Care Home: The Hawthorns.

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What the care home does well People who live at The Hawthorns were told in writing about what it is like to live there before they moved in. A member of staff visited them before they moved in to see what support they needed and to make sure that the home was suitable. The Hawthorns is friendly and relaxed. The manager runs it well and makes sure that people who live there are happy. Staff listen to what people want and if they are unhappy, sort it out. They feel at home and enjoy living in a clean and comfortable house. People are able to make up their own minds about what they do. They can be themselves and have chances to meet other people, enjoy their hobbies and learn more skills. People are able to see their family and friends when they want. The meals in the home are good and people can choose what they want to eat. People are given the support they need and staff are polite and friendly. This is written down in a care plan to make sure that staff are clear about how to help. These are kept safely by staff. Staff look after peoples health and help them to see a doctor or specialist if they need to. There are enough staff to support people when they need it. Staff understand people, fit in with what they need and make sure they are looked after. People who live in the home are protected by the way staff are employed, qualified and looked after. What has improved since the last inspection? This is the first inspection since the home was registered with the Care Quality Commission in April 2009. When the home registered with the Commission, it was agreed that service users would be helped to move out and live in their own homes. The home is in the process of doing this, with one person moved already and plans for others to go soon. What the care home could do better: People who live in the home would be safer of staff had more up to date training. It would be better for people if the home could finish sorting out how they were going to look after their money and if staff were given more written guidelines about how to look after them. Key inspection report Care homes for adults (18-65 years) Name: Address: The Hawthorns. Hawthorns Leeds Road Langley Maidstone Kent ME173JN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Martin     Date: 2 3 1 0 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 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 29 Information about the care home Name of care home: Address: The Hawthorns. Hawthorns Leeds Road Langley Maidstone Kent ME173JN Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Wade Type of registration: Number of places registered: care home 5 Future Home Care Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: Five (5) The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories Learning disability - LD Whose primary care needs on admission to the home are within the following category/ies: Learning disability Date of last inspection Brief description of the care home The Hawthorns was established in the 1980s and converted to its present use to coincide with the closure of long stay hospitals in the area. The home was under the ownership and management of the West Kent and Medway Social Care Partnership Trust, who under the National Plan for the Re Provisioning of NHS supported Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home accommodation, transferred the service to Future Home Care Ltd. and the premises to the housing association MCCH. The Hawthorns has been registered with the Care Quality Commission since April 2009, when the long term plan was to support service users into supported living or sheltered housing accommodation, according to their needs. The home is located in a semi rural area, close to the village of Langley near Maidstone. The property fronts onto a main road, with a steep access drive. Outside at the rear there is level access to a large, elongated area, largely given over to hard standing area for vehicle parking. The Hawthorns provides 24 hour care and accommodation for up to five adults with a learning disability. Accommodation and communal facilities are all at ground floor level, with the exception of stairs to two bedrooms and communal facilities on the first floor. Prior to registration the home was redecorated. Full details of the service provided and the fees charged are available from the Manager. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Hawthorns has been registered with the Care Quality Commission since April 2009, when the long term plan as part of the Re Provisioning of NHS accommodation, was to support service users into supported living or sheltered housing accommodation, according to their needs. Currently The Hawthorns is in a state of transition. All service users are in the process of moving out into supported living accommodation. One individual has recently moved and another is due to leave shortly. The aim is that all remaining service users will have moved out of the home by the end of November this year. After this, the premises could be used temporarily by service users from another home within the organisation, whilst their accommodation is refurbished. The Registered manager stated that the service provided by Future Homecare at The Hawthorns will probably close in early 2010. Care Homes for Adults (18-65 years) Page 6 of 29 All service users who have already moved, or who will move from The Hawthorns into the community need assistance and support with personal care. This service is defined as domiciliary care and as such, requires registration with the Care Quality Commission. Currently Future Homecare provides support with personal care in the community for some people in Kent. A temporary arrangement has been made with Future Homecares domiciliary care agency in Birmingham, whilst the organisation is in the process of application for registration in Kent. The Care Quality Commission will continue to liaise with Future Homecare regarding this issue. The Hawthorns currently provides care and accommodation for up to five adults with a learning disability. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is the first Key Unannounced Inspection undertaken since registering with the Commission. A visit to the service took place on 23rd October 2009, where two Support Workers, the Deputy Manager and the Acting Manager were spoken with and time was spent with four service users. Although not present during the visit, a telephone conversation took place and emails were received from the Registered Manager on 27th October 2009. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. An Annual Quality Assurance Assessment, AQAA, has been received from the home and any other information received since the service was registered has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned in this report where appropriate. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 8 of 29 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 9 of 29 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. People who moved into The Hawthorns were given written information about the service, which helped them make an informed choice. Before they moved in, people were assessed by the home to make sure that staff could meet their needs. Evidence: Written information about The Hawthorns is available. There is a statement of purpose and service users guide about the service offered, which has not been amended since registration with the Care Quality Commission in April 2009. People have been living at The Hawthorns for some time. Before they moved in, they were assessed to make sure that staff could meet their needs. Care plans for the support that people need were developed from this. Currently it is the aim of Future Homecare that all existing service users will move into Supported Living within the community within the next couple of months. Care Homes for Adults (18-65 years) Page 10 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported to make choices and decisions about their lives. Their changing wishes and needs are reflected in care plans, which are stored in a confidential manner. Service users are safer because staff take action to reduce the risk of any harm occurring. Evidence: Individual plans of care for each service user are developed with the aim to identify the support required from staff to meet their personal, social and health care needs. Two care plans seen were in good detail, holistic in nature and reflected service users changing wishes, needs and goals. Information includes social and learning activities, family and friends, health and care needs. Care plans are clear and easy to follow, individual and up to date. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: Service users are supported by staff with any risks involved in being as independent as possible. Risks are assessed and recorded in service users care plans. People are safer, because staff take action to reduce the risk of any harm occurring. Service users are supported to make their own individual choices. Attention is given to support people to make decisions in all aspects of their life. Service users are able to choose how and where to spend their time and supported with domestic tasks. Service users meet together once a week, where various issues are included, including the choice of meals. The confidentiality of service users personal information is maintained through the secure storage of records. Care Homes for Adults (18-65 years) Page 12 of 29 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. Service users enjoy individual lifestyles and are able to choose from a variety of leisure activities; they benefit from opportunities for personal development. Contact between service users and their families and friends is encouraged and supported where possible. Residents enjoy a choice of food. Evidence: Service users are treated with respect and supported with their responsibilities. They are treated as individuals who have different interests and aspirations. Service users are able to choose from a variety of different activities and opportunities. The routines of the home and the number of staff on duty are flexible to accommodate this. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Because of the location of the home it is difficult for service users to access the local environment by walking or by public transport. A vehicle is available, enabling residents to partake in the wider community, retaining their independence and accessing leisure facilities. Staff support service users to enjoy a variety of activities. Future Homecare provides a fund for service users activities. Service users are able to see their family and friends both inside and outside of the home when they wish. Service users benefit from support towards independent living skills, such as in the kitchen and laundry and with domestic chores. One service user is supported with specialist equipment, which helps them to choose the meals they like. Service users were being assisted by staff in the kitchen at the time of this visit. Records are kept of the skills that service users have learnt. Service users can choose what they want to eat. Service users are supported to meet together once a week, to discuss the choice of meals. A menu is planned in advance from this. Staff spoken with demonstrated a good understanding of individuals preferences. Records are kept for food that service users eat and if necessary fluid intake. Care Homes for Adults (18-65 years) Page 14 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from having their social and healthcare needs met in a way that they prefer. It was not possible to fully assess whether service users are protected by the system in place for the administration of medication, due to the nature of staff training records. Evidence: The home provides 24 hour care and accommodation for up to five adults with a learning disability. Service users dignity and privacy are respected. People are asked about their wishes and needs, which are reflected in their care plans. Staff have an understanding of these and fit in with the preferred routines of each person. Service users are able to see social and health care professionals when they need to and staff support people to attend appointments, which are reflected in care plans. A good level of equipment and input from specialist organisations is provided for service users with sensory loss. There is an additional member of staff from the Kent Association for the Blind specifically to provide support for the needs of one individual. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Staff monitor service users nutrition and weight and any ongoing medical conditions. There are guidelines for any challenging behaviour, which is recorded. Service users are assisted with their mobility where necessary. Currently no service users manage their own medication and all benefit from support from staff to do so. There are systems in place within the home regarding the storage and administration of medication. All medication is stored securely and administration records are completed appropriately. There are written guidelines available for staff about the administration of drugs prescribed on a when required basis. All medication is prescribed and there are no homely remedies. The Acting Manager explained that, as a registered nurse they assessed staff competence to administer medication; all staff transferred from the NHS, at the time of registration in April 2009, have been assessed as competent; Future Homecare induction training for new staff includes medication training from an external provider. The training matrix kept at the home includes some entries for medication training; the training matrix from the Maidstone office contains no entries for medication training apart from two booked courses. There were no induction training records available as they had been sent away for assessment. At the time of this visit it was not possible to fully assess whether all staff have received appropriate and up to date training in the administration of medication. A requirement has been made. Care Homes for Adults (18-65 years) Page 16 of 29 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. Service