Care Home: Hatton Grove, 4

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What the care home does well The main strength of the home lies within its staff team. Although there were a number of vacancies, most of the shifts were covered by permanent agency staff to ensure continuity of care. There has practically been no change within the staff team during the past 2 years. Staff demonstrated that they were knowledgeable, skilled and competent. We also observed that staff received training to ensure that they remained competent and skilled to care for the residents. The manager of the home is experienced and runs the home in an inclusive and open manner. There is an effective management structure in the home whereby the manager delegates the responsibility for various tasks, to her senior staff. They then feel empowered and motivated to do their job. The home accommodates some of the most vulnerable people in our society. The manager and her staff are able to demonstrate that they are on the whole well able to care and support the residents that live in the home while promoting their independence and their right to make choices in their daily life. The home is appropriately decorated and provides accommodation to residents in well maintained single bedrooms that are personalised to a good standard. The care records are written in a person centred approach and address the needs of the residents from the residents` perspective. They are easy to read and generally describe the action to take to meet the needs of residents. What has improved since the last inspection? Four requirements were imposed on the service during the last key inspection in June 2007. We found that three of them have been met. The Service users` guide (SUG) and the statement of purpose (SoP) have been updated to make these documents more specific to the home. The home has identified that not all residents would benefit or want to attend a day centre. As a result the home has reviewed the activities that are provided in house. There seems to be a number of social and recreational group activities to suit the needs of residents, while activities are also arranged to suit the individual needs of each resident. The home addresses the subject of ageing and death comprehensively in the care records. The care plan addressing this area also describes the instructions and wishes of residents for their funeral. The home has started to do satisfaction surveys, although a report about the last survey that was carried out, was not yet available. We were unable to find a quality assurance procedure and a quality management system for the service to use to carry out an audit of the service that it provides, according to standards that have been set in the quality management system. What the care home could do better: The home accommodates residents with learning disability needs. As the residents aregetting older they have started to develop frail older people care needs in areas such as incontinence, nutrition, mobility, pressure area care and hygiene. At the same times some of the residents are developing dementia. We noted that the home has already started to address the changing needs of the residents, but we would recommend that staff have more training in understanding the needs of frail older people. As the needs of older people are prone to more rapid changes, care plans and risk assessments must be updated when the needs of residents change rather than after the usual six months, to reflect the actual needs of residents and to detail the action to take to meet these needs. Residents` care plans to manage epileptic fits must be clear about the medicine to use and the circumstances to use these. This would ensure that the residents are being supported appropriately when they have fits. The amount of all medicines that are carried over after a medicine cycle must be recorded in the new medicine record chart. This would provide an audit trail. The clinical/medicines rooms must also be tidy and cleaning materials and equipment should not be stored in the same area for infection control purposes. A number of issues were noted with regards to health and safety. These must be addressed to ensure that people who use the premises are as safe as possible. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hatton Grove, 4 Hatton Grove, 4 West Drayton Middlesex UB7 7AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 0 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Hatton Grove, 4 Hatton Grove, 4 West Drayton Middlesex UB7 7AU 01895441349 01895444134 jdaniell@hillingdon.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Borough of Hillingdon care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 18 The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Hatton Grove is a purpose built home for seventeen adults with learning disabilities. It opened in the 1970s and is owned and managed by the London Borough of Hillingdon. The home is located in a residential area and is about 3-5 minutes walk from Station Road where local shops and amenities can be found. The home has parking areas in front of it and additional parking is available on roads near the home. It is easily accessible by public transport as buses regularly serve Station Road. The home is divided into three self-contained flats, one on the ground floor and two on the first floor. The ground floor flat accommodates residents who have profound learning disabilities as well as physical disabilities. A passenger lift provides access Care Homes for Adults (18-65 years) Page 4 of 37 Brief description of the care home between the ground and first floors. Each resident has their own bedroom with a wash hand basin. The rooms are appropriately decorated and personalised. There are 2 bathrooms on each floor and each flat has 2 separate toilets. There is additional shared space on the ground floor that consists of a visitors lounge and a well equipped activities room. The rear gardens are secure and pleasantly laid to lawn with shrubs and seating on the patio area. The home is managed by June Daniell, the registered manager. She is supported by 4 team leaders and a number of care workers. The home also provides ancillary staff to support care staff. Although the home is registered for 18 residents, the home accomodates 17 residents. The extra bed is for any emergency admission if that is required. There are currently 6 female and 11 male residents in the home. Most of them are funded by Hillingdon Local Authority, but there were a few residents that have come from other Local Authorities. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection took place on Friday 22nd May at 11:00-15:00, Tuesday 26th May at 15:30-18:30 and Monday 1st June from 10:50-14:40. The last key inspection took place on the 29th June when the service was rated good (2 star). We carried out an annual service review (ASR) of the service on the 25th March 2009. During the inspection we talked to at least 8 members of staff and 6 residents. We also toured some of the premises, looked at the care that was being provided to some residents and looked at a sample of records that were kept by the home. The manager completed an annual quality assurance assessment (AQAA) for the ASR and we received some satisfaction questionnaire that we have used to inform this Care Homes for Adults (18-65 years) Page 6 of 37 report where possible. We would like to thank all the residents who talked to us to share their experiences of living in the home and the manager and all her staff for their support and cooperation during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home accommodates residents with learning disability needs. As the residents are Care Homes for Adults (18-65 years) Page 8 of 37 getting older they have started to develop frail older people care needs in areas such as incontinence, nutrition, mobility, pressure area care and hygiene. At the same times some of the residents are developing dementia. We noted that the home has already started to address the changing needs of the residents, but we would recommend that staff have more training in understanding the needs of frail older people. As the needs of older people are prone to more rapid changes, care plans and risk assessments must be updated when the needs of residents change rather than after the usual six months, to reflect the actual needs of residents and to detail the action to take to meet these needs. Residents care plans to manage epileptic fits must be clear about the medicine to use and the circumstances to use these. This would ensure that the residents are being supported appropriately when they have fits. The amount of all medicines that are carried over after a medicine cycle must be recorded in the new medicine record chart. This would provide an audit trail. The clinical/medicines rooms must also be tidy and cleaning materials and equipment should not be stored in the same area for infection control purposes. A number of issues were noted with regards to health and safety. These must be addressed to ensure that people who use the premises are as safe as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures in place and has all the necessary information to provide to prospective residents and their relatives for them to decide whether the home would be suitable for them. The home carries out an assessment of the needs of prospective residents to make sure that the home is suitable for the prospective residents. Evidence: During the last inspection it was noted that the SUG and the SoP that were drawn by the local authority had not been sufficiently adapted to reflect the individual circumstances of the home. A copy of the SoP was forwarded to us and we were able to conclude that the SoP has been updated with the necessary information to personalise this document to 4 Hatton Grove. We also noted that it needed review as it did not reflect current circumstances in the home. For example it says that the home does not provide staff during the day on week days as there are no residents in the home. This situation has now changed and there are residents in the home during the day. Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: The manager stated that both documents are in the process of being reviewed and produced in an easy to read format. The manager confirmed that a SUG is available to people who wish to use the service and that there is an admission procedure for all prospective residents based on providing all the necessary information for them to be able to make an informed decision about using the service. The home has not had any new admissions since the last key inspection in June 2007. There are however procedures in place to ensure that the needs of all people that are referred to the home for admission, are assessed appropriately. We noted during the inspection that the manager and her senior staff are all skilled and competent enough to carry out a thorough assessment of any person that is referred to the home. We looked at whether residents receive a contract of their rights and obligations while living in the home. We noted that residents receive a contract with the local authority to inform them of the terms and conditions of the service that is provided by the home. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has very good care records but these must take into consideration the changing needs of residents and must be amended and updated as and when required. Risk assessments are in place for each resident, not to limit their freedom, but rather as a way to promote their independence and individual lifestyle. Evidence: We looked at the care records of three residents. Each resident had a person centered plan, a working care plan and a diary to record the daily care that is provided to each resident.The person centered care plan was written in an easy to read format and with pictures and drawings where possible, for residents to be able to read and understand their own care plan. The home is commended for this. The choices and likes and dislikes of residents were appropriately recorded throughout the care plans to promote the interests of the residents. Another feature of the care records that is helpful in understanding the needs of residents is the description of a Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: normal morning, normal day, normal evening for