Inspection on 09/01/06 for The Hall

This inspection was carried out on 9th January 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 no outstanding requirements from the previous inspection report, but 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 15/05/06

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 Announced Inspection 9th January 2006 09:50 The Hall DS0000023574.V263615.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.V263615.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.V263615.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.V263615.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 service users shall be sixteen (16) years and over The three (3) service users with physical disabilities must also have a learning disability 27th June 2005 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 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 target age range of people using the service is 16 to 25 years who have a learning disability. 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 a covered area in the garden for smoking by both 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 Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 9th January 2006 between 09:50 and 16:30. The manager, Mr Robert Mycroft was available throughout the inspection and offered assistance wherever required. Although the home is registered to accommodate 9 people, at the time of the visit, 6 people were living at the home. Five service users were out, but the sixth gave feedback. Six service user comment cards were returned, and these helped gain an impression of life in the home, which was generally positive, but two people highlighted (anonymously) that they felt ‘told off’. The manager agreed to look into this with the staff who supported people completing these forms. Other service user comments from verbal and comment card feedback included (paraphrased) - ‘I like the staff’. ‘I like everything about the home, but I want to go to college’. ‘I get privacy’. ‘Its good here’. ‘I like my friends, going out, nice bedroom, shopping and going on holiday’. ‘I don’t like some of the other clients’. ‘I like my mates, college and outings, but don’t like being told off’. One professional returned positive feedback, stating they were satisfied with the overall care provided. As well as speaking to a service user and staff, records of activities, medication, physical intervention plans, pre-inspection questionnaire, quality assurance, and training were inspected. What the service does well: The home has maintained a good standard of service user plans and has ensured that these are kept under review. Individuals’ needs are well assessed, with the right level of staff support provided and support is given to people to achieve their aspirations. Service users are encouraged to take responsible decisions and to acknowledge the risks and outcomes of being irresponsible. Service users indicated that their privacy is supported, and are encouraged to be respectful and maintain good relationships with staff and peers alike. All service users have an education plan, and although one service user’s college course has been put on hold, they are getting involved in the daily running of the home instead. Holidays, fun days out and parties have been taking place throughout the year, and staff turnover has been minimal. Staff say they feel supported, and that the service users benefit from the easy going atmosphere in the home. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 6 The service user seen knew how to use the complaints procedure and was clear that they would be happy to approach the manager if they felt they had a problem. What has improved since the last inspection? What they could do better: The home is due to have some refurbishment and quotes for work have been obtained. Some areas are rather shoddy, and as no date has yet been set for commencement, the manager is urged to finalise this work with the directors. A large proportion of staff statutory training has lapsed, and this needs improving without delay. A recommendation that a training matrix is constructed to enable shortfalls to show up has been made. Some staff have benefited from a TOPSS accredited induction, but this is not available to all. An induction package has been based on the TOPSS package, but does not contain the learning material. The manager must ensure this meets the ‘Skills for Care’ requirements and incorporates the Learning Disability Award Framework (LDAF) learning outcomes. Adult and child protection training has lapsed and needs addressing. Some policies are absent, and these relate directly to the smooth management of the home and outcomes for service users, these are clinical waste; emergency and crisis and continence promotion. Some aspects of medication management need improvement, such as the policy and procedure for medication leaving the home and how it is recorded; the accuracy of handwritten labels and the system by which medication is logged in as received by the home. The current quality assurance system would benefit from improvement, drawing out what is really meaningful to service users and in preparation for inspecting for better lives. Physical interventions are sometimes used, and staff have received training, however this is not accredited through BILD, the organisation approved by the Department of Health. A requirement that this be addressed urgently was made. The Hall DS0000023574.V263615.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.V263615.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.V263615.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): 2 Pre admissions assessments are effective and collect the level of information required; assessing if the home can meet an individuals needs. EVIDENCE: Planned placements benefit from a thorough assessment process. All support needs are kept under strict review, and service users are fully involved with the process. Emergency placements have a full assessment as soon as possible, and thorough care and support plans are developed. The Hall DS0000023574.V263615.