CARE HOME ADULTS 18-65
The Hamlet The Links Resource Centre 21 Cromwell Road Eccles Manchester M30 0QT Lead Inspector
Sylvia Brown Unannounced Inspection 21nd January 2009 09:00 The Hamlet DS0000066572.V374201.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 Hamlet DS0000066572.V374201.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 Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Hamlet Address The Links Resource Centre 21 Cromwell Road Eccles Manchester M30 0QT 0161 707 8856 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) Abbotsound Limited Mr B Booth (unregistered) Care Home 9 Category(ies) of Learning disability (9), Physical disability (9) registration, with number of places The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD Physical disability: Code PD The maximum number of people who can be accommodated is: 9. Date of last inspection 12th March 2007 Brief Description of the Service: The Hamlet is a registered care home that provides care to 9 people with a learning and/or physical disability. The home is single storey and offers all service users single room accommodation. There is one lounge dining room which supports service users to socialise and meet together. The home is attached and part of a building which also provides day services to people with a learning disability and or physical disability. There is also some supported living tenancies and a separate registered care home for three people with a leaning disability. The Hamlet is situated close to the centre of Eccles with public transport within easy access. The Hamlet is owned by Abbotsound Ltd. The fees for the home are £112 to £235 per night. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes.
The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 2nd November 2006. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the manager and staff were not told that we would be visiting. The manager who is also the manager of Bath House was not on the premises when we arrived, however he made himself available throughout the site visit and met with us to receive feedback at the end of the visit. As part of the inspection process we gathered information from a number of people which included, where possible, talking with and seeking the views of service users during the site visit. Prior to the site visit we also sent out surveys to service users and members of staff. This gave them an opportunity to tell us about their opinions on the services provided at The Hamlet. We received four service users surveys which they had been supported to complete by the manager and staff members. We did not receive any completed surveys from staff members. We case tracked two people living at the home, this means we looked in depth at their care support which included looking at their records in detail. We spent some time with service users and observed their day-to-day routines as they received support and assistance from care staff. This helped us get a better view about how people living at The Hamlet are looked after and supported. In December 2008 the manager completed a self-assessment form, which is called an Annual Quality Assessment Audit (AQAA). This document should tell us in detail what the manager has done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. Unfortunately the AQAA was not completed in enough detail to give us all the information we required. As a consequence we spent some time with the manager to gain additional information. We also gathered information through general contact with the home through their reporting procedures which are called ‘Notifications’ and through information we received from other people, such as the general public and professional visitors. We have received a number of complaints about the services provided at The Hamlet within the last twelve months. The AQAA
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 6 identified that the manager had received three complaints at the home in that time which were investigated under the homes complaints procedure. Five allegations of abuse have been made which we were not informed about by the home. We are consulting with the Local Authority about these to ensure they were fully investigated under the Local Authority Safeguarding procedures. Since the last key inspection, we have monitored the service by completing a random inspection in March 2007 to specifically look the management of medication. In March 2008 we completed an Annual Service Review (ASR) which means we gathered information about the service and made an assessment about whether we thought it was continuing to maintain a good standard of care. The outcome of the ASR was that we felt there was no need to alter our inspection programme and that service users were continuing to receive a good standard of support. What the service does well: What has improved since the last inspection?
Records and documentation are continuing to improve. Where service users have difficult behaviour we could see that staff had been provided with more detailed guidance.