each resident. The needs of residents, including their cultural and spiritual needs, were appropriately assessed and recorded in detail. Information about whether residents were actively practicing their religion was also recorded. The abilities of residents to meet their own needs was identified and the support that they require were also clearly identified in care plans. For example care plans for eating and drinking contained information about the extent to which residents could feed themselves, the action to take to help residents with feeding as well as the crockery and and cutlery to use. We noted while tracking the care of residents, that the needs of a resident were changing from learning disability care needs to frail older people care needs. For example, the resident had developed mobility, elimination and nutritional care needs as well as being at risk of developing pressure ulcers. We noted that the care plans to address these needs have not been updated and the resident did not have a care plan to address pressure area care. In cases where residents needs change the care plans must be updated more often to reflect the changing needs of the residents. Care plans could have been a little more accurate in certain areas when describing the time when an action need to be carried out, to ensure that this is carried out. For example the care plan of a resident for the prevention of pressure ulcer for a resident said to turn regularly and the care plan for another resident to manage incontinence said to change regularly and to make regular checks. A range of risk assessments are carried out to ensure the safety of residents while promoting their rights to be independent and to make choices. There were risk assessment for traveling, to take part in the community, for eating and drinking and in cases where some form of restriction was in place such as, when bed rails were in use. Residents, who had mobility needs, had clear manual handling risk assessments. This included photographs of some of the equipment that should be used to move the resident. The home is commended for this. Care plans and risk assessments were reviewed at least every six months. We noted that whilst a date was in place to indicate that the care plans and risk assessments had been reviewed, we noted that a signature was not always present to evidence this. We also did not see a summary of the review in terms of what has worked and has not worked for the resident and what needs amending. We were informed that residents and their relatives were consulted about the care plans and risk assessments in review meeting that are held yearly. However it would be good practice to involve residents, where possible or their representatives as soon Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: as possible when drawing up and reviewing care plans and risk assessments. Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff to lead appropriate and fulfilling lifestyles both inside and outside the home, according to their individual needs and choices. Meals are provided in sufficient quantity and variety to meet the individual nutritional needs of residents. Evidence: The social and recreational needs of residents are addressed in the care records of residents. The life history and social assessment provides information about the things that residents enjoy doing and the support that they require from staff to fulfill these needs. The information included the hobbies and interests of residents in detail. For example there was information about the types of music and films that they enjoyed. The care plans of residents that address the activities and recreational needs of Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: residents look at the abilities of each resident in terms of realistic aims and objectives and at the provision of suitable activities that they will enjoy and that will meet their needs. In cases where it has been identified that residents would benefit from personal development then their care plans reflected this. In a few cases however residents are ageing and are starting to develop frail elderly people care needs or dementia care needs. Therefore, the opportunities for personal development in these cases are limited and the emphasis is on maintaining current abilities. During the inspection we found residents sitting and relaxing in the lounges or staying in their rooms. There was a number of residents who had gone to day centres but it seemed that a significant number of residents were in the home as compared to the findings from the last inspection when 2 residents in the home during the day. The manager confirmed that a number of residents no longer receive day care services after their needs have been reassessed and that some residents have also decided that they do not want to go to day centres. She added that in cases when residents do not go to the day centres, their social and recreational needs are met in the home. Each flat tends to arrange their own programme of activities to take into consideration the needs of the residents living in the flats. There are also communal activities where all the residents who live in the home, can join in. For example there are Fantastic Fridays, when evening entertainment is provided, garden parties, celebrations of the important days of the year such as Halloween and St Georges Day, barbeques and visits by the mobile farm. The home has some resources for the provision of entertainment and activities for residents. Apart from various games, lounges were sufficiently equipped with TV and music system for residents to relax. Residents also have their own music system and TV and can choose what they want to listen or watch. In cases where the younger residents have been identified with particular skills then this is promoted and the residents are encouraged to develop these skills further. some residents are enrolled on courses at the day centre. Residents who have any hobbies or who are interested in particular activities are supported by staff in these endeavours. For example one resident who enjoys gardening was being supported by staff to grow some plants. We visited the home on three different