Care Home: Hixberry Lane

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What the care home does well Hixberry Lane provides a clean and homely environment to residents on short respite stay, either as a holiday break from their own home environment or when their own family or carers are taking their own break. Bedrooms are furnished to provide a private area where residents can also choose to eat and watch television as they wish. The service offers a range of activities and admissions are where possible matched to enable residents to enjoy common interests. The management ensures that residents continue to retain their daily activity routine where possible and also encourage new living skills. Most of the residents are regular clients and members of staff are aware of their wishes and preferences and personal care needs, and staff deliver care accordingly. The service deploys agency workers to make up the numbers. However, these are regular agency workers who know the client groups and therefore there is continuity of care to the benefit of the clients. We received the following comments from residents and their families in our recent questionnaire survey: "Friendly staff." "They always make sure (my relative) has the same bedroom. This is very important to (my relative)." "They always make (my relative) feel welcome." What has improved since the last inspection? Since the last inspection the home manager has registered with us. The Medication Policy and Procedures have been revised and improved to ensure safe administration of medication. The Medication Administration Record (MAR) charts are appropriately recorded, signed and dated by the author. What the care home could do better: The following comment was received from a respondent in a recent survey carried out by us when we asked "What could the home do better?" The reply was: "More activities. This is not possible at the moment because they do not have any transport." It would be good if the management could improve this aspect of the service. The home manager confirmed that residents who require transport will need to use the taxi service which the residents have to pay for themselves. Key inspection report Care homes for adults (18-65 years) Name: Address: Hixberry Lane Respite Care Unit 3 Hixberry Lane St Albans Hertfordshire AL4 0TZ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson Date: 1 9 0 8 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 23 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for 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. 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 Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: Hixberry Lane Respite Care Unit 3 Hixberry Lane St Albans Hertfordshire AL4 0TZ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Learning disability Physical disability Number of places (if applicable): Under 65 4 4 Over 65 0 0 Care home 4 Hertfordshire County Council 01727753142 01727753141 hixberrylane.residentialunit@hertscc.gov.uk Additional conditions: Date of last inspection: Brief description of the care home: D D M M Y Y Y Y Hixberry Lane is a respite care unit that can provide accommodation for up to four people with learning disability and who may also have a physical disability. The main town of St. Albans, with its extensive facilities, is a short drive away and the home is accessible by public transport. Care Homes for Adults (18-65 years) Page 4 of 23 The building at Hixberry Lane is sited next door to Butterwick Day Centre. The respite unit is one of three separate units, all managed together from the main office in the building at 3 Hixberry Lane, but only the respite care unit is registered with the Care Quality Commission. Hertfordshire County Council currently manages this service. The respite unit is on the ground floor and comprises 4 bedrooms with ensuite facilities. There is also a shared lounge/dining room, kitchen and laundry. There is a small garden at the front and a larger garden at the rear, which is shared with people living in the other units. The current weekly fees for respite can be obtained from the manager of the service. Further information about the service can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CQC inspection report should be available in the home. Care Homes for Adults (18-65 years) Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service How we did our inspection: This service had a key inspection in August 2007 and an annual service review in July 2008, which is a review of information received about the service without a site visit since the last key inspection. This unannounced key inspection was carried out on 19/08/2009. The home manager was present. There are 3 people in residence. The inspection included a tour of the premises and general discussion with the home manager and a senior care worker. There were no residents or visitors present during the site visit. Therefore we were unable to obtain their feedback about the service and the care provided. Survey questionnaires were sent to the residents and relatives and their responses and other information received by us were reviewed. This included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the Care Homes for Adults (18-65 years) Page 6 of 23 people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? What they could do better: The following comment was received from a respondent in a recent survey carried out by us when we asked What could the home do better? The reply was: More activities. This is not possible at the moment because they do not have any transport. It would be good if the management could improve this aspect of the service. The home manager confirmed that residents who require transport will need to use the taxi service which the residents have to pay for themselves. Care Homes for Adults (18-65 years) Page 7 of 23 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 websitewww.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 8 of 23 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 10 Individual needs and choices (standards 6 – 10) ................................................... 