Care Home: The Pines (Hindhead)

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What the care home does well Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support. Care plans were written from the point of view of the resident and included their preferences, likes and dislikes with respect to all aspects of their health and personal care and included the gender of their carers. Residents` cultural and religious needs were fully explored and every effort had been made to fulfil them. Communication profiles described to the staff the meaning behind the expressions and movements the residents used to make their feelings known. Residents were encouraged to make choices and, where these had already been established, they were recorded in the care plan to inform the staff. The resident who completed a survey with support commented, `I go to the Harbour Day Centre, which I enjoy, have visits and phone calls to my family and choose my meals and drinks and what clothes to wear.` Movement programmes were in place and guidelines on moving and handling for the staff had been provided by a physiotherpist with photographs to illustrate exactly how they should carry out these tasks for the safety and comfort of the resident. The home provided a specially adapted minibus for wheelchair users to support the residents to access the community and `shopping trips and meals out at local pubs and restaurants were frequently taken`, the manager stated. A staff member commented, `I have worked in care for the last eight years and I think the Pines provides an excellent service. Whitmore Vale have encouraged me to study and complete my National Vocational Qualification at level 3 in Social Care, setting aside the necessary working hours to enable me to study and enjoy completing this qualification.` An educational professional commented in the home`s quality assurance questionnaire, `we have good support from The Pines and the residents are happy and well cared for. They keep us well-informed concerning the resident who attends, have a person-centred approach, and keep the residents involved in the day-to-day running of their home.` A healthcare professional commented, `Support at The Pines is professional, consistent, caring and individual needs are catered for.` This service is good at identifying and planning improvements to the service taking into consideration the views of the residents, their relatives and representatives to ensure the service is run in their best interests. What has improved since the last inspection? An enthusiastic new manager with many years of experience in the field of social care and qualifications in care and management had been recruited since the previous site visit and had applied for and been accepted as registered manager for the home. He was in the process of introducing changes in a measured way. The complaints procedure had been made more accessible by the introduction of forms, which could be completed to give comments on what the Pines could do better, and these were welcomed for the continuous improvement of the service. Greater emphasis had been placed on involving residents more in day to day activities within their home such as cooking and cleaning, aimed at developing skills, increasing confidence and promoting greater interaction and involvement. Light wood-effect flooring had been laid in the communal rooms, replacing the carpets, providing a pleasant and modern feel, and enhancing the homely environment for the residents. `Other remaining carpeted areas were regularly cleaned`, the manager stated. One resident had been involved in the complete refurbishment of their bedroom. The manager wrote in the Annual Quality Assurance Assessment, `we have made improvements as a result of listening to the residents, their reatives and representatives and changed the environment and the way in which we work to enable people to spend more time out of their wheelchairs by providing physio mats and wedges in the lounge.` What the care home could do better: The manager wrote in the AQAA that, `further developments are planned to improve and up-date the residents` communication profiles and to produce a clear interaction plan including more visual prompts, objects of reference and to explore the use of audio/video`. He also intended to continue to expand opportunities for residents to become more involved within their home in dayto-day household tasks, increase opportunities for residents to spend time out of their wheelchairs thus increasing comfort/freedom of movement.To achieve this he planned to introduce a more effective shift planning and recruit a full staff team. Staff, who completed surveys thought that, `perhaps some staff could be a little more flexible,` and `that team building exercises might lead to improved outcomes for the residents.` The staff personnel files were contained in loose leaf folders and should be bound to protect the personal information contained in them from going astray and organised to faciltate the location of documents. Policies and procedures were not all up-to-date with current practice and legislation to inform the staff and cover all current care practise engaged in by the staff. CARE HOME ADULTS 18-65 Pines (The) (Hindhead) Whitmore Vale House Churt Road Hindhead Surrey GU26 6NL Lead Inspector Christine Bowman Unannounced Inspection 14th February 2008 11:00 Pines (The) (Hindhead) DS0000013746.V358024.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 Pines (The) (Hindhead) DS0000013746.V358024.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. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pines (The) (Hindhead) Address Whitmore Vale House Churt Road Hindhead Surrey GU26 6NL 01428 604477 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) Stephenh@whitmorevale.co.uk Whitmore Vale Housing Association Mr Stephen Gordon Hindmarch Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - (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) 2. Physical Disability - (PD) The maximum number of service users to be accommodated is 5. Date of last inspection 4th May 2006 Brief Description of the Service: The Pines is a large detached house providing accommodation and care for up to five service users with physical and learning disabilities. The existing service users are young adults. The home is situated in a rural area on the outskirts of Hindhead. The home shares its premises with the association’s main office, and another care home, which is owned by the Whitmore Vale Housing Association. However, The Pines has maintained its own separate identity and has it’s own entrance. All bedrooms are single rooms with washing facilities. The communal facilities compromise of a large lounge with pleasant views over the large garden and into the valley below. There is a nicely decorated separate dining area, a large kitchen and a laundry room. The bathrooms are quite large, and it has been well adapted to meet the needs of the residents. Service users have access to a well- equipped sensory-room. The fenced and walled terrace to the front of the house is easily accessible for wheelchair users. The home has its own transport and there is ample car parking. The fees charged range from £1,488.70 to £2038.09 per week inclusive of all facilities and services provided. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over five and a half hours and was undertaken by Ms Christine Bowman, regulation inspector. The manager, Mr Steven Hindmarch, was present all day to assist with the inspection process. Throughout the day service users and staff were spoken with and observed as they carried out their daily routines. The Annual Quality Assurance Assessment (AQAA) had been completed by the manager and sent to the Commission for Social Care Inspection (CSCI) to show how the service had improved over the previous year and how the service users’ views were incorporated into all aspects of the running of the home including plans for the future. Other information recorded on the inspection record since the previous site visit was also taken into consideration. The AQAA recorded that individualised communication profiles had been prepared for all the residents to enable a better understanding and greater interaction between service user and their support staff and that staff had accessed training in intensive interaction which is a way of building relationships with people with profound learning disabilities and complex needs. Observations confirmed that the staff understood the service users’ needs very well and one service user had been assisted to complete a pictorial survey to give their views of the service. Five staff members also completed surveys and comments from these sources have been included in the report. A tour of the premises was conducted and three resident’s bedrooms were viewed. Outcomes for service users in respect of the key inspection standards for Care Homes for Younger Adults were assessed and records were sampled including service users’ care plans, staff personnel files, medication administration records, maintenance certificates and accident/ incident and complaints/compliments files to confirm the welfare and safety of the service users was promoted. The home’s own quality assurance process was also viewed. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. Thanks are offered to the management and staff of The Pines for their assistance and hospitality during the visit and to the resident and the staff members for completing surveys. What the service does well: Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 6 Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support. Care plans were written from the point of view of the resident and included their preferences, likes and dislikes with respect to all aspects of their health and personal care and included the gender of their carers. Residents’ cultural and religious needs were fully explored and every effort had been made to fulfil them. Communication profiles described to the staff the meaning behind the expressions and movements the residents used to make their feelings known. Residents were encouraged to make choices and, where these had already been established, they were recorded in the care plan to inform the staff. The resident who completed a survey with support commented, ‘I go to the Harbour Day Centre, which I enjoy, have visits and phone calls to my family and choose my meals and drinks and what clothes to wear.’ Movement programmes were in place and guidelines on moving and handling for the staff had been provided by a physiotherpist with photographs to illustrate exactly how they should carry out these tasks for the safety and comfort of the resident. The home provided a specially adapted minibus for wheelchair users to support the residents to access the community and ‘shopping trips and meals out at local pubs and restaurants were frequently taken’, the manager stated. A staff member commented, ‘I have worked in care for the last eight years and I think the Pines provides an excellent service. Whitmore Vale have encouraged me to study and complete my National Vocational Qualification at level 3 in Social Care, setting aside the necessary working hours to enable me to study and enjoy completing this qualification.’ An educational professional commented in the home’s quality assurance questionnaire, ‘we have good support from The Pines and the residents are happy and well cared for. They keep us well-informed concerning the resident who attends, have a person-centred approach, and keep the residents involved in the day-to-day running of their home.’ A healthcare professional commented, ‘Support at The Pines is professional, consistent, caring and individual needs are catered for.’ This service is good at identifying and planning improvements to the service taking into consideration the views of the residents, their relatives and representatives to ensure the service is run in their best interests. What has improved since the last inspection? An enthusiastic new manager with many years of experience in the field of Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 7 social care and qualifications in care and management had been recruited since the previous site visit and had applied for and been accepted as registered manager for the home. He was in the process of introducing changes in a measured way. The complaints procedure had been made more accessible by the introduction of forms, which could be completed to give comments on what the Pines could do better, and these were welcomed for the continuous improvement of the service. Greater emphasis had been placed on involving residents more in day to day activities within their home such as cooking and cleaning, aimed at developing skills, increasing confidence and promoting greater interaction and involvement. Light wood-effect flooring had been laid in the communal rooms, replacing the carpets, providing a pleasant and modern feel, and enhancing the homely environment for the residents. ‘Other remaining carpeted areas were regularly cleaned’, the manager stated. One resident had been involved in the complete refurbishment of their bedroom. The manager wrote in the Annual Quality Assurance Assessment, ‘we have made improvements as a result of listening to the residents, their reatives and representatives and changed the environment and the way in which we work to enable people to spend more time out of their wheelchairs by providing physio mats and wedges in the lounge.’ What they could do better: The manager wrote in the AQAA that, ‘further developments are planned to improve and up-date the residents’ communication profiles and to produce a clear interaction plan including more visual prompts, objects of reference and to explore the use of audio/video’. He also intended to continue to expand opportunities for residents to become more involved within their home in dayto-day household tasks, increase opportunities for residents to spend time out of their wheelchairs thus increasing comfort/freedom of movement.To achieve this he planned to introduce a more effective shift planning and recruit a full staff team. Staff, who completed surveys thought that, ‘perhaps some staff could be a little more flexible,’ and ‘that team building exercises might lead to improved outcomes for the residents.’ The staff personnel files were contained in loose leaf folders and should be bound to protect the personal information contained in them from going astray and organised to faciltate the location of documents. Policies and procedures were not all up-to-date with current practice and legislation to inform the staff and cover all current care practise engaged in by the staff. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 8 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. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 9 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 Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 10 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): Standards 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides sufficient information in suitable formats to enable prospective residents, their relatives/friends/representatives to decide if the home will meet their needs and a thorough assessment is carried out to ensure the home is able to meet those needs. EVIDENCE: The Statement of Purpose and the Service User Guide provided sufficient information for residents, prospective residents, their relatives and representatives to make a decision about the ability of the service to meet their needs. The new registered manager had reviewed the service user guide in July 2007. It was written in a person-centred way and included photographs of the staff and drawings and symbols to promote the understanding of current and prospective residents with learning disabilities and communication needs. The resident, who completed a survey with support from a carer, confirmed they had been asked if they wanted to move into this home and that they had enough information about the home before they moved in to decide if it was right for them. The manager wrote in the Annual Quality Assurance Assessment, ‘Over the last twelve months we have employed a business manager to offer advice and support in the production of policies, website and brochures and we now have an internet website in addition to the required brochures. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 11 Four of the five residents living at the home had been admitted when the home was first opened and since the previous site visit a resident with a lifethreatening illness had died. The organisation had requested a short-stay emergency placement for a resident of another Whitmore Vale home due to their need for the specialist equipment provided by the Pines and until the original home was able to put the necessary equipment in place. The admissions process was described clearly in the service user guide and included visits to the home to be introduced to the other residents and the staff and short stays to sample life there. A comprehensive assessment procedure and documentation were available to support this process covering all aspects of the service user’s health, social and personal care needs. Information with respect to equality and diversity was collected to enable an individual approach to the service user’s care needs. Assessment documentation viewed on service users’ files included personal details including ethnic origin, religious and cultural needs, communication needs, health and personal care needs and the likes, dislikes and preferences of the service user from which a person-centred plan of care had been drawn up. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 12 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): Standards 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person-centred planning promotes the involvement of service users in decision-making about their lives with appropriate support and independence is promoted through the balancing of the risk factors involved. EVIDENCE: Two residents files were sampled and each contained a personal profile including information with respect to ethnic origin and cultural and religious needs. One resident’s care plan recorded that they were supported to attend church on Sundays and the other resident’s care plan described how they were supported to practice the Hindu faith, describing the daily rituals the resident needed support to carry out, the religious festivals they celebrated including preparations to be made and special dietry requirements. Care plans were written from the point of view of the resident and included their preferences, likes and dislikes with respect to all aspects of their personal care and including the gender of their carer. Communication profiles described to the Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 13 staff the meaning behind the expressions and movements the residents used to make their feelings known. The manager wrote in the AQAA that, ‘further developments are planned to improve and up-date the residents’ communication profiles and to produce a clear interaction plan including more visual prompts, objects of reference and to explore the use of audio/video’. Review dates confirmed the regular monitoring and up-dating of the care plans and were signed by relatives/representatives to confirm their involvement. Residents were encouraged to make choices and, where these had already been established, they were recorded in the care plan to inform the staff. One resident had recently chosen the colour scheme and pictures for their bedroom. The resident who completed a survey with support commented, ‘I go to the Harbour Day Centre, which I enjoy, have visits and phone calls to my family and choose my meals and drinks and what clothes to wear.’ Involvement in all aspects of daily living were encouraged to the level of the resident’s ability and the manager stated that some residents liked to be involved in meal preparation and one enjoyed helping to make their bed. The manager recorded in the AQAA that improvements planned over the next twelve months were to, ‘continue to expand opportunities for residents to become more involved in daily living skills within their home and to identify goals for each resident aimed at promoting greater independence’. When necessary the use of advocates was actively encouraged and the home promoted local advocacy groups to residents representatives. Risk assessments included in the residents’ care plans gave instructions to the staff on how to avoid hazards whist ensuring the residends remained as independent as they were able. Movement programmes were in place and guidelines on moving and handling for the staff had been provided by a physiotherpist with photographs to illustrate exactly how they should carry out these tasks for the safety and comfort of the client. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in appropriate activities that take account of their needs and preferences, they are supported to maintain personal relationships and to be part of the local community. Residents’ rights are recognised and they are offered a healthy diet that reflects their individual tastes and dietary needs. EVIDENCE: On the day of the site visit some of the residents were attending day services in the community. Weekly activity plans showed that one resident attended three sessions per week and another had a full time placement. The resident who completed a survey confirmed they always made decisions about what they do each day and commented, ‘I go to the Harbour Day Centre, which I enjoy’. Records showed that the resident benefited from a variety of educational courses including art and craft, discussion group, drama, swimming and music. The resident confirmed they could do what they wanted during the day, in the evening and at weekends but ‘this often depends on the staff.’ Another resident had favourite compact discs and enjoyed clapping Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 15 to the rhythm of the music. ‘They also liked cooking and trips out and were popular at the day centre they attended’, the manager stated. Two residents especially enjoyed spending time in the sensory room experiencing the stimulation of sensory objects, music, lighting and the waterbed. The home provided a specially adapted minibus for wheelchair users to support the residents to access the community and ‘shopping trips and meals out at local pubs and restaurants were frequently taken’, the manager stated. Records showed that the residents had benefited from a variety of planned trips throughout the past year including a visit to Southsea for a walk along the sea front and a visit to the Aquarium, visits to an Open Air Museum, Bird world, Frimley Park Lodge, Dapdune Wharf and one