Care Home: Hazeldene

Similar services:

• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• Fairways
• Treloar College
• Kestrel House, St Anne`s Opportunity Centre,
• Pinta

What the care home does well The service has an appropriate system in place to assess the needs and wishes of a prospective resident in order to establish whether they can be met. Appropriate individual risk assessments are undertaken. Residents have opportunities to take part in activities and community events as part of the planned day care, and also have opportunities to attend college or undertake supported work placements. The healthcare needs of residents are met effectively. Medication management systems protect residents, and those who are able, are supported to take some responsibility for their own medication. The home provides a homely and safe environment for residents. The provider has a sound recruitment procedure in place, which promotes resident safety, and there are plans to involve residents in future staff recruitment. There is a good core-training programme provided to equip staff with the necessary skills. The views of residents have been sought as part of the self-monitoring of the service and the planning of the care and support provided, and there is evidence of further plans to improve consultation and participation. What has improved since the last inspection? A new standardised care plan format is being established to provide a goalsbased proactive and person-centred approach to supporting residents. The views and goals of residents are likely to be better reflected and realised within the new care planning and working ethos of the home. The "Books of Achievement" which are being introduced, should effectively document the ongoing personal growth and development of individuals. The day care service is also being reviewed and a new day care resource room is being established to replace the previous one. Residents are being encouraged to take a more active part in day-to-day household routines, including cleaning tasks, and in the planning of menus for the group, or individually as appropriate. There is an increasing emphasis on encouraging residents to choose healthier eating options as part of developing the skills of residents. Staff are being encouraged to provide personal support in a proactive and enabling way to support residents in developing their skills. Recording and monitoring of instances of physical intervention by staff has been improved and the ethos is now a more proactive one to seek to avoid the use of physical interventions. Monitoring systems to measure the effectiveness of behaviour management strategies have also been improved. Healthcare planning and recording formats are also being improved. The service has an appropriate complaints procedure, of which most residents are aware. Safeguarding monitoring has been improved. There has been extensive redecoration and re-carpeting since the last inspection. One resident has been provided with a ground floor bedroom to better meet his needs. There are plans to also provide a ground floor bathroom and to rationalise the kitchen/dining areas of the main house to make more effective use of the space. What the care home could do better: At the point of inspection the new proactive and development-based approach to supporting the residents had yet to be fully adopted across the staff team. The manager and provider are working to introduce effective recording and monitoring systems to support the new ways of working and in order to demonstrate the developments by residents. It is suggested that the possible benefits of team-building input should be considered. Additional training is required in some areas to ensure all of the staff are fully up-to-date on all required training. The manager needs to maintain a fully upto-date record of staff training, to enable effective planning. A further quality assurance survey is due and the resulting summary report should be made available to participants and copied to the Commission. The manager should consider the benefits of residents attending a healthyeating course at a local college, to support them to improve their understanding of these issues. Staff should be reminded of the importance of maintaining complete and accurate records of all medication. CARE HOME ADULTS 18-65 Hazeldene 127, 129 and 131 Wantage Road Reading Berkshire RG30 2SL Lead Inspector Stephen Webb Unannounced Inspection 24th April 2008 09:45 Hazeldene DS0000011088.V360983.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 Hazeldene DS0000011088.V360983.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. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazeldene Address 127, 129 and 131 Wantage Road Reading Berkshire RG30 2SL 0118 950 0567 0118 956 6936 hazeldene@choiceltd.co.uk 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) Choice Ltd Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 10 24th April 2007 Date of last inspection Brief Description of the Service: Hazeldene offers twenty-four hour residential care to nine, male service users with varying degrees of learning disability and associated behavioural difficulties. The home consists of three adjacent properties, one separate house with three bedrooms and two combined semi-detached houses containing seven bedrooms. The buildings are spacious with good-sized gardens. The service is one of a number operated by C.H.O.I.C.E. Ltd. The home is situated approximately ten minutes walk from Reading Town Centre and is a few minutes walk from a large park, public houses and local shops. The home has its own transport and public transport is easily accessible. The fees, at the time of this inspection, range from £1,538.00 to £2038.86 per week, dependent on the level of individual support packages provided, based on assessed needs. Between April and September of 2007 the home was without a full-time manager. An experienced new manager was appointed in September 2007. Hazeldene DS0000011088.V360983.