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 7 Parts of the building has been redecorated and the manager and staff team have attempted to personalise the home and make it more suitable for the long term care of service users. What they could do better:
The registered provider does not keep us informed of important issues at the home. We were not informed of the appointment of the current manager, not kept informed of all allegations of abuse or referrals made to the Local Authority and were not informed of all incidents of aggression between service users where injury or harm occurred. Because of this we do not always have up to date and relevant information about the home or how the service is being managed. From our observation when inspecting and from the information we have been given, we think that the service should develop an admissions criteria which is linked to the aims and objectives of the service. It would appear that there is minimal consideration given to the grouping of service users, rather the assessment is based on placement vacancy and if the needs of the service users can be met by the service. There is not enough consideration given to the mix of the already established group, their continued living arrangements and their suitability to live together. Whilst the service does well to support service users with challenging and complex needs and would prefer to provide such a complex and specialised service in the future a review of service users current needs and the aim of their placement should be to make sure all service users are suitably placed at the home. This review should include consultation with family and other important and relevant people to the service users and the Local Authority. We think the registered provider should carry out a review of the service and clarify its main aims and objects which are currently defined within the homes statement of purpose as being a respite care service, when in practice it is the permanent or long term home to most service users. Should the Hamlet continue to be the permanent or long-term home for some service users significant changes will have to be made to systems and investment in the environment will have to be completed to make sure it maintains the standards required at all times and is suitable to meet its aims and objectives. Even though the service is specifically designed to support service users with a learning disability and that the registered provider has access to specialist resources and professionals, they have not ensured that service users have access to or are provided with information which is adapted to enable them to understand what is recorded or said. For example care plans, risk assessments, statement of purpose, menus and activity plans are not in an easy read format. Furthermore service users opinions are not actively sought on the service and they are not able to directly influence how the home is run
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 8 or developed. As a consequence service users are not able to make valued contributions or share their experiences and opinions with people who can act on their behalf. It is important for service users to live in a home which fosters an atmosphere of openness and respect, such inclusion would enable and promote a sense of self worth and involvement for some service users. The registered person must make sure the home is run and managed by a suitable person who is registered with us as a fit person to manage a care home. This would ensure service users live in a home which is run by a person who has completed all the required checks and has the experience, qualifications and skills needed to support them and manage a home correctly and in their best interests. We found the manager open an honest about his learning and how he intends to develop the service, however when asked he was slightly unclear on his role and responsibilities under the Residential Care Homes Regulations 2001 and was not familiar with the National Minimum Standards. Neither was he familiar with the support and advice systems we offer to ensure managers have all the information they require to maintain standards. Because the Hamlet is within a larger building which includes Bath House and the Links, many aspects of the service have become joined, which is not correct. Furthermore boundaries have become vague and in some instances we feel this is one of the reasons why standards have slipped since we last inspected. Documentation is often mixed and includes information about all three services for example, staffing rotas were unclear as to who was working where and who they were supporting when one to one support was in place. Training records were joined with the other services so who had received up to date training at the Hamlets was unclear as were fire safety checks and records of practical fire drills etc. In order to ensure that service users live in a home which has a clear identity and in order to maintain accurate documentation and systems as required within Regulations and Standards, action should be taken to separate all services and provide systems and information which relates to and is specific to each service. There is an opportunity to develop care plans further, with more detailed information on the behavioural difficulties of some service users and how they are best managed. Such plans should focus on the willingness and ability of service users to control their behaviour and work towards managing their aggression, anxieties and fears. This should enable service users to understand more about their own feelings, be supported to gain control and achieve small goals and support them to gain an understanding of how their behaviour impacts on others and if this is acceptable or not. A number of good practice recommendations have been made and we would refer the reader to the end of the report for further details about these. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 9 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 Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 10 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 Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 11 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): 1,2,3 & 4 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective service users have their needs assessed prior to moving into the home. Information provided to them is not in an easy read format or solely relates to The Hamlet. This means prospective service users do not have all the information they need to make an informed choice before they can move in. There was no admissions criteria or assessment process which took into account the needs or abilities of both prospective and current service users or their suitability to live together. Because of this there is a risk of service users living in inappropriate groups. EVIDENCE: We looked at two service users files and found them suitably detailed to confirm that pre admission procedures included an assessment of service users needs by the placing Local Authority. Whilst we found that pre admission assessments were in place, we could not identify any admissions criteria for a placement at the home, furthermore the homes aims and objectives stated within the statement of purpose was vague.
