Care Home: Horizon Close

What the care home does well Residents receive detailed pre-admission assessments so that they can be assured that the home can meet their needs. Residents` needs are regularly assessed and care plans drawn up, to direct staff on how to meet their needs. Staff clearly knew how to meet the needs of the residents and followed care plans. The people who live in Horizon Close are encouraged to take part in community activities. A daily rehabilitation programme is set up for each individual and a recreational assistant has been employed to support them in enjoying other outside activities. Transport has also been provided. Residents said they were able to do what they wanted in the evenings and at weekends. When asked what the best thing about the agency was, one family said: "They look after our relative", and another said: "They are sympathetic to our relative`s needs". A social worker said: "They respond to the individual careneeds of the service users". She also said: "I feel this service compliments the other services we have in place and meets an unmet need in the community". What has improved since the last inspection? This is Horizon Close`s first inspection. What the care home could do better: Care plans and risk assessments were detailed and contained a lot of information. However, some care plans had not been updated, and it was difficult to see when risk assessments were reviewed. The manager has been asked to make sure that these matters are dealt with. There was some old, unused medication lying in the cupboard, which had not been returned to the pharmacy. The manager has been asked to make sure that all unused medication is discarded and returned. Many of the staff working at Horizon Close have transferred from other units within the organisation. However, there was no evidence in some files about training having been completed, and the manager has been asked to make sure that all staff have training in manual handling, infection control and medication administration. All staff must also have two references on file. The premises have been purpose built as a rehabilitation unit for people who have had a brain injury and may have a physical disability. Each bungalow is spacious and well furnished, and the grounds are well laid out. However, there is one area at the back of some of the bungalows where there is a steep bank, with loose stones falling down to ground level outside the house. Staff reported that this gets worse when it is raining, as both stones and earth slides down. This could potentially be very dangerous to residents with an acquired brain injury and perhaps unsteady gait. The manager has been told that there must be a restraining wall or barrier built to stop any further erosion and to make it safe. CARE HOME ADULTS 18-65 Horizon Close Glenside Manor Glenside Manor Healthcare Service Ltd South Newton Salisbury SP2 0QD Lead Inspector Alyson Fairweather Unannounced Inspection 4th July 2008 10:00 Horizon Close DS0000071015.V361817.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 Horizon Close DS0000071015.V361817.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. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Horizon Close Address Glenside Manor Glenside Manor Healthcare Service Ltd South Newton Salisbury SP2 0QD 01722 742066 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) Glenside Manor Healthcare Services Ltd Mrs Elizabeth Vince Care Home 10 Category(ies) of Physical disability (10) registration, with number of places Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Physical disability (Code PD) The maximum number of service users who may be accommodated is 10. Date of last inspection: NA Brief Description of the Service: Horizon Close was purpose built for the rehabilitation of adults with long term neurological conditions. It is one of several registered premises on one campus, and is owned by Glenside Manor Health Services Ltd. Mr Andrew Norman is the nominated responsible individual and the registered manager is Mrs Elizabeth Vince, both of whom have many years experience of working with people with acquired brain injury. The homes are situated in the village of South Newton, on the A36, five miles north west of Salisbury. Horizon Close consists of 10 self contained bungalows, 9 of which are used for supported living and 1 of which is used as an assessment bungalow. It provides maintenance rehabilitation programmes for both male and female service users. No nursing care is provided, although residents who develop nursing needs will be assessed by the District Nurses from the retained General Practitioners surgery. The bungalows have been designed to resemble a small community setting and are domestic in nature. Internal adaptations such as a ceiling track hoist can be fitted based on an individual needs assessment. The design of the home has taken into account the need for personal space and a feeling of living independently. Each bungalow is connected to a central staff area with an emergency call system and integral fire detection system. Attached to the bungalows is a day therapy centre, the Horizon Centre, which service users can access for individual therapy programmes during the day, and provides a venue for social activities in the evenings and at weekends. The range of fees at the time of this inspection was between £750 and £1500 per week. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. We received an Annual Quality Assurance Assessment (known as the AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We sent surveys to the people who live at Horizon Close, so that we could get their own views about the home. We had three surveys back. We also had surveys back from two relatives of people who live there, three members of staff and one social worker. We looked at the AQAA and the surveys, and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home. We made an unannounced visit to the home on 4th July 2008. We met some residents, and spoke to the home’s manager and three staff members. We also met with the human resources manager and the operations manager. We looked at some records, including care plans, risk assessments, medication records and staff files. We saw around the accommodation, and visited one of the bungalows. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: Residents receive detailed pre-admission assessments so that they can be assured that the home can meet their needs. Residents’ needs are regularly assessed and care plans drawn up, to direct staff on how to meet their needs. Staff clearly knew how to meet the needs of the residents and followed care plans. The people who live in Horizon Close are encouraged to take part in community activities. A daily rehabilitation programme is set up for each individual and a recreational assistant has been employed to support them in enjoying other outside activities. Transport has also been provided. Residents said they were able to do what they wanted in the evenings and at weekends. When asked what the best thing about the agency was, one family said: “They look after our relative”, and another said: “They are sympathetic to our relative’s needs”. A social worker said: “They respond to the individual care Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 6 needs of the service users”. She also said: “I feel this service compliments the other services we have in place and meets an unmet need in the community”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 7 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 Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 8 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 and 2 Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. Most residents have their individual needs assessed before they arrive, so that staff know how best to support them, although not all had these on file. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide, which give an overview of the service which will be provided. This is given to every resident, and also gives details of the organisation’s complaints procedure. Of the three who wrote to us, one person felt that they had had enough information on the service prior to admission and two didn’t. Some people had come from hospital following their brain injury, and did not want to have to use rehabilitation services. One person said: “This is not the right place for me”, meaning that they had wanted to move on more quickly. Any prospective resident is invited to look around the units, be introduced to the therapist that will be working with them and be given an information pack prior to their preadmission assessment. Family and friends are encouraged to visit whenever possible. Residents are then are fully assessed by a multidisciplinary team prior to the offer of any placement. The assessment consists Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 9 not only of a care needs assessment to ensure the service can meet the personal care, social and leisure needs of the individual, but also a detailed risk management protocol. This is necessary due to the nature of the service as service users will occupy their own bungalow and are expected to be largely self caring with some support and assistance from staff. Areas that are risk assessed include; risk of self harm, cooking and domestic skills, community skills, risk of absconding, mobility/transfers and the ability to summon assistance, for example. Every new placement is fully reviewed at 8 and 12 weeks to ensure that the home can meet the needs of the residents. Assessments seen were clear and completed in detail. They showed that family members and significant others were also fully involved in the assessment and admission process. Prospective residents are encouraged to visit the unit prior to admission if they are able, and to see the bungalow in which they might live. One person said: “I was going to be sent to Bristol or Bath, but I wanted to come here”. Assessments included those from occupational therapy, social services, speech therapy and psychology staff, as well as medical staff involved. Following this, decisions are made with the resident and their family about the main areas for rehabilitation, and an individual programme is developed. On admission a baseline admission form is completed. This is currently very medical in style, and is similar to those used in the residential and nursing homes run by the organisation. It asks staff to record blood pressure, temperature, pulse and asks them to do a urinalysis. Horizon Close offers nonnursing care, and as such does not routinely collect this information. It is recommended that Horizon Close seeks to develop its own, non-medical admission information. If this information needs to be collated, then advice should be given to care staff about upper and lower limits, and what to do when measurements are outside these. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans reflect the needs and personal goals of residents, who are assisted to make decisions about their own lives. They are supported to take risks where appropriate, and encouraged to be as independent as possible. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Care plans are in place for all residents, and include a personal profile, which helps care staff to get to know a bit about the individual, as well as their needs and likes and dislikes. Care plans included information on communication, literary skills, family life, friendships, health and social activities, and medical situation. Each resident has a goal planner, and this is completed with help from staff. In the evening, staff visit with residents and reflect on any progress made during the day. Care plans are reviewed monthly, as well as when the person’s situation had changed, and are signed by the resident. A system of daily records is also in Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 11 place. All, three staff who wrote to us said they “always” were given up-to-date information about the needs of the people they support or care for. One resident’s care plan said that they have three checks during the night. There was no evidence that this is done, and nothing in the daily records to say that staff have checked. The manager thought that it may not need to be done now. There was also a care plan relating to sleep patterns, which had not been reviewed or signed. This care plan transferred from another unit, and again the manager thought that it was perhaps now not needed. The manager has been asked to make sure that all care plans contain accurate and up to date information. Care plans had been designed to ensure that people’s capacity to decide an individual course of action was reflected. This meant that care staff who completed care plans, recorded decisions or outlined goals, needed to complete a section on the person’s capacity to understand and agree. Unfortunately most of these sections were left blank. The manager said that this was mainly because there had been no training in how to complete the section, and people just didn’t understand it. It is recommended that staff receive this training if the organisation intends to collect information