Care Home: Hazelhurst

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What the care home does well There is a stable staff team at the home and there have been no changes to this staff team since our last visit to the home, providing continuity and a consistent approach for the people who live at the home. It was evident from talking to people who live in the house that their views are listened to by the staff team. In particular those of two people who wish to live more independently.HazelhurstDS0000068902.V377111.R01.S.docVersion 5.2People we spoke with said they were happy at the home and were able to tell us who they would speak with if they had any complaints or concerns. Within completed surveys people told us that the residents have more choices and more activities and staff reported that they are receiving regular supervision and training. What has improved since the last inspection? Individuals can be assured that the contracts in place at the home specify the fees and any additional costs to the placement. Improvements have been made to the inappropriate use of language and terminology within care records written by staff. This demonstrates that staff are aware of their responsibility to treat people with respect and have an understanding of individual’s behaviours and how these should be managed. The home have improved the records that monitor individual’s weight. These records provide some evidence that individuals are supported with their healthcare and dietary needs. Those living at the home can be confident that their money is held securely, as the home ensures that money held on behalf of individuals for safe keeping is locked away. Receipts of individual’s money spent are held at the home, and the home have introduced a system to audit these. The provider has demonstrated that she is committed to maintaining an odour free, well maintained environment. Since our last visit attention has been given to address the odour in the ground floor toilet as the flooring in this area has been replaced, furthermore, broken kitchen drawers noted during our last visit to the service have been replaced. Those living at the home can be assured that staff have been provided with information about the Mental Capacity Act, their knowledge and understanding in respect of the rights of people who are living at the home would be enhanced if staff also received training in this area. A requirement was made by us during our last visit in August 2008 that staff must receive sufficient amounts of training. Training has been provided in key areas such as fire safety, first aid, manual handling and protection of vulnerable adults. Manual handling assessments have been reviewed and updated where required to ensure that individuals living at the home are supported safely in this area. During our last visit to the home a recommendation was made that in order to ensure that accurate, safe information is maintained at Hazelhurst the home should review their fire risk assessment and update this document if required. At this visit we saw that the owner of the home had reviewed this assessment, Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 however, there was no evidence to show that the document had been updated in order to ensure its contents were accurate and that the information/assessment contained within it were robust enough to protect people who work and live in the home. It remains the registered provider should seek advice in this area to ensure the contents of the assessment are sound. What the care home could do better: The registered provider is currently in the planning process to put forward proposals in order to change the accommodation and service provided at the home. This will have a significant impact of the lives of people living at the home and their wishes must be taken into account and recorded. The registered provider and staff must have a clear understanding of their role and responsibility in this area in order that they can ensure the rights and wellbeing of those who live at the home. It is required that staff receive training in respect of the Mental Capacity Act and Deprivation of Liberties legislation to ensure that practices within the home are in line with current legislative requirements. It is also required that the registered provider arranges for independent advocacy support for individuals living at the home in order that they supported to make choices which affect their life. It is essential that those who live at the home are supported with the transition to a new service to ensure that they are receiving the service which they need and want, we have requested that the registered provider forward to us a clear and detailed proposal, including actions and timescale to demonstrate to us that individuals are being supported in line with their wishes and assessed needs. There are no records in the home for ‘stock’ held or ‘homely’ medicines that are given at the home, we were told by the acting manager that such records used to be maintained but were no longer held. It is required that records in respect of ‘homely’ and ‘stock’ held medication are maintained at the home in order to maintain a clear record of all medicines given and to ensure that medication administered at the home is being given as required. It is recommended that a job description for the manager’s post is developed to outline clearly the expectations of the role and the responsibilities associated with the post. It is also recommended that staff details sheets in the front of staff personnel files are reviewed and updated to ensure that information recorded is correct and reflect employment at Hazelhurst. We are satisfied that sufficient amounts of training have been provided, however, we do believe that those living and working at the home would benefit if staff undertook training in Mental Capacity and Deprivation of Liberties Awareness. We also noted that much of the training provided is in the form of video and questioning of individuals understanding, in order to ensure that training provided on video is in line with current good practice it isHazelhurstDS0000068902.V377111.R01.S.docVersion 5.2recommended