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 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit from 9.45am until 7.15pm on the 24th of April 2008. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, operations manager, and briefly with some of the staff members on duty during the day, as well as some verbal feedback from residents. The inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were also completed and returned by all of the residents, (some with support from staff), one healthcare professional, and a staff member. The inspector examined the majority of the premises, including some of the bedrooms, with the consent of residents. Feedback from the residents was broadly positive and some of their comments have been included within the report. The healthcare professional who returned a survey was also positive and the majority of the staff members feedback was also positive. Any issues raised were communicated to the manager in broad terms for consideration. What the service does well: The service has an appropriate system in place to assess the needs and wishes of a prospective resident in order to establish whether they can be met. Appropriate individual risk assessments are undertaken. Residents have opportunities to take part in activities and community events as part of the planned day care, and also have opportunities to attend college or undertake supported work placements. The healthcare needs of residents are met effectively. Medication management systems protect residents, and those who are able, are supported to take some responsibility for their own medication. The home provides a homely and safe environment for residents. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 6 The provider has a sound recruitment procedure in place, which promotes resident safety, and there are plans to involve residents in future staff recruitment. There is a good core-training programme provided to equip staff with the necessary skills. The views of residents have been sought as part of the self-monitoring of the service and the planning of the care and support provided, and there is evidence of further plans to improve consultation and participation. What has improved since the last inspection? A new standardised care plan format is being established to provide a goalsbased proactive and person-centred approach to supporting residents. The views and goals of residents are likely to be better reflected and realised within the new care planning and working ethos of the home. The “Books of Achievement” which are being introduced, should effectively document the ongoing personal growth and development of individuals. The day care service is also being reviewed and a new day care resource room is being established to replace the previous one. Residents are being encouraged to take a more active part in day-to-day household routines, including cleaning tasks, and in the planning of menus for the group, or individually as appropriate. There is an increasing emphasis on encouraging residents to choose healthier eating options as part of developing the skills of residents. Staff are being encouraged to provide personal support in a proactive and enabling way to support residents in developing their skills. Recording and monitoring of instances of physical intervention by staff has been improved and the ethos is now a more proactive one to seek to avoid the use of physical interventions. Monitoring systems to measure the effectiveness of behaviour management strategies have also been improved. Healthcare planning and recording formats are also being improved. The service has an appropriate complaints procedure, of which most residents are aware. Safeguarding monitoring has been improved. There has been extensive redecoration and re-carpeting since the last inspection. One resident has been provided with a ground floor bedroom to better meet his needs. There are plans to also provide a ground floor bathroom and to rationalise the kitchen/dining areas of the main house to make more effective use of the space. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 7 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. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 8 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 Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 9 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): Standards 1 and 2: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has appropriate systems in place to identify the needs and wishes of prospective residents, in order to establish whether it is able to meet them. EVIDENCE: The manager has recently updated both the Statement of Purpose and the Service User Guide. At the point of inspection the new Service User Guide was only awaiting the provision of suitable pictures before being published. Evidence from the report of a recent management-monitoring visit, indicates that the need for these documents to be kept up to date, is monitored appropriately by senior management. There have been no new admissions to the home since the last inspection and therefore no recent preadmission assessments were available for examination. However, the provider’s preadmission assessment and planning processes were assessed as meeting the required standard at the previous inspection. Information from pre-admission assessment documents is used to develop the initial care plan. Hazeldene DS0000011088.V360983.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): Standards 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. The needs, wishes and goals of residents, are increasingly reflected in their care plans, as improved formats are introduced, in order to enable staff to facilitate residents’ individual development. Support for residents to make decisions about their lives is improving, and risk assessments provide staff with guidance on how identified hazards can be addressed, in order that residents are supported to take risks. EVIDENCE: A sample of three current care plans was examined for this inspection. Existing care plans are not all to the same format, and do not yet provide staff with sufficient detail regarding how support should be provided in order to enable and facilitate residents’ growth. In essence they have been less focussed on ongoing development and more geared to maintaining lifestyles, and containing behaviours that challenged the service. Until recently, some care plans had not been reviewed for extended periods, and some documents were not signed or were undated. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 11 Since the new manager was appointed in September the focus has moved towards a more positive, developmental approach. The manager has ensured that all care plans have been reviewed, (confirmed in the March management monitoring visit report), and a new Essential Lifestyle Plan format is being introduced, together with other supporting formats to focus more positively on individual residents wishes, goals and aspirations, and on their ongoing development. As part of this the day-care coordinator has been delegated the lead on introducing “Books of Achievement”, to provide a focus for collecting evidence of how residents achieve their chosen goals. These records will support the move towards a more developmental approach, as well as providing a tangible record of individuals’ achievements, which can also support residents’ more active engagement in their reviews. In the longer term it is intended for these records to be maintained by the keyworker and resident. Across the more recently devised and reviewed formats there is increasing evidence of the preferences, goals and wishes of individual residents and how and when support from staff is to be provided to facilitate their achievement. There is evidence of decision making by residents, about aspects of their lives and choices about daily routines, and the new care plan format should further improve this focus. Various examples of residents’ individual choices were noted, including in regard to bedroom furnishings and décor, menus, pictures for their bedrooms and participation in activities. The management of residents’ allowances and the home’s funds have been subject to an audit and review in relation to previous issues, and recording systems have been improved. An available balance of each resident’s allowance monies is retained individually in the safe with a record being maintained of any transactions, and receipts retained. Each resident has an individual bank/building society account where any surplus, over and above day-to-day needs, is held. The possibility of one resident in the main house having his personal allowance paid directly into an account, which he will manage himself, is being considered. Of the more independent residents, living in number 127, one already holds his own allowance money and the others have free access to their allowance from the safe on request. The latest management monitoring visit report identifies the need for ongoing work with residents to develop their understanding of money, and the manager’s Action Plan from October 2007, indicates that the home is to apply on behalf of some residents, for mobility allowance at the higher rate. Alongside the care plans, behaviour management plans provide guidance to staff on managing identified challenging behaviours, and also include details about known triggers. These formats are also being reviewed to facilitate staff working in a more proactive way and averting situations at an early stage in order to avoid an over-reliance on physical restraint, which is evident from records prior to the appointment of the current manager. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 12 It may be necessary to review the current free-text format for maintaining daily notes in individual diaries, in order to focus more on recording significant activities, goal achievements, behaviour etc. for each resident to enable monitoring and review by the keyworker. Alongside the care plans is a risk management plan, which includes details of how the identified hazards can be addressed. In one situation specific adapted equipment is identified to facilitate a resident to manage an aspect of their care independently, and this has been obtained. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Opportunities for residents to have a fulfilling lifestyle are improving with developments to the day care programme and in the home’s approach, providing access to a broadening range of activities, educational and work opportunities. Residents have opportunities to be part of the local community and family contact is supported by the home. The rights of residents to have a role in day-to-day decision-making and the household routines are recognised and increasingly being put into practice, as the service develops the way it supports residents to take a positive role. Residents are being provided with an improved diet through a focus on encouraging healthy eating within the context of supporting residents’ choices. EVIDENCE: Records of the planned day-care activities for residents are held within their care plans. The home has a designated day-care coordinator who leads on this area of support. As part of a recent change of room functions, a new day care Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 14 room was being established during the inspection, in the old office, which it its hoped will become a focal point within the home. Some evidence of residents stated wishes regarding activities can be found within the “my profile” and “All about me” documents within their care plans, and the need for further development of the opportunities for residents, was identified in the manager’s Action Plan. As part of this the day-care plans have recently been reviewed in order to broaden the range of opportunities, and a group has been set up to develop the independent travelling skills, initially of four of the residents. Work will also address