on capacity in this way. Residents are supported to make decisions about their own lives with guidance from the staff. They are encouraged to manage their own finances wherever possible, although some have family involvement and other support. Where there are restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. Of the three residents who wrote to us, one said they could “always” choose what they liked to do, and two said: “usually”. All of them said they could do what they liked in the evenings and weekends, but two people said they didn’t get to during the day. This reflects the fact that the unit is specifically for rehabilitation, and each person has a routine to follow during the day. One social worker told us: “Care staff look at people’s individual needs re disability, age, gender, and faith. We are at present setting up a group to look at sexual orientation and how we become pro-active rather than reactive”. There were risk assessments in place for residents, and these were kept on file, along with the care plans. Some risks identified included smoking and alcohol consumption, as well as falls and showering. In discussion with the staff, it was clear that they were aware of the ways in which residents could be at risk, and were taking measures to avoid these. However, there was no way of identifying that risk assessments had been reviewed, although the accompanying care plans had been. The manager has been asked to ensure that each risk assessment is separately identified and reviewed on a regular basis. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16 and 17 Social and leisure activities are varied and tailored to individual need, with residents mainly choosing what they wish to do, although rehabilitation programmes are agreed when they move in. Residents have as much or as little contact with family and friends as they wish, and are encouraged and supported by staff. Residents’ rights are respected and responsibilities recognised in their daily lives. They are encouraged to eat a healthy diet. Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visit to the service. EVIDENCE: Horizon Close has employed a recreational assistant and has recently purchased transport so that residents can be taken out more. All residents have a structured rehabilitation plan, which they adhere to during the week, and a new gardening group has been set up to encourage those with an interest in horticulture. They plan to increase social action by holding more social events in the day centre in the evenings and at weekends. They also Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 13 plan to develop an information file containing details of places to visit which might be of interest to residents. Some people are more independent than others and are able to access the local facilities of the area on their own, although some people need support from staff. Some residents have a work simulation assessment done by the Occupational Therapist (OT), a speech and language therapist, psychologists and staff at Horizon Close. One person currently has a cleaning job, and has previously done office work. All recreational interests and work placements are recorded on people’s care plans. There is a designated computer room, with internet access, and this is made good use of. Residents can access the coffee shop, the hydro pool, the podiatry clinic and the hairdresser, all free of charge, and located in the new hospital. The organisation told us in their Annual Quality Assurance Assessment (AQAA) that their plan is to create a warm and friendly community atmosphere and enable and facilitate residents to have a happy and fulfilling lifestyle. They plan to research and investigate all avenues of vocational, therapeutic and educational facilities of interest to the residents. Residents have as much or as little contact with family and friends as they want. We saw one person going out for the afternoon with their family, and others have frequent visits from partners and friends. Whilst all residents live in their own bungalows, it can be difficult for staff to know if there are visitors although if residents are going out they usually inform staff. This could be problematic if there was a fire, for example, and it was not known how many people were in the house. It is recommended that the manager should encourage visitors to announce their arrival so that they could be accounted for in case of an emergency. Residents’ responsibility for housekeeping tasks, such as doing their laundry and keeping their bungalow clean, is specified in their care plan. Each person has their own front door keys. There is a policy of no smoking in bedrooms, and a designated smoking area is planned, although there are seating areas outside. Alcohol is permitted in moderation, unless there is a specific medical reason for not using it. No illicit drugs are allowed on the premises. Most residents cook for themselves, and are helped where necessary by staff. They are encouraged to buy their own food bearing in mind any dietary needs which they might have. They are allocated a food budget, and this money is kept in the safe for them until it is needed for shopping. There is a separate allowance for lunches, and some people choose to have meals on wheels delivered. One person said: “I like trying to cook. The staff help me when I need it, though”. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 14 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, 19 and 20 Residents’ personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. Residents’ are supported to self-medicate where possible, and are protected by the home’s medication policies and procedures. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Some people have needed support with personal care, and this has been catered for with a mix of male and female staff. Residents have regular health and medication reviews by their GP or Consultant, and these are documented in their care plan. Access to the registered GP is made through an appointment system, except in the case of emergencies, and people are encouraged to make their own appointments. All requests for healthcare are dealt with quickly and in privately. Residents can use privacy of their own bungalow for any treatment they may need, for example podiatry. There was one occasion where a hoist was needed for a resident, and staff all had training in how to use that specific hoist. Nutritional risk assessments were in place, and staff were aware of the importance of a balanced diet for people Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 15 who have been ill. One resident said: “I like to be independent. I know I still have some medical problems, but the staff sort it out for me”. One social worker told us that individuals’ health care needs are properly monitored and attended to, and said: “On arrival and via previous assessments the service users needs are discussed with them, the family and any other carers previously involved”. All residents have their own medication facilities in their own bungalow in a locked cabinet. They each have a key for this cabinet, and staff have a record of where the key is kept as well as a spare key for emergencies. At present, nobody self medicates, but each person is supported to be as independent as possible, and have a three-step programme towards this. These include ringing staff when their medication is due, opening their own blister packs with staff present and various other prompts. We looked at the medication cupboard in the office premises. There were good storage facilities and a fridge for those medications which needed to be stored at a cool temperature. They also have a list of all the homely remedies which residents can use alongside their regular medication, and this was signed by a doctor. However, there were some medications in the cupboard which had been discontinued, and had not been returned to the pharmacy. The manager has been asked to make sure that this is done. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 16 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 and 23 Residents’ views are listened to and acted on. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Regular resident meetings are held, and people are encouraged to voice any concerns they may have. There is also a complaints book and a suggestions book available for residents. Horizon Close has a formal complaints procedure, which outlines the steps to take if there are any complaints. This also gives details of how service users and families can contact the Commission for Social Care Inspection (CSCI). A copy of this procedure is given to each resident, and is kept in their bungalow. No complaints had been made to the staff, and none had been received by us. Of the three residents who wrote to us, all said they knew how to lodge a complaint about the home if they needed to. Of the two relatives who wrote to us, one said they knew how to complain and the other said they did not, but both said the service responded appropriately if concerns were raised. All three residents said that they knew who to talk to if they were unhappy. The organisation’s service user guide says: “Our complaints procedure is open and transparent. We embrace complaints and other feedback from service users and relatives as positive, constructive suggestions for improving the quality of service we provide”. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 17 The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. Each resident keeps their own money in their own bungalow, and have a locked drawer for this. All staff are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available for them. Information booklets for local advocacy support and for Independent Mental Capacity Advocates (IMCA) are available. Not all staff had evidence of training in Safeguarding Adults, and the manager has been asked to make sure that this is done. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 18 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 and 30 Residents live in a homely, comfortable and mainly safe environment, although some maintenance at the rear of the property would help to make this even safer. They live in clean, hygienic surroundings. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Bungalows at Horizon Close are purpose built for residents who are trying to live independently following a brain injury. They are light and airy with sufficient room to accommodate wheelchairs. Each bungalow has under-floor, thermostatically controlled heating, a wet room, access to the internet and a telephone line should the resident require a land line. They are fitted with washing machine/tumble dryer, microwave, toaster, fridge and kettle. Should a resident require a cooker, and has had a risk assessment completed by an OT, then the facility is in the bungalows for a cooker to be installed. Any repairs or breakages are dealt with quickly and efficiently by a team of maintenance workers and most repairs are dealt with the same day. The Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 19 grounds around the bungalows are on the whole well maintained which creates a pleasant and calming atmosphere for the service users who wish to sit outside. However, at the back of some of the bungalows there is a steep bank, with loose stones falling down to ground level outside the house. Staff reported that this gets worse when it is raining, as both stones and earth slides down. This could potentially be very dangerous to residents with an acquired brain injury and perhaps unsteady gait. The manager has been told that there must be a restraining wall or barrier built to stop any further erosion and to make it safe. Residents have their own laundry facilities in their own flats, and do their own washing. Red alginate bags are provided if there is any soiled linen, and these can be transferred directly into the washing machine. This means that soiled or infected laundry will not be hazardous to residents or to care staff who may be helping them. All rubbish bags are emptied on a daily basis to avoid attracting vermin. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 20 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): 32, 34, 35 and 36 Residents’ individual and joint needs are met by staff who have had induction training, are undertaking NVQ, and are well supervised. They are supported by the home’s recruitment policy and practices, but would benefit from some added staff training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There are usually three members of staff on duty at any one time, including the team leader. A recreational assistant has also been employed. The organisation has reported that 77 of their staff have been trained to NVQ Level 2 or above. Regular staff meetings are held and a fixed agenda ensures that important issues are discussed, including resident needs and staff training. Of the three residents who wrote to us, two said that staff “always” treat them well, and one said: “usually”. One family said: “They look after our relative very well”. When asked if the service’s managers and staff have the right skills and experience to support individuals’ social and health care needs, one social worker said: “The team have been appointed with a mix of skills to meet individual needs. Where needed, training is also available”. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 21 There was evidence that new staff have induction training when they start to work at Horizon Close. One staff member spoken to confirmed that she had had induction training in fire safety and manual handling. All three staff members who wrote to us said that their induction covered everything they needed to know to do the job when they started. Other staff training has included catheter care, the psychological effects of brain injury, first aid, conflict resolution, health and safety and communication training. One team leader’s file had no evidence of any medication training, although team leaders were said to administer medication. Some other files showed that some staff had not had training in safeguarding adults, infection control, food hygiene or manual handling. The manager has been asked to make sure that all staff receive training in these areas, and that evidence to support this is kept on file. Staff would also benefit from having epilepsy training. A central human resources department supports the recruitment of all new staff. Staff files showed that they provide a CV/application form and that this is discussed at interview, where a full interview assessment is completed. All new staff complete a health check and have relevant police checks performed. There should be references from at least two people on file, although one person only had one reference. The human resources manager explained that this was because a previous employer had refused to send a reference. If this situation arises, there should records kept of any conversations with the employer, and greater effort paid in trying to obtain a reference from the next most recent employer. The manager has been asked to ensure that all staff files contain two written references. In December 2007 the organisation was awarded the “Disability Symbol” by Jobcentre Plus, part of the Department for Work and Pensions. Achieving and being a user of the disability symbol shows their commitment to employing disabled people. Horizon House staff have regular staff meetings and supervision sessions. The manager provides supervision for senior staff, who in turn supervise care staff. Three staff reported that their manager “regularly” meets with them to give them support and discuss how they are working. One person said: “I have supervision regularly, and feel able to go to my manager at any time for advice and support”. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 22 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, 39 and 42 Residents benefit from a well run home. Their views and that of their families will underpin the monitoring and review of care practice, once this information is recorded. Their health, safety and welfare is promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Horizon House is a purpose built facility for rehabilitation of people who have long term neurological difficulties. The manager, Mrs Beth Vince, was previously manager at another of the Glenside Group homes. She has many years of experience of working with brain injury and dementia units, and has gained her Registered Manager’s Award. The home has only been operational for around six months, but plan to provide an annual questionnaire for residents, their families and other interested Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 23 parties to gauge their satisfaction with the service. Comments and suggestions about how they could improve are welcome, and there is a system of regular internal audits in place. As part of the audit process, one of the responsibilities of the senior managers of registered care homes is to visit the home on a monthly basis and to write a report about what they looked at and to whom they spoke. This is to ensure that they are monitoring both the health and safety of the residents as well as the quality of the service offered. The reports completed by the management at Horizon Close are of a good quality and identify issues which need to be addressed, not only good practice matters. Each bungalow has its own smoke detectors, fire extinguishers and fire blanket. There are currently no immobile residents and nobody with any pressure sores. Fire checks and other health and safety checks done at various daily, weekly, monthly or annual intervals. Each resident has a separate risk assessment in place for living in their own bungalow, and these are reviewed on a regular basis. Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 2 3 4 5 Standard YA6 YA9 YA20 YA23 YA24 Regulation 15 (2) (b) 13 (4) (c) 13 (2) 13 (6) 23 (2) (b) 13 (4) (c) 17 Schedule 2 (3) 18 (1) (c) Requirement All care plans must contain accurate, up to date information. All residents’ files must contain evidence that risk assessments have been reviewed. All unused medication must be discarded and returned to the pharmacy. All staff must have training in Safeguarding Adults. A restraining barrier must be erected against the sloping wall outside the bungalows in order to make it safe. All staff must have two written references on file. All staff must have evidence of training in manual handling, infection control, food hygiene and medication administration. Timescale for action 04/08/08 04/08/08 04/08/08 04/10/08 04/10/08 6 7 YA34 YA35YA35 04/08/08 04/10/08 Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations Horizon Close should seek to develop its own, non-medical admission information. If this information needs to be collated, then advice should be given to care staff about upper and lower limits, and what to do when measurements are outside these. Staff should have training in collecting the information needed about service users’ capacity to understand care plans and any decision making associated with them. Information about voting should be removed from the care plans and placed alongside the service user guide which is kept in residents’ flats. Where BMI is used as an indicator for pressure risk assessments, explicit instructions should be available for staff in order to calculate this. Visitors should be encouraged to announce their arrival so that they could be accounted for in case of an emergency. All staff should be offered epilepsy training. 2 3 4 5 6 YA6 YA6 YA9 YA15 YA35 Horizon Close DS0000071015.V361817.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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