users benefit from their views being listened to, considered appropriately and action being taken. Service users are safeguarded, although they may be better protected if improvements were made to the systems in place for managing their personal finances. Evidence: At the time of this visit service users were at ease and relaxed talking and spending time with staff who listen to their views and concerns. Service users meet together once a week, where various issues are included. There are a range of policies and procedures available for staff, including the protection of vulnerable adults and complaints. The latter is presented in a way that service users can more easily understand. The majority of staff have received up to date training in the protection of vulnerable adults. The Acting Manager described how the home took appropriate action regarding one service user; no further incidents have occurred since the individual has moved to a more appropriate placement. All service users have independent advocates. There is a system in place which aims to protect the financial interest of service users. The home holds small amounts of cash on behalf of service users, which is stored Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: individually and securely. Cash checked tallied with transaction records seen; receipts for purchases are kept. Currently service users do not have their own individual bank account and monies are held by Future Homecare. The Acting manager explained that this is a temporary arrangement and stated that all service users will have their own bank account when they move out of the home into Supported Living shortly. The Provider is strongly recommended to fulfil their stated intention to ensure that all service users have individual bank accounts. Care Homes for Adults (18-65 years) Page 18 of 29 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. Service users benefit from living in a well maintained, homely and comfortable environment. Evidence: The Hawthorns is located in a semi rural area, close to the village of Langley near Maidstone. The property fronts onto a main road, with a steep access drive. The building has a style and atmosphere suitable for people who live there. Service users benefit from living in clean, tidy, comfortable and homely accommodation. The premises are suitable for their current needs and attractively decorated. Outside at the rear there is level access to a large, elongated area, largely given over to hard standing area for vehicle parking. The Acting Manager stated that a risk assessment had been undertaken for the use of this area by service users and that this was safe. Accommodation and communal facilities are all at ground floor level, with the exception of stairs to two bedrooms and a communal toilet on the first floor. Ground floor facilities include an office, services area, with laundry, refrigerators and medications cupboard, a refurbished Kitchen, service users dining room, communal lounge, bathroom with WC, separate shower room, two bedrooms and a storeroom. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Service users rooms are attractively decorated and personalised according to their preference. Prior to registration the home was redecorated. Despite the steep access drive, the home is accessible for wheelchairs and also provides specialist equipment where necessary. A good level of equipment and input from specialist organisations is provided for service users with sensory loss. The Acting Manager stated that no service users are able to use a staff call bell system. The inspector was assured that, as there are only four service users, staff know their whereabouts and welfare. Staff are provided with a Lifeline system for use in an emergency. The home is in the process of acquiring a new hoist. Service users can use the utility room and the kitchen with support from staff, both of which are domestic in nature. Service users are protected by the procedures in place for infection control. Care Homes for Adults (18-65 years) Page 20 of 29 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. People who live in the home benefit from the support of a committed and enthusiastic staff team who have a good understanding of their needs. Service users are safeguarded by the systems in place for staff recruitment, although they would be better protected by additional staff training. Evidence: A good rapport was observed between service users and staff. Staff spoken with were clear about their roles and responsibilities and communicate well with each other. There were enough staff on duty at the time of this visit to meet service users needs. There are usually three staff during the day with one sleeping in at night. Staffing levels are flexible depending on service users needs and reflected in a written rota. There is an additional member of staff from the Kent Association for the Blind specifically to provide support for the needs of one individual. Staff are provided with a system for use in an emergency. The home has a procedure in place which aims to recruit suitable staff who can meet the needs of residents. The Registered Manager described this as including pre employment checks, such as references, identification and a criminal records bureau Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: check. The Acting manager stated that at the time of registration, Future Homecare undertook new criminal records bureau checks for all transferred staff. The home is currently in the process of recruitment and new staff have and are due to be employed shortly. Staff recruitment files were not available at the time of this visit, having been moved to the Maidstone office in preparation for the move to Supported Living. However the Registered Manager provided written confirmation that appropriate pre employment checks had been undertaken. An induction programme is in place for all new staff. The Acting Manager explained that this included in house training in addition to that provided by Future Homecare; there is also ongoing training for all staff and that specialist courses are provided to meet individual service users needs. The majority of staff have received up to date training in the protection of vulnerable adults. Records show that over 50 per cent of the staff team have achieved or are undertaking a National Vocational Qualification at level 2 or 3. However, whilst some records show up to date courses undertaken, others show that updates are needed and some entries are blank. There are two training matrices, one kept in the home and one in the Maidstone office of future Homecare. The latter records 13 people including the Acting Manager and 2 new staff. This shows for example, Moving and Handling training was undertaken by 5 staff over a year ago in 2008, 1 member of staff has up to date training, with the remaining records being blank. 8 people have undertaken a food safety course and 5 entries are blank. 