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Inspection on 17/12/08 for Tinkers Hatch Limited

Also see our care home review for Tinkers Hatch Limited for more information

This inspection was carried out on 17th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prospective clients are given the information they need about Tinkers Hatch which is produced in a variety of formats to ensure clients have a good understanding of what Tinkers Hatch can offer to them. The pre-admission assessment for prospective clients is completed in detail, with evidence gained from the client and or their family or representative, together with other evidence gained from external multi disciplinary professionals. Person centred care plans are being developed within the home, and several have already been completed. This in itself is a lengthy process with key workers spending many hours with clients ensuring that their assessed needs are met in the clients preferred manner. Clients have a variety of activities they can participate in, this includes college courses, their chosen activities, and other activities either within the home itself or in the day centre in the grounds of the home. All clients are given the opportunity to choose from a variety of annual holidays, which have been agreed via Client Forum meetings. Clients are given choices in the decoration and furnishings of their own bedrooms, and communal spaces that they use within the home. Each of the clients bedrooms contain their own personal items of furniture, or interests individual to them. All six residents who spoke with the inspector said how much they enjoyed living at Tinkers Hatch. One relative spoken to over the telephone said that they were more than happy with the care and social care their son received. Medication is well managed within the home, and the registered manager carries out regular monitoring checks to ensure staff are recording and administering medication appropriately and safely. Tinkers Hatch has an warm homely atmosphere, and residents have access to a variety of communal space including the well tended gardens, and day centre. Staff have a variety of skills, knowledge and qualifications to ensure that clients complex needs can be met.

What has improved since the last inspection?

The risk assessments in care plans are individual to each client in the home, and now contain fire risk assessments for each individual client. The provision of food within the home has improved since the last key inspection. Clients now have a choice menu on each table in the dining room, there is a staggered lunch time meal with different sittings, and clients are able to choose which sitting they prefer. Clients who require puried food have health reasons for this written into their care plans. While there is not a generic PRN (as required) medication policy and procedure, those clients who do have PRN medication have procedures for administration written into their care plans.Each clients has a daily routine written up individually for them and this is reflected within the weekly plans of care. Where a client has more complex needs, their daily routine is kept within the bedrooms, to ensure staff have immediate information as to how the client wishes his/her care needs to be met.

What the care home could do better:

The weekly activity rota for each client should be extended to cover the activities they participate in at weekends, while it is acknowledged that they may receive unexpected visitors at weekends, this could be written into the activity rota, showing that weekend activities might not take place depending on family visits, and the clients choice. Where an external professional writes a report, this must be dated and signed by that person to show whether the information is current. Where mid cycle medication is brought into the home this should be entered onto the Monthly Administration Record, with the day it was received and the quantity that has been received together with the initials of the person receiving that medication into the home. Any incidents however minor that has an effect on another client must be reported to the Safeguarding Vulnerable Adults Team, and reported to The Commission for Social Care Inspection via a regulation 37 report. The home must ensure that a Legionella check of water system is carried out annually.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tinkers Hatch Limited New Pond Hill Cross In Hand East Sussex TN21 0LX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: June Davies     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Tinkers Hatch Limited New Pond Hill Cross In Hand East Sussex TN21 0LX 01435863119 01435864062 services@tinkershatch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Neil Sellman Type of registration: Number of places registered: Mr Nigel Ashton,Mrs Sarah Brown care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: A maximum of four (4) service users who also have a physical disability can be accommodated on the ground floor. Service users accommodated will have a learning disability. That a maximum of eight (8) service users can be accommodated over the age of sixty-five (65) as long as their individual needs can be met within the home. Individual placements must be reviewed on an annual basis. The maximum number of people to be accommodated is thirty-two (32). This number may be increased to accommodate thirty-three (33) service users in line with the variation approved on 23rd December 2004. Date of last inspection Brief description of the care home Tinkers Hatch is situated approximately one mile from Heathfield town centre, where a limited bus service can be accessed. On site accommodation is provided in the main Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 32 4 Brief description of the care home house, which accommodates 24 service users, the cottage which accommodates five, the flat which is for two service users and a unit for one service user. The home is registered to accommodate up to 32 adults with a learning disability four of whom may also have a physical disability and eight of whom may be aged over 65 years of age. The basic weekly fee for 2006/7 is #597.97. The current fee range is #597.97 #1500.00. Fees cover hotel and staffing costs `in house? day care and entertainment and #200 towards the cost of an annual holiday. Optional additional services include Counselling, 1-1 massage, sports therapy, Horse riding, College courses, literacy and gym work the costs for which vary and are not included in the fees. Additional care hours are charged at - #10 per hour. Copies of the Inspection report is available upon request from the office at the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out on the 17th December 2008 over a period of 7 hours. During the inspection the inspector spoke with Registered Providers, the Registered Manager, three members of staff, and eight residents. The inspector viewed some parts of the premises, medication, and documents relating to the standards inspected within the report. Some information was used from the Annual Quality Assurance Assessment sent to The Commission for Social Care Inspection by the registered manager. Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? The risk assessments in care plans are individual to each client in the home, and now contain fire risk assessments for each individual client. The provision of food within the home has improved since the last key inspection. Clients now have a choice menu on each table in the dining room, there is a staggered lunch time meal with different sittings, and clients are able to choose which sitting they prefer. Clients who require puried food have health reasons for this written into their care plans. While there is not a generic PRN (as required) medication policy and procedure, those clients who do have PRN medication have procedures for administration written into their care plans. Care Homes for Adults (18-65 years) Page 7 of 31 Each clients has a daily routine written up individually for them and this is reflected within the weekly plans of care. Where a client has more complex needs, their daily routine is kept within the bedrooms, to ensure staff have immediate information as to how the client wishes his/her care needs to be met. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective clients are given the information they need about Tinkers Hatch in a format they are able to understand to enable them to make an informed descision about moving into the home. The registered manager ensures that the home has the experience and knowledge to meet a prospective clients needs prior to them taking up permanent residence in the home. Evidence: Statement of purpose and service user guide have been produced in four different formats, audio, simple language, pictures and photographs and Makaton language, to help clients to understand these documents. The inspector viewed four pre-admissions assessments and found these to be detailed. The registered manager also obtains information from other multi disciplinary agencies including Care Managers from the funding authority as well as the Community Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: Learning Disability Teams, where necessary information is also obtained from health consultants and general practitioners. Great care is taken when accepting a new client into the home to ensure that the home can meet the prospective clients needs, and to ensure that the client will fit in with the existing client group. All prospective clients are required to visit the home prior to taking up permanent residence, to ensure their needs can be met, and to give the prospective client the opportunity to meet other clients in the home and enable them to make an informed choice about moving into the home. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system in the home is good, and reflects that clients are involved in drawing up their individual care plans. Evidence: All clients in the home are involved in helping their key worker develop their individual person centred care plan, this included information on how the client wishes to be treated and what must be done by staff when carrying out personal care and giving assistance at mealtimes. The information covered in each clients care plan was also based on their pre-admission assessments and assessments obtained from other multi disciplinary agencies. Each issue identified within these pre-admission assessments is discussed with the client, then put into the clients own words on their plan of care. On one care plan there was evidence that behavioural issues had been discussed with the client and there were clear guidelines for staff as to how they could minimise behavioural issues with this client. Each care plan is developed in writing, pictorial and widget format to ensure that clients are able to have a greater understanding of their Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: care needs. The Community Learning Disability Team have given the home assistance in developing these person centred care plans. Where a client has complicated needs part of the person centred plan is displayed in their bedroom to ensure the staff are able to follow the detailed steps required in meeting the clients needs. All four care plans viewed had been reviewed on a regular monthly basis. In these reviews the weekly plan of care is used to enable staff to form a judgement as to whether care plans need to be adjusted in the light of changes to health, personal and social care of the clients. From viewing risk assessments contained within the care plans it is evident that staff are well aware of the importance in providing assistance in helping the clients in the home make informed choices in regard to their lifestyles and daily living decisions. Care plans give details of how clients wish to communicate with the care team, be it through ordinary speech, Makaton, a mixture of Makaton and other sign language, facial expressions, or a talking board. Clients are able to make informed decisions in regard to risk taking. Each care plan viewed contained risk assessments individual to each client. Clients are informed of the level of risk involved in particular activities, and the steps that they and staff need to take to help the client keep the levels of risk to a minimum. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients are able to access education and activities of their choice both within the home and the community. The manager and staff ensure that clients are able to maintain family and personal relationships and are given assistance by key workers if required. Staff respect the clients rights to privacy and dignity. Clients are offered a healthy, nutritious diet with a good variety of choice to meet the clients likes and dislikes. Evidence: From care plans viewed and conversation with clients in the home on the day of this Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: key inspection it was evident that clients with assistance from key workers are able to access college courses and follow activities that interest them. Several of the clients in the home attend the local college to follow life skills, food hygiene and animal care. It is unfortunate that due to financial cuts by the department of education, many of the courses are no longer available to this client group. One client has a part-time job. The home has its own day centre, that clients in the home are able to access, and the inspector witnessed cookery, craft sessions including