Care Home: 23 Hathaway Road

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What the care home does well 23 Hathaway Road provided a flexible service to meet the needs of the people who stay there and support to their carers/relatives. Surveys showed that people felt that they had good information about the service before they chose to use it and were kept up-to-date during stays. Information from the home`s own feedback forms said "manager did her utmost to accommodate us at short notice and the staff are always very helpful". A health professional felt that what the service did well was that the "manager keen to find out particular needs and preferences of the service user to reduce anxiety at staying in unfamiliar surroundings." People using the short stay respite service at Hathaway Road were able to continue their everyday lives as much as possible, such as going to their day centres. Staff supported them to develop everyday life skills and also to enjoy leisure activities in the community. In the section on what the care service did well, a social worker survey included "good assessments, planning their stay, good communication and provide good leisure activities for service users". A person using the service said "we do good things ... like seeing a film". Hathaway Road had a stable and well-established staff group. This provided familiar faces to the people who come to stay there. Information from the home`s own feedback forms said "the team at Hathaway are fantastic people and have really been good to my relative. They really enjoy their time there and I never have to worry about them." What has improved since the last inspection? The garden had been developed to be more spacious and so provide another space for people using the service to enjoy. A new form had been introduced to make it easier to record compliments and complaints so that the information can be seen clearly. Staff had been working on providing information to people in ways that they might find easier to understand, such as pictures about where they could go for activities or what food to choose. What the care home could do better: The care plans that show the needs of people using the service and how they are to be met in a safe way, must be clearer and have more information so that people get the best care outcomes possible in a consistent way. To show that the premises and equipment are maintained, and to ensure the safety of the people who stay and work at the home, certificates need to be available for the gas, fire equipment, alarm and the emergency lighting. CARE HOME ADULTS 18-65 23 Hathaway Road 23 Hathaway Road Grays Essex RM17 5LB Lead Inspector Mrs Bernadette Little Unannounced Inspection 21st July 2008 09:30 23 Hathaway Road DS0000036448.V368749.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 23 Hathaway Road DS0000036448.V368749.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. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 23 Hathaway Road Address 23 Hathaway Road Grays Essex RM17 5LB 01375 383556 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) Thurrock Council Joyce Kathleen Tree Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal care to be provided to up to 4 service users with learning disabilities who require a short break service only. Personal care to be provided to up to 4 service users with learning disabilities under the age of 65 years. Number of service users whom personal care is to be provided shall not exceed 4. 31st July 2007 Date of last inspection Brief Description of the Service: 23-25 Hathaway Road provides a short break service for young adult men and women, 18-65, with a learning disability and operates from a five-bedroom house. Thurrock Council owns the house. Referrals are usually based from a community care assessment made by individuals Social Worker. The Home is situated in the centre of Grays and is a short walk to the High Street, bus and train stations. The premises are made up of two joined properties, which are maintained, decorated and furnished to a fair standard, providing four bedrooms. There is no off-street parking outside the home as parking is by permit only, although the home does have visitors permits which can be used up to 5 hours and after 6pm - until 9.00am parking is permitted. The Home has a ramp leading to the side door and two good-sized rear gardens. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The site visit was undertaken over a five-hour period as part of the routine key inspection of 23 Hathaway Road. Time was spent with some residents who were at home at times during the day and one person was able to offer their views on aspects of the service. Observations of interactions between staff and people who used the service were noted during the day and these are reflected as part of the report. The manager submitted an Annual Quality Assurance Assessment as required prior the site visit. This details their assessment of what they do well, what could be done better and what needs improving. This information was considered as part of the inspection process and reflected as part of the report. Prior to the site visit, the manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for people who use the service, relatives, staff, care managers and healthcare professionals. Four responses were received from people who use the service, three from relatives/carers, three from staff, two from health professionals and one from a care manager/social worker. The responses received from people who use the service showed where they had had assistance to complete the form and from whom. This was for example a keyworker at the day centre and involved just reading the questions and writing down the answers given by the person who used the service. The information they contained was included as part of this report. The manager was on annual leave at the time of this unannounced site visit. Two staff were present and were very helpful although