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 12 From our observations we are not confident that the mix of service users has been or is being considered when referrals are made. Some service users have complex needs which leads them to have unpredictable behaviour which leads to conflict with others. To make sure that consideration is actively given to meet the services aims and objectives and that all service users are suitably placed, the manager should have an admissions criteria which is used when assessing and considering new placements and whilst service users continue to live at the home. The manager told us that as far as possible all placements are planned and that it is rare for the service to provide emergency placements unless the service user is already know to the manager and staff team. The manager confirmed that as far as possible he visits prospective service users in their own home or placement and that they are invited to visit the home, meet with others and take part in the day to day routines before making any decisions about moving in. Two of the four surveys returned by service users indicated that they had not received enough information about the service prior to and when moving into the home. The statement of purpose provided to us was not specific to the service, it was not in a format which could be easily understood by service users and it failed to contain most of the essential and required information as stated within Regulation 4 and Schedule 1. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 13 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 written care plans and risk assessments in place which are kept under review. This means that their needs are known by staff members. EVIDENCE: Each service user has a written care plan which details their needs and support requirements, they also included risk assessments which were kept under review. Some service users have behaviours which can be unpredictable which makes them a risk to others or themselves. This was recorded and some details were included about how to manage difficult and challenging situations. From reading service users records and other documentation we identified that on occasions the use of restraint was carried out, we also saw that some service
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 14 users are hit by others. We had not been notified of these events as we would have expected, we are therefore recommending that until further notice, we are notified when staff have completed restraint procedures and when service users cause harm to themselves or others including staff. This will enable us to accurately evaluate and monitor how such occurrences are being manage. Some service users have restrictions placed upon them and have complex needs which require additional support. Where this applies specific and detailed care records should be maintained in greater detail. Behaviour modification programmes should have review dates and goals set to enable accurate monitoring of service users progress and achievements. We observed some service users making decisions and choices for themselves about how they occupied themselves and what clothes they wore. Their care records identified that they had been consulted about their personal preferences and support requirements. However service users were not generally consulted about matters relating to the running and development of the home and were not actively able to influence how the home was run. Service users were not given the opportunity of meeting together to discuss their opinions on the service, neither did they have access to or were provided with comprehensive, understandable, up to date information in suitable formats about policies and procedures, activities and services provided and operated at the home. Annual quality assurance audits are not publicised therefore service users are not informed of the outcome. We have not been provided with a copy of the quality assurance report which is required by regulations. The last key inspection identified similar findings about service users involvement in developing the service and annual quality audits and as a consequence issued a good practice recommendation which was not acted upon by the registered provider. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 15 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. Systems were in place to support service users to live as they would like. This means that some service users are able to continue with their chosen hobbies and interests. They have meals which are enjoyable but not always well balanced, healthy or offers choice. EVIDENCE: Service users records contained details about their daily routines. They stated that though they can do what they like during the day and at week ends, there are restrictions in the evening. We have been made aware that at times the activities plan in the evenings can not always be followed and that activities are not always carried out as planned. The manager stated that because of improved night time staffing ratios, there are financial restraints which have impacted on the service, particularly the ratio of evening staff. Despite this the manager gave assurances that planned activities will be supported .
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 16 There was no formal process in place for routine planned group activities and service users do not have a choice of entertainment brought into the home. Friends and families are made to feel welcome at the home with a number of service users receiving regular visits from people they know and trust. Service users are able to spend time away from the home with their friends and family staying away overnight when they wish. Service users have the opportunity of sitting together in a communal lounge dining room when they receive their meals. The menu provided to us during the site visit appeared designed to be enjoyed by younger people but was not a nutritionally balanced menu which offered choice and variety. Breakfast options were not recorded, rather cereals and toast was described as the breakfast option. Lunchtime meals consisted of such food items as waffles and spaghetti, burgers and chips, fry-ups, pasta bake, sandwiches and chips. Teatime meals were recorded as chicken wraps and rice, sausage and mash, corned beef hash, fish in sauce, take away and roast dinner. Supper meals were not recorded at all. Furthermore there were no alternative options detailed. The service does not employ a cook and staff have responsibility for preparing meals, this means a reliance on pre cooked and prepared foods, rather than meals which contain fresh vegetables, quality meats and home made puddings. The menu was not in an easy read format and there was no indication that service users have been consulted about the development of the menu. Though service users commented positively about the food we believe the manager has an opportunity to develop this area of the service. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users have their personal and health care needs recognised recorded and met. This means they receive support as far as possible to maintain good health. EVIDENCE: All service users had written care plans which recorded their health care needs, this means staff had the information they required when supporting service users. Visits by medical health care specialists were recorded and the service users attendance for healthcare checks and appointments were up to date. Since the appointment of the new manager, care files and records have been reviewed by him and additional information has been obtained to make sure they are reflective of the service users current needs and how they should be supported.
