Care Home: Park Hill House

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What the care home does well This is a new service and the manager and staff team have worked well to prepare for people coming to live in the home. Before anyone moved in, the staff team were given lots of training to enable them to meet people`s needs and understand the way the home should be run. Admissions to the home are well managed and arranged in a planned way so that people`s needs are fully assessed, whilst ensuring that the home is suitable for them. Individuals are central to the planning of their care and staff have good information on how to meet each person`s needs. One to one staff support is offered from a stable team who have worked in the home since it opened. There are good links with other healthcare professionals so that changes in individual needs are acted upon and adjustments to their care and support are put in place. People are treated with respect and dignity that promotes their individuality and values their rights. People take part in leisure activities which are meaningful to them and take account of their social interests, choices and personal capabilities. There are lots of things for people to do and the home is working hard to increase its range of social activities even further. The manager is knowledgeable and experienced and provides the staff team with good support and leadership. Written feedback included "Happy home, well experienced staff, down to earth manager and proprietor." Other comments were "Numerous activities for clients." "Good communication between staff" and "Each individual is supported as an individual and is offered a variety of choices both in the home and out." The staff show commitment and enthusiasm to run the home in the best interests of the people who live there. Good training and supervision systems support staff to do their jobs well and reflect upon their performance and practice. The house is decorated to an excellent standard and provides people with comfortable and homely surroundings. The communal space for people is very good and gives choices for people to relax and enjoy quieter areas of the home. The bedrooms are spacious, each have their own bathroom and people are encouraged to decorate and personalise them in the way they prefer. Likewise, people are provided with any necessary equipment to meet their physical needs. The home is kept very clean and tidy and provides a safe environment for people living and working there. Feedback from all the comment cards we received was positive about the home. What has improved since the last inspection? This was the home`s first inspection so it was not possible to identify where improvements have been made. CARE HOME ADULTS 18-65 Park Hill House 25 Park Hill Road Wallington Surrey SM6 0SA Lead Inspector Claire Taylor Unannounced Inspection 27th & 28th August 2008 10:00 Park Hill House DS0000071962.V368193.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 Park Hill House DS0000071962.V368193.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. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park Hill House Address 25 Park Hill Road Wallington Surrey SM6 0SA 0203 337 2253 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) parkhill6@btinternet.com Loving Care Ltd Carol Ann Enever Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A- New Service Brief Description of the Service: The home is a large detached property in a quiet residential area of Wallington and is well placed for local shops, amenities and public transport links. This service was newly registered in April 2008 and is owned by Loving Care Limited who also run another residential care home in Wallington. Park Hill House is registered to provide care and accommodation for up to six young adults with learning disabilities. The house has been converted and refurbished to a high standard and offers six spacious bedrooms over three floors. All six bedrooms have en suite bathroom facilities that include a toilet, hand washbasin and bath or shower. As well as a bedroom, one of the first floor rooms provides additional living space for one person. The two ground floor bedrooms have been equipped with assisted bath facilities for two people living in the home. Shared living areas include a lounge, fully fitted kitchen /diner with a ground floor laundry room. There is an enclosed rear garden with patio and lawn area and paved front driveway for parking. There is also a separate toilet and shower room on the first floor that is primarily identified for staff and visitor use. More detailed information about the services provided can be found in the home’s Statement of Purpose and Service User Guide – copies of these can be obtained directly from the home. Fees start at £2300 per week and were correct at the time of this inspection. Park Hill House DS0000071962.V368193.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 stars. This means the people who use this service experience good quality outcomes. This was the home’s first key inspection since it was newly registered in April of this year. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that the provider (owner) must complete every year. It is used to tell the Commission about the services provided, how the home makes sure of good outcomes for the people using it and any planned developments. The completed AQAA provided us with useful information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. We spent a day and a morning in the home and the manager was available throughout our two visits. Three people have moved into the home since it opened. We looked at various records in relation to their care, staffing and the way the home was being run. People living in the home do not have the capacity to share their views regarding their care. In order to make judgements about the care that individuals receive, we observed care practices; interactions with staff and tracked records of care. We also looked around the building and talked to some of the staff who work at the home. The three people living in the home completed comment cards with support from either a relative or advocate. We also received surveys from eight staff and one relative. We told the manager what we found at the end of our visit. All those who took part are thanked for their time and contribution to this inspection. What the service does well: This is a new service and the manager and staff team have worked well to prepare for people coming to live in the home. Before anyone moved in, the staff team were given lots of training to enable them to