knitting and sewing taking place. There was evidence in care plans that clients are able to follow up activities in the local community that interest them such as swimming and football. Nearly all the clients in the home have some kind of contact with the local community. Clients told the inspector how they like to go shopping, visit theatres and cinemas and go to the pub for a drink. Two clients stated how they like to use public transport when they go out. Some of the clients attend their chosen place of worship on Sundays. The local neighbours are very supportive of the home, and attend all the homes parties and other events. Clients in the home told the inspector how they were involved in drama, and that they would be involved in a production of Grease, which they were going to perform to the public on the day following this inspection. All the clients involved in this production were very excited about the performance. Every client in the home has their own timetable for weekly activities or college courses they participate in. It was noted however that these timetables only cover week days and do not cover week ends. This was discussed with the one of the directors and registered manager of the home, who explained that weekend outings etc. are usually logged in the daily diary. This means that residents names are kept collectively and breach the Data Protection Act 1998. A recommendation is being made that client activity rotas include weekend activities and perhaps specify that if a clients family arrive the activity may change or be cancelled. Six clients told the inspector how they had regular contact with their families, either with staff support or independently. One client said that when her sister visited her, her sister was able to stay for a meal. Evidence was available within the care plans that residents are able to maintain personal relationships and visit or meet up with friends and are supported by key workers to do this. Several of the clients in the home are able to help in the kitchen areas of the home, help to maintain the grounds of the home or help domestics with cleaning chores. Three clients told the inspector that they had been supplied with keys to their bedrooms, and there was evidence through observation that the majority of clients have a key to their own personal space. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: From observation the inspector noted that staff respect the clients rights to their privacy and dignity being maintained. This was especially evident at lunch time where one client needed assistance with feeding, this was being carried out discreetly, with full attention being given to the client. All clients are called by the preferred names and this is also noted within the clients care plan. Interaction between clients and staff takes place on a one to one basis. There is space on each clients activity rota where they wish to have time on their own to chill out. From observation on the day of this key inspection is was noted that clients are able to wander the grounds, attend the day centre, or use communal lounges and dining rooms as and when they wish to. Some clients have access to the laundry area of the home so that they can launder their own clothes. One client has a pet rabbit, and receives assistance from their key worker in ensuring this pet is kept clean and well fed. Since the last key inspection, the provision of food and choices have improved. Lunch is served between specific times with clients being able to choose which sittings they wish to have. Tables are set with condiments and choice menus. These menus are written and in pictorial format. The inspector was able to witness clients making choices as to what lunch they would like, and what desert they would like, there is a choice of drink available to the clients as well. Where clients needs assistance from staff with feeding this is carried out discreetly and in a professional manner. One particular issue raised at the previous inspection was in regard to puried meals being puried for each seperate item. In one case in particular the client is unable to have his meal puried seperately due to different textures of food and swallowing difficulties, but this is included within that clients plan of care. Clients nutritional status is regularly monitored and any concerns would be reported directly to the clients General Practitioner. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients are able to state how they wish to receive personal support from key worker and what level of support they require. There is good evidence in care plans and weekly plans of care that health care needs are well managed in the home and there are good working relationships with all external health care professionals and the multi disciplinary teams. Medication in this home is well managed, ensuring that clients are not placed at risk. Evidence: One client has complex personal support needs, his person centred care plan is written in such a way, that it gives staff clear guidelines as to how they can meet these needs in the clients preferred way. This relates to the way in which the client wishes to be moved, and includes details of getting up, going to bed, bathing, washing, feeding and activities they wish to participate in. This client also requires specialised overhead hoisting which has been fitted into their bedroom. All clients care plans viewed showed their explicit wishes as to how personal hygiene needs are met, with assistance when Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: required from staff. One care plan showed in pictorial form how a client could manage their oral health care, and what assistance is required by staff. Evidence in care plans and weekly plans of care showed where specialist support is supplied by physiotherapists, occupational therapists, speech and language therapist and others. It was noted that in one clients care plan there was a write up from his external masseur, but this had not been dated or signed, so it was not obvious as to who carries out the massage, or if the report was current or not. The community nurse visits the home to renew dressings. The inspector spoke with this nurse who stated that the all the staff working in the home are professional, that any directions given by community nurses are well supported by the staff. The community nurse also stated that the home is managed and run in a very non-institutional manner, with clients wishes, choices and needs always coming first. Clients are able to choose their key workers and retain them. There was good evidence in weekly plans of care, that clients are able to access a whole variety of health care professionals, and are enabled to do this with assistance from their key worker, team leaders or the registered