered areas in the garden for smoking by staff and service users. The garden area is secluded and is mainly patio and bark covered, enabling it to be used all year round. The range of fees is from £201.90 to £411.00 per day. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15th May 2006 between 09:50 and 16.45. A newly appointed team leader and staff on duty assisted with the process. The registered manager, Mr Robert Mycroft, was present from 2pm onwards, after an earlier appointment. Six people were living at the home; two were out at college. The remaining four was happy to give their impression of the home. The inspection process consisted of information collected before and during the visit to the home, and care management feedback through the adult protection process. Other information seen included incident report forms, assessment and care plans, medication records, duty rota, goal plans and daily records. What the service does well: Service users are generally happy living at The Hall. They say that staff are good and particular staff are brilliant. Three of the four service users said that when at senior team leader is on duty, life is really good. Two service users said the management was ‘for the residents’ and that they were impressed with the support they got when sorting out situations. Activities out of the home are well planned and enjoyed by all. Opportunities to do fun and unusual things are frequent. People are supported to cook their own meals and be responsible for their domestic chores. Generally, decision-making is well supported. Staff deal with demanding situations in a calm manner. The statement of purpose and service user guide clearly says what service will be offered. Alternative communication versions are being developed. Needs assessments draw out the aspirations of the service users. Relationships are supported within individual risk guidance. Recruitment practices are sound. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Service user plans are easy to use and descriptive, but behaviour management plans border on unethical practices. Service users said that a staff member had a too bossy attitude. Better arrangements are needed so service users are not bored when in the house. Routines of chores are carried out, then service users, unless at college or work, are often at a loose end. Service users want more involvement in menu planning – they don’t want a rolling menu. Documented personal support needs are being kept in a communal bathroom. Medication management and staff awareness needs improvement. Staff are still awaiting adult and child protection and restraint training – but it is scheduled to take place in the next 4 weeks. Service users would benefit from staff that are trained to engage them in activities within the home. The manager must periodically revise the NMS, including the 16 – 17 years supplements. The minimum age of potential staff must be considered in relation to the age of the service users. Service user views must be sought to inform the quality assurance system and future development of the home. Safety checks must include the effectiveness of the fire doors. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 7 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 Hall DS0000023574.V292774.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 Hall DS0000023574.V292774.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 The overall quality of service is good. This judgement has been made using available evidence including a visit to the service. The statement of purpose and service user guide clearly says what service will be offered. Needs assessments highlight individuals specific support requirements. EVIDENCE: The service user guide (SUG) and statement of purpose (SOP) has been reviewed. The SUG, at request, can be put on tape and will shortly be developed into picture format. Needs assessments draw out the support requirements and long-term aspirations of the service users. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 The overall quality of service is adequate. This judgement has been made using available evidence including a visit to the service. The service user plan easy to use and descriptive, but behaviour management plans border on unethical. On the whole, decision-making is well supported – but service users are bored. Risk management is improving. EVIDENCE: The service user plans are easy to use and spell out the individual support required. These are written from the staff point of view. Improvement in service user consultation would be beneficial. Service users say they are bored, they should be offered more chance to say how they want their lives to look. Service users say staff respect their decisions and the management is very supportive. Several said that one staff too bossy; this was fed back to the manager. The need to have staff support for certain activities limits the The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 11 decision-making opportunities – service users say they are bored. The right mix and amount of staff available must meet service user needs. Management of aggression / restraint training will be given from Mid May onwards. Risk assessment training is being given 19th May. Generally good feedback from service users – they feel safe and well supported, although bored. Behaviour management plans that restrict a person’s freedom of choice and treatment must be given ethical consideration. Staff must be wary of judging service user behaviour. Good quality assessment is needed prior to any restrictive plans are put in place. Consultation with a qualified professional as well as the service user is essential. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 The overall quality of service is adequate. This judgement has been made using available evidence including a visit to the service. Better arrangements are needed so service users are not bored when in the house. Social events and community contact is reasonably well supported. Relationships are supported within individual risk guidance. Routines of chores are carried out, then service users, unless at college or work, are at a loose end. Service users want more involvement in menu planning – they don’t want a rolling menu. EVIDENCE: Service users were in the home said they were bored. All indicated that they would like more structured things to do – staff have not had training in The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 13 engagement techniques. Evidence that staff help service users to practice their academic skills semi-regularly was in place. College and work placements are enjoyed. When these are not available, service users say they are bored in the home. Getting out and about happens for everybody several times a week. Some people go shopping, others to college, or work in the local area. Fun outings and events take place regularly. Recent trips to Diggerland and Chessington were discussed, and enjoyed. Relationships are supported within individual risk guidance. Service users said staff help them see their friends and family. Service users are clear on their roles for daily routines, but are bored when the ‘chores’ are over. All service users seemed happy with the busy part of the morning. They are keen to develop skills. They need staff who are trained to support them in the most effective way. Service users say they want more to do with the menu planning. They want more say as to what goes on it. It is a 4-week rolling rota at the moment, but that is not what service users want. Likes and dislikes are known, but these people want to make decisions. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The overall quality of service is adequate. This judgement has been made using available evidence including a visit to the service. Personal and healthcare needs are well documented and supported. The location of personal support plans does not protect service user dignity. Management of medication and staff training needs improvement. EVIDENCE: Personal support is assessed and discussed with individuals. Service users are encouraged to carry out all of their personal care needs. A personal care document was kept in the communal bathroom. This is unnecessary and undignified. Healthcare is well documented and supported. Service users are supported to access healthcare as required. Some improvements to medication management had taken place. The meds folder was much more orderly. Checking medication in was safer. Staff who were administering medication had no training. There was uncertainty about giving pain relief. Pharmacy labels were not the same as the The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 15 directions on the records sheet. Event codes were confusing. Staff were unable to say what they would do in the event of an error – other than it hadn’t happened to them. The homes own policy and procedures were not being followed. The Hall DS0000023574.V292774.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): The overall quality of service is poor. This judgement has been made using available evidence including a visit to the service. Staff are doing a good job supporting service users with their problems. Staff are still awaiting adult and child protection and restraint training EVIDENCE: Service users said they knew that they would be taken seriously if they had a problem. Evidence bears this out. The manager has an open approach to dealing with problems. Staff were said to be ‘on our side’. Staff have not had the adult and child protection training still. It is planned for early June though. Staff, as seen in standard 6, need to be aware of what is abuse. It is because staff lack this education, that the overall quality rating of concerns, complaints and protection is poor. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The overall quality of service is good. This judgement has been made using available evidence including a visit to the service. The house has had refurbishment and redecoration in most places. Further improvements are planned. Service users like their bedrooms. Some service users do not have sufficient furniture. There is lots of comfortable shared space. There are two bathrooms and three toilets. It is clean and tidy and seems hygienic. The laundry room will be refurbished this year. EVIDENCE: The service users like the house, they enjoy where it is and the size of it. Recent redecoration has really cheered the place up. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 18 Most bedrooms have had a repaint in a neutral colour. Service users have personalised their rooms. Someone requested to move into a smaller room, which made them happy. Some rooms have inadequate furniture. Clothing was stored in piles on the floor. The manager was aware and is dealing with it. Shared space is bright and cheerful and well furnished. One bathroom has been completely refurbished and looks much better. The other bathroom has plans to be updated this year. The laundry room is adequate, but run down. It will be refurbished this year. There are cleaning schedules dotted around the home. These are dangling of bits of string from fire points. Service users said they were silly. They are unnecessary and are not homely. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 19 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): 32, 33, 34, 35 The overall quality of service is adequate. This judgement has been made using available evidence including a visit to the service. Service users would benefit from a team with a wider range of skills. Staffing numbers must be sufficient to meet service user needs. Recruitment practices are generally sound. Training provision is improving. EVIDENCE: Some staff have NVQ training. Service users have said boredom is a problem. Staff say service users are hard to motivate, and have short concentration spans. Staff need to have the right training to understand service user needs and methods of getting them involved in activities. Staff said that staffing numbers limited what they could do with service users. This needs reviewing. Recruitment practices protect service users. The age of potential staff must be considered in relation to the age of the service users. The supplementary The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 20 standards for younger people (16 to 17 years) gives guidance as to the suitable minimum age. Training provision is improving. Inductions have improved. Service users would benefit from staff that are trained to engage them in activities within the home. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The overall quality of service is adequate. This judgement has been made using available evidence including a visit to the service. Overall, the manager is competent, but periodic reviewing of the standards, including the 16 – 17 years supplements, would be beneficial. Service user views must be sought to inform the quality development of the home. Safety checks must include the effectiveness of the fire doors. EVIDENCE: Service users find the manager fair and easy to get along with. The home is meeting many of its aims, but some crucial ones need improvement. This needs the manager and team focus. The Manager should frequently revise NMS and the 16-17 supplementary standards. Oversights have led to poor decision-making. This could have been avoided. The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 22 Seeking service users views on how the house is run is essential to improvement where it matters. Service users want more involvement in activities and menu preparation. The way visits by the registered provider take place have been reviewed. These should improve the level of involvement service users have in shaping the home. Health and safety matters are generally well managed. All service certificates are up to date. Fire and health and safety checks are regular. Sticky fire doors have not been noted, and need addressing. The Hall DS0000023574.V292774.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X 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 X 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 1 X X 2 X The Hall DS0000023574.V292774.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 YA6 Regulation 14 15 18 12 13 14 & 15 13 18 Requirement This relates to standards YA6 & YA35 Review and increase activities in the house. Staff to have skills to engage service users. This relates to standards YA6 & YA7 Behaviour plan be reviewed with qualified professional psychologist and service user. Previous requirement – timescale 01/03/06 unmet. MAR directions to exactly reflect the pharmacist label directions. Staff be given sufficient time off shift to complete their medication training. Staff to be suitably and adequately trained and have the competencies and knowledge to carry out the work. Previous requirement – timescale 31/03/06 unmet. All staff to have child & adult protection training and periodic reviews. Timescale for action 01/08/06 2 YA6 01/07/06 3 YA20 01/07/06 4 YA20 13 18 01/07/06 5 YA23 13 18 21 01/07/06 The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Hall DS0000023574.V292774.R01.S.doc Version 5.1 Page 27 - 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!