Care Home: Hexthorpe House

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What the care home does well Hexthorpe House provides a good quality service meeting the needs of the people. Staff understood peoples needs and interacted well to offer choices and promoted an independent lifestyle. The person living there told us, I am very happy here. The staff are lovely. The care plans clearly identified peoples needs and had measures in place to meet those needs. The care plans were regularly reviewed and were person centered. The home was clean well maintained and provided a homely environment for the person who lived there. Staff training was all up to date, which ensured staff were appropriately trained to meet the persons needs. There was robust recruitment procedures followed which protected people. What has improved since the last inspection? The manager is now registered and has successfully completed the registered managers award. What the care home could do better: The manager and providers continually look at ways to further improve the service. Some areas we identified that could further improve were staff training in appropriate restrain and redirection techniques, although this had been discussed with professionals and staff, no formal training had been provided. The manager completed an AQAA however more detail could have been included to show improvements made and quality outcomes for people. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hexthorpe House 31 Spansyke Street Hexthorpe Doncaster South Yorkshire DN4 0AX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Powell     Date: 0 1 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Hexthorpe House 31 Spansyke Street Hexthorpe Doncaster South Yorkshire DN4 0AX 01302363674 NONE leebrewster@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Active Care Homes Ltd care home 1 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 1 Hexthorpe House is a mid-terrace house on a residential street in Hexthorpe near the town of Doncaster. The home provides care for one person with a learning disability aged between 18-65 years. The home has two bedrooms, although one bedroom is used as a dressing room for the service user. There are two reception rooms and an open plan kitchen. The fees for the home are 3,700 pounds per week as the sevice user is staffed two to one, and no other service users live there. There are additional charges for toiletries and activities. The Statement of Purpose and Service User Guide were available for inspection. Care Homes for Adults (18-65 years) Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced key inspection and took place on 1st July 2009 at 09:50 and finished at 13:20. Care Homes for Adults (18-65 years) Page 5 of 24 The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources includeReviewing information that has been received about the home since the last inspection. The annual quality assurance assessment (AQAA) Which had been completed and returned by the manager. This focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. Surveys were not sent out on this occasion as it was not appropriate for this visit, the person that lives at Hexthorpe House spoke to us during our visit. Notifications (Regulation 37) relating to incidents in the home would be looked at, however none had been received in the last 12 months, this was reviewed during the visit and no incidents had occurred that required a notification to be completed. At the site visit one inspector spent 3.5 hours at the home. During this time observations of care practices took place. We spoke to the person using the service. Discussions with the manager regarding meeting needs, care plans, training, mealtimes, protecting people and the environment took place. We observed the person who lives at the home preparing there lunchtime meal with the assistance of staff. We looked at care plans, the environment, and a selection of records. We spoke to two members of staff during our visit to gain an understanding of their knowledge and how the home is managed. Feedback was given to the manager at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessments clearly identified peoples needs to be able to determine if they could be met. Evidence: The person had been fully assessed prior to moving into Hexthorpe House. The assessment of needs was in the plan of care. The assessment was comprehensive and clearly detailed the needs of the person to ensure the home could meet these needs. Infomation from specialist nurses was also in the plan of care for staff to read and understand the persons needs. The home had not carried out any further assessmetns as only one person lived at the home. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person in the home had a plan of care with clearly identified needs, these were met, and people were treated with respect, were able to make decisions about their lives and take risks as part of an independent lifestyle. Evidence: We looked at the persons plan of care in detail to determine the persons needs had been assessed and met. The person told us they were aware of the plan and had involvement in what the staff wrote. the person also told us that staff understood them and helped them when they had a bad day. The care plan was comprehensive, had identified all the persons needs and how to meet them. Risks had also been identified and risk management measures in place to ensure the person was able to lead the life they wanted. the persons limitations due to their disabilities were clearly recorded and the person told us that staff understood Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: their problems and how to look after them. A person centered plan was also completed, which showed clearly that the person and their advocate had been involved. These ensured their choices and needs were identified and could be met. It also identified the persons choices and goals and how these could be met. The person was actively involved in the day to day decisions made in the home and was very clear on what they wanted to be involved in and what they preferred not to be involved in. The staff told us they respect the persons wishes and choices. The persons advocate told us that the person was very settled and that their needs were met at Hexthorpe house. A health action plan was also in place ensureing all health care needs were identified and could be met. It was evident from talking to staff that the person was able to make decisions, were given choices and were able to take reasonable risk as part of an independent lifestyle. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People exercised choice and control over their daily lives and activities ensuring their needs were met. Evidence: The person centered plans provided information about supporting people to take part in daily tasks within the home. The routines, activities and plans were individualised and reflected diverse needs. It was clear from the information that staff are clear about how to encourage involvement in the tasks and the intervention needed if people display inappropriate behaviour. The person told us they understood the importance of time out in their room to help to reduce their anxiety. Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: The manager told us the person had been consulted about their interests and lifestyles, although decisions to take part in activities would only be made at short notice to minimize distress. Activities include weekly grocery shopping, trips to Yorkshire outlet, bowling, meadowhall, trips to the coast and the cinema. The person told us they enjoyed the activities and were able to make choices. It was evident talking to staff and the person that they enjoyed the life opportunities and experiences. Staff also took into consideration what the person didnt like doing and avoided this at all times. The person did not like being away from the home overnight so holidays were not considered, other opportunities were offered, day trips and activities. Staff we spoke to were very knowledgeable on the persons needs and had clear understanding on how to meet those needs. Meals were varied and healthy, people told us that they were able to choose what to eat and when, they were also involved in preparing meals. Staff told us that the persons appetite had greatly improved since they first arrived at Hexthorpe House and they Had gradually introduced new food and they now had a very varied diet. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs were met and they were supported in the way they preferred. Medication procedures protected people. Evidence: Staff supported the person in the way they preferred to encourage them to have control over their life. They were supported to attend appointments with consultants, to ensure their mental health needs were met. Community nurses also supported staff by visiting on a regular basis. The manager told us healthcare plans identified protocols to minimize distress to the person prior to attending any health appointments. These protocols were in the plan of care they ensured the persons needs were met. staff had received specific training on the persons health care needs including mental health awareness and challenging behaviour. Staff discussed with specialist nurses the appropriate redirecting techniques to be used, when the person presented with challenging behaviour, however there had been no formal training provided. Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: Medication polices and procedures in the home were very good, all medication was documented on arrival, and was documented when administered and disposed of. Medication was appropriately stored. All staff that administer medication had successfully completed accredited medication training to protect people ensuring there needs were met. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived in the home were listened to and protected. Evidence: There was a clear and effective complaints procedure, which includes set timescales. No complaints had been received. The home has a good safeguarding policy, which clearly defined different types of abuse, and staff were aware of different types of abuse and they were also aware of the importance of whistle blowing. Staff understood that the use of physical intervention was as a last resort, staff would benefit from training on the appropriate physical intervention to use to ensure peoples needs are met. Staff were due to receive training updates in safeguarding in September the manager had already booked this training to ensure peoples needs were met. Care Homes for Adults (18-65 years) Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was homely, clean, comfortable and well-maintained. Evidence: The person who lived at Hexthorpe House agreed to show us around the home, we looked at every room, they were all well decorated and furnished to a good standard. The person told us they did not like much furniture in their room, and her wishes had been adhered to. They also told us they had chosen the wall colour and the bedding. The home is close to local amenities including shops, restaurants and cinemas. No adaptations are required in the home for the person that lives there, although the staff told us these would be provided if required. The standard of cleanliness throughout was good. The home was suitable, safe and well maintained. Care Homes for Adults (18-65 years) Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training was up to date. Recruitment procedures were robust protecting people who lived at the home. Evidence: All staff had achieved NVQ level 2 and three staff also had NVQ level 3, ensuring people are supported by competent and qualified staff. The home operated a thorough recruitment process, taking into account equality and diversity as part of the recruitment process. We looked at a selection of personnel files, they all contained all the required information and checks to ensure people were protected. All staff had a clearly defined job description, signed and placed in their personal files. All staff have skill for care induction training, which includes all requirements of the service. We looked at a selection of staff training files, records were good and all training had been carried out to ensure peoples needs were met. The manager had also implemented a rolling programme of training to ensure staff were regularly updated, to ensure peoples needs were met by appropriately trained staff. The manager and senior support worker had attended a course specific to learning disabilities, the Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: providers were looking at providing this course to all staff. Some staff had also attended training in the mental capacity act and the deprivation of liberty to ensure their knowledge was up to date to meet peoples needs. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration safeguards people, good health and safety policies and procedures were in place ensuring the safety of people in the home. Evidence: The registered manager is competent and qualified to run the home, she had successfully completed her Registered Managers Award. The manager completed an AQAA prior to the visit and returned it to the commission, this was fully completed, however more detail could have been included in the information supplied. This would give us a better understanding of the achievements made and the performance of the home. There was a good quality monitoring system in place based on seeking peoples views. There was a good health and safety policy and all staff had received an update in health and safety training to ensure the safety of people. Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: The maintenance records for electrical safety, Portable appliance testing, legionella, fire checks, water temperatures and safe environment including equipment and machinery were all available at the time of the visit and up to date ensuring peoples safety. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 Staff would benefit from attending training on how to manage challenging behaviour in the event restraint or redirection is required. It is recommended that all staff gain learning disability qualifications. The AQAA could give us more detailed information in oder to make judgments on the overall quality outcomes for people. 2 3 35 42 Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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