they were unable to provide all the documents requested for inspection as they did not know where to access them, or advise on current fees for the service. A tour of the premises was undertaken with the support of a person who used the service and available records, policies and procedures were sampled. The outcomes of the site visit were discussed with the staff throughout the day and opportunity was given for clarification where necessary. What the service does well: 23 Hathaway Road provided a flexible service to meet the needs of the people who stay there and support to their carers/relatives. Surveys showed that people felt that they had good information about the service before they chose to use it and were kept up-to-date during stays. Information from the home’s 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 6 own feedback forms said “manager did her utmost to accommodate us at short notice and the staff are always very helpful”. A health professional felt that what the service did well was that the “manager keen to find out particular needs and preferences of the service user to reduce anxiety at staying in unfamiliar surroundings.” People using the short stay respite service at Hathaway Road were able to continue their everyday lives as much as possible, such as going to their day centres. Staff supported them to develop everyday life skills and also to enjoy leisure activities in the community. In the section on what the care service did well, a social worker survey included “good assessments, planning their stay, good communication and provide good leisure activities for service users”. A person using the service said “we do good things … like seeing a film”. Hathaway Road had a stable and well-established staff group. This provided familiar faces to the people who come to stay there. Information from the home’s own feedback forms said “the team at Hathaway are fantastic people and have really been good to my relative. They really enjoy their time there and I never have to worry about them.” What has improved since the last inspection? What they could do better: 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. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 7 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 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of staying at Hathaway Road will have a full assessment of their needs to make sure that the service can meet them and will be able to visit and try the service out before their first full respite stay. EVIDENCE: A copy of the statement of purpose and service user guide was requested but staff were unable to locate them at the time of the inspection. These are documents that should provide information about the service to people who might be interested in it. Surveys from residents showed that they had been asked if they wanted to stay at 23 Hathaway Road and that they had been given enough information about the service before they stayed so that they could decide if it was right for them. One survey had the comment “ I like staying at Hathaway Road”. Staff advised that there had been no new people using the service recently although they were aware that some pre-admissions assessments are planned. They said that one person has started visiting so that they can be familiar with their surroundings, other residents and staff before their first full stay. It also allowed staff to further assess the person’s needs and consider compatibility with other people who might be staying at the home. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 9 In their survey, a social worker said that, even though in an emergency situation the process of providing information could be delayed, Hathaway Road’s assessment arrangements ensured that accurate information was always gathered and that the right service was planned and given to individual people. The social worker further added that something the service does well was “appropriate preparation to get a service user introduced to Hathaway Road for the first time”. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at Hathaway Road experience good care outcomes that meet their expectations and needs, but shortfalls in care planning could limit this. EVIDENCE: In their Annual Quality Assurance Assessment, the manager said an Individual Support Plan was set up with each person who uses the service with their full involvement. These were said to have included a communication plan enabling guidance on behaviour management, risk assessment, personal information and medical information that was reviewed and updated at each visit and provided in an accessible format. Care plans were reviewed for three people who use the service and included people who were currently staying at Hathaway Road. Care plans would show staff how each person was to be supported in everyday life during their stay, to meet their needs safely and respect their preferences and wishes. While there was assessment information that perhaps was one or two or three years 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 11 old, no actual support plan was found to be available on any of the three files sampled. This meant for example that there was no information to say whether a person liked to have a shower or bath or what support they needed or if and was it safe for them to get themselves drinks and food as they choose. There was no evidence to show that residents had been involved in planning their care during their stay. Staff spoken with said that there usually was more information and advised that there had been discussion about writing care plans in a way that was more person centred. A recent tick box style risk assessment document was noted on the files of people who had recently stayed at the service. For one person this identified there was a high risk relating to using the kitchen and with road safety awareness. There was no follow up information to identify how the risks should be managed