9 staff are trained in fire prevention, although 6 of these courses were undertaken over 1 year ago; there are 2 courses booked and 2 blank entries. Records show that not all staff have received up to date training appropriate to safeguard and meet the needs service users. A requirement has been made. Staff spoken with said that the Acting manager was very supportive and always available. Informal support takes place regularly and there is a system in place for formal recorded 1:1 supervision, which is recorded. Care Homes for Adults (18-65 years) Page 22 of 29 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. People enjoy living in a well run home with a relaxed atmosphere. Service users benefit from their views being sought about the service they receive. The health and safety of people who live in the home is safeguarded, although this may be improved by additional written policies being available for staff. Evidence: The Hawthorns was established in the 1980s and converted to its present use to coincide with the closure of long stay hospitals in the area. The home was under the ownership and management of the West Kent and Medway Social Care Partnership Trust, who under the National Plan for the Re Provisioning of NHS supported accommodation, transferred the service to Future Home Care Ltd. and the premises to the housing association MCCH. The Hawthorns has been registered with the Care Quality Commission since April 2009, when the long term plan, as part of the Re Provisioning of NHS accommodation, was to support service users into supported living or sheltered housing Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: accommodation, according to their needs. Currently The Hawthorns is in a state of transition. All service users are in the process of moving out into supported living accommodation. One individual has recently moved and another is due to leave shortly. The Acting Manager explained that the aim is that all remaining service users will have moved out of the home by the end of November this year. It was said that, after this, the premises could be used temporarily by service users from another home within the organisation, whilst their accommodation is refurbished. The Registered manager stated that the service provided by Future Homecare at the Hawthorns will probably close in early 2010. The home has developed Best Interest meetings to ensure that any actions or decisions taken on behalf of those Service Users without capacity to give informed consent are taken in their best interests. Care plans seen show assessments regarding Deprivation of Liberty. All service users have independent advocates. All service users who are moving out of the home into Supported Living within the community have been assessed by Future Homecare, NHS and their Care Manager in liaison with any family members. The Registered Manager is experienced in the management and care of people with learning disabilities. They hold various qualifications in health and social care, one of which is confirmed as equivalent to a National Vocational Qualification at level 4. The Registered Manager is registered to manage two homes within the same organisation and although available, is not based at The Hawthorns on a daily basis. The home is run on a day to day basis by the Acting Manager, who states that because of imminent and future plans for the home, it is currently unlikely that they will apply for registration with the CQC. The Acting Manager is supported by a Deputy Manager. There is an open and inclusive atmosphere in the home. At the time of this visit service users were at ease and relaxed talking and spending time with staff who listen to their views and concerns. People benefit from being asked about their wishes and needs. Service users meet together once a week, where various issues are included, including the choice of meals. The organisation uses a quality assurance system, which includes questionnaires to gain opinions of the service from service users, their families, staff and health and social care professionals. The Acting Manager said that visits to the home from a representative of Future Homecare as the Provider take place on a monthly basis and regular audits are undertaken. An Annual Quality Assurance Assessment for the home has been returned to the Care Quality Commission. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: There are a range of policies and procedures available for staff, including the protection of vulnerable adults and complaints. The latter is presented in a way that service users can more easily understand. Staff guidelines regarding the promotion of continence are available, although this is not reflected in a Future Homecare policy. The homes Annual Quality Assurance Assessment indicated that policies had not been developed for quality assurance, contact with family and friends, death, pressure relief and record keeping. It is recommended that the Provider should undertake a review to confirm that staff are provided with appropriate written guidelines for the work they do. A number of records have been looked at as part of this inspection and these have been mentioned within this report where appropriate. Accidents and incidents are recorded appropriately. The homes Annual Quality Assurance Assessment indicates the regular testing and maintenance of systems and equipment within the home. The home has undertaken a fire risk assessment. The fire alarm was serviced in March 2009 and the system is tested on a regular basis. The Acting Manager assured the inspector that the frequency for testing the emergency lights would be increased immediately from three monthly to monthly. The premises and the accommodation are monitored with the aim that potential hazards to the health and safety of service users can be identified and addressed. Service users are protected by the procedures in place for the use of cleaning chemicals. The kitchen is clean and tidy. In order to reduce the risks of scalding, all hot water outlets have mixer valves fitted and bath temperatures are checked regularly. The Acting Manager assured the inspector that temperatures would be tested for all hot water outlets from now onwards. Radiators seen are of the type that provide low surface temperatures. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 17 The Registered Person shall 20/12/2009 maintain in the care home the records specified in Schedule 4: A record of all training undertaken. The Registered person shall ensure that the records are kept up to date and are available at all times for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. To ensure that service users are protected, records must be made available for inspection in order to fully assess whether all staff have received appropriate and up to date training in the administration of medication. 2 35 18 The Registered person shall ensure that the persons employed to work at the care home receive training 28/02/2010 Care Homes for Adults (18-65 years) Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action appropriate to the work they are to perform. Staff must be provided with up to date training appropriate to safeguard and meet the needs service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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