days, at different times and met different members of staff. Our observations showed that all interactions of staff with residents were appropriate and managed in a respectful manner.We observed a number of residents moving independently over the home without any restrictions. In other cases members of staff asked residents about their choices. In cases where residents were in Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: their rooms members of staff asked the residents whether they could come into the residents rooms. The home is located about 3-5 minutes walk from Station Road, where a range of amenities and shopping facilities are available. Residents are encouraged to take part in the local community and to access the local amenities. When we arrived at the home on the first day of the unannounced inspection we noted that two residents were being taken out by staff for a walk and to visit the local shops. We were informed that each flat does its own shopping and that residents at times accompany staff to do the shopping. The home has a van/car type vehicle and a larger mini-bus for residents to go out.The vehicles are used for trips in the local community and for longer trips such as, to the sea-side. We were informed that residents have the opportunity to go for holidays at a seaside resort. The people that are important in the life of residents are identified in the care records of residents. These include not only members of staff and of the multidisciplinary team but also relatives and friends. Care staff were able to talk about the relatives of residents and said that they contact the relatives of residents when there are changes in the condition of the residents. We were informed that care staff also invite the relatives of residents for review meetings or when there are social events in the home such as, a fete or a barbeque.The home has an open visiting policy and there are no restrictions on visits by relatives and friends. Each flat has an appropriately furnished dining area and residents are encouraged to have their meals in these areas. We observed lunch on the first day of the inspection. There was steak and kidney pie with mashed potatoes and bake beans. The main meal of the day is served in the evening when residents return from the day centres. Each flat has its own menu that is available in a picture form, but we noted that the desert was not always described in the menu. We were informed that residents contribute where possible in drawing up the menu such as during residents meeting that are arranged for each flat. There were records of all meals that were cooked in the home and we were able to decide that the home does offer varied and nutritious meals. We also observe a range of fresh fruits in the home and well stocked larders, fridges and freezers. Few residents were able to offer feedback about the meals, but two residents who were able to, said that they are able to make choices about their meals and that they enjoy the meals that they receive. Care Homes for Adults (18-65 years) Page 18 of 37 Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive appropriate personal and healthcare support from staff, to ensure their welfare. Issues of ageing, illness and death are addressed in care records and are dealt with sensitively. The management of medicines is generally carried out to an appropriate standard to ensure the safety of residents. Evidence: The home has some residents over the age of 60 and many of them have older people care needs such as, poor mobility, continence management and require support with pressure area care, personal hygiene and nutrition. A few residents have also been diagnosed with dementia and have cognitive impairments. Staff in the home have in the past generally cared for people with a learning disability but as residents get older and as their needs change to frail older people care needs, they have had to provide more care and support to older people. They do quite a good job considering that some of the residents have quite high dependencies. Some members of staff have had training in understanding dementia but they would however benefit from more training in terms of caring and supporting older people such as managing incontinence and Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: managing pressure area care. All residents presented as clean, appropriately dressed and groomed. Male residents were shaved as required. The personal care of residents was carried out in their respective bedrooms or in bathrooms. The home has the necessary equipment such as, hoists, bath hoists and shower trolleys, for staff to use when they provide personal care to residents. The key worker and the associate worker for the resident were clearly identified in the care plan and they tended to work primarily with the residents that they have been allocated to. Those residents who were able to, chose their own clothes and made decisions about their personal appearances. For example a resident who wanted to keep a beard, had a beard and female residents had their own make up if they wanted to. We noted appropriate interaction between members of staff and residents and all residents who were able to talk to us said that they were very happy in the home. One person said that everything in the home was good. We observed that members of staff took their time to talk to residents to explain things to them. Staff also listened to all residents, even those who had difficulty with communication. It was obvious that some members of staff knew the residents very well as, they were familiar with the way that individual residents communicated and they understood the residents much more easily than a visitor to the home would. The evidence above therefore, shows that the privacy and dignity of residents are respected by staff in the home. All residents have a recorded Health Action Plan. They are registered with a GP and there was evidence that the GP was called when required to see residents. Records showed that residents were also seen by a range of other healthcare professionals such as, the dentist, optician, chiropodist, psychiatrist, physiotherapist and occupational therapist. Outcomes of the