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 18 The management of medication was being carried out correctly. Medication was stored safely and medication administration records were correctly signed. This means that service users were receiving their medication as and when prescribed. Throughout the site visit we observed staff supporting service users. We saw that they were able to adapt their practice to meet the individual needs of the service users they were supporting. Service users surveys stated that they felt well cared for, listened to and that staff were always available when needed. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 19 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. Service users were aware of the homes complaint and safeguarding procedures, however they are sometimes placed at risk and complaints are not investigated and resolved correctly. Because of this some service users are harmed by other service users and families do not trust that their complaints will always be taken seriously. EVIDENCE: The Hamlet has a written complaints procedure in place. Service users returned surveys indicated that they were aware of the complaints procedure and had someone they could talk to if they felt they had any concerns. We have received a number of complaints about the service which have not yet been fully resolved. Due to the nature of the complaints and the time it has taken for the complaints to be resolved the Local Authority have been contacted to look into the issues raised. From the information we have received we do not think that the complaints procedure is always consistently followed. The service maintains a record of complaints recorded, however the complaints given to us were not all recorded. The AQAA stated that three complaints had been received at the home all of which were resolved within the twenty eight day timescale.
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 20 Service users are protected by adult protection procedures, in addition the manager is aware of his responsibility to know of and follow Local Authority safeguarding procedures . Since the last inspection we have been contacted by a Local Authority regarding the number of complaints and concern they have received about this service. As a consequence they have commenced safeguarding procedures to look into their concerns and assure themselves that service users are not being placed at undue risk or being harmed. The AQAA recorded that there have been five allegations of abuse made at the home, all of which have been investigated correctly. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 21 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): 24,25,27,28 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is in need of repair and upgrading. This means that some parts of the home are not homely or an inviting place to live. EVIDENCE: Since the last inspection whilst there have been attempts to improve the standards of the home by the manager, but their does not appear to have been any significant meaningful investment in the property by the registered provider. The Hamlet is a specialised home which describes itself and is registered as a respite care home for people with a disability. Because of this it is required that the registered person maintains the required standards as detailed within Regulations and the National Minimum Standards and further enhances the environment to make sure it is fit for purpose and suitable to accommodate people with complex needs.
