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Inspection on 05/01/07 for Tinkers Hatch Limited

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

This inspection was carried out on 5th January 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 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

What has improved since the last inspection?

Since the last Inspection the home has reviewed and updated it`s policy in relation to adult protection and of how to make an adult protection alert. They have also introduced a timetable of activities that is now included in individuals` care plans.

What the care home could do better:

In relation to care planning there are inconsistencies in the quality and amount of information they contain and this needs to improve. The specific guidance that should be in the care plan for staff to follow when supporting residents is not always detailed. All care plans should be based on robust assessments of residents needs and include assessments of all areas of their lives including how individuals like to spend their time, how they like their personal care to be delivered, how staff should support residents with health care management etc. Likes, dislikes and preferences also need to be documented. All activities that residents participate in should be risk assessed including access to the home, grounds and the community. Where risks are identified then guidelines for staff to follow to minimise these risks must be written up and included on the care plan. When a resident sets new goals at a review they should be documented in the care plan along with details of how the progress made towards meeting them is to be monitored. It is recommended that the home writes a daily routine for each resident to show how they spend a typical day. This will give staff a good idea of the individual this too should be kept on the care plan. Alongside this it is also recommended that the home extend the daily activity timetable to include evenings and weekends to show how residents like to spend their time. The manager needs to obtain specific guidance from residents` prescribing GP`s in relation to the administration of PRN or `as and when` medication and homely remedies. The arrangements for the provision of food at meal times need to improve. Residents must be more involved in the setting of the menu, the purchasing, preparation and serving of food. A full review of these arrangements must take place in consultation with the residents of the home. A choice of food should be available and this should be specified on a menu. Food should only be platedup when needed and should be kept warm. Residents needing assistance to eat should be supported in a timely manner. Food should not be blended unless a soft textured diet has been advised by a health care professional and specific guidelines have been provided for staff to follow. If food is blended items should be blended individually and be well presented. Individual fire risk assessments should be completed and used as a basis to write a new fire evacuation procedure.

CARE HOME ADULTS 18-65 Tinkers Hatch Limited New Pond Hill Cross In Hand East Sussex TN21 0LX Lead Inspector Elaine Green Key Unannounced Inspection 5th January 2007 10:00 Tinkers Hatch Limited DS0000021272.V322344.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 Tinkers Hatch Limited DS0000021272.V322344.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. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tinkers Hatch Limited Address New Pond Hill Cross In Hand East Sussex TN21 0LX 01435 863119 01435 864062 services@tinkershatch.co.uk Tinkershatch.co.uk Mr N Ashton & Mrs S Brown 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) Mr Neil Sellman Care Home 32 Category(ies) of Learning disability (32), Physical disability (4) registration, with number of places Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. Service users accommodated will have a learning disability. A maximum of four (4) service users who also have a physical disability can be accommodated on the ground floor. 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. 14th November 2005 2. 3. 4. Date of last inspection Brief Description of the Service: 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 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. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 5 Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The National Minimum Standards refer to individuals who reside in Care Homes as “Service Users”. The people who live at Tinkers Hatch will be referred to as “Resident(s)” throughout this report. As part of the unannounced Inspection of Tinkers Hatch, a site visit took place to the home on the 4th January. As part of the Inspection the Registered Manager completed a Pre Inspection Questionnaire that provided the Inspector with statistical information relating to the home. Residents of Tinkers Hatch and their relatives or representatives were also given the opportunity to complete surveys and return them to the Inspector. Feedback from them will be included in this report. On the day of the site visit, issues relating to the day-to-day running of the home were discussed with the Registered Manger, and two of the staff on duty. Discussions also took place with five residents. A range of documents were examined including four residents care plans, three recruitment files, a selection of the homes’ policies and procedures and some of the homes daily records. What the service does well: Prospective residents of Tinkers Hatch have their needs assessed prior to moving into the home and are given all the relevant information they require in order to make an informed decision about whether or not to reside there. Residents are provided with the opportunity to participate in stimulating and enjoyable activities in the home and by accessing the facilities on offer within the local community. They are able to make choices about the way they spend their time and about the way they decorate and furnish their rooms. Residents are also supported to express themselves through their appearance and are given the opportunity to have a supported annual holiday. Residents care plans are individualised and provide staff with some specific guidance they require to support the residents appropriately. Some residents have their own person centred plan that details their likes, dislikes and preferences. The home has a large lounge where residents can gather and watch television and a large dining room. Residents’ bedrooms are individualised and reflect their personal tastes and interests, they also contain the specialist equipment they need to promote their independence. One relative wrote ‘My son is very happy living here. He likes his room – it is quiet.’ A resident wrote ‘I like it here.’ The food provided is wholesome and mealtimes are relaxed and informal. The medication policies and procedures adopted by the home are safe and residents’ health care needs are met. Referrals are made to the relevant health Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 7 care professionals when required and adult protection alerting procedures are followed when required. The staff team are open and enthusiastic to new ways of working. They receive appropriate training and are supervised on a regular basis. Informative handovers take place at the beginning of each shift ensuring that all relevant information is passed onto the staff coming on duty. The management of the home are open and transparent and there are systems in place to ensure the home is run in the best interest of the residents. What has improved since the last inspection? What they could do better: In relation to care planning there are inconsistencies in the quality and amount of information they contain and this needs to improve. The specific guidance that should be in the care plan for staff to follow when supporting residents is not always detailed. All care plans should be based on robust assessments of residents needs and include assessments of all areas of their lives including how individuals like to spend their time, how they like their personal care to be delivered, how staff should support residents with health care management etc. Likes, dislikes and preferences also need to be documented. All activities that residents participate in should be risk assessed including access to the home, grounds and the community. Where risks are identified then guidelines for staff to follow to minimise these risks must be written up and included on the care plan. When a resident sets new goals at a review they should be documented in the care plan along with details of how the progress made towards meeting them is to be monitored. It is recommended that the home writes a daily routine for each resident to show how they spend a typical day. This will give staff a good idea of the individual this too should be kept on the care plan. Alongside this it is also recommended that the home extend the daily activity timetable to include evenings and weekends to show how residents like to spend their time. The manager needs to obtain specific guidance from residents’ prescribing GP’s in relation to the administration of PRN or ‘as and when’ medication and homely remedies. The arrangements for the provision of food at meal times need to improve. Residents must be more involved in the setting of the menu, the purchasing, preparation and serving of food. A full review of these arrangements must take place in consultation with the residents of the home. A choice of food should be available and this should be specified on a menu. Food should only be plated Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 8 up when needed and should be kept warm. Residents needing assistance to eat should be supported in a timely manner. Food should not be blended unless a soft textured diet has been advised by a health care professional and specific guidelines have been provided for staff to follow. If food is blended items should be blended individually and be well presented. Individual fire risk assessments should be completed and used as a basis to write a new fire evacuation procedure. 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. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 9 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 Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents are supplied with the information required in order to make an informed decision about whether to reside in there. EVIDENCE: The manager explained that prospective residents are assessed prior to them moving into the home. A pre admission assessment was examined and was found to be in order. There is trial period to enable prospective residents to test drive the home and this is specified in the contract. Contracts were examined and confirmed this. Contracts are also costed so that prospective residents are aware of the services that fees cover. The homes admission policy was examined and is comprehensive. The homes statement of purpose and service user guides were examined and found to be satisfactory. These documents have been reviewed and updated. The manager has given assurances that all residents in the home are provided with copies of these documents. In addition to the standard version these documents are available in 4 other formats, there is an audio version, one in simple language, one using pictures/photographs and one using a symbolic language called Makaton. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,&9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans are reviewed and amended as required however they do not all provide the information required for staff to support service users in all areas of their daily living. EVIDENCE: Four residents’ care plans were examined. In parts they are based on comprehensive assessments and provide the guidance required by staff to support the residents effectively and appropriately. Some of the care plans are plans are individualised, person centred and include personal history and lifestyle plans. However, generally more specific guidance and information is required in order for staff to follow to ensure residents are being supported to make choices and become independent as well as ensuring a consistent care approach is adopted by the staff team. Care plans should document the sort of choices individuals are able to make and what support they require from staff to make these choices e.g. whether able to choose clothes for the day with or Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 12 without assistance or whether able to choose own college courses etc. Some care plans contained detailed and specific guidelines for how personal care should be delivered including specifying residents preferences. This should be introduced for all residents that require this sort of support. It is recommended that care plans contained a daily routine for individuals to give staff an idea of the sort of things that and individual does during a typical day and the amount of support they require. Residents’ likes, dislikes and preferences should also be documented on the care plan. All activities should be risk assessed and relevant guidelines introduced for staff to follow when supporting residents participate in activities or access the community where a risk is identified. For example some people may not be able to use escalators but can use lifts independently and staff would need to know this if planning an outing to ensure that they were going somewhere where lifts were available. Other people may have preferences in relation to where they sit so that they feel safe and anxiety levels are kept low. It is this sort of detail that is