that the provider contact the distributors and obtain written confirmation of their validity. The registered provider was not able to provide evidence that portable electrical appliances within the home such as radios, televisions, stereos etc... have been tested, by a qualified person. The home were requested to forward this to us. This information had not been received by us at the time of writing this report and therefore a requirement has been made that equipment in the care home for use by service users or persons who work in the home is maintained and kept in good order, evidence of electrical safety is required and records of this must be maintained by the home. In the rear garden on the path we noted that two paving slabs were loose and those living and working in the home could trip or fall. It is required that that attention is given to the path in the rear garden in order to make this area safe. Individual’s inventories should be better maintained, this would ensure that items which are of importance to the people living in the home are accounted for. Key inspection report CARE HOME ADULTS 18-65 Hazelhurst 1 Broncksea Road Filton Park South Glos BS7 0SE Lead Inspector Odette Coveney Key Unannounced Inspection 8th September 2009 09:00 Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelhurst Address 1 Broncksea Road Filton Park South Glos BS7 0SE 0117 9855009 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) Pryce-Jones (Filton) Ltd Mrs Hazel Lilian Pryce-Jones Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th August 2008 Brief Description of the Service: Hazelhurst is a care home, which is registered with the Commission for Social Care Inspection,(CSCI). As from April 1st CQC are now known as the Care Quality Commission. The current maximum fee charged at the home is £974.81 per week, this is calculated and based upon an assessment of individuals needs. Hazelhurst is privately owned and is the second care home of the proprietors who also own St David’s Lodge, Fishponds. Mrs Hazel Pryce Jones took over as both the registered Provider and the Registered manager of the home in January 2007. The house is in north Bristol, close to the A38 Gloucester Road, where there are local shops, a library, a leisure centre and churches of various denominations. There is a regular bus service to Bristol centre, which is approximately 3 miles away. The home is also close to the Avon ring road, which connects to the motorway system. The home is a detached house that has been converted and renovated to comply with the Care Homes Regulations 2001 and National Minimum Standards. There are gardens to the front and to the rear of the property. There are communal areas for service users (a lounge, dining room and a sun lounge). There is no provision at the home for respite placements. Wheelchair access is via the rear of the property. A stair lift has been installed to the first floor of the house. All of the service users have a variety of activities that they choose to do during the day, such as attending day centres and college courses. Hazelhurst DS0000068902.V377111.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 two stars this means the people who use this service experience good quality outcomes. This unannounced key inspection took place over 8 hours and was completed in one day. The acting manager and the registered provider was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: • • • • • • • Information provided by the registered provider with the completed Annual Quality Assurance of the service. Information taken from comment cards. Directly speaking with people who live and work at the home. A review of individuals care records. A tour of the home Examination of some of the homes records Observation of staff practices and interaction with the people who live at the home. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act and to review the quality of the care provision for the individual’s living in the home and to also review the seven requirements and eight recommendations made during our last key visit to the service which was undertaken in August 2008. Some comment cards were received prior to the inspection, one was from a person who lives at the home and it was clear that they had been supported to complete the form by their relative, one was from health care professional who has supported residents at the home in the past, however, they had not been to the home for a number of months. Two completed surveys were also received from staff who work at the home. Comments made were reviewed during the inspection visit and comments, maintaining individual’s confidentiality, were shared with the acting manager and registered provider and some of these have been incorporated within this inspection report. What the service does well: There is a stable staff team at the home and there have been no changes to this staff team since our last visit to the home, providing continuity and a consistent approach for the people who live at the home. It was evident from talking to people who live in the house that their views are listened to by the staff team. In particular those of two people who wish to live more independently. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 6 People we spoke with said they were happy at the home and were able to tell us who they would speak with if they had any complaints or concerns. Within completed surveys people told us that the residents have more choices and more activities and staff reported that they are receiving regular supervision and training. What has improved since the last inspection? Individuals can be assured that the contracts in place at the home specify the fees and any additional costs to the placement. Improvements have been made to the inappropriate use of language and terminology within care records written by staff. This demonstrates that staff are aware of their responsibility to treat people with respect and have an understanding of individual’s behaviours and how these should be managed. The home have improved the records that monitor individual’s weight. These records provide some evidence that individuals are supported with their