and the additional support needed to reduce them as much as possible to help to keep the person safe while respecting their independence. All the surveys received from relatives/carers showed that they felt that the service always met the needs of the person using the service. Additionally all confirmed that the service always gave the support to the person using the service to the expected or agreed level. One person added the comment “more often than not the care that is given is over and above what would be expected, nothing is too much trouble”. Discussion with staff showed that they knew the individual residents and their needs and observation of practice provided evidence that these were met. Staff were clear that the service was not meant to meet the needs of people with very challenging behaviour. A health professional survey said that staff are able to support people with less challenging behaviour. Examples were given where assessed needs had been considered and where staff had put planned programmes into place to support residents to develop skills and independence, for example with having a shower. A planned cooking group activity took place during the site visit, which provided residents opportunity to develop life skills. There was other information on files that showed the people using the service did make decisions and take risks in aspects such as managing their own medication, or looking after their own money. In surveys, all the people who use the service confirmed that they can make decisions about what they do each day. A person using the service said that they “like coming here”. Staff were able to provide the collated responses to feedback forms from carers over the previous year. Comments included “we are happy with the level of support offered”, “…(person using the service) asks to go to respite – a good indicator of how things work for her.” 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at 23 Hathaway Road can expect to have a varied diet and enjoy leisure activities of their choice that meets their needs. EVIDENCE: A person using the service was positively encouraged by staff to tell us about their weekend at the service and how they had gone, the previous evening, to see a film at the cinema and on the previous day to a farm as the person really likes animals. The person confirmed that they had really enjoyed these activities and said they “do good things here”. While a care plan was not in place, a sheet was available called an Activity Plan. This listed the person’s interests and hobbies, recorded planned routine activities such as attendance at the day centre and then recorded the activities that people using the service had been involved in. Staff spoken with said that this allows residents to make choices. A photograph book was available 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 13 showing different activities available and staff explained that they use these with some people use the service to help them to make choices and communicate these. Records of activities seen on the sampled files of people using the service included baking cakes, invited a friend for lunch, Grays shops and market, colouring, cinema or the farm and going out for lunch. In their Annual Quality Assurance Assessment the manager advised that they try to disrupt people’s everyday routines as little as possible during their stay, for example attending their day resource centres, but they also try to create the opportunities using community resources to promote independence adhering to the guidelines set down in the Individual Support Plan. A planned cooking group activity took place during the inspection and people using the service were supported to cook their own lunch. A staff member from the resource centre supported a resident with this, along with two other people who used both the day service and Hathaway Road and who the resident knew. In a survey of people who use the service, one person commented “I enjoy staying at Hathaway Road, I like having a break there from my family”. A person visiting said “it’s good here, I’ve been before and I’m coming again”. Anecdotal discussions with staff showed that people who use the service were supported to maintain friendships and relationships with other people. This included supporting people using the service to invite a friend for a meal and evidence of this was seen in the care records. Surveys indicated that people could choose what they wanted to do during the day and one included the comment “we all discuss things we want to do”. There was evidence that the manager and staff tried to provide residents with information in other formats to help them to make decisions and choices. This included the activity photo book and pictorial menus from which to choose foods that they would like to have. During a site visit it was observed that staff offered choices to people who use the service and also gave them time to think about these and communicate their decisions, such as whether they would like to show the inspector their room. Staff advised that they had obtained larger sized playing cards in preparation for the short stay of a person who has sight difficulties, as they feel this will be an activity that person will enjoy and now will be able to participate in. A record was kept of the food served and the nutritional intake of each resident to help to monitor their nutritional intake to ensure their well-being. There were ample food supplies available in the home that supported the choices shown on the records, as exercised by residents. A resident spoken with confirmed that they enjoyed their lunch. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at Hathaway Road can expect to be supported to access healthcare services, to manage medication safely and be treated with dignity and respect. EVIDENCE: The systems for supporting the healthcare and medication needs of people using the service were reviewed to assess if residents needs were being met at Hathaway Road. While some records were not up to date and accurate, there was evidence to show that people’s needs were being met. In the Annual Quality Assurance Assessment, the manager said that they have medical update forms to ensure that the person’s current health status is known prior to each visit. Medical profile sheets were seen on the files sampled and these gave useful information about the person such as where somebody was registered blind or they generally enjoyed good health. However for a person currently using the service this was dated 2003 and so this record was not up to date and needs to be reviewed alongside the care plans and risk 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 15 assessments for each short stay to ensure that staff have all the necessary and up-to-date information. Surveys from health professionals indicated that the staff seek advice and act upon it to manage and improve the persons health care and that individuals’ health care needs are always met by the care service. One person said that staff had alerted them when a previously arranged visit to give an insulin injection for a person using the service had not taken place. Another health professional said “the service is keen to joint work with others to support people during their short stay” and if appropriate, the individual’s health care plan will be discussed with care staff prior to the person’s short stay visit. A health professional said that staff are aware of individual’s privacy and respect their dignity especially when there was a mixed group of people staying at the service. Staff spoken with also demonstrated awareness of promoting privacy and dignity for users of the service, both in their own practice and encouraging residents for example to close the door when they are using the toilet, or not to enter another resident’s bedroom without their agreement. Each resident has their own bedroom that they can lock from the inside. While key locks were fitted, staff advised that residents do not really use these. It is recommended that this is reviewed and where appropriate, each resident is offered the active choice of using a key to lock their room while they are out to offer them greater opportunities for privacy. Clear records were available on each person’s file sampled of the medication they brought to the service, including the name, time for administration and amount of medication received, and this was signed as checked in by two staff, which is good practice. The medication administration records sampled showed staff signatures for each time the medication was administered and concurred with the medication available for that person. Medication was safely stored. In the Annual Quality Assurance Assessment, the manager confirmed that all staff had been provided with training by the county pharmacist since the last inspection. This was confirmed with staff spoken with who advised that regular agency staff had also been included. Staff spoken with confirmed that some people who use the service do manage their own medication, and while staff may remind them of prompt them to take it, they do not record this as they do not administer the medication. A safe storage facility was seen to be available in each bedroom. The surveys from health professionals confirmed that the service always supported individuals to administer their own medication or manager it correctly where this was not possible. One included the comment “staff seek advice on medication arrangements prior to short stay and will adhere to the care plan to help individual in medication management” 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at Hathaway Road will be listened to and will be safeguarded by staff knowledge and training. EVIDENCE: In the Annual Quality Assurance Assessment, the manager advised that a more accessible format to record compliments and complaints had been devised and an external advocate was now available should residents required the support. At the time of the site visit, staff advised that no complaints had been received and this was confirmed in the log of complaints and compliments received, as well as in recent reports of visits to the home by the registered provider. The Commission had received no complaints about this service since the last inspection. The last inspection report identifies that a complaints procedure was contained in the service user guide and statement of purpose in a format that was easy to understand. At the time of this site visit information on the complaints procedure was displayed in the entrance hall. This advised people inaccurately that the Commission for Social Care Inspection would investigate their complaints and did not provide up-to-date contact information for the Commission as required. The complaints procedure was not in a user-friendly format and this should be reviewed so that residents have regular access to information in a way that is more appropriate to their needs. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 17 In the Annual Quality Assurance Assessment the manager said that a member of staff sits with each person at the start of their stay to tell them about the complaints procedure adds that the external advocate will also be asking people for their views regarding the service. Staff spoken with said that they also sit with each person at the end of each steady to complete a form “About Your Stay” where they could raise any concerns. The manager showed awareness that some residents tell staff what they think they want to hear rather than their actual viewpoint and that as a service they could do better at checking out the accuracy of people’s information. In surveys, all residents indicated that they would know how to make a complaint, that staff listen and act on what they say and one person commented that they were “very caring”. Surveys received from relatives/carers also indicated that they would know how to make a complaint about the care provided if they needed to. The health professionals indicated that they have never had to raise concerns about the care received by people using the service. A social worker survey confirmed that the service had responded appropriately if they had raised any concerns. Compliments were recorded from relatives/carers for example thanking the service for the care provided and the compliment was also noted that the community nurse for the support provided for their client. In their Annual Quality Assurance Assessment, the manager advised that no safeguarding referrals have been made since the last inspection, and that staff are provided with regular training on safeguarding vulnerable people to promote residents will being. This was confirmed with staff spoken with who were clearly aware of different types of abuse and confident about whistleblowing. 