visits of the various healthcare professionals were recorded in the care plans. We noted that the plan to care and support a resident when they have epileptic fits was not very clear. It mentioned that a medicine should be given to the resident when they have fits, but that medicine was not stocked by the home. Instead a different medicine was in stock. We looked at the management of medicines in flats A and C. The rooms were generally tidy but the medicines room in flat C was also used to store cleaning materials. The home uses the Boots monitored dose system to manage medicines. We found that medicines administration records charts were signed as required and that the amount Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: of medicines was recorded when received in the home but the amount of medicines that remained after a medicine cycle, was not always carried forward in the new medicine chart. As a result it could be difficult to audit medicines, particularly when auditing the amount of medicines that should be in place. Medicines are administered by seniors only, and we noted that they have all had medicines training. There were no sample of the initials of staff at the front of the folder that contained the medicines administration charts. This is normally helpful in quickly identifying the person that has administered medicines and it is therefore recommended that a sample of the signatures and initials of staff be kept in the folder that contains the medicines record charts. We noted that the knowledge of the seniors about medicines was quite good. They generally knew the indications and side effects of the medicines that they administer. The medicines reference book (BNF) in the home was slightly old and dated from 2004. The home would benefit from a newer version of a medicines reference book. The dates when liquid medicines bottles were opened were generally recorded. The temperature in the clinical rooms was being monitored and was reading 26 degrees centigrade on the 2nd day of the inspection, when it was not particularly hot. It is very possible that this temperature would rise significantly when the weather gets warmer. Death and dying is now addressed comprehensively in care records. There is a dedicated care plan that addresses this aspect of care. Clear information is provided about the instructions and wishes of residents not only about end of life care but also about funeral arrangements. We noted that some members of staff have also received training on bereavement and loss. Care Homes for Adults (18-65 years) Page 22 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints seriously and provides an opportunity for people who use the service and for other stakeholders to raise complaints. The manager and her staff are appropriately trained to deal with allegations and suspicions of abuse. Evidence: According to the manager the home has not had any complaints. The complaints procedure is produced in an easy to read format and is given to all residents who use the service. Staff indicated that they knew that any complaints have to be referred to the manager, as soon as possible. Staff that we spoke with stated that they would report any suspicions and allegations of abuse to the person in charge of the shift or to the manager. The training records showed that members of staff have regular update training on safeguarding adults and that this training is one of the mandatory training for all care staff. According to the AQAA all residents personal money is managed by the local authority. They have individual accounts with the local authority and their benefits are deposited in these accounts. The accounts are adjusted for any expenses that are made for residents. We were informed that receipts are kept for all expenses. We were not able to fully look at the accounts as the records were not kept on the premises of the home. We were informed that the personal money of residents is audited as part of the audit of the Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: local authority. Residents valuables and property are recorded and agreed with residents or their representatives where possible. The manager stated in the AQAA that residents valuables are kept in the homes safe. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a suitable environment where the needs of residents can be appropriately met. Evidence: The grounds of the home, in the front, on the side and at the back were on the whole maintained. The lawn was trimmed and the bushes and trees were maintained. We noted that flowers have been purchased to use in pots and flower beds to bring additional colour to the grounds. The exterior of the building appears in good condition. The home is purpose built and is functional. The corridors are wide enough to allow wheelchair access and there are suitable adaptations where necessary, to promote the independence of residents. The standard of decoration is on the whole good and one resident described how he helped to remove the wall paper and helped to choose the colour scheme in one lounge. As mentioned previously, the home is divided into three flats that are self-contained. Each flat has a kitchen, lounge and dining areas, a bathroom and toilet and a medicines room. In addition to that, there is a main activities room on the ground floor that is used for activities where all the residents are involved such as, when there are Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: shows and meetings. The lounge and communal areas are in an appropriate state of decor and are furnished as required. There are also specialist seating arrangements for those residents who have been assessed as requiring this. There are suitably adapted bathrooms and toilets for residents on each floor. Support is provided to residents by staff as and when required for residents to use these areas. There are hand rails in all the corridors and grab rails in the bathrooms and toilets. The bedrooms of residents were appropriately furnished and personalised to the residents tastes, where they were able to make decisions. There were pictures, photographs and personal possessions to make the bedrooms more homely. We were informed