appropriate behaviour in the community as part of developing their broader independence skills. Participation in activities and day-care is currently noted within individual’s daily records, though as these opportunities for engagement in the community increase as part of planned goal-setting, this should also be noted with the new “Books of Achievement”. During the inspection, residents had opportunities to go out on activities and also to attend college. Two residents opted not to attend their college courses and after checking they were sure, their wish was supported by staff. The residents in number 127 have a mix of supported work placements and college attendance and spend their weekdays mostly out of the house. Feedback from three residents was positive about the activities available to them, and college, meals out and shopping trips were popular. Two of the residents spoken with said they took part in shopping for meals and the cooking, and one said he preferred not to take part in this, though he did agree he could choose what was on the menus. Some residents were observed to be encouraged and supported to be involved in the daily routines and household tasks. This is an area where improvements have been made. The manager had identified some concern that residents’ bedrooms were being left as solely a resident’s responsibility in terms of their cleanliness. The staff have now been encouraged to work more proactively with individual residents, to support and enable them to take better care of their bedroom. During the inspection, staff were seen to use a positive and enabling approach to one resident, who is often reluctant, in supporting him to clean his bedroom. At present none of the residents choose to attend places of worship, though one has done so in the past, and has said that he no longer wishes to do so. The service would be able to support attendance at places of worship, as part of meeting the cultural and spiritual needs of residents, should these be identified. The manager is considering ways to enable residents to have further opportunities for pursuing spiritual needs, to establish whether they still decline to do so. One resident said he was looking forward to his planned holiday at Butlins and described the things he liked about going there. The manager indicated that there were plans for another resident to go on a holiday overseas, with staff support. Appropriate risk assessments had been completed. Contact with families is supported where appropriate and the home provides staff support and has its own transport to facilitate this. Residents are Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 15 encouraged to attend outside events, both within the learning-disabled, and the wider community, to broaden social opportunities, within the context of any necessary risk assessments. The most recent management monthly monitoring report notes an increase in family contact for two of the residents. Residents’ involvement in meal preparation and cooking has varied. Residents had previously been encouraged to plan their own menus for themselves and prepare their own meals individually, with staff taking a hands-off approach. This had tended to lead to a lot of convenience foods, processed meals and unhealthy options being selected. Evidence that this was not working appropriately was the existence of a separate budget for food for staff meals. The manager identified this as an area for improvement in his October 2007 Action Plan for the service, and residents in the main house are now planning a collective menu with the support and guidance of staff in order to maintain a health-eating overview, and each has a share of the responsibility for shopping and meal preparation with support from the staff. The menu has two main meal choices daily and that in the first instance, at least, one resident takes part in the shopping each day and two of them are supported to prepare the main meal. The intention is that this will encourage an improved focus on healthy eating through the involvement of staff. The manger also stated in the pre-inspection document, that “five-a-day” fruit and vegetable charts had been introduced to encourage awareness. Consideration should be given to seeking appropriate opportunities for residents to attend a healthy-eating course at a local college, to support them to improve their understanding and broaden their experience. A team training session by a dietician might also be of benefit to the staff, whose level of awareness of healthy-eating issues is likely to be variable. It is noted that this issue has also been identified by the manager within his Action Plan for the service, and has been referred to the assistant psychologist to pursue. The more independent residents in number 127 still plan and buy for their own menus on a weekly basis, with staff support. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 16 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): Standards 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. Systems are being improved to ensure that the staff provide personal support in a proactive way to residents according to their needs and wishes, to improve monitoring of the use of physical interventions and to monitor and review the effectiveness of planned behaviour management support. The healthcare needs of residents are met effectively and healthcare planning and recording formats are also being improved. Medication management systems protect residents, and those who are able, are supported to take some responsibility for their own medication. EVIDENCE: The care plans examined contained varying levels of detail about the individual support needs of residents, and of their preferences and wishes about they are supported. The Essential Lifestyle Plans that are now being introduced will provide a more systematic and consistent format for recording the individual support needs and preferences of residents, and what is important to them as an individual, and will