healthcare and dietary needs. Those living at the home can be confident that their money is held securely, as the home ensures that money held on behalf of individuals for safe keeping is locked away. Receipts of individual’s money spent are held at the home, and the home have introduced a system to audit these. The provider has demonstrated that she is committed to maintaining an odour free, well maintained environment. Since our last visit attention has been given to address the odour in the ground floor toilet as the flooring in this area has been replaced, furthermore, broken kitchen drawers noted during our last visit to the service have been replaced. Those living at the home can be assured that staff have been provided with information about the Mental Capacity Act, their knowledge and understanding in respect of the rights of people who are living at the home would be enhanced if staff also received training in this area. A requirement was made by us during our last visit in August 2008 that staff must receive sufficient amounts of training. Training has been provided in key areas such as fire safety, first aid, manual handling and protection of vulnerable adults. Manual handling assessments have been reviewed and updated where required to ensure that individuals living at the home are supported safely in this area. During our last visit to the home a recommendation was made that in order to ensure that accurate, safe information is maintained at Hazelhurst the home should review their fire risk assessment and update this document if required. At this visit we saw that the owner of the home had reviewed this assessment, Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 7 however, there was no evidence to show that the document had been updated in order to ensure its contents were accurate and that the information/assessment contained within it were robust enough to protect people who work and live in the home. It remains the registered provider should seek advice in this area to ensure the contents of the assessment are sound. What they could do better: The registered provider is currently in the planning process to put forward proposals in order to change the accommodation and service provided at the home. This will have a significant impact of the lives of people living at the home and their wishes must be taken into account and recorded. The registered provider and staff must have a clear understanding of their role and responsibility in this area in order that they can ensure the rights and wellbeing of those who live at the home. It is required that staff receive training in respect of the Mental Capacity Act and Deprivation of Liberties legislation to ensure that practices within the home are in line with current legislative requirements. It is also required that the registered provider arranges for independent advocacy support for individuals living at the home in order that they supported to make choices which affect their life. It is essential that those who live at the home are supported with the transition to a new service to ensure that they are receiving the service which they need and want, we have requested that the registered provider forward to us a clear and detailed proposal, including actions and timescale to demonstrate to us that individuals are being supported in line with their wishes and assessed needs. There are no records in the home for ‘stock’ held or ‘homely’ medicines that are given at the home, we were told by the acting manager that such records used to be maintained but were no longer held. It is required that records in respect of ‘homely’ and ‘stock’ held medication are maintained at the home in order to maintain a clear record of all medicines given and to ensure that medication administered at the home is being given as required. It is recommended that a job description for the manager’s post is developed to outline clearly the expectations of the role and the responsibilities associated with the post. It is also recommended that staff details sheets in the front of staff personnel files are reviewed and updated to ensure that information recorded is correct and reflect employment at Hazelhurst. We are satisfied that sufficient amounts of training have been provided, however, we do believe that those living and working at the home would benefit if staff undertook training in Mental Capacity and Deprivation of Liberties Awareness. We also noted that much of the training provided is in the form of video and questioning of individuals understanding, in order to ensure that training provided on video is in line with current good practice it is Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 8 recommended that the provider contact the distributors and obtain written confirmation of their validity. The registered provider was not able to provide evidence that portable electrical appliances within the home such as radios, televisions, stereos etc... have been tested, by a qualified person. The home were requested to forward this to us. This information had not been received by us at the time of writing this report and therefore a requirement has been made that equipment in the care home for use by service users or persons who work in the home is maintained and kept in good order, evidence of electrical safety is required and records of this must be maintained by the home. In the rear garden on the path we noted that two paving slabs were loose and those living and working in the home could trip or fall. It is required that that attention is given to the path in the rear garden in order to make this area safe. Individual’s inventories should be better maintained, this would ensure that items which are of importance to the people living in the home are accounted for. 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 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. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents or their families have all relevant information to make a decision about the nature of the home. People who live at the home have a contract which outlines the written terms and conditions for the home. EVIDENCE: No changes have been made to the Statement of Purpose and homes brochure, since the last inspection and both contain all information as detailed in the National Minimum Standards. The documents are available in the home, along with the previous inspection reports. It was noted by us that these documents are in need of some updating in order to record information about the skills, knowledge and experience and to acknowledge the position of the current ‘acting’ manager. Mrs Pryce Jones confirmed to us that she would attend to this. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 11 There have been no admissions into the home since our last visit to the service in 2008. At this visit we saw that all of those who live at the home are funded by the local authority. For those people whose records were viewed we saw that the home had in place a comprehensive care management assessment in order to make a decision on whether the home and the skills of the staff team are able to meet the individual’s needs. During our last visit to the home a requirement was made by us that contracts must contain information about the fees which are to be paid and must contain accurate information within the included policies. At this visit we saw that all of the contracts contained information about the level of fees and what was no be paid, information about some of the homes policies, for example how to make a complaint, were also included. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place and individuals assessed needs are recorded and kept under review. EVIDENCE: During this visit we reviewed the care and associated records for two of the people who live at the home. Within individuals files we saw that the home maintains care plans and the associated strategies to support people. We saw that information recorded within the care plan covered areas such as the support required with personal care and healthcare, communication, accessing the community, and also the support required for individuals at night. Care plans had been generally well written and those seen by us had been kept under review and updated as required. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 13 Within one persons care plan we saw a separate agreed plan of action for personal hygiene which had been developed to support a person with complex needs. Whilst we understand the purpose of this plan we did not agree with the ‘tone’ and some of the wording within this. We discussed this with Mrs Pryce Jones who agreed with us and removed this from the individuals file, to be re written and further discussion and consideration to be given to this sensitive area. This is to ensure that the individual is being assisted in line with their needs in a respectful manner, whilst maintaining independence. During this visit time was spent discussing the proposals for change of use of the home, we saw that people living at the home had been informed of the proposed changes, two people have said that they wish to move out of the home into a more independent environment, other people we spoke with were unsure and were unclear about what this may mean for them and their future. Whilst we recogonise that consultations are still in the early stages it is required the registered provider, Mrs Pryce Jones, ensures the home is conducted to enable those who live at the home to make decisions with respect to their care they are to receive and their health and welfare. Arrangements are to be made for the re assessment of individuals needs, by an appropriately qualified person, to ensure that all aspects of their assessed needs and personal wishes and choices are known and taken into account. Furthermore, advocacy support should also be provided for individuals in order that they can be independently supported to make decisions that affect their life. During our last visit the home in August 2008 we saw that in some peoples records that staff had written inappropriate comments to describe individual’s behaviour. This is not acceptable and a recommendation was made by us that consideration should be given to the use of language and terminology within individual’s daily records to ensure it is respectful. As part of this visit we reviewed care plans and corresponding daily records as saw that recording in this area had improved. Residents meetings are held at the home, the most recent meeting was held on 1st August 2009, prior to this a meeting was held in July 2009. Areas of discussion included menu planning, life skills, how to raise concerns and activities. All living in the home were asked for their views and these had been recorded and where possible acted upon. Risk assessments were seen by us for some people who live at the home. Risk assessments included making hot drinks and what individuals would do in the event of a fire; assessments are kept under review by the home. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: 12, 13, 15, 16, 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in activities and to be part of the local community. EVIDENCE: Prior to our visit feedback was received from a relative of an individual who lives at the home, they reported that their relative appears to be satisfied at the home and that as a family they feel their relative is treated well and is happy. At the home there is a comfortable dining area for individuals to have their meals in. The Home operates a rotating menu and the Registered provider and staff confirmed to us that people are able to make choices about their meals and also that those who live at the home take it in turns to choose a ‘take Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 15 away’ meal on a weekly basis. People living at the home told us that they enjoyed meals at the home and that they were able to ask for something else if they didn’t like the meal being offered. Within the AQAA completed by the home and sent to us prior to our visit the home had recorded; ‘Service users are asked to contribute to menu planning during house meetings, all likes & dislikes are taken into account & we aim to provide the 5 a day within the menu. Service users can prepare snacks & drinks when they wish’. There is a small self contained