that many residents have purchased their own beds and furniture for their bedrooms. Regulation 16(2)(c) of the Care Homes Regulations 2001 states that it is for the registered person to provide adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment in bedrooms occupied by people who use the service. While residents may very well want to buy their own furniture and other items that they wish to, we were unable to see evidence that informed consent has been sought from residents before buying items of furniture or other goods on their behalf. The home produces some clinical waste. There is no sluicing disinfector but the clinical waste is contracted out to be collected. Training records showed that staff have had training in infection control and have regular updates in this area. Care Homes for Adults (18-65 years) Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriate staffing levels to meet the needs of residents that are accommodated in the home. Recruitment of new members of staff is carried out according to robust procedures to ensure the safety of people who use the services. Staff receive training to make sure that they are competent to care for residents, but some of the training could be provided in a more timely manner to ensure that staff are fully up to date with mandatory training. Evidence: There are 3 members of staff on Flat A and 2 member of staff on flats B and C. There is also a senior residential care worker who is responsible for the shift and who floats between the flats but tends to be based on the ground floor. At night, there is a sleepin senior and two care workers. At times, more staff are provided in the home such as when residents go for outings or when there is an entertainment session in the home. At the time of the inspection there were 5 senior and 18 care workers in post. Staff vacancy at the time consisted of 3 part-time and 2 full-time care workers. The last members of staff were recruited at the end of 2007. There were also some members of staff who transferred to Hatton Grove from other Local Authority care homes, when Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: these closed. To cover the shifts, the home uses permanent agency staff to ensure continuity and consistency of care. One agency worker said that they have worked in the home for more than 5 years and feel like a permanent member of staff. We noted that the manager was interviewing staff to fill the vacancies at the time of the inspection. We observed that residents were involved in the recruitment of staff as they were also part of the interview panel. we looked at the personnel files of two members of staff. We found that all the records as required by legislation were in place. They all had a completed application form, proof of identity and eligibility to work in the UK, a CRB check and two references. The work history of applicants was on the whole appropriately completed. The manager stated that any new member of staff will receive induction according to the Local Boroughs induction procedures and the common induction standards from Skills for Care. Staff in the home received a number of training including mandatory training that are accessed by applying to the training department of the Local Borough. We looked at the training records of 6 members of staff. We noted that only one member of staff was fully up to date with all the mandatory training. The remaining were not up to date in one or two areas. The training coordinator for the home has applied for staff to have the training in areas where they have not had the training, but there was some time delay before they would be able to have the training. Records showed that care staff were receiving supervision on a regular basis. Supervision was provided according to the homes procedure for supervision and according to this staff should have 10 supervision sessions during one year and an annual appraisal. We also mentioned previously about the changing needs of residents and how many of the residents now have frail elderly people care needs. We noted that staff have received some training in areas normally associated with the care of frail elderly people such as dementia care training, bereavement and loss training and managing challenging behaviour training. We would recommend that staff are offered more training in areas that address the needs of frail elderly people, to fully understand these needs so that they would be able to provide as high a standard of care as possible, to residents. For example the areas for training could include the ageing process, the management and prevention of pressure ulcers and managing incontinence. Care Homes for Adults (18-65 years) Page 28 of 37 Care Homes for Adults (18-65 years) Page 29 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in an open and inclusive manner to demonstrate that it is being run appropriately. The home seems to have some form of system to monitor quality, but without a quality assurance procedure and quality management system, the home might not address quality in a systematic and targeted manner. A number of health and safety issues have to be addressed to ensure that all people who use the premises are as safe as possible. Evidence: The manager stated that she has been running the home for about 3 1/2 years. She is registered and she has a qualification in care and management. We noted that she knew all the residents well and was familiar with their needs and individual circumstances. Our findings and feedback from staff and resident shows that she runs the home in an open and inclusive manner. The home arranges residents meetings for each flat when residents can decide about Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: the menu and suggest activities. Relatives meetings are held every three months. Staff confirmed that regular staff meetings are held and that they have the opportunity to contribute their ideas and suggestions about the running of the home. According to the manager a customer satisfaction survey is carried out by the Local Authority every year. She said that a customer survey was carried out in March 2008 and that another survey would be conducted later this year. The