Care Home: HMT Care Ltd

What the care home does well The home has a clear ethos of promoting residents` independence as much as possible, and helping them to do things for themselves. This was reflected in the results from survey forms. Care plans have been very well developed, and clearly show the effects that Huntington`s Disease (HD) is having, and how best to cope with the assessed changes. The plans are now far more HD oriented than previously, and include associated health care and mental and emotional support. The Head of Care and staff ensure that residents are enabled to keep in touch with family and friends, and keep them up to date with ongoing changes. Relatives stated that they are "very happy" with the care given, and feel confident that people in the home are well looked after. The home encourages a slow process for new residents moving into the home, so that they have time to become familiar with staff and other residents, and are not rushed into any decision about staying in the home. Quality assurance procedures are excellently managed, and show that residents`, relatives` and staff viewpoints are listened to and acted on. The home is very proactive in helping relatives and health professionals understand the nature and difficulties with HD, and runs a support group for families and friends. The home has improved in many areas, and is now assessed as excellent in several areas. There is the opportunity for the whole home to be rated by CSCI as "Excellent (3 stars)" if the improvements continue. What has improved since the last inspection? The home has employed a staff member as Head of Care with a view to him taking up the manager`s post. New policies and procedures have been implemented. A new Speech and Language Therapist has been employed to give input in regards to communication problems, and eating and drinking. New quality assurance procedures ensure that internal audits and surveys are carried out. This means that any concerns or suggestions are picked up quickly, and are acted on. The building of a two storey extension has been carried out, the passenger lift fitted, and other improvements to the building commenced. What the care home could do better: CARE HOME ADULTS 18-65 HMT Care Limited 48 Albany Drive Herne Bay Kent CT6 8PX Lead Inspector Mrs Susan Hall Unannounced Inspection 11 March 2008 09:05 th HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service HMT Care Limited Address 48 Albany Drive Herne Bay Kent CT6 8PX 01227 742992 01227 743265 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) HMT Care Limited vacant post Care Home 5 Category(ies) of Physical disability (5) registration, with number of places HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2006 Brief Description of the Service: HMT Care Ltd provides a specialist service for people diagnosed with neurodisabilities, specifically Huntingtons Disease. There are two homes in the group and they are sited near to each other. Both homes cater for people of either sex, with ages mostly ranging from 18-65 years. Older people may be admitted from time to time if they fit in successfully with existing residents. 48, Albany Drive, is a large Victorian detached house. It is situated on a corner of two side roads, in a residential area of Herne Bay. It is near to local shops, the seafront, and other facilities, and can be easily reached via rail, or by road - using the M2 or M20 motorways. There are three floors (ground, first and second), with bedrooms on the ground and first floors. All bedrooms are for single use, and include en-suite toilets and wash basins. The home has a lounge/diner on the first floor, and a second lounge is currently being provided. A 2-storey extension is being added to the property, and will provide 2 additional bedrooms, and more communal facilities. The property has an enclosed garden to the rear, and front and side gardens with flower borders. There is plenty of space for on road parking. Fees currently range from £1305.00 - £1450.00 per week. All fees are set according to individual requirements, and by discussion with the funding authority. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which takes into account all information obtained since the last inspection. This includes the home’s own self assessment – the “Annual Quality Assurance Assessment” (AQAA), which was provided when CSCI requested it, and was very well completed. It provided clear insight into how the home is currently running, and plans for future development of the service. CSCI sent out our own survey forms to residents (who filled these in with assistance from their key workers); relatives, health professionals and staff. 15 completed forms were returned, and demonstrated that residents feel safe and secure in the home, and feel well looked after. Relatives expressed their satisfaction with the home with comments such as “the service is very helpful all the time. They look after my relative well, feed him/her, keep him/her clean and well presented, and safe. They try and let people do as much as they can within their capabilities.” The inspection included a visit to the home which lasted for 6 hours, and included chats with 5 staff as well as the Providers, meeting 4 residents, viewing the building, observing interaction with staff and residents, and reading documentation. The building was nearing the end of a building programme, providing a 2storey extension. This will increase the numbers of bedrooms to 7, improve bathroom facilities, increase communal areas, and provide a passenger lift. The work has been carried out to a high standard, and the external building fits in well in the area. The home is registered for Physical Disability, but specialises