23 Hathaway Road DS0000036448.V368749.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at Hathaway Road will find a homely and comfortable environment that meets their needs. EVIDENCE: All areas of the premises were viewed, some in more detail than others. A person using the service showed us their room and confirmed that they found it very comfortable. Each of the four bedrooms had a television set so people could choose to watch it there if they preferred. One bedroom, and a bathroom fitted with overhead tracking, were available downstairs should an individual person’s mobility needs require this. There were two lounges, both with televisions and allowed for music to be listened to in one room if other people wished to watch television in the other. The Annual Quality Assurance Assessment stated that the garden had been developed since the last inspection to provide more opportunities and space for people using the service. It was accessible, appropriately equipped and 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 19 spacious and provided a pleasant place for people to sit or undertake activities. There was a separate kitchen, dining room and laundry room. One survey from a relative/carer included the comment “supplies a safe and stimulating environment”. All areas were seen to be clean and tidy and there were no obvious health and safety hazards. The carpets in some of the downstairs rooms including the lounge, dining room and bedroom were stained and marked. Staff on duty advised that plans are in hand to replace these and quotes have been obtained. This is recommended to be actioned in a timely way to ensure a pleasant environment is available to people using the service. A staff survey stated the need to have better facilities for people who use wheelchairs as doorways are not wide enough and the bathrooms too small. Reports on the service undertaken on behalf of the registered person showed that there are plans to develop the bathroom and upstairs shower room but no further detail was available about this. Staff spoken with said that there were currently no wheelchair users amongst the people who use the service. 23 Hathaway Road DS0000036448.V368749.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 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported by a competent and safely recruited staff team that will work positively with them to promote good care outcomes. EVIDENCE: Staff spoken with said that there is always one member of staff on duty while users of the service might be at home and this was confirmed in the rotas seen. There may be no staff in the home if all the people using the service at that time are attending other services, but there is always an on-call person should they be required. Staff spoken with advised that staffing levels are adequate to meet the needs of the people using the service and there are occasions where an additional member of is on duty where this was identified as required for a specific user of the service. A staff survey indicated that occasionally, due to sickness, unfamiliar agency staff may be used, and this affected continuity for people using the service. Staff spoken with advised that this had not happened for some time, although they have staff on long term sick leave they have a regular agency staff. Two weeks rotas available showed that regular staff had been on duty. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 21 Staff advised of good communication systems and support within the team. Time was allocated between each shift to allow a detailed handover. This allowed staff coming on duty have all up-to-date information about what has happened with people using the service on the previous shift to help them to provide best possible care outcomes. One staff survey said they needed a structured framework for meetings and supervisions on a regular basis. Staff spoken confirmed that they have regular staff meetings and supervision sessions with their manager, which gives them an opportunity to look at their practice, any concerns, ideas or training needs they have to help them to do their job better. While not a key standard and not fully reviewed, supervision records were seen on files. The Annual Quality Assurance Assessment stated that four of five care staff currently working in the home had achieved NVQ level 3. Certificates to evidence this were seen on the staff training files sampled. Staff advised that no new staff had been recruited since the last inspection. This ensured that people coming to use the service would see familiar faces and staff would know them and their individual needs. Observations and discussions on the day of the site visit showed that staff were knowledgeable about residents needs and personalities, and that residents responded positively to them. One survey from a person who used the service commented “I like all the staff, I get on with everyone” and all surveys indicated the people using the service felt that staff treated them well. A resident spoken with said the staff were nice. Staff recruitment files were