home did not have a quality management system such as an audit system, based on standards that have been set and that reflects the service that the home provides. It did not also have a quality assurance procedure to state how it plans to ensure the provision of a quality service. There was however, some evidence that the quality of the service was being monitored in some areas. We noted that regulation 26 visits are carried out generally monthly. The reports are comprehensive and look at a number of performance indicators for the Borough. The manager also confirmed that she has to give information to line management every three months, about a number of performance indicators. Maintenance of the home and of equipment is managed by the facilities and maintenance services department of the local authority. We were able to see evidence that the hoists and lift have had recent safety checks and were appropriately maintained. We were informed that the portable appliances test certificate was carried out a week before the inspection and that a certificate has yet to be received. We did not see an electrical wiring certificate. A gas safety certificate was seen and was up to date. Fire detector tests are normally carried out weekly but we noted that the tests were not carried out every week in March and April, and that no tests have been carried out for May. Fire emergency lights test are carried out by the contractor that maintains the fire detector system. Fire drills, according to the fire procedure of the home are to be held every six months. One was held in April 2008 and the next one (and last one recorded) was held in January 2009. The manager stated that these should be held every six months. Fire drills should be held at intervals to ensure that all staff take part in a fire drill at least once every year to make sure that they fully understand the action to take if there is a fire. The home did not have a comprehensive fire emergency plan although it had some of the information that would be required in the fire emergency plan, in different places and records. A comprehensive fire risk assessment was available for inspection. Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: We asked for the homes health and safety risk assessment. There were a number of risk assessments such as glazing risk assessment, work place risk assessment and a COSHH risk assessment, but we did not see a full health and safety risk assessment about the premises and the activities that take within these premises. Some of the areas of risk include the risk of trips and falls throughout the home, restriction of access of residents to some areas such as the kitchen, locking of some areas such as the electrical intake room, access of residents to the stairs and the use of coded pads to restrict access to and exit out of flats. Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 24 A structure for the 01/11/2007 assessment of quality monitoring must be produced. Information must be sought in accordance with the elements of Standard 39.6 & 39.7 and the outcomes published in accordance with Standard 39.4. Care Homes for Adults (18-65 years) Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be reviewed 01/09/2009 and changed as required when the needs of residents change. To provide a guarantee that the changing needs of residents have been accounted for. 2 19 12 Care plans or protocols to manage resident when they have epileptic fits must be clear about the medicine to use and the circumstances to use these in managing the fits. To ensure the welfare of residents 01/09/2009 3 20 13 The amounts of all medicines that are brought forward must be recorded in the new medicines record charts. To ensure a clear audit trail for medicines 01/09/2009 Care Homes for Adults (18-65 years) Page 34 of 37 4 39 24 The home must have a quality assurance procedue and quality management system To monitor the quality of the service that it provides 01/10/2009 5 42 13 There must be a full health and safety risk assessment of the home and its premises To ensure the safety of the premises 01/09/2009 6 42 13 The home must have an electrical wiring certificate available for inspection. To ensure that the elctrical system is safe. 01/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The service users guide should be updated with things that have changed in the home such as the current arrangement regarding the provision of staff throughout the day. Care plans should be as accurate as possible and avoid words such as regular. The person reviewing and evaluating care plans should sign the care plans to say that they have reviewed these and should add a statement about what actions have worked and have not worked for the resident. It is recommended that a sample of the signatures and initials of staff that administer medicines be kept in the folder that contains the medicines record charts, to quickly identify the persons administering medicines The temperature in the clinical rooms should be maintained below 25 degrees centigrade either by the use of air conditioning or otherwise. Page 35 of 37 2 7 3 20 4 20 Care Homes for Adults (18-65 years) 5 6 7 20 35 35 The medicines rooms should not be used to store cleaning products and equipment. All staff should have mandatory training in a timely manner. The home should consider providing more training to staff in areas that address frail elderly people care needs such as managing incontinence and pressure area care. The result of the customer survey should be summarised in the form of a report that should be made available to all stakeholders of the service. The home should ensure that fire drills are carried out at the frequency as indicated in its fire policy and that all staff have the opportunity to take part in a fire drill at least once a year. The home should carry out weekly fire detector tests on a regular basis. The home should organise all the various information that it has about the fire procedure and fire management into a fire emergency plan as per the Regulatory Reform (Fire Safety) Order 2005. 8 39 9 42 10 11 42 42 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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