11 Lifestyle (standards 11 – 17) .............................................................................. 13 Personal and healthcare support (standards 18 – 21) ............................................. 15 Concerns, complaints and protection (standards 22 – 23) ....................................... 16 Environment (standards 24 – 30) ........................................................................ 17 Staffing (standards 31 – 36)............................................................................... 18 Conduct and management of the home (standards 37 – 43) ................................... 20 Outstanding statutory requirements..................................................................... 21 Requirements and recommendations from this inspection ....................................... 22 Care Homes for Adults (18-65 years) Page 9 of 23 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 who use 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 have the information they need to make an informed choice. A full assessment will be carried out before a prospective resident is admitted to ensure that all their care needs can be met. Evidence: The pre-admission documents for two recent admissions were examined and they showed that a thorough pre-admission assessment was carried out prior to their admission to ensure that all their personal, healthcare and social care needs can be met. The home will not admit a prospective resident whose care needs cannot be met. Some people return regularly to the respite unit and prior booking is usually made for them. Each resident receives a Service User Guide on admission. Care Homes for Adults (18-65 years) Page 10 of 23 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 who use 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 who use the service will be given the opportunity to participate in the daily routine in the home and they will be supported to take risks as part of an independent lifestyle. Their assessed and changing needs will be reflected in their written care plan to enable staff to care for them appropriately. Evidence: Each resident has a written care plan which has improved since the last inspection. The care plans examined reflected the person-centred care provided. This ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people using the service. As most of the people are short stay residents, reviews of their care needs may not be carried out during the time of their stay. However since many of these residents use the service on a regular basis, the home manager ensures that any changing care needs are documented appropriately during the time of the new admission process. Prior booking is usually made for these people. At the time of our site visit, there were no residents present as all the three residents were at the day centre. Residents are involved in their daily living routine. Individuals are encouraged to maximise and maintain their independent living skills and they are encouraged to learn and experience new skills. The staff liaise with residents own carers to ensure new skills learnt are maintained. Detailed risk assessments are carried out at each Care Homes for Adults (18-65 years) Page 11 of 23 admission and the residents wishes and preferences are taken into consideration during the care planning process. Residents are encouraged to take risks and make their own decisions within a risk management framework. Care Homes for Adults (18-65 years) Page 12 of 23 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 who use 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 who use the service can expect that their rights will be respected and that they will be encouraged to lead an independent lifestyle and engage in communal activities. They will be encouraged to maintain contact with their family and friends. A healthy and wholesome diet is promoted. Evidence: Residents have the opportunity for personal development both within the home and through an individual daytime activity programme. The manager said that staff actively encourage and support residents to try new living skills such as putting their clothes on themselves or making a cup of tea for themselves or others. Residents are encouraged to enjoy a full and stimulating lifestyle. Their wishes and preferences are considered and they are encouraged and supported in their chosen social and leisure activities. The home manager said that outdoor activities are limited owing to the lack of transport and the problem with deploying agency workers to make up staff numbers. Residents have to pay for their transport if they wish to attend activities that are not within walking distance of the unit. Local outings include pub visits, shopping and gardening. Most of the residents continue to attend the day centre and they are encouraged to carry out their usual daily routine. Residents are encouraged to keep in touch with their family. Care Homes for Adults (18-65 years) Page 13 of 23 Residents are involved with the planning of the menu and some assist with the food preparation. The home manager said that some residents prefer take-away meals and staff will assist them to ensure that residents have healthy food. Care Homes for Adults (18-65 years) Page 14 of 23 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 who use 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 who use the service can be assured that they will be treated with respect and that they will receive personal care in the way they require and need and that they will be protected by the homes Medication Policy and Procedure. Evidence: Residents have access to specialist professionals such as the family doctor, community mental health professionals and district nurses should the need arise. Any health and behavioural concerns are referred to the doctor or the psychiatric team for assessment and review. The service is run by Hertfordshire County Council and is well supported by the Community Learning Disability Team. The senior