manager. Weekly care plans showed regular visits to or from chiropodists, community nursing, dentists, opticians, hospital consultants, speech and language therapists, Community Learning Disability Team and continence nurse. Where there are external appointments, clients are escorted by their key worker. The community nurse stated that where there were health issues that concerned the staff, this was reported directly to the General Practitioners or to the community nurses. Medication in the home is well managed, the medication policy and procedure has recently been reviewed and is explicit. In regard to PRN medication (as required) while there is not a common policy and procedure the procedures are written into individual clients care plans where PRN medication has been prescribed. The registered manager carries out his own regular monitoring of the medication system within the home, if any errors are noted, the member of staff is asked if they wish to receive further medication training to ensure that the same errors do not recur. It was noted by the inspector that while generally Monthly Administration Charts are signed off when medication has been administered, further improvements needs to be made of recording of receipt of medication. This mainly applied to medication brought into the home mid cycle, or carried forward medication such as PRN (as required) medication, which may carry over from month to month. In the case of mid cycle medication and carried over medication, this should have the date the medication has been received, in the case of PRN (as required medication) the date should be replaced with C/F, then the quantity of medication received or carried over should be entered together with the initials of the person receiving or carrying the medication over. At the present time the home does not use any controlled drugs, but a controlled Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: drugs cupboard is supplied which is securely bolted to the wall, and double locked, and the home has a controlled drugs register. Only one client is happy to manage their own medication, and this has been appropriately risk assessed and monitored. Where a client goes away for a few days to visit relatives, the bubble packs are signed out with the quanity of medication taken and signed back in with the quantity of medication the client has returned with. The majority of staff have received accredited medication training via the pharmacy supplier. The pharmacy also visits the home every six months to audit medication. The audit sheets were viewed by the inspector and these showed that receipt, administration, storage and return of medication is appropriately managed by the home. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients know that their complaints will be listened to and acted on. Staff have good knowledge and understanding of Safeguarding Vulnerable Adults which protects the clients from abuse. Evidence: The complaint policy and procedure has been updated, and produces in pictorial and easy ready format to ensure that clients are able to understand what they need to do should they need to raise a complaint. This complaints policy and procedures was updated to include easy read and pictorial format as a result of clients attending the clients forum meetings. The home has only received one verbal complaint since the last key inspection. This was investigated and discussed with a psychologist, and appropriate steps were taken to ensure the needs and choices of the client were met. This was then fed back to the complainant. While the registered manager had knowledge of this complaint it would be good practice to record verbal complaints and retain them within the complaints file. Two residents in communication with the inspector said that they would know how to complain if they needed to, and they were able to tell the inspector who they would complain to. There have been no safeguarding vulnerable adult alerts since the last key inspection. The safeguarding of vulnerable adults policy and procedure, and whistle blowing policy Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: and procedure have been reviewed and are up to date. All staff are rigorously vetted by way of Protection of Vulnerable Adults register check, Criminal Records Bureau check and two bona fide references prior to being deployed to work in the home. None of the staff are allowed to use restraint on the clients in the home. Where clients request the home to manage their personal monies, this is managed in a clear and transparent manner, with all individual accounts being maintained for the clients. It was noted while viewing the accident book in the home that an incident had occurred at the beginning of December 2008 which should have been reported to the Safeguarding Vulnerable Adults Team and Commission for Social Care Inspection, through discussion with the registered manager he was able to assure that any future events will be reported directly. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good providing clients with an attractive and homely place to live. Evidence: Tinkers Hatch comprises a main building with a seperate smaller cottage, two seperate flats attached to a detached day centre, another building containing a flat and and an administration block. On the day of this key inspection all parts of the home were clean and hygienic. The whole of Tinkers Hatch has an annual improvement plan, which ensures that all buildings on site are kept in a good state of repair and refurbishment. Clients have free access to the gardens that surround the home. Some of the clients enjoy helping the gardener to keep the gardens in a well tended condition. Recently the dining room and main communal lounge in the main building have been refurbished. On the day of the key inspection the registered manager said that they are just waiting for new furniture for the communal lounge, which had been redecorated and had a new carpet fitted. Clients living in the home have been able to make choices in regard to decoration and furniture in both the dining room and Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: communal lounge. All clients are able to choose with help from their key worker, decoration styles and colours when their bedrooms are re-decorated. The home overall has a homely and comfortable atmosphere to it. The kitchen in the main building has a number lock on the door. Some clients following risk assessment are able to gain access to the main kitchen, where they enjoy helping with general kitchen duties. Four clients were more than willing to show the inspector their bedrooms, and these contained many personal items which reflected the clients interests and personalities. Some bedrooms have sensory equipment of the clients choice. Communal toilets and bathrooms are kept in a clean and hygienic condition, all were seen to be well decorated and were provided where necessary with aids to assist clients with their mobility. The laundry is housed in a seperate part of the home and is kept locked to prevent accidents. Some of the clients after risk assessment are able to access the laundry so they may launder their own clothes. The staff working in the home adhere to infection control procedures, to insure that clients are not placed at risk of cross infection. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Stafffing levels are good and staff rotas adjusted to meet the clients social and personal needs. Staff are knowledgeable and skilled which enables them to meet the needs of the clients in the home. Recruitment practices are good and clients received care from appropriately vetted staff. Evidence: From viewing the training matrix and staff personnel files it was found that all staff have received work related training to enable them to meet the assessed needs of the clients living in the home. Training is identified through one to one supervision, and suitable training courses are then sought by the registered manager. Over 50 per cent of staff have achieved their National Vocational Qualification at level 2 or above. From observation on the day of the inspection it was noted that clients are able to approach the staff at any time. Staff use the method of communication chosen by the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: client. Throughout this inspection it was noted that staff respect clients and there is good interaction at all times. One member of staff said that it is the practice of the home to escort clients to health care appointments to ensure that the client has a full understanding of what is being discussed, the decisions that need to be made and the treatment being prescribed. The staffing levels in the home vary from day to day, and are dependent on what activities the clients are participating in and what support the clients needs to enable them to carry out their activities. Staffing levels are also dependent on the health needs of the clients. The home has a good supply of bank staff, to ensure that residents know the people that are caring for them. Many of the staff working at the home have been employed by Tinkers Hatch for many years and there is limited staff turnover in the home. The inspector viewed four staff personnel files and found that all files contained application forms, at least two forms of indentification, and CRB checks. Three of the staff files seen show that these staff have been employed by Tinkers Hatch for a number of years and there was no Protection of Vulnerable Adults register check. The one member of staff recently employed did have a Protection of Vulnerable Adults register check, which had been obtained prior to that member of staff being deployed to work in the home. All four files contained contracts and terms and conditions of employment. All staff from the registered manager down receive regular one to one supervision at least six times per year. Staff have been instrumental in drawing up their own supervision policy and procedure, and can also select who they wish to be supervised by. Staff also receive an annual appraisal. Both supervisions and appraisals identify the staffs understanding of the philosophy of the home, their work with clients and the support and guidance they need. From the staff training matrix and certificates contained within the staff personnel files, the inspector found that all staff have completed their mandatory training, with further up date training in the process of being booked for 2009. All new staff are inducted into the home and complete a Skills for Care induction modules. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is supported well by senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. There is a good awareness of health and safety procedures in the home to ensure that clients who live in the home and staff working in the home are safe at all times. Evidence: The registered manager has obtained his NVQ level 4 and Registered Managers Award. He has been employed at Tinkers Hatch for over twenty years. Staff find him to be approachable and fair. There is a clear management structure in the home. The home has developed a good quality assurance system in the home where the views of the clients, relatives, friends and some visiting professionals are sought. The registered manager monitors systems used in the home. Clients views and ideas are also sought through client forum meetings. An annual business development plan is Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: produced. One of the registered providers carries out regular monthly regulation 26 visits. There is a health and safety and fire risk assessment for all the buildings and rooms at Tinkers Hatch. The home has up to date health and safety policies in place. All equipment used in the home has an up to date maintenance certificate. Fire points and hot water delivery temperatures are check weekly. The Legionella check is overdue. All clients accidents are recorded and monitored by the registered manager. Where a clients are shown to have several accidents in a short space of time, the registered manager seeks assistance from the relevant health care or learning disability team. The staff Skills for Care induction pack contains a module on health and safety issues. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 37 The registered person shall 30/01/2009 give notice to the Commission without delay of the occurrence of (c) any event in the care home which adversely affects the well-being or safety of any service user. Where there are outbursts of aggression from clients which has an affect on another client, this must be reported directly to the Safeguarding Vulnerable Adults Team and to the Commission. When reporting such events to the commission a regulation 37 form must be used. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 13 It is good practice to develop an activity rota that also included weekend activities, with the understanding with Page 29 of 31 Care Homes for Adults (18-65 years) the client that should their family arrive, the activity might be cancelled, so they are able to spend time with their visitors. 2 20 Where medication is brought into the home mid cycle or medication is carried over from one month to another month, this must be properly record onto the Monthly Administration Record. The registered manager should ensure that regular annual Legionella checks are carried out on the water systems in the home. 3 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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