area in which people can prepare drinks and snacks, one person told us that they make their own drinks and that they are able to do this when they want to. The AQAA also reported; ‘Service users are receiving 1-1 life skills day & are being trained how to prepare food, clean their rooms & attend to their laundry’. On the day of our visit one of the service users was home for the day and were tidying their room as part of their lifer skills day, when we asked them is they were happy to do this they said it was “ok”. We saw that people are supported to participate in social, leisure and educational activities, within individuals records we saw that people attend church regularly, visit the local library and go shopping. We were also informed that an aromatherapist visits people at the home on a monthly basis and give people a massage for relaxation should they wish. On the day of our visit five people were out to day centres for the day. Three people have accessed college placements and are undertaking cookery and communication classes in order to improve their skills in this area. The home have been awarded a five star food hygiene award. This was issued by South Gloucestershire Council based on standards provided by the Food Standards Agency. The home is to be commended for achieving this award. Hazelhurst DS0000068902.V377111.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal, physical and healthcare. Generally medication is well managed at the home, however improvements must be made to the recording of stock held and ‘homely’ medication. EVIDENCE: Hazelhurst provides accommodation and personal care for up to ten adults, male or female, who have a diagnosis of learning difficulties. At the time of our visit there are seven people who live at the home and there are no planned admissions into the home, there have been no new admissions since our last visit to the service. During this visit time was spent with people who live at the home, the registered provider and two members of staff (including the acting manager). We were informed of proposals for the change of use of the home and were provided with some information about this. The registered provider, staff and people who live at the home attended a meeting chaired by a representative of Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 17 South Gloucestershire’s community care and housing department. The purpose of this meeting was to discuss the plans to change the current status of the home from one which provides residential care to that of a service which provides ‘supported living’. We discussed with the registered provider some of the arrangements and plans currently being developed. We are aware that this proposal in still very much in the developmental stages however, it is essential that those who live at the home are supported to ensure that they are receiving the service which they need, we have requested that the registered provider forward to us a clear and detailed proposal, including actions and timescale to demonstrate to us that individuals are being supported in line with their wishes and assessed needs. People living in the home are registered with a local doctor’s practice. Medicines are supplied to the home using a monthly blister pack system. All the medicines used in the home are given by staff. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each person’s medicines, along with a copy of the home’s medicine policy. This means that staff can be clear about how to give medicines safely. We saw some medicines being given at breakfast. Medicines were given from the labelled containers provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. We saw that the home has a medicines disposal book to record how unwanted medicines are disposed of. There are no records in the home for ‘stock’ held or ‘homely’ medicines that are given at the home, we were told by the acting manager that such records used to be maintained but were no longer. It is required that records in respect of ‘homely’ and ‘stock’ held medication are maintained at the home in order to maintain a clear record of all medicines given and to ensure that medication administered at the home is being given as required. Staff have received medication training from the pharmacist who supplies medication to the home, Mrs Pryce Jones and the ‘acting’ manager both confirmed that medication competency refresher training is planned and that this would be taking place in the form of a distance learning pack which has been purchased for the home. People are supported with their primary healthcare needs such as the dentist, chiropody and optician, these had all been recorded. At the time of our visit one of the people who live at the home was supported by the community district nursing service and this service is provided on a regular basis. We saw Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 18 that the home contacts individuals GP or the district nursing service promptly when a need has been identified. During our last visit to the home on 20th August 2008 we reported that some people at the home are supported to maintain a healthy diet. We saw at that visit that each person had in place a record of their weight and it was indicated that these weights should be monitored and checked on a monthly basis. For some people these records had not been completed for a number of months. A recommendation was made by us that in order to evidence that individuals are supported with their healthcare and dietary needs the home should improve the records to monitor individual’s weight, where these records are required. A review of these records found that generally these were better maintained, the acting manager and the registered provider both confirmed to us that although people are generally supported with their diet in order to maintain a healthy lifestyle there is currently no one living at the home for whom there are concerns over their weight. During our last visit to the home we also recommended at information should be provided to staff in respect of the Mental Capacity Act in order that they can be aware of their role and responsibility in this area. We saw this information