missing from some of the care plans that were examined and although staff know the residents well and are aware of their needs, writing guidelines ensures staff work consistently, minimises risks to residents and promotes independence. The home has a robust system in place for ensuring care plans and the associated documentation are reviewed and updated on a regular basis. Each resident has a ‘weekly care plan’ and this is a summary of the support needs in relation to medication, healthcare, personal care needs, things the carer needs to look out for and monitor, appointments for optician, dentist, whether been complaining of bad back etc. All updated information is highlighted in red so that it stands out to the reader, staff read this information on a daily basis. Some residents are involved in the running of the home. Some people help to keep their rooms clean and the residnts in the smaller house are able to help with their laundry. Other people like to help around the grounds and a small number help out in the kitchen with domestic tasks. Residents are able to make choices about how they spend their time. Timetables detail all the activities that residents participate in during the day but they do not include evenings and weekends it is recommended that this is introduced. Residents’ reviews are documented and specify what the individual has stated they would like to do in the future and specify the goals that have been set. However, the detail in relation to how these goals are going to be met and the way they are to be monitored was not recorded in sufficient detail in all the plans examined. In contrast to this, the information provided by key workers in relation to the progress individual have made over the last 12 months in the form of a report, is extremely detailed and informative. An examination of these key worker reports also confirms that residents are leading stimulating, meaningful lifestyles that they enjoy and that staff are supporting them to do so. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16&17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents with the opportunity to access the community and participate in meaningful and appropriate activities. Albeit residents are provided with a healthy diet independence and choice are not promoted at meal times. EVIDENCE: Through discussions with residents and staff and the examination of daily records it is evident that most of the residents lead active lifestyles. Trips out are organised for groups and for individuals. A supported annual holiday is provided for those who want to go. On the day of the site visit a resident had been out and told the Inspector that they had enjoyed themselves. Another resident indicated that they had enjoyed a trip out to the seaside with staff they had been on recently. Some other residents were going out in the afternoon with staff while others were attending a group session in the homes’ Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 14 day care building. The home has close links with a local college and the residents spoke enthusiastically of the pantomime they had taken part in at the home over the festive season that had been as part of a course run by the college. One resident spoke to the Inspector about where they were going to buy a computer game from and said they were going to get themselves information from a shop about prices next time they went into town. They stated that they often go into town with staff. Several residents spoke out going to visit family over the festive period and about their family visiting them at the home. Staff confirmed that they support residents to visit their families and that visitors are welcomed into the home. The Inspector joined residents in the dining room for their midday meal. The meal was hot when it was served and well presented. However, there was no choice available. One resident was given an alternative but this did not include any vegetables and the food did not look appetising. Staff explained this individual did like this food and a list is kept in the kitchen of the food individuals do not like so that the cook knows to provide an alternative. A choice of food should be available and this should be specified on a menu that is accessible to all residents of the home and in a format they can understand. Several residents were given a pureed meal. The whole meal had been blended together and served in a bowl, this looked very unappetising. In addition to this staff placed the pureed food in front of residents who needed assistance to eat and then continued serving the other residents before returning to support them. This meant a long wait for these individuals and that the food was probably cold by the time they ate it. Residents who require help to eat should be supported to do so in a timely manner. Food must only be blended when a soft textured diet has been recommended by a health care professional and specific written guidance has been provided for staff to follow. Each item of food must be blended separately and well presented. Two other residents’ food was plated up and left on the table for them before they were seated. This food would also have been cold by the time it was eaten. Staff explained that usually they kept food warm for residents but on this occasion the residents concerned had been unusually late. The practice of plating up food in advance should stop and food should be kept warm. There were no condiments available, there was no menu in the dining room and residents were not as involved in the arrangements for the meal as much as they should be. Residents should be involved in setting the menu, buying provisions, preparing and serving the food and condiments should be available at the table. The home should undertake a full review of the provision of food at meal times in consultation with the residents and establish their likes, dislikes and preferences in relation to the food they are served and all the other related arrangements e.g. seating arrangements, décor of room, times of meals, who serves the food, where they eat. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19&20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are met and personal support is provided appropriately. Albeit the homes’ medication policies and procedures are generally safe, risks could be further minimised. EVIDENCE: Observations of practice on the day of the site visit, an examination of records and discussions with residents and staff confirms that residents’ health care needs are met. Referrals are made for input from health care professionals when required and residents receive support and treatment in the privacy of their own rooms. Where specific exercises are required in order to e.g. improve mobility, this is monitored. Clear and specific guidance is provided in a care plan for staff to follow in relation to supporting one particular resident with their exercise and in relation to preferences for how they receive personal care. The support guidelines in relation to residents’ health care needs and the support they require from staff to manage conditions such as epilepsy is inconsistent. In one care plan the information was detailed and specific but on Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 16 another it was vague and there were no clear guidelines for staff to follow. Clear and specific management guidelines should be introduced for all residents with health care needs such as epilepsy or pressure area care needs etc. Requirements are made in relation to this under standard 6 of the report. All service users have an allocated key worker. Times for getting up, going to bed etc are flexible. Residents are given the freedom to express themselves through their choice of clothing, hairstyles and make up and are supported to do so by the staff team. Medication records were examined and found to be in order however there were gaps identified in relation to the specific guidance required by staff for when ‘as and when ‘ medication can be administered. This was discussed with the manager on the day of the site visit who assured the Inspector he will make sure that all the residents G P’s are contacted in respect of getting clear guidance for how, when and why ‘as and when’ medication and ‘homely’ remedies can be administered. Residents’ medication is administered at the specified times. The manager explained the system the home has in place to ensure that the risk of errors being made are minimised and that if errors are made they are identified as soon as possible and the appropriate training provided for the staff member who has made the error. Training is provided for staff in relation to the administration of medication and is done so on a continual basis. Some medication was being taken out of the packaging it came in and left in the medication cupboard in smaller quantities to make it easier for the staff to do medication audits. This is not considered good practice and should stop as this increases the chances of errors being made. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are listened to. The homes’ adult protection policies and procedures protect residents from abuse and harm. EVIDENCE: Some residents can display a level of behaviour that may be challenging. Guidelines for staff to follow in relation to managing this behaviour is included on their care plans thus minimising the risk of harm. Some staff have received training in relation to the protection of vulnerable adults and a programme for all staff to receive this training is in place. An ‘in house’ induction adopted by the home ensuring that all new staff receive information, guidance and ‘in house’ training on how to work with specific individuals with difficult or challenging behaviours. The manager is aware of the need for referrals to be made to the local social service department when required in line with local guidance. The home has worked closely with the local Community Learning Disability Team and other professional bodies in order to achieve the best outcome for the residents involved and ensure residents safety. Residents are able to make complaints and there are a number of ways they can do this. Some residents stated that they would speak to their key worker others to their family or the manager. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,29&30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable, residents own rooms promote their independence and the home is suitable for its’ purpose. EVIDENCE: The Inspector had a tour of the building on the day of the site visit. The home is comprised of one large main building, a separate smaller house, a separate flat, separate building housing the office and another housing the homes, day care centre. All of these were found to be both clean and hygienic. The flat and smaller house are decorated and furnished in a modern style to a good standard and the main building although in a fair state of repair some areas e.g. the dining room, are in need of some updating. All rooms in the small house and flat are domestic in character, have a homely and comfortable feel to them and are fully accessible. In the main building the communal rooms are large and lack the ‘homeliness’ of the smaller house and flat but do provide communal space in the hallways/entrance halls both on the ground and first Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 19 floors where residents like to congregate. There are bedrooms on both the ground and first floor of the main building. Residents’ own rooms in all the buildings are decorated and furnished to their own tastes and personalised with their belongings. All bedrooms meet the needs of the residents they accommodate. They are individualised and are fitted with the specialist equipment that they require to maximising their independence. Several rooms have sensory equipment and all rooms are reflective of the individuals’ taste and interests. On a survey one relative wrote ‘My son is very happy living here. He likes his room – it is quiet.’ A resident wrote ‘I like it here.’ The kitchen in the main building is bright and provides ample workspace and storage. Unfortunately this kitchen is a catering kitchen and whilst this meets the needs of the catering staff it does not provide the opportunities for residents to be involved with the daily running of the home that a domestic kitchen(s) would do. The kitchen in the small house is domestic in character and does provide residents with an environment in which they can become more involved with the running of the home and thus become more independent. Washing facilities are appropriately sited in the kitchen and in the separate laundry. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 20 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 excellent. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are good and consistently followed. All staff receive regular documented supervision and appropriate training. The home is staffed by an effective staff team. EVIDENCE: All staff, including the manager, receive formal documented supervision at least 6 times a year plus an annual appraisal. Staff were consulted with and involved in the writing of the homes’ supervision policy and are given a choice in relation to who they will be supervised by. All mandatory training has been provided for the staff at Tinkers Hatch this year. Further training needs are identified through supervision and additional courses are sourced according to individual residents changing needs. Currently 50 of staff have obtained a National Vocational Qualification (NVQ) in Care at level 2 or above as is required by national minimum standards. The staffing levels of the home vary from shift to shift and is dictated by the activities that residents are participating in and the amount of support they require. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 21 Staff recruitment, induction, training and supervision files were examined. The recruitment procedures adopted by the home are safe and all the required security and identity checks are undertaken prior to staff being deployed to work in the home. The homes’ ‘in house’ induction package that all new staff must complete when they start work at Tinkers Hatch was examined by the Inspector and was found to be comprehensive, covering all aspects of the running of the home, including; the main points of care in relation to the residents, a health and safety induction, introduction to medication administration and assessment, time to read residents care plans, information relating to the Protection of Vulnerable Adults and details of the fire evacuation procedures. This will link to the new Common Induction Standards and cover all the required areas. All staff receive appropriate specialist training they need in order to deliver the care and support that the residents of the home require. The home has a comprehensive training programme for 2007. This covers a whole range of training some of which will be provided in house but the majority is being provided by external trainers specifically for the staff at Tinkers Hatch. The training programme that was examined specified the course title, the date, who it was being provided for and what the course would cover. It also covered group meetings that were to be held to discuss specific issues with staff. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 22 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): 37,38,39,40,41&42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and experienced and the management and administration systems are good. This service is run in the best interest of the residents whose health and safety and financial interests are protected. EVIDENCE: The registered manager of Tinkers Hatch is experienced and holds the relevant qualifications required to manager a care home. The management of the home monitor staffs’ understanding of the homes’ policies and procedures and whether or not they follow them at all times. All staff have to read and sign that they understand the homes’ policies and procedures on a 6 monthly basis. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 23 The homes record keeping is of a good standard. The records examined were all up to date and accurate and some of them were comprehensive and detailed. A range of documentation and certificates in relation to residents’ health and safety were examined and found to be in order. The temperature of the hot food that is prepared in home is routinely recorded as required. All staff who handle food receive training in respect of food handling and preparation. The manager monitors the homes’ performance and the information gathered from this process is then used to identify the homes shortfalls and ways in which the home can improve the service they provide. Residents are regularly consulted over how they think the service is performing; this is by means of regular key worker meetings and by their completion of questionnaires. The manager of the home produced a staff survey and the results of this have been used to introduce changes to reflect the views of the staff. All the staff that the Inspector spoke to spoke positively about the home and the way it is run. The staff stated that they felt the manager had listens to them and that they felt valued. Records are kept of residents’ financial transactions and a small amount of money is kept in the home for each resident. These records are checked regularly and the Inspector can confirm that on the day of the site visit a resident accessed their own money from a locked cabinet in the office. They had full access to their own money tin and bank books and discussed in detail their plans for spending their money with the manager who was supportive and gave the resident the relevant advice and guidance in relation to their proposed purchase. Regular alarm tests and evacuations are carried out and detailed records are kept. Some residents’ care plans contained fire risk assessments but not all. A fire risk assessment should be completed for each resident and guidelines written up in respect of the support they need from staff (if any) to vacate the building. In addition to this the homes evacuation procedure should then be reviewed and rewritten if necessary based on the out come of these risk assessments. Further risk assessments are required to be completed for individuals in respect of the environment and accessing the community e.g. whether able to access grounds on own or if staff support required, whether is able to travel on escalators etc requirements in respect of this are made under Standard 6. The home records all accidents and incidents and these are audited on a regular basis to see if any patterns are emerging and if there are any steps that can be taken to reduce the risk of them happening again. The management and administration systems adopted by the home are good. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 24 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 4 2 3 3 3 4 3 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 3 3 2 x Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Timescale for action 12(1ab,2,3) Care plans must be expanded 30/05/07 14(abc) to ensure they are based on 15(1,2abcd) robust assessments as 16(mn) specified in standard 2 and as Sch3 specified within the report. 14(1ac2ab) A full review of the 30/04/07 16(hi) arrangements for the provision of food at meal times should take place in consultation with the residents of the home. As specified within the report. 13(2) Guidance in relation to the 30/03/07 12(1ab) administration of PRN medication and homely remedies as specified in the report should be sought from the prescribing GP. Medication should not be removed from its’ original packaging until it is dispensed. 12(1a) A risk assessment must be 28/02/07 23(1abc(iii)) completed in relation to the risk of fire for each individual resident. The homes’ evacuation procedure should then be based on the outcome of these risk assessments. Regulation Requirement 2. YA17 3. YA20 4. YA42 Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations That the home writes up the daily routine for each resident (as detailed in the report) and that this is included on the care plan. That the activities timetable is extended to cover evenings and weekends to show how individuals like to spend their free time. Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tinkers Hatch Limited DS0000021272.V322344.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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