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 Service user plans remain comprehensive and reflect individuals support needs and goals. EVIDENCE: Care, goal, and support plans were very well documented and were being reviewed on a regular basis. Service users are involved in the development of goals and are fully aware of the content of support plans. Staff actively encourage service users to make decisions that have a positive outcome for the individual. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 16 The service users choose age and peer appropriate activities; education is well supported. Rights and responsibilities are a key feature of the ethos of the home. EVIDENCE: All service users are enrolled on college courses that have been chosen by them and reflect their future aspirations. Activities within the home promote independence, however an individual who was awaiting a course to re-start expressed frustration in its delay. Staff stated, and the service user agreed, that they were helping out more in domestic chores and household duties in the meantime. One service user specifically fed back, via comment card, that their privacy was respected. All residents have a bedroom key and staff were seen to knock on the bedroom doors and wait for an invitation before entering. There is no restriction to any part of the home other than the offices, where service users are permitted to access, with staff support, their personal records. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 12 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): 19, 20 Healthcare support has improved. Medication storage has improved, but some areas of practice need attention to ensure the system is safe. EVIDENCE: Service users are supported to lead healthy lifestyles, and a recent policy revision has now brought the smoking policy for the home in line with the NMS. Staff no longer have their cigarette breaks with service users. On the whole, the management of medication is good, however some areas need improvement, such as updating the policy on medication leaving the home and how it is signed out; the accuracy of the medication administration record directions, compared with the pharmacy label, as these are handwritten) and the manner in which medication is recorded as being received by the home. Additionally, the policy should make clear the process for checking in medication. A generally tidy-up of the files and an individual over-view of medication used per service user plus a clear photograph was recommended. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users feel sure that their concerns will be listened to and acted upon, and are happy to speak to staff or supporting professionals with concerns. Staff have not had adult and child protection training for many years, this is urgently needed. The British Institute of Learning Disabilities (BILD) has not accredited restraint training currently employed. EVIDENCE: Service users returned comment cards clearly indicating that they knew that they would be listened to if they had a concern. An individual stated that they felt safe in the home and knew staff were there to help resolve problems. The home has a complaints policy and procedure, and people living and working at the home are aware of this. A professional therapist is available on a fortnightly basis for all service users, another route for concerns to be raised. Adult and child protection training is considerably out of date; only one staff member appears to have had this training since 1997. Training and development standard number 35 looks at this in more detail. The home does not have the latest Kent & Medway Adult Protection protocols (that should have been received by all adult registered establishments), and are urged to obtain them and ensure the home’s procedures are revised accordingly. Restraint training has been provided to staff, however the organisation who have ‘trained the trainer’ are not accredited with BILD – who are the body stated in the Dept. of Health restrictive practice guidance as authorise to accredit. Revising this training provision is required to ensure the safety of service users and staff alike. Two service users reported, anonymously, that they felt ‘told off’; a staff member had assisted service users complete these, therefore the manager agreed to follow up and find out what prompted such a response. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 14 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, 30 The house is homely and comfortable. Service users bedrooms do meet individual needs and promote independence, but the quality of decoration and physical maintenance in several rooms needs improvement, including the upstairs bathroom. Toilets and bathroom quantities are below national minimum standards, but are situated in easy reach, both upstairs and down. Shared space meets service users needs; some old adaptation that has not been used for many years would benefit from being removed. The home generally seems clean and hygienic, but bathrooms need improvement. EVIDENCE: The home has had some communal areas redecorated recently, and carpets cleaned, giving a more homely and warm feeling. The main entrance hall staircase has a (said to be obsolete) casing for a stair lift, which looks really out of place and is recommended, if it is obsolete, to be removed. Service users have had input and have been involved in improving the large downstairs bathroom, by choosing a screen for the window. The home has two bathing and toilet facilities available to service users, although the visitors / staff toilet is made available whenever required. The bathroom, on the ground floor, has a separate shower cubicle, and is in a large room; a recommendation to assess the feasibility of separating the two areas and increase the provision has been made. The upstairs bathroom is in need of improvement, as is worn The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 15 and stained. Maintenance work that has taken place has not been finished off, leaving tiles missing from behind the WC area, and replacement doors not painted. Individual bedrooms are personalised to taste, but maintenance issues and general decoration is in need of improvement. The manager has obtained quotes for redecoration, but does not have a date for commencement. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 16 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): 35, 36 Staff training provision needs improvement to ensure the continuing safety of service users. Supervision frequency has increased, and follows a specific format focusing on the service. EVIDENCE: Some staff have received TOPSS accredited induction training, but no certificates were available, while others have something similar, but it is not accredited. None of the ‘in house’ induction had learning resources for the new staff member to refer to. The change in mandatory induction training was discussed, and the use of LDAF and common induction standards; information was passed on, and a recommendation made that these areas be revised and included towards staff NVQ award. Adult and child protection training has not been offered regularly, and only one staff member has had an update since 1997. Much health and safety training is out of date (standard 42), and there is no system in place to look at the staff team as a whole to spot these shortfalls. Essential training must be organised and provided on a rotational basis to prevent it becoming out of date, and it is strongly recommended that all staff training provision be displayed on a matrix to prevent shortfalls occurring in the future. The manager acknowledges these shortfalls and the organisation have recently employed a training co-ordinator. Staff said that they have regular supervision and feel fully supported by the manager and senior team. The manager advised that staff have now benefit The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 17 from regular supervision, and that questions relating to the wellbeing and adult protection issues of service users are raised. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 18 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 manager is a competent individual, however must ensure that the service users safety and standard of living is not compromised by slippage occurring in training provision and the maintenance of the physical environment. Quality assurance systems to seek service users views are in place, but are not used in a way that formally feeds into the development and improvement of the home. Shortfalls in statutory training provision leave the service users and staff in a vulnerable position. EVIDENCE: The home is run with the best interests and development of the service users in mind, but the overall responsibility of the home meeting the NMS falls to the manager, and the shortfalls of training highlighted in the report leave gaps where both service users and staff could be made vulnerable. Better systems to keep up to date with changes (in restraint, for example) and to prevent staff training lapsing, are required. Staff must be given sufficient time off direct duty to complete essential training. Service user meetings, key worker 1:1 discussion and reviews as well as day-to-day input all feed into the QA process used by the home. There is a service user and family questionnaire in place, The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 19 but has had limited success in response. A discussion regarding ‘Inspecting for Better Lives’, and the way in which services will be inspected in the future took place, and a recommendation that the QA system be reviewed to be ready for the future was made. Including, within the QA process, must be a way of monitoring the essential health and safety training staff require to keep themselves and service users safe. There are significant shortfalls in training, and the manager has recognised this. Discovering shortfalls is not appropriate, and better management strategies need to be employed to prevent this happening. The pre-inspection questionnaire stated that most maintenance certificates were up to date, and fire checks took place regularly. The portable appliance test had lapsed, and was being conducted the day after inspection – again, the systems must be in place to prevent the lapse occurring. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 20 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 X 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 2 25 2 26 3 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 2 X 2 X X 1 X The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 21 NO 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 YA20 Regulation 13 (2) 18 Requirement Timescale for action 01/03/06 2 YA23 13 21 3 A24 16 YA25YA27YA30Y 23 MAR directions to exactly reflect the pharmacist label directions. 09/02/06 Improve system of receiving in medication. 01/03/06 Review policy and procedure for checking in and medication leaving the home. 01/03/06 Staff be given sufficient time off shift to complete their medication training. 01/03/06 All staff to have child & adult 31/03/06 protection training and periodic reviews. 01/03/06 New staff to receive this as part of their induction. 31/03/06 Obtain the Kent and Medway Adult protection protocols and procedures, and revise home policy accordingly. 31/03/06 Restraint training to be supplied by an organisation who is accredited to BILD. 01/03/06 Submit an action plan stating 31/03/06 dates of redecoration and DS0000023574.V263615.R01.S.doc Version 5.1 Page 22 The Hall improvement of environment 4 YA35YA42 12 13 16 18 23 Conduct full training audit and produce a matrix and submit a copy to CSCI. Ensure all statutory health and safety as well as service specific training does not lapse. 01/03/06 5 YA35YA42 18 New staff to benefit from 01/04/06 Skills for Care / LDAF induction that includes child and adult protection training. 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 Refer to Standard YA20 YA24 YA27 YA39 Good Practice Recommendations Give MAR folder a tidy up – including the MAR charts. Individual overview of medication used, reason for meds, and side effects plus a clear photograph of service user. Remove the obsolete stair lift casing. Research feasibility of creating a further bathroom / WC. Review the Q.A. process against this NMS and ‘Inspecting for Better Lives’ guidance. Include training and service issues in the annual development plan. Create strategy to prevent training shortfalls occurring in the future. The Hall DS0000023574.V263615.R01.S.doc Version 5.1 Page 23 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.V263615.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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