support worker ensures that the residents care needs are reviewed regularly and their care plans updated. Medication is appropriately stored in a metal drug cupboard and there is a controlled drug cupboard. The management confirmed that only trained staff administer medication and that there have been no medication errors since the last inspection. Proper medication records are kept. Care Homes for Adults (18-65 years) Page 15 of 23 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 who use 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 who use the service can be assured that the service has a robust Complaints Policy and Procedure and that they will be listened to and be protected from harm and abuse. Evidence: The management confirmed that the Complaints Procedure is available in the Service User Guide which is given to each new client at the time of admission. The Complaints Procedure is available in different languages and picture format and is available to the residents. All complaints are recorded together with the responses and outcomes. Any concerns raised by individuals and family members are taken seriously and acted upon appropriately. The home manager confirmed that there was one written complaint about clothing and this issue was resolved with the client and their family. Staff have had training on safeguarding issues and the Whistle-Blowing Policy. The home follows the Hertfordshire County Council Joint Safeguarding Procedure. There have been no safeguarding referrals made recently. Care Homes for Adults (18-65 years) Page 16 of 23 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 who use 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 who use the service live in a homely, safe and comfortable environment, with access to all communal facilities and the bedrooms provided allows them privacy and maximise their independence. Evidence: On the day of the site visit the premises appeared clean and tidy with a homely atmosphere. The home has no dining room but there is a lounge and dining area. It seemed to meet the needs of the residents. The home has been completely redecorated and new furniture has been provided. Each bedroom is spacious and is equipped with suitable furniture and fittings, a television and a small table. The resident can choose to watch television or to have their meal in the bedroom or to spend a quiet time by themselves if they choose to. New profiling beds have been purchased and they are more suitable for the residents especially those with restricted mobility and special care needs. There is a spacious assisted bathroom to accommodate individuals with a physical disability who may be wheelchair users and who may need to be hoisted. Care Homes for Adults (18-65 years) Page 17 of 23 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 who use 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 who use the service can be assured that they will be well supported by staff and they can be confident that they are safeguarded by the homes robust Recruitment Policy and Procedures. Evidence: The respite unit has a senior care worker and two permanent care staff. Agency staff are deployed to make up the staff numbers as the need arises. As residents are usually in their respective day centre throughout the day, staff numbers are adjusted accordingly to the care needs and the time residents return from their day centre. On the day of the site visit the home manager and a senior care worker were present. An agency care worker was on site to do the daily domestic chores. There were no residents present at the time as they were all at the day centre. Staff have the experience to care and support the residents, who are safeguarded by the homes recruitment policy and procedure. The service follows the Hertfordshire County Councils own Recruitment Policy and Procedure. The manager confirmed that staff receive regular one-to-one supervision and an annual appraisal. All new staff are vetted and they only commence working after clearance is established in regard to the Protection of Vulnerable Adult (POVA) checks and the Criminal Record Bureau (CRB) checks. The staff files examined were found to be properly completed and they were kept up to date. New staff have a period of induction including mandatory training. The service follows the Skills for Care Induction training programme. As the service is under the Hertfordshire County Council training programme, staff have opportunities to attend specialist training to respond to individual needs such as epilepsy, autism, dementia, Care Homes for Adults (18-65 years) Page 18 of 23 communication and person-centred planning. All staff have the opportunity to enrol for NVQ2 or NVQ3 courses. The current group of permanent staff are NVQ trained. Care Homes for Adults (18-65 years) Page 19 of 23 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 who use 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 who use the service can be assured that the home will be run in their best interests and that the management will ensure that their health, safety and welfare will be promoted and protected. Evidence: The registered manager is a trained social worker with management qualifications including NVQ Managers Award in Care and Management. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The home is not involved in the residents finances. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. These survey questionnaires are also available in picture format and other languages. The audit documents were readily available for inspection. There is a monthly visit and report carried out by the provider in compliance with regulations. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and has been included in this report. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes No √ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 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 Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: 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). 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