resident, who was interested in history, had visits planned to Portsmouth and London. The home actively supported the residents to keep in regular contact with their families and friends by keeping notes of birthdays or special occasions and supporting the sending of cards/presents, regular telephonecalls and visits. ‘We also encourage visits to the home and make people welcome when they visit’ the manager stated. The manager recorded in the AQAA that improvements made as a result of listening to residents, their relatives, and representatives included the provision of more structured movement/physio sessions and had changed the way in which the home works with residents to enable them to become more involved in everyday tasks within their home such as cooking and cleaning. Residents’ preferences with respect to food was recorded in their care plans and one resident especially liked mango, avacado and stewed apple but could not eat beef for religious reasons. Staff personnel files sampled confirmed that food hygiene certificates had been obtained for the safe handling of food. A balanced menu was provided with plenty of choice and care plans recorded how residents were to be assisted to eat and drink in a safe, unrushed and respectful manner. On the tour of the premises, a resident was observed being assisted to eat an orange by a member of staff, who was sensitively encouraging them. Towards the end of the site visit, a pleasant aroma of the evening meal in the process of being prepared, permeated the air and a support worker assisted by a resident were cooking chicken masala for tea in the kitchen. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 16 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): Standards 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal, health, physical and emotional needs are met according to their preferences and wishes and safe procedures promote their access to medication. EVIDENCE: Care plans sampled recorded how one client , ‘liked to look nice and buy new clothes’, and their support needs with respect to dressing clearly stated their preferences. The five carers who completed surveys confirmed they were always given up-to-date information about the needs of the people they support or care for. Comments from carers included, ‘Staff are always encouraged to provide input to the care planning process’ and ‘all information relevant is passed on in care plans and at handover meetings.’ Records were kept of specialist involvement including physiotherapists, district nurses, General Practitioners, chiropodists, dentists and an aroma-therapist and the home had a number of compliments from healthcare professionals in their own quality assurance surveys included, ‘support at the Pines is excellent Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 17 and always appropriate, with excellent standards and levels of care’. Carers confirmed in the surveys they completed that the results from hospital visits, doctors and other specialist appointments were always passed on to the staff for their information. Good records were kept for the monitoring of dietary intake and elimination to ensure prompt identification and response to residents’ changing health needs and the manager stated, ‘we have developed support networks in the community with a range of specialists including a speech therapist, dietitian and the epilepsy nurse and we ensure the privacy and dignity of the residents is protected by giving all intimate care in private and following our policy of always knockinging on doors before entering the residents’ bed and bathrooms. Medication administration records for two service users were sampled, neither of which were able to self-medicate. Both had a clear photograph of the service user for identification, information was clearly recorded, a sample of staff signatures kept and also records of medication received and returned to the pharmacy. Most of the medication was supplied in a monitored dosage system from the local pharmacy and protocols were in place giving instruction to staff on when and how often to administer ‘as required’ or ‘as directed’ medication to prevent errors to safeguard the service users. Staff personnel records confirmed that the staff responsible for the administration of medication had accessed medication training. ‘The shift leader maintained responsibility for the medication’, the manager stated, ‘and audits were carried out twice daily’. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 18 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): Standards 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home endeavours to ensure that the communication needs of the residents are met to enable them to make their feelings, wishes and views know so they may be acted upon. Complaints are welcomed and systems are in place to protect the service users from the possibility of abuse, neglect and self-harm. EVIDENCE: The home had a clear complaints policy and procedure and a pictorial version for the residents, which were displayed on a notice board to inform residents, their relatives, friends and representative of the process should they wish to use it. The manager had also produced forms, which could be completed to give comments on what the Pines could do better, and their completion was welcomed for the continuous improvement of the service. Since the previous site visit the home had received one complaint, which was in the process of investigation. The Commission for Social Care Inspection had received a concern, which was then shared with the home by the person concerned, and a satisfactory outcome had been achieved. The resident, who completed a survey with support from the staff, confirmed knew who to speak to if they were not happy and how to make a complaint. They commented, ‘I have voiced concerns in the past and these have been addressed and sorted out.’ The staff member supporting the resident commented, ‘this resident has voiced concerns to both support staff and management in the past.’ Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 19 The five staff who completed surveys were all aware of the procedure to follow should a resident, their relative or representative have concerns about the home. A staff member commented, ‘I would reassure the complainant, always following company procedure and inform the complainant of outcome of the enquiry.’ The home provides staff training in ‘Intensive Interaction’ and has developed individual communication profiles to promote the understanding of residents’ feelings and views. The manager recorded in the Annual Quality Assurance Assessment that the home, ‘intends to make further improvements to the complaints/comments procedure making it more user friendly and accessible and to encouage the greater use of the quick comment/concerns form’. The home held a copy of the local authority ‘Safeguarding Adults Policy and Procedure’ to inform the staff of the referral process and the local authority contact details should they need to make a referral. The manager stated that he had attended ‘Safeguarding Training’ provided by an independent trainer and by the local authority. Staff training records showed that all the staff attended the Protection of Vulnerable Adults training annually. Certificates held on staff personnel files verified this. The staff recruitment process safeguarded residents and records confirmed that the staff, whose files were viewed, had been through rigorous recruitment checks including Criminal Record Bureau and the Protection of Vulnerable Adults list checks prior to the offer of employment. Over the previous twelve months one safeguarding referral had been made by the home with respect to a resident being upset because they had been left alone in a minibus by another agency. Appropriate procedures had been followed and a plan had been drawn up to ensure the situation would not recur. A letter of apology in symbolic format was filed in the resident’s folder. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 20 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): Standards 24,25,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, homely and safe environment, which is adapted to meet their needs and clean and hygienic. EVIDENCE: A tour of the premises was undertaken and three residents bedrooms were viewed. The manager stated that the home had originally been a hotel and the communal living area contained some original features such as high ceilings with decorative moulding, original fireplaces and other ornate features, which gave a feeling of elegance. The large window in the sitting room made the room light and airy and glass doors connected this room to the dining room providing another source of light. There was a window seat around the large window looking out onto the terrace below and a view through the wooded area beyond. Light wood-effect flooring had been laid in the communal rooms, replacing the carpets and providing a pleasant and more modern feel to the home. ‘Other remaining carpeted areas are regularly cleaned’, the manager Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 21 stated. Pictures, which had been created by the residents, were nicely framed and displayed on the walls and potted plants enhanced the environment. The home was wheelchair friendly, being spacious and having extra large door frames and ramps. Some electrical points at higher levels and some low level kitchen and laundry work tops enabled the residents to participate in the activites of daily life. The manager wrote in the Annual Quality Assurance Assessment, ‘we have made improvements as a result of listening to the residents, their reatives and representatives and changed the environment and the way in which we work to enable people to spend more time out of their wheelchairs by providing physio mats and wedges in the lounge’. It was good to see the bowl of fruit in the kitchen contained a number of mangoes noted in a resident’s care plan to be one of their favouite fruits. In addition to the shared rooms already mentioned, the home provided a sensory room, which, ‘two of the residents particularly enjoy’, the manager stated, ‘they like the waterbed, the music, the light settings and the soft toys.’ The room contained many and varied objects, including a water feature, for sensory stimulation, mobiles hanging from the ceiling and other specialist equipment to support residents with limited mobily to have pleasurable sensory experiences safely. The terrace at the front of the home provided a safe area for residents to enjoy the fresh air and the view and in the summer months, the manager stated, the residents like to sit outside under the parasols and have bar-bcues. The home was, however, situated on a hill and accessed by a narrow winding road with a steep gradient which did not promote the residents’ ability to access the local community independently of the specialised transport, which was provided. One of the resident’s bedrooms, which was viewed, had recently been redecorated. The resident had chosen the colour scheme and the soft furnishings, the manager stated. Large posters of London shows covered the walls and a collection of music, story tapes and family photographs personalised the space. Suitable domestic furnishings were provided and a wash hand basin for personal use. The bedrooms and shower room viewed contained the specialist equipment necessary to