meet people’s needs and understand the way the home should be run. Admissions to the home are well managed and arranged in a planned way so that people’s needs are fully assessed, whilst ensuring that the home is suitable for them. Individuals are central to the planning of their care and staff have good information on how to meet each person’s needs. One to one staff support is offered from a stable team who have worked in the home since it opened. There are good links with other healthcare professionals so that changes in individual needs are acted upon and adjustments to their care and support are put in place. People are treated with respect and dignity that promotes their individuality and values their rights. People take part in leisure activities which are meaningful to them and take account of their social interests, choices and personal capabilities. There are lots of things for people to do and the home is working hard to increase its range of social activities even further. The manager is Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 6 knowledgeable and experienced and provides the staff team with good support and leadership. Written feedback included “Happy home, well experienced staff, down to earth manager and proprietor.” Other comments were “Numerous activities for clients.” “Good communication between staff” and “Each individual is supported as an individual and is offered a variety of choices both in the home and out.” The staff show commitment and enthusiasm to run the home in the best interests of the people who live there. Good training and supervision systems support staff to do their jobs well and reflect upon their performance and practice. The house is decorated to an excellent standard and provides people with comfortable and homely surroundings. The communal space for people is very good and gives choices for people to relax and enjoy quieter areas of the home. The bedrooms are spacious, each have their own bathroom and people are encouraged to decorate and personalise them in the way they prefer. Likewise, people are provided with any necessary equipment to meet their physical needs. The home is kept very clean and tidy and provides a safe environment for people living and working there. Feedback from all the comment cards we received was positive about the home. What has improved since the last inspection? What they could do better: Some additional details about the home are needed so that people using the service have all the required information about the costs and the services they can expect to receive. Each person must have an up to date and relevant contract so that they have accurate information about how much they will pay and what the home provides for the money. It will also help each individual and/ or their representative have a better understanding of the care that is promised to them. Management of risk for people could be improved by ensuring that each assessed risk around vulnerability is recorded separately. This is to ensure that staff have clear information on how each risk should be managed whilst promoting the person’s safety and independence. On the whole staff are safely recruited, but the employer must make sure that references requested are appropriate and not from family or friends. In addition, full employment histories must be explored so that people using the service are protected from unsuitable workers. Operational visits to the home as required by regulation 26 had not started. As this is a new service, copies of these reports need to be sent to the Commission until further notice. This is so we can monitor how well the service is running in its first year. Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 7 As well as the Regulations and National Minimum Standards for Care Homes for Younger Adults, various guidance and information documents are available to service providers on our website. (www.csci.org.uk). 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. Park Hill House DS0000071962.V368193.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 Park Hill House DS0000071962.V368193.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, 2, 3, 4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are arranged in a planned way and the needs of people who use the service are fully assessed prior to moving in. This ensures that the needs of the person are understood and can be met. People need a contract so that they have full, accurate information on how much they will pay and what the home provides for the money. EVIDENCE: We looked at the home’s Statement of Purpose and Service Users Guide. These both provide most of the necessary information about the range of services and support the home is able to offer. Some minor improvements will ensure that people who wish to use the service are fully informed however. For example, the guide needs to specify the fees and any extras that people using the service would be expected to pay. Amendments are needed in the Statement of Purpose to include details about the qualifications and experience of all staff working in the home. In addition, there must be information about the number and size of the rooms in the home. For what the home does well, the AQAA stated, “Full thorough assessment of all new clients, using our assessment tool, ensuring that we would be able to meet the clients needs. Assessments carried out by our Behavioural nurse Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 10 specialist, myself, prospective client, current home, any family/advocate involved, and also discussed with staff team, to ensure suitable person for the home.” We looked at the care records for three people living in the home and each file contained a detailed needs assessment that reflected this practice. As part of the admission process, the home carries out its own needs assessment which focuses on achieving positive outcomes for people. The assessment covers all aspects of a person’s life, including their strengths, hobbies, social needs, dietary preferences, health and personal care needs and ability to take positive risks. Some equality and diversity issues are also explored through assessment. Examples seen included details about people’s ethnicity, preferred faith and culture. Records showed that individuals were given the opportunity to spend time in the home before moving in. Admissions to the home only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective person. People are invited to view the home, stay for a meal and overnight. The manager advised that people are offered a transition or introductory period of