in Huntington’s Disease, and only takes in residents with this debilitating and progressive illness. The home’s ethos is to plan forwards, to prepare for changes in residents’ physical and mental states, and to enable them to lead as fulfilling lives as possible. The home has been without a registered manager for 8 months, but one of the providers (who is the home’s “Responsible Individual”) informed CSCI that she would be acting in this capacity while training a staff member for the manager’s role. She has many years of experience in understanding Huntington’s Disease, and of overseeing this home and the company’s associated home nearby. She has been training the Head of Care, who is nearly ready to apply to CSCI for registration as manager. The Acting Manager, the Head of Care, the Director and the Quality Assurance Manager were all present during the day. The Head of Care assisted with the inspection by discussing all aspects of the running of the home, and by being present throughout the visit. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has employed a staff member as Head of Care with a view to him taking up the manager’s post. New policies and procedures have been implemented. A new Speech and Language Therapist has been employed to give input in regards to communication problems, and eating and drinking. New quality assurance procedures ensure that internal audits and surveys are carried out. This means that any concerns or suggestions are picked up quickly, and are acted on. The building of a two storey extension has been carried out, the passenger lift fitted, and other improvements to the building commenced. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 7 What they could do better: The home could improve the amount and range of activities for some residents. This has already been recognised by the Head of Care and other staff, and proposals are in place to take action on this. There are still outstanding environmental changes needed in the home, and plans are currently under discussion to determine the best use for existing rooms. These include: • • • • • • • Making a decision about the ground floor bathroom adjacent to the kitchen. Improved storage for the hoist and other equipment. Additional storage for medication if numbers of residents increases. New carpeting/flooring in some areas. Improved en-suite facilities for some existing rooms. Improved laundry facilities. Improve the identified bathroom on the first floor. The garden landscaping is already in progress. The Head of Care should apply to CSCI for registration as manager as soon as the company feel this is applicable. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in this outcome area is good. Information about the service provides sufficient details for enquirers. There are good systems in place for assessing residents prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose has been amended since the last inspection, but was due for updating again in regards to a few details. The senior management of the home were fully aware of this, and had already planned this into the timetable for amending it again during March 2008. Apart from these few details (such as the impact of new smoking legislation), the statement of purpose includes all the necessary information, and is well presented. The service users’ guide also contains all relevant information in regards to facilities and services offered by the home, terms and conditions of living in the home, and arrangements for such items as social activities, and dealing with complaints. However, this could be further developed, so that there is an additional service users’ guide which is more applicable to prospective residents who may have lost some mental capacity. For example, it could be further enhanced by adding in some photographs of the property, and a simpler version could have some pictures/symbols, and less words. The HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 10 management stated that photographs of the exterior and the interior of the home are already available, and can be taken out separately to show to prospective residents. The home has a robust process for ensuring that prospective residents are fully assessed, and this was demonstrated by reading documentation for a recently admitted resident. Several visits may be made to prospective residents in their own home or hospital prior to inviting them to view the home, and stay for a meal, or a day. Further visits may be made to the home before the person makes a decision about moving in. This process is backed up by obtaining as much information as possible from health professionals, family and care staff. Admissions are also made with reference to the specific Huntington’s Disease consultancy, based at Guy’s Hospital in London, and with associated assessments by psychiatrists and psychotherapists. A full CPA assessment is also carried out. As Huntington’s Disease is such a specific illness, the admission process ensures that new residents will fit in as well as possible with other residents; and the staff also take into account that this is a degenerative illness, and the impact that this will have on their future care. The Head of Care ensures that the room available is suitable for the person concerned, and will continue to meet their changing needs. The breakdown of the fee system is transparent. The fee includes everything except personal items e.g. cigarettes, alcohol, clothes, personal toiletries & personal social expenses. Each resident is provided with a contract, and with a copy of the service users’ guide and complaints procedure. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good. Residents are enabled to make individual decisions about their day to day lives; and are included in making decisions about changes in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are drawn up with the involvement of the resident, the Care Programme Approach co-ordinator, health professionals and the next of kin or family as appropriate. Two care plans assessed showed clear evidence that the residents take part in ongoing care plan reviews, and discussions about the best way forward for them. They sign a statement to show their agreement to the care plan. Each care plan is divided into clear sections with an index at the front, so that information can easily be obtained, and the plans are stored confidentially in each resident’s own room, with their agreement. This also makes them available for staff to check any relevant/changing details. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 12 The care plans viewed were excellently put together, and have specific information relating to Huntington’s Disease, and the way it is affecting the individual person. The nature of the illness means that the deteriorating process may affect the physical, cognitive, mental or emotional ability of the person, and may be a very slow development, or rapid. Care plans therefore take into account each area of concern, and how these are being addressed. For example, there are sections for managing communication difficulties, eating and drinking, mobility changes, cognitive changes, personal care needs, social and cultural needs, physical health, and medication. The care plans are backed up by a “kardex” system – a daily recording process, which is used for every day management. The support staff write these during the day, whenever there is anything to report, so that they are an ongoing documentation process. The kardex includes the daily charts to show how personal care has been given; notes from GP and health professional visits; weight records; physiotherapy records; social activities records; and the support staffs’ written daily reports. Residents are enabled to make their own decisions as much as possible, and staff obtain as much history about the resident as they can, so that they know how they would previously have liked things done, if they can no longer voice their opinion clearly. Each care plan includes a personal profile, with relevant past history in regards to family and employment, hobbies and interests. Likes and dislikes are clearly documented – such as food preferences, and “does not like noisy environments”; “likes to watch sport on TV”. Each resident has a key worker, so that they can get to know the needs and aspirations of the resident in more detail. Target sheets are formulated so as to have clear guidelines for things to aim for. All residents currently need support with managing their finances, and each one has an individual personal account. Clear audit trails are maintained for all income and expenditure. The management staff ensure that advocacy arrangements are provided if needed. Residents are involved in decision making and participation within the home as much as possible. For example, they are able to choose the décor for their bedrooms, and discuss décor for communal areas together. They also discuss day trips and outings together with staff. Each social activity or part of day to day care is backed up with a risk assessment. The Head of Care had recognised that risk assessments in relation to going out of the home were not sufficiently detailed, and was in the process of drawing up detailed risk assessments in regards to the type of transport to use for each person. Some residents now have difficulty with getting in/out of a car, and may need to be re-assessed for using wheelchair friendly taxis. Any restrictions on freedom (such as the use of bed rails) are fully discussed and agreed with the resident and relevant health professionals. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 13 Storage of some data is currently in the room used for residents who smoke. This room is being used in this capacity as a temporary measure, and the residents who smoke have poor mobility and are unlikely to reach documentation in this area; however, the staff must ensure that confidentiality of all documentation is maintained. HMT Care Limited DS0000047536.V359362.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): 11-17 Quality in this outcome area is excellent. Residents are supported in developing new skills and maintaining existing skills. Ongoing discussions take place to determine their preferred lifestyles, and staff assist them to achieve these as much as possible. Food is well managed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a strong emphasis on maintaining residents’ existing skills, and being able to continue with previous hobbies and interests. As this is a progressive illness, they also look at finding new ways for residents to express themselves or to find alternative skills for those they are losing. For example, where mobility is being lost, a resident may gain a new sense of freedom in being able to use their own wheelchair; or where verbal communication is diminishing, they may start to use signs or gestures. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 15 A personal history is recorded after admission, and includes checking if the resident has any specific cultural or spiritual needs. The staff will ensure that every effort is made to enable residents to continue with these. The staff promote the maintenance of relationships with family and friends, and keep them up to date with any changing needs of residents. The Head of Care has a policy of phoning the next of kin each month, to inform them as to how the resident is coping, and how they have got on since the previous visit or phone call. The relatives appreciate this. One wrote in a survey form: “ I am given monthly updates on X’s mental and physical progress, and social events etc. The home does everything well. I could not wish for a better place for X. The peace of mind I and my family have knowing how very happy and well cared for X is, is priceless, from all aspects.” The residents are fully involved in the local community, and have the opportunity to go out as individuals or as a group. Each person is accompanied when they go out. One resident likes a daily walk – along the beachfront when possible, and others like to go out shopping, to the cinema or theatre, music events, day trips to London etc. The Head of Care hires a minibus with a wheelchair facility if the residents and staff all decide to go out together. The management work hard to meet residents’ aspirations, for example, they arranged for one resident to have a day at a premier league football club, meeting and having lunch with the manager and players, and bringing home a signed T-shirt. Another used to be in a rock band, and the home has found a suitable drum kit for this resident to play. There are now 2 separate lounges being developed, and this is a real asset. A musical therapist has been booked to come and assist with this every 2 weeks. The home is also getting an allotment, so residents can help the gardener with this. However, there could still be an increase in the type and range of activities overall, and this is currently being looked at. Holidays are arranged in accordance with residents’ wishes. One has already decided to have a week in Cornwall this year. Residents are all provided with a mobile phone on admission, and the first topup card. This enables them to make phone calls in private. Mail is given unopened, and assistance will only be given with reading this where requested/needed. Their right to vote in elections is promoted, and support is given with attending a voting site, or having a postal vote if preferred. Residents can get up and go to bed at their preferred times. The illness tends to make residents tire easily, and the staff try to ensure they have naps during the day if needed. They also plan to use the newly acquired Parker bath as a method of relaxation as well as for personal hygiene. Bath bubbles, aromatherapy, a favourite drink and even chocolates are suggested for use as part of this relaxation therapy. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 16 Residents usually have gradually deteriorating swallowing reflexes, and this causes difficulty with eating and drinking. The home employs a Speech and Language Therapist, who comes into the home on a regular basis, and assesses resident for their current needs. This includes finding the best posture to aid a resident when eating; using thickener in drinks; checking if a soft or pureed diet is needed; and using the right spoon or fork to assist the resident. Clear guidelines are included in each resident’s care plan. One of the residents said that the food is “always excellent”, and if they don’t feel like what is on the menu they can always ask for something else. The cook is familiar with the need to provide these residents with extra calories and snacks, and keeps additional soft foods available such as caramel crème, jellies, mousses, and cakes. The kitchen was seen to be clean and well organised. The cook works to a 4 weekly menu, which is discussed with management and residents. As it is a small home, the cook knows individual likes and dislikes, and usually provides one main meal, with alternatives as requested. There are good processes in place to ensure that residents are not rushed with their meals, and have the support they need from staff. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-21 Quality in this outcome area is good. Personal and health care support is very well managed in the home. Medication is safely stored and administered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Having Huntington’s Disease (HD) means that residents know they have an ongoing deteriorating physical condition as well as being affected cognitively and mentally. HD usually produces jerky, uncontrolled movements at times, which are very tiring, and interfere with mobility and dexterity. Residents therefore need assistance with maintaining personal care – bathing, showering, washing, cleaning teeth, shaving etc. A resident said he is helped to have a bath and shave every day, has cream applied, and is assisted with nail care, mouth care, and hair washing. Staff record this on daily charts, and this documentation was of a good standard. Residents said that they choose their clothes themselves, and this is a good example of empowering residents within their abilities. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 18 Any bruises or injuries found are carefully investigated, and are recorded on body map charts with appropriate follow up. Falls are also investigated, to see if these could have been prevented. This is a constant challenge, as most have deteriorating mobility, but still want to retain the independence of walking for as long as possible. The physiotherapist advises on this. Health care is very well managed. The senior management staff have built up an excellent working relationship with the HD team at Guy’s Hospital, and liaise with them on all aspects of medical care and treatment. The clinician now visits the home on a monthly basis, assessing each resident, and so avoiding long, difficult trips to London for them. All medical care is carried out in association with their GPs, and includes input from other health professionals. The home employs a