support residents with their mobility needs and to ensure their safety. One bathroom was in need of refurbishment and was not in use because the resident, who preferred and was able to use the bath had an ensuite bathroom. The manager stated that a decision would be made with respect to this bathroom when the needs of the permanent new resident were known. The home had a separate sluicing room in addition to the laundry room and both were appropriately equipped with impermeable surfaces and suitable facilities. There was an infection control policy and there was evidence of infection prevention and control training as part of the induction process but Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 22 no evidence in the staff records viewed that this training had been regularly updated. The home was clean and fresh on the day of the site visit and a resident commented in the survey they completed with support from the staff that they, ‘thought the home was always fresh and clean. An on-going programme of maintenance, repair and refurbishment ensures this home is a comfortable, safe and pleasant place for the residents to live. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Safe recruitment practices, appropriate induction and mandatory and specialist training prepare the staff for the supportive role and to meet the service users’ individual needs. EVIDENCE: The AQAA confirmed that more than 50 of the staff team had either achieved a National Vocational Training Qualification at Level 2 or above or were working towards one. Four of the five staff who completed surveys thought there were always enough staff to meet the individual needs of the residents and one that thought there usually were. One carer commented, ‘extra staff are supplied if they are needed and there is always enough staff on each shift to meet the needs of the residents. If we are short of staff for some reason our manager is always there to help,’ and another carer wrote, ‘this service is very good at ensuring enough staff are on duty to meet the residents’ needs, attend appointments and take outings.’ Three full-time staff had left in the previous twelve months and the manager stated that a recruitment drive had been instigated. In the meantime agency staff, who were familiar with the home, had undergone the necessary checks and been appropriately inducted were being used by the home. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 24 The recruitment procedure, described by the manager, was confirmed in the records of two newly recruited staff. The five staff, who completed surveys, confirmed their employer carried out checks, such as CRB and references, before they started work. One carer commented, ‘one of my references was late and I was not allowed to commence work until all written references were received and CRB check was returned.’ Four of the five thought the induction covered everything they needed to know to do the job when they started and one thought it mostly did. The staff induction programme was based on the Common Induction Standards with modules from The Learning Disability Award Framework to support staff working with people with learning disabilities. The AQAA recorded that, ‘The Pines support staff are a mixed ethnic group reflecting the local population. To support equality and diversity legislation a date of birth is no longer requested on the recruitment application form, therefore when shortlisting takes place the risk of ageism is reduced.’ The manager stated that ‘the majority of team members have attended a training day on equality and diversity and further training and refresher training for all team members is planned.’ The staff personnel files contained the relevant documents to confirm safe recruitment but were not bound to protect the personal information from going astray or organised to faciltate the location of documents. The manager stated that, ‘both our business and training managers are currently reviewing our recruitment process’. All the five support workers who completed surveys confirmed the training they were given was relevant to their role, helped them understand and meet the individual needs of the service users with respect to equality and diversity and kept them up to date with new ways of working. One support worker commented, ‘I am encouraged to attend not only statutory training courses but also courses that are appropriate to the service users’ needs such as an Interactive Communication course,’ another support worker stated, ‘my training is always up-dated,’ and ‘we all go on regular training and are trained to a high standard.’ Certificates viewed on the staff files sampled included, the Principles of Manual Handling, Health and Safety, Fire Safety Awareness, Fist Aid, Food Safety, Epilepsy Awareness, Equality and Diversity, Medication Administration and Safeguarding Adults. The Introduction to Intensive Interaction training was explained as a way of building relationships with people with profound learning disabilities and complex needs and had been undertaken by the staff whose files were sampled. The resident who completed a survey confirmed the staff always treat them well and that they always listen and act on what they say. The resident was supported to complete the survey by a student nurse who wrote, ‘ I have assisted the resident to complete this form acting as his advocate. Questions that in my opinion they did not understand I have only partially completed or left blank. On the whole the resident appears to be happy with the service.’ The manager had written in the AQAA of improvements he intends to Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 25 introduce in the next twelve months including, ‘ensuring all night support workers receive regular supervision sessions and completing the recruitment drive’. Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 26 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): Standards 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well managed home which is run in their best interests. Their health, safety and welfare is promoted and protected. EVIDENCE: An enthusiastic new manager with many years of experience in the field of social care and qualifications in care and management had been recruited since the previous site visit and had applied for and been accepted as registered manager for the home. He was instigating change in a measured and considered manner and had an open and inclusive management style. The manager stated that the organisation was very supportive and ensured the residents’ needs were fulfilled as a priority. The Chief Executive and the Assistant Chief Executive carry out the statutory monthly visits, the manager stated. The support staff were complimentary about the manager and all Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 27 those who completed surveys confirmed their manager met regularly with them to give support and to discuss how they were working. One support worker commented, ‘I receive regular supervision from my manager which I find helpful. Also my manager is always available should I have a problem and he will always find time to support his staff.’ Another support worker stated, ‘My manager is very good at answering any questions, if he does not know the answered he will find out from someone who knows for instance a physiotherapist, a General Practitioner or a district nurse.’ The homes’ annual quality assurance surveys had been returned and they contained many positive comments from residents, their relatives /friends and representatives and other stakeholders including health, educational and social care professionals. One resident commented, ‘I like my room especially now it’s been decorated’. A staff member from the Harbour Day Centre, which one of the service users attends stated, ‘we have good support from The Pines and the residents are happy and well cared for, they keep us wellinformed concerning the resident who attends, have a person-centred approach, and keep the residents involved in the day-to-day running of their home.’ A healthcare professional commented, ‘Support at The Pines is professional, consistent, caring and individual needs are catered for.’ The manager wrote in the Annual Quality Assurance Assessment, ‘barriers to improvement in the undertaking of the home’s quality assurance assessment was that the residents have limited understanding/speech and as such it has been difficult to develop user friendly formats to gain accurate first hand feedback regarding the service on offer, however investing in further intensive interaction training is reducing this barrier.’ The manager stated that the quality assurance assessment feedback informed the annual development plan and planned improvements recorded in the AQAA confirmed that this service was continuously seeking to develop the service in the best interests of the residents. The Annual Quality Assurance Assessment (AQAA) completed by the manager and sent to the Commission for Social Care Inspection recorded that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body and certificates for the gas appliances and the boiler sampled confirmed they had been serviced in 2007. The Control of Substances Hazardous to Health (COSHH) had been appropriately risk assessed to safeguard the residents, the COSHH cupboard was secured and the equipment was colour coded for hygiene purposes. Policies and procedures and codes of practice in relation to Health and Safety had not all been reviewed in a timely manner to ensure the staff were kept up-to-date with current legislation and practice. Policies and procedures listed did not include pressure relief although special equipment had been purchased and a client was at risk of developing pressure areas and there was no policy reflecting the home’s access for staff to the ‘Common Induction Standards’ to inform the staff. Maintenance certificates sampled were up-to-date and staff training logs confirmed that training in manual handling, food hygiene, first aid, fire training, risk assessment and Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 28 receive regular refresher training had been regularly updated to inform the staff. Records were kept of accidents and other serious incidences and the home kept the Commission for Social Care Inspection appropriately informed of such events. There was an ongoing programme of maintenance and repair. A staff member commented, ‘I have worked in care for the last eight years and I think The Pines provides an excellent service. Whitmore Vale have encouraged me to study and complete my National Vocational Qualification at level 3 in Social Care, setting aside the necessary working hours to enable me to study and enjoy completing this qualification.’ Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations The staff personnel files should be bound to protect the personal information contained in them from going astray and organised to faciltate the location of documents. Policies and procedures should be kept up-to-date with current practice and legislation to inform the staff and cover all current care practise engaged in by the staff. 2. YA40 Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South East Oast House Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pines (The) (Hindhead) DS0000013746.V358024.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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