one month and a fourth prospective person was going through this process at the time of our visit. Records showed that the home manages the transition in a well thought out and structured way. This ensures that any new person has the time they need to settle in and that staff get to know their support needs. The home ensures that families or representatives are also involved where appropriate. Following the person’s trial stay, we suggest that a record of the six weekly review meeting is kept to show that the person is happy in the home and that it is suitable for them. Each person also had an assessment of needs undertaken through their care management arrangements in the local authority of Wandsworth. We saw contracts for each person that had been provided by the placing local authority but the home’s contract was not available. The manager explained that they were in the process of completing an individual contract for each person. The contract must specify what the person is expected to pay and include accurate information about the facilities and services that people can expect to receive. Any arrangements for charging ‘additional costs’ that are not covered by the basic price of each person’s placement must also be fully reflected in their terms and conditions. Following the visit, the home sent us an example of a blank contract which contained all of the required information. People who use the service must now be provided with a completed contract. Park Hill House DS0000071962.V368193.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, 7, 8 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are met as the home has a plan of care that the person, or someone close to them, has been involved in making. Individuals are consulted and given opportunities to influence how the home is run. People are supported to take risks that promote their independence although some plans need more detail to fully safeguard individuals from potential harm. EVIDENCE: For what the home does well, the AQAA stated, “Full individual care plans/support plans for all clients in a picture format suitable for their needs, written with the clients. All clients have a key worker to suit their individual cultural/gender needs. Clients all have an advocate, and involved in all decisions made regarding their lives. Manager is appointee for all clients, and clear records kept. All clients have a full ‘whole life’ risk assessment, with individual risk assessments where needed.” Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 12 We looked at care records for all three people living in the home. Although the home has not been open very long, each file contained a range of records that look at all areas of the individual’s life in a person centred way. The manager and staff had taken steps to obtain lots of useful information about each person so that they would know what support they require. Care records included up to date person centred plans from each individual’s previous home. Plans included good information about each person’s goals and aspirations, their skills and abilities, social lives and preferred lifestyles. There were detailed needs assessments with well-written support plans based upon each area of need. Examples included using the community, making choices, personal care and taking medication. Each person’s preferred communication style was clearly recorded so that staff can recognise and understand their unique behaviours, moods, signals and temperaments. One person uses Makaton signing and staff were due to complete further training so that they can support their communication needs more fully. The manager explained that she was in the process of updating the person centred plans as the staff team were still getting to know the three people who have moved there. Revised plans for individuals will be based upon observations and settling in time. The manager and staff plan to adapt them with further pictures and photos so that they are more meaningful to people who have communication difficulties. Once this work is complete, each person will have a care plan that is an up to date working tool used by the individual and all involved staff. We also suggest that any historical records be archived so that only relevant and up to date information is held on each person’s file. There are good systems in place that will ensure that the placement and the care plans are reviewed regularly. These also involve people’s care managers, family and other representatives as necessary. Care records showed that each person has a named ‘keyworker’ staff and meetings are held every two months to monitor progress, what has worked for the person and identify where changes are needed. There are advocacy arrangements, as well as family input, to represent people’s interests. Individual diaries are used daily and records seen were thorough, relevant, and also gave a sense of that person’s experience of their day. We think that the home should consider organising informal meetings for the people who live there. This would give individuals further opportunities to comment on the way the home is run and show how their views have influence. We saw risk assessments that were recorded on a ‘whole life’ risk assessment. These assessments aim to support each person to take acceptable risks in order to maximise their independence wherever possible. They covered key areas such as accessing the local community, safety in the home, taking medication and ‘vulnerability’. The information about a person’s vulnerability included several different areas of risk but it was not clear how each one was managed. This therefore needs some improvement and each assessed risk around vulnerability must be recorded separately. This is so that staff have full information on how to support the person’s needs. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities that are appropriate to their age and culture and are part of their local community. The home supports people to follow their personal interests and activities. Relationships with family and friends are well supported and daily routines ensure that people’s individual rights’ and responsibilities are recognised. People who use the service are offered a healthy diet and enjoy their meals at times that suit them. EVIDENCE: We looked at records relating to the lifestyles for all three people. An activities coordinator works in the home three days a week. Since the home opened, their role has involved looking at interesting and different activities that people may enjoy. Outings have been organised to a variety of places including parks, restaurants, theatre shows and a recent boat trip. These activities were being Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 14 regularly reviewed to ensure that they meet the person’s needs and preferences. Detailed records were available to show what activities people had joined in with and whether they were a success or not. Care plans also had good information about what activities each person likes to take part in and how staff should support them. People are supported to follow their chosen interests and hobbies. For example one individual enjoys sport and their keyworker supported them to attend a local gym during our first visit. Another individual likes swimming and the staff team were in the process of finding a suitable facility that could accommodate the person’s specific needs. People regularly access their local community with appropriate staff support. Activities include trampolining, evening social clubs, pubs, shops and eating out. Two people went out for lunch at a local cafe during our second visit. Two people also had an aromatherapy session when we visited. People have an individual planned activity programme, which takes account of their preferences, interests, experiences, age and capabilities. Records showed that people were able to continue with activities from their previous homes. Most of the daily activities offered are through local college courses, day centres and local community facilities. The centre offers a range of activities such as drama, music, keep fit and cookery. As a new service, the home has plans to provide a wider range of social and leisure activities once more people have moved in. During both visits, the two people we met appeared relaxed and comfortable in their home. Staff spoke respectfully with individuals and supported them with their day-to-day routines. There is some indoor entertainment including a widescreen television, art and craft materials, a jukebox and music system. Care records included details about each person’s social network and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. Records showed that family, friends and guests are welcome at the home and that the manager maintains good communication links with people’s respective families. Comment cards received from a relative were complimentary about the home. “ We are very pleased with the way … has settled into his new home, and with the care and attention that he has received. Also he is very happy in himself.” People are able to eat at flexible times according to their routines and social lives and are actively involved in cooking and meal preparation. We saw records to show that people are asked what they want to eat and that their food choices were included on the weekly menus. A copy of the current menu is displayed on the dining tables and reflected a healthy and varied diet. We suggest that the menus could include pictures and photos to help those people with communication difficulties. Staff supported individuals to make their own drinks during our visit. The manager said that the home buys its main food provisions through Internet shopping on a weekly basis. The staff also support people to shop locally however for their chosen items. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 15 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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. The home’s medication practices are well managed. If people cannot manage their medicine, the care home supports them with it in a safe way. EVIDENCE: For what the home does well, the AQAA stated, “All clients have a detailed personal support plans for their personal care, all registered with the local G.P. all referred onto any specialist as needed, and all health visits/outpatients visits recorded in their notes, all have a Health Action Plan. All medication is checked and recorded as per CSCI guidelines, the clients are unable to administer their own medication, but all have their own personal medication cabinet in their own rooms, with own personal recording sheets in file. We have no clients on Controlled drugs.” People’s preferences about how they receive personal care were recorded in their support plans. Where support is required with personal physical care, this Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 16 is identified and guidance is available to staff on how specific tasks should be undertaken such as using the assisted bath. Records and observations showed that staff respect people’s choices and know their preferred routines. Times for getting up and going to bed are flexible, as are mealtimes. One person chose to stay in bed when we visited as they had experienced a restless night and were feeling unwell. One staff we spoke to said that another person likes to watch television until late evening after others have gone to bed. Keyworkers take responsibility to support individuals to shop for clothes and personal toiletries or go on outings of their choice. There is a balanced staff group that enables choice of male, female and age related preferences in delivering personal care. We saw that good information about healthcare needs is available in people’s individual care plans. People are supported to use other NHS healthcare facilities in the local community. Plans included details of GP involvement as well as Consultant, dentist, optician and routine hospital appointments. Staff keep a record of all appointments, outcomes and any follow up action required. This shows that the staff team monitors healthcare needs closely and takes action to address any changes. The manager plans to develop health action plan books for all people living in the home. These will provide a more person centred profile of an individual’s healthcare needs and detail how they will be met. One such plan had been completed for one person. The home has a detailed policy on the management of medication and all staff have received training. People who live in the home need full support to take their own medication and this was reflected in their care plans. Each individual has their own supply of medication in a lockable metal cabinet in their bedroom and there were risk assessments in place to support this practice. The home uses the Boots Pharmacy monitored dosage system and this was being well managed. Records were accurate for the control of medication and sampled administration charts were signed and accounted for. Staff also make a weekly recorded check on medication stock. The manager said she plans to carry out an assessment of competency for each staff to make sure that they support people safely when administering medication. Medication cabinets in the vacant rooms were due to be affixed to the wall once they become occupied. One area for improvement is that people living in the home must have guidelines for the use of as required medication. They should specify the reasons for use and what action staff should take before medication can be given. We further suggest that each person has a profile that outlines what his or her regular medicines are prescribed for. This will provide staff with on hand information about the type of medication and why it is needed. Medication is reviewed at regular intervals and according to any changed needs. An appropriate healthcare professional reviews each person’s condition regularly to ensure that they receive the correct medication regime or treatment where necessary. The manager confirmed that the home received good support from the local GP practice. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 17 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 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or those close to them, know how to complain. Their concern is looked into and action taken to put things right. Arrangements for protection from abuse are well managed and help ensure that people living in the home are safe. EVIDENCE: For what the home does well, the AQAA stated, “We have Policies and Procedures for the protection from abuse for the clients, and also concerns and complaints, All staff have attended training for POVA, we have had no incidents, but if we do, then the correct guidelines and paperwork will be followed, i.e. Reg.37, and Suttons Abuse Policy would be implemented. We have clear records showing all the clients monies, for the money held in the house, at present waiting to open bank accounts for them, when their benefits have been changed over.” We saw a complaints policy that provides clear details of how concerns would be listened to and acted upon. The current group of people living at the home would need total support to make a complaint and would rely on a relative, staff or other people to raise a concern on their behalf. There is a complaints book and one complaint has been made since the home opened. Records showed that the issues were investigated in line with the organisation’s policy and that the home and registered provider takes people’s views seriously. We have received no complaints about this service since its registration. As people using the service have varied communication abilities, we suggest that the Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 18 home consider looking at ways to adapt the complaints procedure in other formats that meet their needs. Records confirmed that staff are properly inducted on abuse awareness and there are policies and procedures for safeguarding adults that give clear specific guidance to those using them. Local authority procedures were also available. We saw that the manager and staff received training on safeguarding vulnerable adults in April of this year. Discussions with three staff confirmed that they were aware of their responsibilities to report any suspicion of abuse and knew what action to take. People living in the home need full support with their finances and the manager is the designated appointee for each individual. Appropriate documentation was in place with regard to income/expenditure made on people’s behalf as well as policies to safeguard their personal interests. We saw that accurate records are kept of all financial transactions and daily checks are made to ensure that these are correct. Personal expenditure sheets were sampled and balanced correctly with cash amounts held in the home. These systems help to ensure that people’s financial interests are safeguarded. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 19 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, 28, 29 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with safe, comfortable and homely surroundings in a house that is kept clean and well maintained. People have spacious bedrooms and one of the rooms has additional living space for personal use. The home makes sure people have the right specialist equipment that encourages and promotes their independence. EVIDENCE: Park Hill House is a very well maintained, attractive home and has good access to local community facilities and services. The accommodation is arranged over three floors and decorated to an excellent standard. All six bedrooms have modern en suite facilities. On the ground floor there is the entrance hallway, two bedrooms, kitchen (with dining space), laundry room, comfortable lounge and an enclosed rear garden with patio. On the first floor there are three bedrooms and an office that is also used for staff who sleep-in. There is a separate shower/toilet facility for staff and visitors to use. There is one Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 20 bedroom on the top floor which also has an ensuite bathroom. The kitchen has been decorated and furnished in an American diner style and was described as a popular feature with the three people who live in the home. The design and open layout enables people to be involved in domestic tasks as part of developing or maintaining their independence. Individuals are encouraged to see the home as their own. People have personalised their rooms how they like and been involved with choosing their room colour and furnishings. The staff have ensured that each person’s bedroom reflects their interests, hobbies and personal identities. This includes possessions that are meaningful to each person such as music CDs, soft toys and family photographs. Specialist equipment has been purchased to meet the individual needs of two people who use the service. Each person has an assisted bath fitted in his or her ensuite. The manager explained that as the two ground floor rooms were occupied, the home would not be able to admit anyone else who had physical disabilities or significant needs associated with mobility. During our visit work was being carried out to complete the paving and lawn area in the rear garden. New garden furniture had also been purchased. The manager advised that people would therefore be able to access the garden within a few days. A part time cleaner is employed and people living in the home are supported to join in with housekeeping tasks. We saw that the home was very clean and tidy good hygiene practices in place. One comment card said, “It is kept clean to the highest standard.” The organisation employs a handyman to carry out maintenance work as necessary. The home plans to keep a record of any repairs as and when they occur. We saw that the local fire authority carried out an inspection of the premises before it opened. The fire safety report identified some areas that needed attention. Records showed that the manager had taken action to address them. The home should arrange a follow up visit however to confirm that the premises now meet with current fire regulations. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 21 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, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their manager. There are good recruitment practices which safeguard people from unsuitable staff although some additional checks are needed to ensure that people are fully protected. EVIDENCE: For what the home does well, the AQAA stated, “We have employed experience staff, with 80 have their NVQ, all working through Skills for Care Induction programme, we have clear recruitment guidelines and procedure, and all staff files, containing all the required information, i.e. CRB, 2 references. We have a training and development plan for the staff, with this being addressed in supervisions. Which all staff have, both myself and the Deputy manager undertake the supervisions, and we have both had training on this.” Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 22 There is a stable staff team who have worked at the home since it first opened in April of this year. Two of the staff are related to the manager and most of the team previously worked together within another organisation. Rotas were sampled and allocation allows for a minimum of three staff on each day shift with one waking staff at night and additional sleep in. At the time of our inspection, there was one to one staff support for each of the three people living in the home. Observations showed that staff respect people’s individuality and support them to make daily choices. All three staff we spoke to had a good understanding of each person’s specific needs and their unique ways of communicating. In addition, each staff was clear about their role as a keyworker and knew the principles of person centred care. Regular staff team meetings are held; minutes were clear and focused on people’s needs as well as the day-to-day running of the home. Eight staff have completed their NVQ level 2 in care and three were studying for their level 3 qualification. This exceeds the minimum requirement for which the home is commended. There are detailed procedures to ensure that staff are vetted correctly before they begin work. Some improvements are needed with the home’s recruitment practices however. We looked at records for four staff and these contained most of the required legal checks and documentation. For three staff however, there were some gaps in their employment histories (no explanation) and insufficient references for one staff member. The manager is directly related to this member of staff and completed one of their references. This did not correspond with the organisation’s job application form which stated that references from family or friends were not acceptable. The activities coordinator is also related to the manager and again, alternative references must be sought. The correct recruitment checks must be carried out on all employees to ensure that people are fully protected. We also recommend that the provider develop a policy on family members working in the care home so that there are clear lines of accountability for those staff members and that any conflicts of interest are considered and managed. Aside from these issues, all other recruitment checks had been completed appropriately including CRB and POVA checks; proof of identity and a health declaration. Before the home started providing a service to people, the staff were given lots of training to prepare them for their work. We saw certificates that reflected this. Courses were run on person centred planning, communication, epilepsy, autism, challenging behaviour and Makaton signing. Discussions with staff confirmed that they found training valuable and relevant to their work. Loving Care have also developed an annual training plan for the staff that identifies what courses have been undertaken and when refresher training is due. Written comment cards from eight staff were very positive on their experience of working at the home. All staff said that they had appropriate recruitment checks carried out prior to them starting work. All ticked that their induction to the service covered everything they needed to know ‘very well’. One wrote, “everything I needed to know was very clearly stated and understood.”They all responded that they are given training relevant to their role. One staff wrote, “excellent training”. During our visit staff spoke about “how well everyone gets on as a team” and that it was a “nice atmosphere to work in.” Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 23 Records confirmed that staff had started to receive regular supervision with the manager or deputy. There are plans for all staff to have an appraisal of their work each year and for the deputy to attend a supervision course. These systems therefore support staff to do their jobs and reflect upon their performance and practice. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 24 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, 40, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has relevant qualifications and a good leadership approach to run the home in the best interests of the people who live there. Record keeping is well managed to ensure that people’s rights and best interests are safeguarded. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The manager Carol Enever has been running the home since it opened. She has attained the required NVQ level 4 management qualification as well as the NVQ assessor’s award. Previous experience has included many years work in a variety of learning disabilities services. She also has experience in working with people who have mental health needs. Staff were positive about her leadership Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 25 qualities and felt that the team works well together in a friendly run atmosphere. All staff who completed questionnaires said that they ‘regularly’ meet with their manager and one wrote, “good amount of feedback”. Discussions and observation confirmed that the manager understands the importance of person centred care and improving outcomes for people in the home. Operational visits to the home as required by regulation 26 had not started. The manager stated that the organisation has appointed a representative to complete an audit of the service once a month. As this is a new service, copies of these reports need to be sent to the Commission until further notice. This is so we can see how the service is running in its first year. As the home has only been open for six months, the overall effectiveness of the quality assurance systems could not be assessed. The home has plans to ensure that the quality of the service is monitored however. Plans on the AQAA stated, “Setting up a Quality Assurance file, where standards will be checked and recorded each month, and writing up new Survey Questionnaire forms for all clients, families, advocates, outside agencies and staff. For when we have been open 6 months.” “Undertake surveys, on clients, families/advocates, outside agencies, staff, and improve what we need to depending on answers.” The quality of record keeping in the home is generally good, with all records required during our visit easy to access and stored securely when not in use. The home has good systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In addition, there is clear policy guidance for staff to follow regarding a range of health and safety activities. The organisation has a rolling programme of mandatory training to ensure that staff update their skills and knowledge in key health and safety topics. Before the home opened, staff completed training on fire safety, moving and handling, infection control, food hygiene and first aid. The completed AQAA stated that all relevant safety checks were up-to-date. Some health and safety records were sampled including fire safety and general risk assessments. We examined the fire log, which shows that tests on the alarm system are carried out each week and each person who lives in the home, and staff members, take part in regular fire drills. There were appropriate maintenance contracts for the home concerning gas and electrical safety and for servicing equipment such as the assisted baths and wheelchairs. There is a health and safety coordinator within the staff team. A regular check of the environment is carried out monthly to ensure that it remains safe. Accurate records are kept for accident and incidents. Detailed risk assessments were in place concerning the premises and safe working practices. These aim to safeguard the welfare of all people living and working in the home. Examples included moving and handling, fire; use of hot water, access to the cellar and storage of knives and sharps. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 3 4 3 5 2 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 4 25 x 26 4 27 X 28 4 29 3 30 3 STAFFING Standard No Score 31 X 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 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 3 3 X Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA1 Regulation 4(1)(c) 3 & 16 Requirement The Statement of Purpose needs some additional information so that people using the service have all the required details about the care home’s services. The Service Users Guide needs amendment so that people using the service have all the required details about the fees and costs for living in the home. Each person needs an up to date and completed contract so that they or their representative are given full information about the services that are being arranged and what the home provides for the money. Timescale for action 30/11/08 2. YA1 5(1)(bbbd) 30/11/08 3. YA5 5 (1)(c) (3) 31/10/08 4. YA9 12(1 a) 13(4)(5) Specific risks concerning each 31/10/08 person’s vulnerability need to be recorded separately. This is so that staff have clear information on how each risk should be managed whilst promoting safety and independence for the person. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 28 5. YA20 13(2) Written guidelines are needed concerning the use of as required medication. This is so that staff have clear instruction and an agreed timescale on when to administer this type of medication. When recruiting new staff appropriate references must be relevant to work and not obtained from family or friends. This makes sure that all people who work at the home are safe to do so. All of the required information and vetting checks must be obtained prior to staff beginning work. Full employment histories with an explanation of any gaps must be explored and recorded. This makes sure that all people who work at the home are safe to do so. The responsible individual must ensure that visits are carried out monthly and reports are made available. As this is a new service, copies of the regulation 26 visit reports must be sent to the Commission until further notice. This will show how the organisation monitors the conduct of the home and how well the service is running. 30/11/08 6. YA34 19(1)(c ) sch.2 (3) 31/10/08 7. YA34 19 (1)(b) Sch 2 (6) 31/10/08 8. YA39 26 (5a & b) 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 29 No. 1 Refer to Standard YA4 Good Practice Recommendations Following the trial stay, a record of the review meeting is kept to show that the person is happy in the home and that it is suitable to meet their individual needs. Once the person centred plans have been completed, some records should be archived that are not relevant to a person’s current needs or plan of care. Regular meetings should be held for people living in the home. This will promote further opportunities to comment on the way the home is run and show how their views have influence. That the menus could include pictures and photos to help those people with communication difficulties. Each person has a profile that outlines what his or her regular medicines are prescribed for. This will provide staff with on hand information about the type of medication and why it is needed. As people using the service have varied communication abilities, the home should consider looking at ways to adapt the complaints procedure in other formats that meet their needs. The home arranges a follow up visit with the local fire authority to confirm that the premises now meet with the required fire regulations. That the organisation develops a policy on family members working in the same care home. This is so that there are clear lines of accountability for those staff members and that any conflicts of interest are considered and managed. 2 YA6 3 YA7 4 5 YA17 YA20 6 YA22 7 YA24 8 YA34 Park Hill House DS0000071962.V368193.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Park Hill House DS0000071962.V368193.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. 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