Speech and Language Therapist, a Physiotherapist (who visits monthly or as requested), and a Physical Therapist – who visits twice weekly. The Physical Therapist carries out passive exercises and massage, and show support staff how to carry these out on other days. The home is actively providing detailed information about HD to local GPs and other professionals (e.g. District Nurses, dietician) so that they can familiarise themselves with the details of this condition. The home also has a library of information with books and videos for staff, families and friends. A Consultant Geneticist visits the home every year, and family members are enabled to receive counselling, support and information about their own health in regards to having HD. All staff are receiving specific training about HD. Medication is stored in a small clinical room, which is fitted with a storage cupboard, controlled drugs cupboard, and a drugs fridge. Storage space is currently just sufficient for the needs of 5 residents, but as the management is looking to increase the numbers to 7 residents, there will need to be additional space in the future. They are already aware of this. Medication is administered on an individual basis, as most is given at mealtimes, as it is easier to swallow with food, and meal times may vary. Medication Administration Records (MAR charts) were viewed and were neatly and accurately completed. Each care plan includes a detailed analysis of the resident’s medication, with each drug itemised, showing what it is for, and any side effects to look out for. These are very clear records. Residents are offered the opportunity to discuss their feelings and wishes about end of life care. This may be with management, key workers or a solicitor. If they decline to discuss this, the opportunity is offered every 3 months, and is recorded. Any specific wishes are clearly written down, and family members are included in the discussions if the resident wishes for this. HMT Care Limited DS0000047536.V359362.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. The complaints procedure is accessible to residents and visitors. Complaints are handled appropriately, and dealt with effectively. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Any concerns or complaints are taken seriously and are properly investigated. There had been one complaint made to the home since the last inspection, and the documentation confirmed that a thorough investigation had taken place, and meetings with the complainant. No concerns or complaints have been voiced directly to CSCI, and there have been no referrals to the Social Services Adult Protection department. The complaints procedure is satisfactory, and each resident has a copy as part of their service user guide. The management are in the process of developing a “community passport” for each resident, which is a quick overview of the residents’ needs, health status, communication ability, and medication. This includes a simplified concerns/complaints procedure, with pictures and short sentences to remind residents what to do and who to speak to if they are unhappy. The Head of Care said that the key worker system helps staff to become more closely acquainted with residents, and to notice if they are unhappy or agitated. They will then try to find out the reason why, and do what they can to improve the situation. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 20 Staff receive training in prevention of adult abuse during the induction period, and on an ongoing basis. The management are proactive in following up any concerns raised, and would refer staff to the POVA register if there was any possibility of abuse having occurred in any way. They are familiar with the Kent & Medway protocols for the prevention of abuse. All financial transactions made on behalf of residents comply with the homes policies and procedures and are fully recorded. A new resident to the home spent time with the home’s Finance Director, who helped him/her to organise how to best manage their personal finances. HMT Care Limited DS0000047536.V359362.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26, 27-30 Quality in this outcome area is adequate. Alterations to the premises are improving the facilities for residents. The home is kept clean, and suitable health and safety measures are in place during the alterations process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas of the home were viewed. It was unavoidably dusty in some areas as a 2-storey extension is nearing completion, and internal work has caused higher levels of dust. However, residents’ own rooms, communal rooms and bathrooms were generally clean and in reasonable condition. The management have commenced a plan of action to improve the facilities in the home, and to increase the number of residents from five to seven. The extension was commenced in November 2007, and has been carried out with the least disruption possible. Residents did not show any concerns about the building work going on, and one said it was interesting to see the changes to the building. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 22 The changes will include a lounge/diner and a separate lounge on the first floor; two additional en-suite bedrooms on the ground and first floors; a passenger lift – (which is fully fitted but has not yet been commissioned); a new bathroom with a Parker bath installed; and newly landscaped gardens. The home currently has a bathroom where residents/staff have to go through the kitchen, which is unsatisfactory for infection control. This is due to be altered for a different purpose. Another bathroom on the first floor is of poor quality, and there are plans to alter this. A storage cupboard on the ground floor is unlocked, and currently full of unwanted equipment and domestic items. This is also under discussion, for how to improve storage facilities. The laundry is carried out using a washing machine in a small room on the second floor; and with 2 tumble dryers in a room used temporarily as a residents’ smoking room. This is not satisfactory, and is another item on the management’s plan of changes. Residents’ own rooms are satisfactorily decorated and furnished, including some of their own items. Some of the furniture and carpeting is old and of poor quality, and the Head of Care stated that these are also included in the improvement plans. En-suite areas in existing bedrooms are generally unsatisfactory, with only partial screening between floor and ceiling. One of these is due to be altered to provide the resident with an en-suite shower facility. Other en-suite areas have been improved with new toilets fitted, and better pipe work. Each bedroom is fitted with a door lock so that the resident can retain their own key if they wish to do so. The door locks can be overridden in any emergency. The Head of Care has obtained advice from an Occupational Therapist and the Physiotherapist, as well as senior management, in providing specially modified chairs for 2 residents so that they can sit more comfortably. A new bed is being ordered for another resident. Bed rails, grab rails, raised toilet seats and other equipment is provided as needed. The home has a hoist which can be used for lifting residents from the floor if they fall. Each room is fitted with a call bell that residents are able to use. The rear garden is currently untidy due to the building work, and new landscaping is about to commence. The management are providing playground type soft surfaces for safety outside, as a well as a lawned area and raised flower beds. Although there is still much work to be done, it was evident that the providers are working hard to bring the facilities up to a good standard. Decisions about the laundry, additional kitchen storage, medication storage and staffing facilities are current points of discussion. HMT Care Limited DS0000047536.V359362.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 Quality in this outcome area is good. Staffing numbers are adequately provided, and new staff are given a detailed induction. Good staff training programmes are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Head of Care, or an experienced support staff, work alongside new support staff until they show competence and understanding in key areas. They have a detailed induction programme in line with Skills for Care, which includes all aspects of the work. They are familiarised with the aims of the home, and the importance of understanding Huntington’s Disease and the changing needs of individual residents. New staff are only employed if they are willing to carry out NVQ training after their probationary period. 70 support staff have currently completed this, and others are either taking it or are booked to commence. There is a 6 month probationary period with monthly induction meetings. Mandatory training is carried out during this time. All staff are given a copy of the GSCC codes of conduct at the commencement of their induction training. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 24 Staffing levels are currently set at 2 support staff on duty throughout the daytime and evening, and 1 support staff at night. The Head of Care is also on duty during normal working hours Monday to Friday; takes part in helping to deliver care, and comes in as extra staff at any time needed. Residents tire easily with this condition, and the current residents are already in bed or ready for bed by the time the night staff comes on duty. At night, there is always a second member of support staff on call. The management have assessed that additional support staff will be needed with an increase in the number of residents. The Head of Care said that he can arrange for additional staffing at any time if the need arises – e.g. a resident with a hospital appointment, or someone going out for a considerable length of time. Recruitment is carried out by the Acting Manager and Head of Care working together, and there are basically good systems in place for recruitment. Two staff files were examined, and had the appropriate data in place, except that each had only had one written reference returned. The Head of Care stated that he had been discussing staff files with senior management and they had already arranged to carry out a full check of all staff files. However, there is a recommendation to ensure that 2 written references are obtained prior to commencement of employment. The home has good systems in place for ensuring that staff keep up to date with training requirements, and the staff training matrix confirmed this. Staff training booked for the coming year included additional subjects as well as updates in mandatory training, such as working with people with diabetes, supervision and performance management, and safe handling of medication. Senior staff have already attended training in the Mental Capacity Act, and all staff are now booked to carry out this training. All staff have access to the Genetics Consultant and Counsellor from Guys hospital as the team now visits the home. This allows effective dissemination of information, and more training, from a highly specialised team, working with people with Huntingtons Disease. Staff receive ongoing supervision and support, with formal one to one supervision at least 6 times per year, and an annual appraisal. The Head of Care has designed a new format for supervision, to ensure that all related subjects are covered. He also works alongside staff throughout the week, and is accessible to them. Staff reported that they can approach the management at any time. One survey included the comment: “You can at all times approach the Head of Care and other managers if you are unsure of anything. This includes work related and personal issues.” Another staff member commented on a survey form that they would like more time to spend with residents, and this might be achieved if more domestic staff were employed to help with laundry and washing up etc. This may be a valid consideration for a home which is increasing the numbers of residents. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37-42 Quality in this outcome area is good. The Responsible Individual has effectively covered the manager’s role since the manager’s position became vacant. Quality assurance procedures are very well handled. The staff are aware of promoting health and safety in the home for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) was completed when CSCI requested it, and included very comprehensive information in response to the questions. The home has been without a registered manager for about 8 months, and one of the Providers (the home’s Responsible Individual who has considerable HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 26 experience and knowledge of HD) – has been acting as manager, and training the Head of Care for this position. The Head of Care has now started to run the home on a day to day basis, and is therefore effectively acting as the manager. The Responsible Individual has carried out monthly regulation visits during this time, to keep a close check on how the home is running. She also has office space within the building, along with the Quality Assurance Manager and the Director, and so is frequently on the premises. The Head of Care has now applied to commence Registered Managers’ Award (RMA) training, starting in April 2008, and will soon be applying to CSCI for registration as manager. It was evident that he is fully aware of all aspects of the running of the home and the health and welfare of the residents. He has worked with HMT Care for 4 years, and has gained much knowledge and experience of HD during that time. He provides a clear sense of direction and leadership to other staff, while also promoting a relaxed atmosphere in the home. The home has an outstanding management system for quality assurance, with a dedicated Quality Assurance manager for this home and the other associated HMT Care home. The quality assurance process includes yearly surveys for residents, relatives and friends, stakeholders and employees. The results of these are carefully analysed to highlight areas of commendation, and areas which can be improved. For example, the most recent surveys showed the need to have a performance review of activities available; and the need for better communication at all levels. Processes are being put in place to address these. Internal audits are carried out in regards to staffing, training, documentation, catering, housekeeping, drug storage and administration and security and safety, as well as care plans and social needs. A separate overview of each National Minimum Standard is carried out, with their own appraisal of how well these standards are being met. This showed a detailed understanding and knowledge of the standards, which underpins the whole ethos of the home. The home has an Annual Development Plan, and the proposed outcomes for 2007 have been achieved. Policies and procedures are reviewed yearly, and these are clearly written so that they are applicable to the staff. A copy is kept available for staff, as well as a copy in the manager’s office. Records were seen to be well maintained. Those viewed included care plans, food and fluid charts, medication charts, water temperatures, kitchen cleaning and fridge/freezer temperatures, and some staff files. Safe working practices include checking fire equipment, fire door closures and fire drills regularly; safe storage of chemicals, and keeping staff up to date with mandatory training. Incidents and accidents are clearly recorded, and CSCI is notified appropriately of incidents under Regulation 37. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 27 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 3 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 2 27 2 28 2 29 3 30 2 STAFFING Standard No Score 31 3 32 4 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 2 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 2 3 4 3 3 3 X HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 28 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 YA24 Regulation 23 (2) (a,b) Requirement To provide CSCI with an action plan in regards to the following environmental decisions: Change of use for the ground floor bathroom adjacent to the kitchen; Improved storage facilities for equipment; New flooring/carpets planned throughout the building; Any planned changes to existing en-suite facilities; Proposed changes for laundry facilities; Alteration to the identified bathroom on the first floor. 2 YA37 8,9 To appoint a registered manager. 31/07/08 Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000047536.V359362.R01.S.doc Version 5.2 Page 29 HMT Care Limited 1 2 3 Standard YA1 YA10 YA14 To produce the Service Users’ Guide in a simplified format (e.g. photographs, pictures etc.) To ensure that all relevant records are stored confidentially. To continue looking at possibilities to further increase the range of activities available. HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI HMT Care Limited DS0000047536.V359362.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!