in place at the home and also saw that this had been discussed with some staff during their one to one supervision with the acting manager, however, in light of the proposals to change the accommodation at the home, this will have a significant impact of the lives of people living at the home and their wishes must be taken into account and recorded. The registered provider and staff must have a clear understanding of their role and responsibility in this area in order that they can ensure the rights and wellbeing of those who live at the home are acted upon. It is required that staff receive training in respect of the Mental Capacity Act and Deprivation of Liberties legislation to ensure that practices within the home are in line with current legislative requirements. All individuals spoken with said they like living at the home, and that they feel well cared for, that staff listen and treat them well and knew that they have a care plan in place. All knew who to speak with if they had any concerns. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. EVIDENCE: The homes complaints procedure is included in the homes statement of purpose and a copy of this is also contained within individual’s contracts relating to the terms and conditions of their placement. Individuals spoken with during the course of the visit said they would talk to the staff if they were not happy about anything and named individuals who they would speak with should they have any concerns. Prior to our visit to the home two complaints about the service were received by us. We asked the provider to investigate and respond to one of the complaints. As the other complaint was made by an anonymous person we looked into the issues raised as part of the inspection process. Mrs Pryce Jones informed us of her investigation findings and told us what she had done to resolve the issues. We are satisfied that both complaints have areas that have been upheld and that Mrs Pryce Jones has taken appropriate action to ensure that the concerns have been resolved. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 20 Two staff are undertaking the National Vocational Qualification in care award, two staff have already completed this training and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. All staff have completed training ‘in house’ in respect of abuse of adults with learning difficulties. The home were reminded by us that the local authority provide free protection of vulnerable adults training to care home staff. The home have in place a copy of South Gloucestershire’s protection of vulnerable adult’s policy. During our last visit to the service we were concerned to note that the cabinet which contained resident’s money was not kept secure and locked, a requirement was made by us that money held for individuals living at the home must be stored securely. At this visit no concerns were noted by us. The home has good systems in place to manage any monies they hold on behalf of the residents. During this visit two of the accounts were checked against the records held and they tallied. It was also during our last visit that two recommendations were made in respect of auditing individuals property and finances, these were that inventories of individual’s personal property should be reviewed and updated in order that they contain accurate information and also that a system should be developed by the home in order to audit the receipts, which show what individuals have spent their money on. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of residents had been reported to the Care Quality Commission. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally individuals live in a home that is safe, comfortable and homely, and equipped to meet their needs. However, attention must be given to the path in the rear garden to ensure that it is safe. EVIDENCE: The house is in north Bristol, close to the A38 Gloucester Road, where there are local shops, a library, a leisure centre and churches of various denominations. There is a regular bus service to Bristol centre, which is approximately 3 miles away and also to The Mall, a large shopping complex located in Cribbs Causeway. The home is also close to the Avon ring road, which connects to the motorway system. The home is a detached house that has been converted and renovated to comply with the Care Homes Regulations 2001 and National Minimum Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 22 Standards. There are gardens to the front and to the rear of the property. We did note upon arrival to the home that the gates and railings at the front of the home are in need of re painting. Mrs Pryce Jones informed us that as part of the homes plans to change to a supported living environment these railings and gates would be being removed and the front garden area would be paved over to allow for off road parking facilities, Mrs Pryce Jones is aware that should the plans for this area change the railings and gate would be required to be repainted in order to demonstrate a commitment in providing a well maintained environment for the residents. The home has a large rear garden and seating is provided, people were seen sitting and chatting with staff and enjoying this area, we did note that two paving slabs were loose and those living and working in the home could trip or fall. It is required that that attention is given to the path in the rear garden in order to make this area safe. There are communal areas for service users (a lounge, dining room and a sun lounge). There is no provision at the home for respite placements. Wheelchair access is via the rear of the property. A stair lift has been installed to the first floor of the house, we saw in records that this piece of equipment had been recently serviced and was deemed fit for use. There are adaptations in place throughout the Home and specialist equipment including mobility aid, sensory aids and handrails. Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. During our last visit to the home a requirement was made that odour in the ground floor toilet area must be eliminated. No concerns were noted during this visit. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. The Home looked clean and tidy in all areas that were viewed. During our last visit to the home a requirement was made that broken and missing drawer fronts in the kitchen must be repaired or replaced. No concerns were noted during our visit and we saw that these had been replaced. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are cared for by sufficient numbers of competent staff that are provided with training and supervision in order to fulfil their roles and responsibilities; however those living at the home may benefit from staff training in areas of mental health legislation. Safe vetting and recruitment procedures are in place. EVIDENCE: During our last visit to the home it was difficult to identify what training had been completed by staff, a recommendation was made by us that an audit of staff training should be undertaken in order to provide an overview of training provided and planned for the future. At this visit a training audit was shown to us, this recorded training which had been completed since January 2009, all staff were included in this audit with dates of when the training had been completed. At this visit the training records of staff were reviewed and staff are well supported in this area. Records evidence that staff have undertaken Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 24 training in the following areas: First aid, infection control, manual handling, fire safety, medication competency, food hygiene. The achievement of a National Vocational Qualification is well promoted within the home. We are satisfied that sufficient amounts of training have been provided, however, we did note that much of the training provided is in the form of video and questioning of individuals understanding, in order to ensure that training provided on video is in line with current good practice it is recommended that the provider contact the distributors and obtain written confirmation of their validity. Whilst at the home we observed staff and they were seen to be supportive to people who live at the home. It was noted that staff were very patient and ‘asked’ people who live in the home questions and encouraged them to make decisions, rather that deciding for them and encouraged individuals to make choices. There have been no changes in the numbers of the staff team since our last visit to the service and their remains a stable staff team at the home. At this visit the staff records for three staff members were fully reviewed and two staff members were spoken with as part of the inspection process. The home operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of people who live at the home. Written references, protection of vulnerable adult’s checks and criminal record bureau checks had been undertaken for staff prior to their commencement at work. In the front of each staff members file there is an information details sheet that records staff role, number of hours and personal information. It was noted that for two people their current position at the home was not the same as was recorded on their sheet, also the heading of the sheet related to a different home, it is recommended that staff details recorded on the front of their personnel file should be updated to reflect the correct information relating to their employment at Hazelhurst. At this visit time was spent with the ‘acting’ manager of the home, this person is a senior member of staff who has worked at the home for a number of years, this person has completed a National Vocation Qualification in care at levels two and three. This person told us about their role and they were able to demonstrate a clear understanding about their role and responsibilities, we looked at the file for this member of staff and could find no job description for their managerial role. It is recommended that a job description for the manager’s post is developed to outline clearly the expectations of the role and the responsibilities associated with the post. We have seen previously that staff complete a comprehensive induction and receive ongoing training in order to fully undertake their role effectively. We spent some time throughout the day talking to staff and observing them carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humoured and sensitive towards the residents within a relaxed, Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 25 calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Hazelhurst. Hazelhurst DS0000068902.V377111.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are clear policies and procedures in place at the home to direct and guide practice. Health and Safety is generally well managed, however, the home must ensure that all portable electrical appliances are safe for use. Staff receive appropriate supervision. EVIDENCE: Hazelhurst is privately owned and is the second care home of the proprietors who also own St David’s Lodge, Fishponds. Mrs Hazel Pryce Jones took over as both the registered Provider and the registered manager of the home in January 2007. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 27 Mrs Pryce Jones is supported by a senior member of staff who is currently ‘acting’ manager. Within the AQAA completed by the service and forwarded to us prior to our visit the registered provider had recorded: ‘The experienced manager remains objective & communicates a clear sense of direction & leadership & acts in a responsible manner at all times ensuring the protection & welfare of others is paramount. All policies, procedures, NMS, Regulations, and Legislation is maintained as required. Both service users & staff receive regular fire drills & procedures. The manager ensures the health, safety & welfare of service users & staff are promoted & protected’. Within the section of the AQAA which asks for information from the homes to evidence how they do this they had recorded; inspection reports, policies & procedures, staff training files, fire log book, service user files, service user & staff meeting records. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. The fire logbook records showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of those who live and work at the home. During our last visit to the service we were concerned to find that staff were not receiving sufficient amounts of fire instruction and a requirement was made by us that staff must receive fire training to ensure they maintain their knowledge of their responsibility in this area. A review of training records showed us that all staff had recently completed a fire drill, incorporating a full evacuation and had also undertaken fire prevention training in January 2009. Some of the Health and safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including gas safety, all fire alarms and equipment and emergency lighting and emergency call bells, however, the registered provider was not able to provide evidence that portable electrical appliances within the home such as radios, televisions, stereos etc... have been tested, by a qualified person. The home were requested to forward this to us. This information had not been received by us at the time of writing this report and therefore a requirement has been made that equipment in the care home for use by service users or persons who work in the home is maintained and kept in good order, evidence of electrical safety is required and records of this must be maintained by the home. Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 28 It was required by us during our last visit to the home that manual handling assessments must be reviewed and updated to ensure individuals are supported safely. At this visit no concerns were noted by us, manual handling assessments had been kept under review and updated as required. During our last visit to the home in August 2008 we recommended that individual’s inventories should be better maintained, as this would ensure that items which are of importance to the people living in the home are accounted for. At this visit we saw that no action had been taken, we discussed this with Mrs Pryce Jones who said that this would be dealt with and full audits would be undertaken, we will review this again at our next visit to the home. We received two completed surveys from staff who work at the home in the section of what could the home do better it was recorded to have more staff meetings in order to stop ,misunderstandings and accusations and to keep staff informed or any changes. At our last visit to the service we made a recommendation for their to be more staff meetings at the home and that these should be recorded. At our visit staff confirmed to us that their had been a meeting held recently, however this had been the only meeting and this meeting had been held to discuss specifically the proposal to move to a more supported living environment at the home. We still recommend that staff meetings are held and these should be done so on a regular basis, this would provide all to have an opportunity to air their views and encourage discussed and debate. Meetings should be recorded to evidence decision making processes and outline agreed actions to be taken and by whom. Hazelhurst DS0000068902.V377111.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 3 4 3 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 2 25 x 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 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 3 3 X 2 X Version 5.2 Page 30 Hazelhurst DS0000068902.V377111.R01.S.doc 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 YA20 Regulation 13(2) Requirement The Registered Person shall make arrangements for the recording of medicines received into the home to ensure that records in respect of homely and stock held medication are maintained at the home in order to maintain a clear record of all medicines given and to ensure that medication administered at the home is being given as required. The Registered Person shall ensure the care home is conducted to enable service users to make decisions with respect to their care they are to receive and their health and welfare. Timescale for action 09/09/09 2. YA7 12(3) 09/12/09 3. YA42 23 (2)c To ensure that individual’s needs are re assessed by an appropriately qualified person and also advocacy support must provided for individuals in order that they can be independently supported to make decisions that affect their life. The registered provider must 09/10/09 DS0000068902.V377111.R01.S.doc Version 5.2 Page 31 Hazelhurst ensure that equipment in the care home for use by service users or persons who work in the home is maintained and kept in good order, evidence of electrical safety is required and records of this must be maintained by the home. 4. YA24 23(2)b The Registered person shall 09/10/09 ensure that the premises internally and externally are kept in a good state of repair. The registered person must ensure that attention is given to the path in the rear garden to make this area safe. The Registered person shall 09/12/09 ensure that people who work in the care home receive the training appropriate to their work. Staff must receive training in respect of the Mental Capacity Act and deprivation of Liberties Legislation. 5. YA32 18(1)c RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA38 YA31 Good Practice Recommendations Staff meetings should be held at the home, these should also be recorded. A job description for the manager’s post should developed and provided in order to outline clearly the expectations of the role and the responsibilities associated with the post. Staff details on the front of their personnel file should be updated to reflect the correct information relating to their employment at Hazelhurst. Inventories of individual’s personal property should be reviewed and updated in order that they contain accurate information. DS0000068902.V377111.R01.S.doc Version 5.2 Page 32 3. 4. YA41 YA23 Hazelhurst 5. YA42 The homes fire risk assessment should be reviewed to ensure it contains accurate information. As required by the fire authority. Written confirmation of the validity of training provided by video should be obtained to ensure training is in line with current good practice. 6. YA35 Hazelhurst DS0000068902.V377111.R01.S.doc Version 5.2 Page 33 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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