provide information on their communication repertoire. The new “Books of Achievement”, being introduced will provide a focus for more consistent input by staff on a day-to-day basis to support the emotional Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 17 and social development and wellbeing of residents within the context of the new proactive approach being developed. In one example observed during the inspection, staff demonstrated an appropriate approach to supporting one resident to clean his bedroom, which enabled the task to be completed by the resident with support, in his own time, and avoided a potential confrontation, had he been pressured to complete this within a staff-imposed timeframe. The manager’s action plan notes the need for further improvement in the way personal care support is being provided, which is being addressed on an ongoing basis, through team meetings, supervision as well as through the new planning recording and monitoring systems being put in place. Behaviour management guidelines are being reviewed and revised by the psychology team, to reflect a more proactive approach and increased use of effective strategies for early interventions to avoid the excessive use of restraint, which records indicate to have been a factor in the period before the appointment of the current manager. Approved behaviour management strategies are now more clearly identified on an individual basis, including information about known triggers, and how to approach the individual to defuse and de-escalate situations and divert attention onto more constructive activity. There are signature sheets in place for staff to sign to confirm the new behaviour management strategies have been read. However, at the point of inspection these forms had not been signed by all of the staff. The manager indicated, on the day after the inspection, that he had instructed that all staff read and sign these documents by an appropriate deadline. New behavioural monitoring charts have also been devised to record instances of identified behaviours and the use and success of, planned management strategies. This will enable a more systematic review of the effectiveness of these interventions as part of ongoing support for each resident. The manager also provided examples of new monitoring and review formats to be completed in instances where physical intervention is used. Greater clarity has also been provided to staff about what constitutes physical intervention. The staff have all received SCIP (Strategies for Crisis Intervention and Prevention) training, which includes as a last resort strategy, training on specific physical intervention techniques, but also focuses appropriately and primarily on other non-physical interventions. Evidence from available records is inconsistent but indicates possible over-use and inappropriate use of physical interventions in the past, though there has been a significant reduction in their use since the appointment of the current manager. The manager produced new guidance to staff on physical interventions in January 2008. In the past there have also been instances of failure to properly report the use of physical interventions, and the manager and operations manager suggested there might have been some under-reporting of some forms of physical Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 18 intervention such as “leads/escorts”, which are nevertheless to be considered techniques of physical intervention. The new recording and monitoring formats now being introduced will enable closer monitoring of any instances, and will include a debriefing process to look at how a situation was managed and whether other approaches could have been used. The manager has also cooperated fully in providing retrospective notifications of past events, prior to his appointment as manager, where required. The files examined contained some healthcare plan elements and information about residents’ healthcare needs such as epilepsy management. The new Essential Lifestyle Plans that are being introduced contain more detailed health action plans to address residents’ health and wellbeing systematically, as well as providing guidance on managing specific healthcare needs such as epilepsy. The plan also includes a record of allergies, medication and any relevant mental health issues, and a section for information of how the individual responds to healthcare professionals and environments, which is useful in planning and risk-assessing upcoming appointments. Healthcare appointment records were already in place and included separate recording by key disciplines to enable ease of monitoring. In some cases monitoring systems have been used to listen in on individuals in their bedrooms as part of epilepsy risk management, but at the point of inspection no written guidance was in place to govern their use. Following the inspection, the manager confirmed that written guidelines had been produced and included within the new epilepsy management formats. The changing needs of one resident have been addressed by a reconfiguration of the use of some of the rooms in order to provide him with a ground floor bedroom, which he is very happy about. There are also plans to provide him with ground floor bathing facilities. One resident was observed taking his medication, in the presence of staff and then initialling his own Medication Administration Record (MAR) sheet. A member of staff also signs as a witness, to confirm administration. Two of the residents in number 127 also do this, but their medication is managed on behalf of the other residents, by the staff at present. The home has an appropriate system for managing the medication where necessary, which includes records of the medication coming in, its administration/refusal and a record of any returns to the pharmacist. The medication file contains the current individual MAR sheets, a medication profile and photo for each resident, details of any individual administration methods as described above, and guidance on the use of emergency epilepsy medication, where applicable. All of the staff apart from the most recent recruit have received training on general medication administration and the use of emergency epilepsy medication, though a training update is to be provided with respect to orally Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 19 administered emergency epilepsy medication, which is currently being explored for residents, as an alternative better suited to respecting their dignity. Examination of a sample of the MAR sheets indicated a small number of gaps in recording. Staff should be reminded of the importance of maintaining accurate and complete records of all medication. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 20 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): Standards 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most of the residents are aware of how to raise a complaint by telling either the manager or a member of staff, and complaints are appropriately investigated. The improved monitoring systems and more proactive approach now being developed, offer improved protection to residents, from abuse and neglect. EVIDENCE: The service has an appropriate complaints procedure in place. Examination of the complaints log indicates two recorded complaints since the current manager was appointed in September 2007. One was relating to the failure to properly report an incident of restraint, prior to the appointment of the current manager. The matter has been reinvestigated and records indicate that appropriate action was taken as the result of investigations undertaken at the time. Appropriate details of the incident, its investigation and outcomes, have now been provided. The other complaint was anonymous and related to excessive noise and music in the garden, and appropriate action was also taken to address this. Two of the residents spoken with during the inspection were clear about who they would speak to if they were unhappy about something or wanted to complain. Of the nine residents who completed inspection surveys, (some with support from staff), eight said they know how to raise a complaint. Some added that they would speak to the manager or a staff member. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 21 The service has appropriate safeguarding procedures, though as noted above proper reporting was not undertaken in one past case. As noted earlier there is some evidence in the past of an over-reliance on physical interventions, and failure to follow behavioural guidelines, by staff in the period before the appointment of the current manager. However, it is evident that recorded instances of restraint have reduced over the past seven months and the new systems recently introduced to record, analyse and monitor incidents, should help to develop more proactive interventions and improve the protection of residents. Observations of staff practice during the inspection included some good examples of proactive working by staff. The manager has also produced new guidance for staff in January 2008 on the use of physical interventions. Staff all receive accredited SCIP (Strategies for Crisis Intervention and Prevention), training on working with instances of challenging behaviour. The manager’s updated Action Plan for the unit also indicates that a new monitoring system for any instances of physical intervention was put in place in January 2008. Two safeguarding incidents have arisen since the last inspection, one of which led to a referral for inclusion on the POVA list, which was reportedly declined. All of the staff have received safeguarding training, according to the preinspection questionnaire (AQAA) completed by the manager, and the training records provided indicate that five staff received this in February 2008, and that six others are booked on safeguarding training updates. The most recent monthly management monitoring report includes discussion about the wellbeing of each individual resident and of any incidents in which they have been involved, as a standing item within the format, which indicates ongoing monitoring of these issues by senior management. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 22 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): Standards 24 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a homely and safe environment for residents, and is subject to ongoing developments to improve its suitability for residents. Standards of hygiene have improved and staff are now encouraged to take a proactive role to encourage residents to participate in household tasks. EVIDENCE: The home consists of the main house, comprising house numbers 129 and 131, containing seven bedrooms and an adjacent but separate house, number 127, occupied by three residents who live more independently. The main house is pleasantly decorated throughout and a lot of areas have been redecorated and re-carpeted since the last inspection. The lounge is pleasant and there is a separate quiet room offering an opportunity to be away from the group if preferred. House number 127, however, provides a more domestic and homely environment, and reflects the more independent lifestyle of its residents. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 23 As noted already the usages of some of the rooms in the main house were recently reconfigured to provide a ground floor bedroom to meet the needs of one resident. There are also plans to develop a ground floor bathing facility for him in the near future. As part of this, the office was in the process of relocation to the first floor and a new day care resource room was being created to replace the old one. Discussions with three of the residents confirmed that they had been involved in choosing pictures, furniture and colour schemes in their bedrooms. The bedroom seen reflected the individual personalities and interests of their occupant, with two of them being especially homely. One of the staff also confirmed that residents were consulted when redecorations are planned. Since the last inspection two of the bedrooms have also been adapted to include en suite facilities. Seven of the nine current residents have their own bedroom key, to maximise their privacy. There are plans to rearrange and improve the kitchen facilities in the main house. At present there are two kitchens remaining from the two houses that have been combined, one of which is rarely used. It would be a positive step to rationalise the use of space in the kitchen and dining areas to make better use of that available. There is a good-sized garden combining the space from both of the semidetached houses and number 127 has separate garden connected by gate to the main garden. Though an “allotment” area has, in the past been created in the garden of number 127, additional work will be needed to fully develop its potential. The manager indicated that the development of an outdoor seating area is being considered in an area of the garden, just outside the dining room. The standards of hygiene observed were satisfactory and there is an appropriately equipped laundry available. In response to a previous recommendation to ensure good standards of hygiene throughout the home, a domestic has been employed working 30 hours per week. The manager explained that in the past some staff had taken the stance that cleaning was something that the residents should be undertaking, but the staff had not been proactively supporting them in this. The manager has now indicated that he expects staff to take an appropriate enabling and supporting role in encouraging residents to contribute to the household cleaning tasks, but that the staff have a responsibility for maintaining satisfactory overall hygiene standards. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 24 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): Standards 32, 34 and 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The effectiveness of the staff in providing proactive support to residents to develop their skills, is currently diminished, because the new ethos and approach has yet to be adopted fully by everyone. The provider has a sound recruitment procedure in place, which promotes resident safety and a core-training programme, which equips staff to meet the needs of residents, though additional training is required in some areas to ensure all staff remain fully up-to-date. EVIDENCE: As noted already, observations of staff interactions with residents during the inspection were positive, with some staff demonstrating a good understanding of proactive working. Feedback from residents in conversation, was mostly positive about the support provided by the staff, though some more negative comments were made within inspection surveys, including “some staff are grumpy”, “sometimes they (staff), butt-in” and “I don’t like getting in trouble”. Two residents commented that staff do not always listen to them, but one said that the “staff listen to things I like”. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 25 The manager indicated that the new ways of working were developing, though there remain some differences of attitude and style across the team. The operations manager acknowledged that there was a need for further work to establish the new approach throughout the team. The recent management monitoring report and the manager’s Action Plan both reflect ongoing work in a number of areas to address aspects of staff attitudes and approaches to their role, in order to work towards a consistent approach. Levels of staffing appeared sufficient to meet the needs of residents during the daytime, with a minimum of four or five support staff on throughout the day, plus management cover, and night-time staffing of three staff between the main house and number 127. At present there is one waking night staff in each house and one person sleeping in, within the main house. The manager is considering redistribution of these resources to make more appropriate use of staff time, by moving the sleep-in staff to number 127, and having the two waking night staff in the main house. The level of NVQ attainment across the team has been reduced by the loss of eight staff in the past year. At present only five of the twenty-three staff have attained NVQ level 2 or above, though a further six staff are working towards their NVQ. It would be appropriate to continue to register staff on NVQ, once they have completed their induction and foundation training, but budgets were reported to be a limiting factor to the numbers being registered. New recruits have replaced the majority of staff who have left, and at the time of inspection, only one senior support worker post was vacant. The manager indicated that this post is due to be advertised in the near future. Consideration is being given to the possible ways to involve residents in the staff recruitment process, and the manager is planning to discuss possible interview questions with the residents at a house meeting. Examination of two recent recruitment records indicated an appropriate recruitment and selection system, though in one case no record of a “POVA First” check was available. The manager indicated that most staff had attended the core training and an overall training spreadsheet was being developed. Copies of monthly training booking forms provided indicated a range of appropriate core training being provided on an ongoing basis, though confirmation of attendance was not included on all of the forms. A recent training shortfall analysis had been undertaken, which indicated some requirements for either initial training or updates. The monthly booking forms noted above indicate ongoing action to address these. The manager should periodically review all core training across the team to ensure that everyone has attended the required courses. A system of annual staff appraisals is soon to commence, and the level of supervision is improving, now that the new supervision matrix is being monitored. Supervision roles are delegated between the management team. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 26 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): Standards 37, 39 and 42: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are beginning to benefit from the improving ethos of the home, which is increasingly based on an appropriately proactive and person-centred approach. The views of residents have been sought as part of the self-monitoring of the service and the planning of the care and support provided, and there is evidence of further plans to improve consultation and participation. The degree to which the health, safety and welfare of residents is effectively promoted and protected, has improved. EVIDENCE: The home experienced a period without a permanent manager in post, following the last inspection, until September 2007 when the current manager was appointed. The new manager is appropriately qualified and experienced to manage the home and had begun, with the support of the provider, to Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 27 instigate a range of changes designed to lead to a more proactive and developmental approach to the support provided to residents. He has also begun to develop the monitoring and management systems in the home, some of which had not been properly in place previously, and has recently reinstated expectations of regular supervision and annual appraisal for all staff. The manager confirmed that he was about to submit his application to become registered manager. The manager had provided information as requested, to the Commission, regarding an incident at the home, prior to his appointment, and the expectations with regard to the reporting of events notifiable under Regulation 37 were clarified in discussion. Feedback from two of the residents indicated they found the manager to be approachable and helpful. Two said they would raise any concern they had, with him directly. It was evident from observation during the inspection that there was an appropriate rapport between the manager and the residents. The provider has a quality assurance system, and a survey was last undertaken in February 2007, of residents, relatives, care managers and staff. The manager indicated that the surveys had been returned directly to head office and a copy of the summary report was not available in the home. A further survey is due to be undertaken in May, and a copy of the resulting summary report should be made available to participants and forwarded to the Commission. The views of residents are also sought through residents meetings and reviews and in day-to-day conversation. As noted earlier, the involvement of residents in the process of interview and selection for new staff is also being considered. The manager had drawn up an Action Plan for the development of the service in October 2007, which is regularly reviewed during management monitoring visits and progress noted in the resulting reports. From the evidence seen during the inspection, good progress is being made on the identified issues. Examination of a sample of health and safety-related service certification indicated that required servicing had been undertaken with an appropriate frequency. The format for monthly management monitoring visit reports includes health and safety issues as a standing item. The home had a fire risk assessment in place, dated May 2007 and regular fire drills had been undertaken. Where individual residents have failed to respond to the fire alarm the manager stated that the safety issues had been discussed with them. As noted earlier in this report, the service is moving away from the use of restraint, towards a more proactive approach to managing difficult and challenging behaviour, which also provides improvements to the health, safety and welfare of residents and staff. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 28 The accident records are being maintained using the appropriate tear-off pad. Completed forms are file collectively, for each resident. The manager said that a monthly summary is also completed and sent to the provider. It is suggested that an individual record of accidents to residents should also be maintained within their case record. The manager agreed to consider how best to achieve this. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 30 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 YA32 Regulation 12 Requirement The manager and provider must continue to work to develop a consistent approach throughout the staff team, in order to ensure that residents are supported to develop their skills to enable them to enjoy an enriched quality of life. The manager and provider must ensure that identified shortfalls in core training, (including appropriate refresher training), are addressed, in order to ensure that all staff receive the necessary training to perform their role effectively. Timescale for action 24/07/08 2. YA35 18 24/07/08 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 YA17 Good Practice Recommendations Consideration should be given to seeking appropriate opportunities for residents to attend a healthy-eating course at a local college, to support them to improve their DS0000011088.V360983.R01.S.doc Version 5.2 Page 31 Hazeldene 2. 3. YA20 YA32 4. 5. YA35 YA39 understanding of these issues. Staff should be reminded of the importance of maintaining complete and accurate records of all medication. The provider and manager should consider the possible benefits of team-building input, in helping to develop a consistent team ethos and approach to supporting residents. The manager should ensure that an up-to-date picture of staff training received is available at all times to enable shortfalls to be addressed promptly. The summary report of the upcoming quality assurance survey should be forwarded to the commission. Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hazeldene DS0000011088.V360983.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!