looked at for two members of staff to assess if all the required checks had been done on staff to safeguard users of the service. These showed that there was the required evidence of identity, two references and criminal records bureau checks. Evidence of recent/updated criminal record bureau checks were also on file, which is good practice. Staff spoken with said that they had good access to training including medication, health and safety, first aid and more recently training on Understanding Behaviour as Communication. Staff stated that one module of their NVQ training related to protecting vulnerable people. In a survey a health professional said that care staff were aware of diversity and equality issues and supported individuals with different needs including the preparation of foods from different cultures and supporting an individual to meet their religious needs. Surveys from relatives/carers indicated they felt that care staff have the right skills and experience to look after people properly and one person said, “my relative always had staff who know what their problems are and how to deal with them if necessary. Another comment was “my relative is well looked after and cared for when they visit the respite home. They are always happy to attend. The staff do a fantastic job”. 23 Hathaway Road DS0000036448.V368749.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 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People staying at 23 Hathaway Road will find a well managed service that is run in their best interests. EVIDENCE: The manager was unable to contribute to the information gathered at the site visit as they were on leave, but we were able to use information from their Annual Quality Assurance Assessment. The manager is experienced and the service generally well organised. While staff were helpful, they were unaware of how to access some documents and support with this could be considered as they are often the only person on duty in the service. A comment in a professional’s survey was “when home manager not on duty, some staff unable/unwilling to process enquiries of a general nature”. 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 23 The staff spoken with spoke highly of the manager’s support and approachability. Reports of visits that were undertaken on behalf of the registered provider to assess how the service was running were available. The manager had asked the views of people who used the service and they were asked to complete a feedback form at the end of each stay. These were in a user friendly format supported by symbols. In the Annual Quality Assurance Assessment the manager stated that one of the ways they know what they do well is feedback from service Commissioners and other professionals and verbal feedback at carers coffee mornings. There was evidence that the views of carers had been sought, collated and any queries responded to. No information was available on whether the views of others, such as health professionals or care managers/social workers had been taken up. The registration certificate and a current certificate of liability insurance were displayed. Accident records were available and the limited number of entries contained appropriate information. Records were securely stored. Staff were unable to locate the certificates that showed that the fire alarm, fire equipment, emergency lighting and gas had been tested and were safe. A record of fire drills/practices showed the residents, but not the staff that had been involved. Records of testing of the water temperatures stopped some time back. Staff said this was because regulators were now in place and were advised to seek further advice and clarification on this. While the new certificate was not yet available, staff were able to provide evidence that the portable appliances had been checked very recently to make sure they were safe. Records examined show that staff checked the fire alarm weekly. 23 Hathaway Road DS0000036448.V368749.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 2 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 X 3 2 3 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement So that residents are cared for consistently and safely, care plans must identify all current assessed needs in a person centred way, and supported by risk assessment, provide staff with enough information and clear instructions to offer residents care and assistance in a way that has been agreed with them. So that residents’ well-being and safety is promoted, certificates must be available to show that appropriate checks have been done on the equipment relating to fire and gas on the premises. Copies of the certificates to be sent to the commission by 01/09/08. Timescale for action 01/09/08 2. YA42 23 (2) & (4d) 01/09/08 23 Hathaway Road DS0000036448.V368749.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. Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service user guide should be readily available in the home and known to staff so that people can access information when they need it. So that people using the service have accessible information, the complaints procedure should be more readily available in a user-friendly format and have correct information. The stained carpets should be replaced in a timely way to ensure that people using the service stay in a pleasant environment. So that the quality of the services is fully monitored in residence best interests, other interested people or stakeholders of the service should be included in quality assurance information gathering. The names of all staff involved in regular fire drills and practices should be recorded so the manager can be reassured that all staff are fully aware of the procedures to be followed in case of fire to ensure resident well-being. 2. YA22 3. YA24 4. YA39 5. YA42 23 Hathaway Road DS0000036448.V368749.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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