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 22 The Hamlet has been converted from a Victorian bath to its present day purpose, as time moves on and standards improve this building has become outdated and ill equipped. Though the manager has attempted to improve and personalise some living areas the home has an institutionalised feel about it. At the last key inspection we required the registered provider to make repairs to ceiling tiles and various other improvements. This has not be complied with. We found evidence of previous leaks so ceiling tiles were stained and decoloured, some were dislodged. This not only means they are unsightly it is also a significant risk in the event of a fire. Florescent lighting in corridors is inappropriate and not suitable for everyday living environments. Toilet pedestals have been secured in place by concrete at the base, which is porous and significantly increases the risk of the spread of infection. Furthermore the home is without a laundry. The washing machine and dryer are stored within a cupboard in a corridor. When we asked how incontinent and soiled clothing and bedding was rinsed we were told that bathrooms used by service users were used. The washing machines were domestic in style and we were told by staff that they did not have a sluicing facility. There was no appropriate work surfaces to fold and prepare laundry. Carpeting in not of good quality and the main entrance door had a poor locking device which is placed too close to the closure and increased the risk of accidents occurring. Externally much is required to make the immediate area used by service users suitable. The area appears shabby and uncared for and does not portray a positive image of the care home. Despite the more negative aspects of the environment some service users have been supported by family and staff members to decorate their rooms and personalise them. Some service users have spent their own finances or those of their family, refurbishing their rooms and providing their own beds etc . However we could find no detailed records of this in service users personal possessions records. It was clear that staff had gone to some considerable lengths to support those without communication to have personalised rooms, however all rooms were emulsioned., though in different colours service users had not been given the opportunity for wallpaper which again gave an institutionalised feel to the environment. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 23 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): 32,33,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been a minimum number of staff leaving within the last twelve months. Staff are correctly recruited, trained and supervised . This means that service users are more likely to receive care and support from people they know and who are appropriately skilled to support them. EVIDENCE: The manager ensures that robust recruitment and selection procedures are completed. Staff files contained application forms and references, in addition statutory checks were received prior to new staff commencing duty. The AQAA confirms that of the fifteen members of staff twelve had completed induction training as recommended by Skills for Care. Two staff members are recorded as leaving the home within the last twelve months , which means service users benefit from receiving support from an established staff team all of whom have achieved NVQ training at level 2 or above which exceeds the minimum standard. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 24 The manager has improved the frequency of staff supervisions and conducts team meetings which makes sure members of staff receive the support they need and provides them with up to date information about any changes in policies and procedures. We were provided with two weeks rota, however due to the complexity of staffing arrangements and the individual need for support of some service users we were unable to accurately assess if staffing numbers were correct throughout the day. We were informed that some service users required one to one support, for others they may share a support worker with another service user. When we looked at the rota this could not easily be traced, furthermore staffing levels reduce significantly from 8pm when evening and night time staff commence duty with 6 staff members on 8 am – 8pn with an additional 3 members of staff supporting them at different times, whilst from 8pm there are only three staff on duty. As a home for younger adults we can see no reason why the staffing level should be reduced so early in the evening and goes someway to explain why service users are not able to do the activities they like in the evening. The rota should be more specifically detailed and indicate who staff are supporting or are allocated to supervise when they are on duty. The delegation of tasks should be identified for example we could not tell who was responsible for the preparing of meals and how they were allocated for such tasks. The manager should also make sure that the staffing rota contains only the staffing ratio and plan for The Hamlet. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 25 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 & 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service use live in a home which is run to an adequate level and managed by a person who is not registered with us. There is no meaningful quality assurance procedure which seeks the views of people who use the service. Health and safety checks are carried out. This means service users receive the support they require and are kept safe, but their views on the services are not actively sought on how systems and routines could be developed for their benefit. EVIDENCE: Since the last inspection the registered manager has left and a new manager has been appointed which we were not informed about. The manager has not submitted an application for registration with us. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 26 During the inspection the manager made himself available and provided us with all requested information. The manager has the experience and skills to manage a care service but has not completed the Leadership and Management Award The manager was able to explain the process taken to review the service since his appointment and though some changes have been made he is aware that many more are necessary to ensure that the service develops to meet best practice and the National Minimum Standards. As stated previously the service has not completed a specific annual quality assurance audit which was based on seeking the views of service users, their family, friends, advocates or stake holders. We have not been informed about the completion of regulation 26 visits which should be conducted monthly by the registered provider or their representative. These visits should include talking with service users and staff, the monitoring of records and care practice and inspecting the building. We looked at health and safety records and can confirm that annual services have been carried out by appropriate professionals and safety checks were routinely completed. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 27 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 1 2 3 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 3 28 2 29 x 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 2 15 3 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 2 2 x x 3 2 The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement The registered provider must produce a statement of purpose and service users guide which is specific to the services at The Hamlet. The documents should be in a format which is suitable for the service users for whom they are written. This will mean that prospective service users, their family and placing Authorities will have clear and up to date information about the services available at The Hamlet The registered provider must replace all missing, dislodged and stained ceiling tiles on corridors to ensure effective containment in the event of a fire and improve the appearance of the environment. This requirement was first issued in November 2006 with a compliance date of 12/3/07 Failing to comply with this requirement will result in consideration being given
The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 29 Timescale for action 01/07/09 2. YA24 23 20/04/09 regarding enforcement action. 3 YA24 23 The registered provider must ensure that a full audit of all parts of the environment is completed with a view to improvements being made where identified and a planned programme of upgrading put into place. A copy of the planned upgrading must be provided to us in detail and include timescales for action and completion of each part. This should make sure that service users live in a home that continues to improve in a timely manner which can be affectively monitored. The registered person must make sure that the home is run and managed by a suitable person at all times. An application for registration must be submitted to us without delay. This will ensure that service users live in a home which is run and managed by a competent and fit person. 01/06/09 4 YA37 9 01/04/09 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 YA3 Good Practice Recommendations The registered provider should develop an admissions criteria and pre placement assessment process which are reflective of the services aims and objectives and supports the manager to make an informed decision when considering new placements at the home.
DS0000066572.V374201.R01.S.doc Version 5.2 Page 30 The Hamlet 2 YA6 3 YA6 4 YA8 5 YA8 6 7 8 YA8 YA14 YA14 9 YA14 10 YA17 11 YA26 12 YA26 We should be notified of all significant events occurring within the service which may affect the health, wellbeing or safety of service users. This includes the use of restraint, injuries caused by service users in conflict with each other, acts of violence and serious accidents where service users receive medical treatments or assessments. Care plans should be developed to specifically record procedures to safeguard and manage service users likely to be aggressive or cause harm or self harm, focusing on positive behaviours, ability and willingness to work towards minimising challenging behaviour. The registered provider should make sure that service users are offered opportunities to contribute towards the day to day development of the home and running of the service. This includes seeking the opinions of the service users as individuals and as a group. The registered provider should ensure that a annual quality assurance audit which specifically relates to The Hamlet is completed, the outcome of which is made public. Service users should have access to the public report, a copy of which should be provided to us. All information, documents and reports which service users have access to should be in a suitable and understandable format. Service users should receive the support to complete their individual chosen leisure activities as detailed and agreed within their care plans. Action should be taken to develop planned group activities such as the provision of entertainment being brought into the home and service users having the opportunity to attend group activities outside of the home. Service users in longer term placements at the home should have the opportunity of a minimum seven day holiday each year which they have helped to choose and plan. After consultation with service users and consideration of their individual needs, a menu should be put into place which offers them a varied, nutritious and enjoyable diet, which includes freshly prepared home cooked quality food items. Accurate records of service users personal possessions should be maintained, this includes any and all fixtures and fittings that they have purchased or which belongs to them. Service users should be given the opportunity to have their room decorated with wallpaper of their own choosing unless otherwise required. Where wallpaper is not appropriate risk assessments and records should detail the
DS0000066572.V374201.R01.S.doc Version 5.2 Page 31 The Hamlet 13 14 YA22 YA30 15 YA33 16 YA38 17 YA43 reasons why and agreements to this. The Homes complaints procedure should be followed correctly at all times ensuring complainants are informed of the outcome of all investigations into their complaints. Action should be taken to provide an appropriate laundry facility which is maintained at the approved standard which meets with Environmental Health and Infection control Standards. An accurate record of the staff rota should be maintained. It should clearly record the staffing complement for the Hamlet only and contain how staff time is delegated and to whom. It is important that the registered person recognises the Hamlet as a registered care home in its own right and that action is taken to create its own identity, ethos and service. Management systems and service provision should be service specific and relate only to the services provided at the home. The registered provider should complete regulation 26 visits as required and until further notice provide us with copies of each visit. The Hamlet DS0000066572.V374201.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ 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
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