Care Home: Hylton Bank (28)

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What the care home does well There is high staff moral and the staff feel well supported by the manager. The staff work well as a team and their practices are enhanced by the regular training and supervision from the manager. The staff have had good training. What has improved since the last inspection? There were no requirements made in the last key inspection report for the home to address. What the care home could do better: The worktops in the kitchens are beginning to suffer from wear and tear and should be addressed. Key inspection report Care homes for adults (18-65 years) Name: Address: Hylton Bank (28) Hylton Bank (28) South Hylton Sunderland SR4 0LL The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sam Doku Date: 0 8 0 7 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 30 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Hylton Bank (28) Hylton Bank (28) South Hylton Sunderland SR4 0LL 01915341185 01915342137 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northumberland, Tyne & Wear NHS Trust Name of registered manager (if applicable) Ms Paula June Halliday Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 9 0 care home 9 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability Code LD, maximum number of places: 9 Date of last inspection 1 5 1 2 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home 28 Hylton Bank is a care home for nine people who have a learning disability and who have autism or behaviours associated with an ASD (Autistic Spectrum Disorder). The rate of charges in the home is between 951.00 and 1895.83 Pounds per week per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home During the inspection the inspector talked to the service users, staff and the manager. He looked at information about the home and the service users. He looked around the house to make sure it is safe for the service users. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well What has got better from the last inspection There were no requirements made in the last key inspection report for the home to address. Care Homes for Adults (18-65 years) Page 8 of 30 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 9 of 30 If you want to speak to the inspector please contact Sam Doku St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good admissions policy involving assessment of needs, which identifies care needs of the individual including considerations for their aspirations. This promotes the service users’ welfare and wellbeing. Evidence: The home has not had an admission since the last key inspection. The staff and the manager described the admissions procedure, and this includes planned introductory visits to the home for the person to get to know the people they would sharing the home with. The inspector reviewed the admission process and found the arrangements to be good. Detailed assessments were carried out and this formed the basis for the support plans. The manager confirmed that the first six week of residence is often classed as trail period, but the staff to provide a lot of support to enable the person to settle into their new home. The service users support plans set out each persons care needs and how those needs are to be met. The home continues to involve the service users in assessing and planning for their care. Page 12 of 30 Care Homes for Adults (18-65 years) Evidence: Each resident has a contract and this is in a pictorial format, which makes it easier for the them to understand the content of the contracts. Care Homes for Adults (18-65 years) Page 13 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to involve the service users, with support, in some aspects of the running of the home thus empowering them. Furthermore, the service users are supported to take reasonable risks. This enables them to make independent decisions while at the same time protecting them from harm. Evidence: The home uses a person-centred approach to plan for the needs of the service users. The staff are good at involving the service users, however limited, in the planning of their care and to support them to make decisions about their life and how they are to be cared for. Three service users support plans were examined and they reflected the needs of the people. The files also show evidence of the efforts made by staff to involve the service users in some aspects of the day to day management of the home. The service users have input into the planning of menus, social and recreational activities. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: The inspector had discussions with staff about involving the service users in the planning of their own care. Staff gave specific examples of how they are able to do, including going out for meals, social and recreational arrangements, outings and going out for meals. The home continues to carry out thorough risk assessments for each service user. There are detailed risk management plans for each of the risk areas that have been identified and staff have good information on how to manage any risk that has been identified. By carrying out such detailed risk assessments and providing risk management plans, the service users are able to enjoy a fulfilling lifestyle and without exposing them to undue risks. The risk assessments are regularly reviewed to ensure that they remain effective in safeguarding the safety and welfare of the residents. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are supported by a team of committed staff to engage in community activities. This enhances the service users’ sense of belonging. Evidence: The home continues to maintain the good standards that were commented on in the last key inspection report for this outcome areas. Each service user has a programme of activities, which sets out the arrangements for ensuring their involvement in community activities. Records show that the service users are supported to remain part of the local community and to engage in community activities. The service users are supported to take part in social, recreational and educational activities. These activities include regular visits to local pubs, theatre, cinema, shopping, attending discos, opportunities to attend college courses and other community facilities. There are also arrangements for the service users to engage in indoor activities such as board games, video films and watching TV and to visit friends and families. The home continues to review the service users interests in these activities and changes Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: are made where necessary. Practices observed during the inspection visit shows that the staff continue to involve the residents in the drawing up of the weekly menus and also take part in the weekly shopping for the home. The service users are offered choice of meals and continue to be encouraged by staff to maintain some level of independence regarding meals. Service users are frequently offered the opportunity to go out for meals. The staff also support the service users to eat healthy and balanced diet. The support plans show that the service users dietary needs are met. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of the service users are fully met. Evidence: All the service users have their own GPs and they are supported to attend appointments with their doctors when required. There are other arrangements for the service users to attend specialist out-patient appointments and other healthcare professionals. The psychiatric consultant based at the local hospital is closely involved in the care of the service users. The service users files contain notes of psychiatric reviews and assessments. The service users are supported to attend other healthcare appointments. There is evidence of service users visiting optician, dentist, chiropodist, epilepsy specialist nurse and other healthcare clinics. These visits are recorded in the individual life plans and in daily report books to show that they have been receiving the care that they are entitled to. The support plans, risk assessments and other care records show that individual care needs continue to be clearly identified and care programmes have been put in place to meet them. The care staff ensure that the care provided matches what has been agreed in the support plans. Where there are changes, the support plans are altered to take account of the changes to the individuals needs. The service users reactions, their views and that of relatives and advocates are taken into account when reviewing their care. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The inspector looked at the drug administrative system in the home. There are written drugs policies which provide guidelines for the staff to follow. The drugs administration system was inspected and there were no discrepancies noted. Staff who have responsibility for administering medicines have had suitable training in safe handling of medication. Detailed written policies on medicines were also available for inspection. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements in the home to promote the safety and welfare of the service users. Evidence: This inspection was carried out as a result of events in the home regarding the measures that needed to be taken to protect service users from harm. The inspector looked at the arrangements for instigating Deprivation of Liberties (DOL) procedures in the home. The inspector found that the home had taken prompt and appropriate action to protect the service users. DOL assessment was undertaken for each of the service users because of their vulnerability. The Best Interest assessor also carried out an assessment as part of the protection of the service users from harm. These assessments were well documented and the staff demonstrated good level of professionalism in instigating the DOL procedures. The inspector further looked at the policies and procedures and staff training in protection of vulnerable adults. There are detailed protection of vulnerable adults policies and procedures in the home and the staff who were spoken with demonstrated good knowledge of how to protect the service users from any from of abuse. All the staff have received training in safeguarding adults and have good knowledge and understanding of the procedures. The home has a written complaint procedure, which is part of the Northumberland, Tyne Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: and Wear NHS Trust complaint procedure. Summary of the complaint procedure is included in the Statement of Purpose and also in the Service User Guide and copies are retained on individual files. The Trust also has a Whistle Blowing policy and copies of these procedures are available in the home. The staff who were spoken with confirmed that they have received training in the City of Sunderland Local Authoritys MAPPVA (Multi Agency Panel for the Protection of Vulnerable Adults) procedures and on whistle blowing policies. The manager and the senior support workers have had DOL training and there are arrangements for all support workers to receive this training. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and meets the needs of the service users. Evidence: The home is designed to meet the needs of people with a wide range of physical disabilities. The corridors and doorways are wide enough to allow easy access and comfortable movement of people. The generous room sizes allow the residents to furnish their rooms with personal items while leaving sufficient spaces for movement within their rooms. The two lounges are suitably furnished and decorated. This provided a pleasant, spacious and comfortable environment for the service users. Generally, there is good standard of hygiene but one of the bathrooms need attention as the bathroom was noticed to have musty smell and the tiles on the wall need the grouting to be re-done. The kitchen, lounge and bedroom were all noted to be clean and in good order. However, the kitchen benches are suffering from general wear and tear and would need to be replaced. The laundry machine has programme facilities to meet disinfecting standards, thus ensuring good control of infection practices and protection of the service users from cross contamination. The cause of the musty smell in one of the shower rooms should be investigated and remedied as this is becoming increasingly worse. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: There are policies and procedures in place regarding safe handling and disposal of clinical waste, dealing spillage, the provision of protective clothing and hand washing. Antibacterial hand washing facilities were available in the toilets and bathrooms. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by a staff that are appropriately trained to undertake their duties. Furthermore, the residents enjoy good staff to service user ratio, enabling them to enjoy personalised care and attention. These promote the service users safety and welfare. Evidence: Since the last key inspection, there has been a stable staff team who continue to support the service users to achieve their potential. Staff stated that they are well supported by the manager and the senior staff team. Staff appear very confident in their work and there appears to be high moral amongst the staff team. In an agreement between the Commission and the Trust, two inspectors carried out an inspection of staff personnel files at the Trusts headquarters and the findings, relating to all the Trust services are stated here. As a large employer, the Trust has a centralised team of Human Resources staff. Part of their role is to help with the recruitment of new staff. Inspectors looked at the files of 14 newly recruited staff during the visit. Records showed that staff employed by the Trust only start work once a Criminal Records Bureau disclosure, two written references and a health clearance is received. However, some Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: staff (who had used the standardised NHS on-line application form) had not provided a full employment history. And, the gaps in their employment record had not always been explored with them at interview. It is a vital part of the recruitment and vetting process that a full employment history is obtained and any gaps in working time are fully explored with candidates before they are offered a post. This should include why they have left previous care settings. The manager provides regular supervision for all the staff and staff who were spoken with confirmed that this takes place on a regular basis and that they find the supervision sessions very helpful. Staff also confirmed that they have contract of employment and they all have job description which states what their roles are. Staff training included moving and handling, first aid, fire safety training, food hygiene, autism awareness, epilepsy, challenging behaviour management, protection of vulnerable adults awareness training. There is a greater awareness and understanding amongst staff of Mental Capacity Act 2005 and Deprivation of Liberties. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run and managed in a way that promotes the health, safety and welfare of the service users. Evidence: The home is managed by a registered manager and is supported by supported by two senior support workers who also have good experience in the care of people with learning disabilities. Staff were very complimentary of the manager and the support that they get from her. The staff, again stated that the manager runs the service for the benefit of the service users and has positive relations with the staff and the service users. The Trust has detailed Health and Safety policies and copies of these were made available for inspection. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). The manager stated that all staff have had training in food hygiene, fire precaution and first aid. The staff record that were examined showed the details of the training that each staff member had received. Records relating to fire instructions have been maintained. Records show that all portable appliances have been Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: tested. A record is maintained of monthly water temperature tests in the home. There is evidence of regular servicing of fire equipment, gas and electrical appliances. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 The worktops in the two kitchens are begining to suffer from wear and tear and the Trust should make the necessary arrangements to address this. Ensure gaps in employment shown on application forms are fully explored and this is clearly shown within the record of interview. 2 34 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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