Care Home: Turning Point Hazel House

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What the care home does well People who live in the house said that they felt supported and encouraged to be involved in the running and decision making of the house and to live as they wished. Hazel House have a dedicated and experienced manger who is focused on the needs of the people who live in the home. There is a stable staff team who were very positive about working the training and support they received. The home has a good ratio of staff. Observation of the interaction between staff and the people who live in the home showed a natural mutual respect. There was good evidence of promotion of equality and diversity. The manager has developed a good detailed continuity plan in the event of any emergency. What has improved since the last inspection? All of the people spoken with in the home knew what to do if they wanted to complain or raise a concern. There is good management of medication. All the window restrictors are in place. The issue of risk assessments for people who smoke had been addressed though it needs to be developed further. What the care home could do better: The decoration and maintenance of the home needs attention. The lounge used by smokers needs to be decorated urgently as it is in a neglected state. This room was purposefully left out of the last decoration whilst its future was being determined. The consultation is planned for the next month and the urgentTurning Point Hazel HouseDS0000026015.V376235.R01.S.doc Version 5.2 redecoration and refurbishment needs to take place following that. The level of cleanliness needs to improve with particular attention to people`s rooms, the kitchen and the exterior of the home. The management and recording of the weekly support sessions needs to improve to ensure that there are action plans with follow up and continuity. The activities and personal development of people needs to be increased. People`s diets need to be monitored and recorded so as to ensure each person has a balanced healthy diet. Key inspection report CARE HOME ADULTS 18-65 Turning Point Hazel House 67 Warwick Road London SW5 9ST Lead Inspector Ann Gavin Key Unannounced Inspection 14th July 2009 10:40 Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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 home adults 18-65 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. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 2 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 Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Turning Point Hazel House Address 67 Warwick Road London SW5 9ST 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) 020 7244 7533 020 7244 6874 christine.dearden@turning-point.co.uk www.turning-point.co.uk Turning Point Limited Ms Christine Dearden Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 10 15th October 2007 Date of last inspection Brief Description of the Service: Hazel House is a large terraced property providing accommodation for up to 10 people with a mental illness. The registered provider is Turning Point Ltd. a registered charity. Accommodation over the five floors includes a non-smoking dining area, kitchen, laundry and a toilet on the lower ground floor. The team office, sleep-in room, lounge, toilet and separate shower room with toilet are on the ground floor. There are four bedrooms on the first floor, two on the second and four on the third floor. All floors where service users are accommodated have bathing and toilet facilities. To the rear of the home there is a large garden, which is shared with the occupants of the surrounding buildings. The home is accessed via steps up to the front door, and the upper floors by internal stairs. The home is not accessible for people with limited mobility. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection undertaken by the lead inspector and Local Area Manager took place on Tuesday 14th July 2009 from 10:40 – 16:10. Time was spent talking with five people living in the home, two staff and the home’s Manager. The care of two residents was tracked through talking with them, their key worker and reviewing their care records. The people who live in the home were positive about the staff and the support they receive. Their comments are included throughout the report. The weekly fee for the service is £1,065.44. What the service does well: What has improved since the last inspection? What they could do better: The decoration and maintenance of the home needs attention. The lounge used by smokers needs to be decorated urgently as it is in a neglected state. This room was purposefully left out of the last decoration whilst its future was being determined. The consultation is planned for the next month and the urgent Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 6 redecoration and refurbishment needs to take place following that. The level of cleanliness needs to improve with particular attention to people’s rooms, the kitchen and the exterior of the home. The management and recording of the weekly support sessions needs to improve to ensure that there are action plans with follow up and continuity. The activities and personal development of people needs to be increased. People’s diets need to be monitored and recorded so as to ensure each person has a balanced healthy diet. 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. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hazel House provides good information for prospective residents. Each person has a full assessment of their needs and aspirations prior to admission. EVIDENCE: ‘We ensure that a thorough assessment takes place before a new service user moves into Hazel House. All referral documentation i.e. risk assessment/CPA reports/care plans is gathered prior to formal care needs assessment. The assessment is carried out by senior workers at the Home, with input from the potential service user and their family/friends/advocates (as appropriate) for service user, and external professionals’ ‘Extract from the Managers Annual Quality Assurance Assessment (AQAA) Looking at the two care plans it was clear that the admission process to the home is very thorough. Each person had a detailed agency and client assessment referral, an assessment from Kensington and Chelsea Social Services and health professional assessments. All of the four residents spoken with had been given good information about the home. Each confirmed that they were given an opportunity to visit and spend time in the home. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 9 One of the residents talked through the way they were admitted. Initially they met someone from Hazel House this was followed by an invitation to spend an afternoon, then an overnight before being admitted. They said that they were given a choice of two placements and Hazel House was the preferred choice of both themselves and their care managers. Residents were clear about what to expect at Hazel House and signed up to the house rules and a civil rights form which clarified, amongst other aspects, what to do if you had a complaint, wished to have an advocate. The house rules were updated in May this year. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are involved in the planning of their care and support. They are involved in assessing risks to their safety. However these need to be developed further with clear details of the actual risks and the actions taken to minimise them for the safety of residents. EVIDENCE: ‘The staff are really helpful. I can always talk with them’ Quote from a resident The care plans of two people living in the home were looked at. They showed that residents were involved in the creation of their plan of care and in setting achievable goals. The care plans covered residents’ mental and physical health, medication, social networks, living skills, cultural and spiritual factors, activities and finance. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 11 The plans gave a good profile of the resident and the aspects they wished to work on and develop in each area. One person wanted to build up their confidence and skills with cooking, laundry and keeping themselves and their room clean. They agreed to be supported in this by the staff through daily cleaning with staff prompting and working along side them. The care plan is followed through weekly support sessions with either a project worker or support worker. The typed weekly support notes two people were seen. Whilst the notes were focused on the resident there was a concern of lack of continuity and consistency. One person saw two different support workers over a three week period. One had set goals but the next worker did not follow up on these and set other goals with no reference to the previous session which is confusing. One resident said they had got stuck in the bath yet there was neither a goal set nor new risk assessment. A plan needs to be set out as to how to support the resident in the future. One resident spoken with said how staff had been speaking about getting them a subscription to a specific magazine. This was also noted in the weekly session some weeks earlier. The resident had asked but the staff member did not have the information about who was obtaining the subscription. There was no follow up of this by staff the following week. Another staff member had completed a one off session with a resident on a specific subject. The other residents weekly support notes seen found that the resident and worker had been discussing helping with showering for some weeks but there was no goal set as to how this might be achieved. The last session was dated the 23 June. The Manager looked for the notes of the last two sessions and found that they were not on the shared drive she said these probably were filed in the staff private drive. Many of the sessions seen in both files were not signed by the resident. Staff must improve the management and recording of the weekly support sessions for residents so that there is always continuity with action plans in place which are followed up. Alongside the care plan are risk assessments of the various areas of people lives and a clinical risk profile completed by health professionals. These were present in the two files seen and were personalised to the resident and to any potential area of risk assessments. There were some good clear risk assessment and action plans regarding vulnerability around finance and safeguarding the resident as well as other areas the last inspection highlighted assessments around smoking. These had been completed but were vague and did not address the key areas and actions required. These need to be developed with clear details of the actual risks and the actions taken to minimise them for the safety of the specific resident and all those in the home. The assessment of risks specific to people living in the home involves a Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 12 number of different forms. Combining and simplifying the forms might ensure a more comprehensive overview of each person’s safety issues. The Manager and staff at Hazel House ensure that residents information is kept secure. Both care files had consent forms agreeing to the storage of their personal information as well as confidential waiver agreements to enable staff to share information on a need to know basis. The form was well designed to enable the resident to specify any person or group of person they specifically did not wish any information shared with. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,14,15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff respect people’s rights and choices and support people to with dignity and respect. There are opportunities for social and community activities which could be developed further. EVIDENCE: All service users, as part of their recovery, have an individual activities care plan. These plans are negotiated with the service user and care team to support individuals to engage in meaningful activities…. As much as it is possible - individuals are encouraged to make their own choices regarding activities and lifestyle. This is made possible by annual activity/satisfaction surveys, regular discussion of service user interests in monthly house meetings and planning individual interests in 1:1 keyworking sessions ‘Extract from the Managers Annual Quality Assurance Assessment (AQAA) Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 14 The people who live in Hazel House spoke of how they are free to choose to socialise and take part in activities. There are communal lounges and people were seen relaxing there. A number of people were also seen during the day in the lounge set aside for smokers. Everyone spoken with was looking forward to the planned annual holiday. There are two weekly groups, one for cooking the other a walking group. One of the people spoken with said they were trying to become more interested in the cooking. They were aware it was an area where they needed support to develop their skills. They said the staff were very supportive. People were observed going for walks in the private shared garden at the rear of the home. Throughout the home there were photographs of past holidays and previous days out. Some of the people in the home also access local day centres. The care plans showed that the manager and staff actively seek to address equality and diversity. In one of the one to one sessions it was suggested that more board games were purchased with a regular time set aside each week to invite people to use them. The level of in-house, social and community activities need to be further developed to enhance people’s experiences. Hazel House has a policy for visitors who are welcomed to the home subject to agreed restrictions. The manager said they are currently in the process of updating the policy together with the people who live in the home. There are monthly residents meetings and plans for the home are discussed. People can bring up any concerns or any area they wish to discuss. Every person in the home can prepare their own meals. The level of support is discussed at weekly sessions a range of support is offered tailored to the individual. Support can be from shopping and menu planning to support in meal preparation. Staff have the ability to work flexibly with people. The majority of people eat in the kitchen or the dining room people can also choose to eat in heir rooms. On Sundays there is a communal lunch. The kitchen is planned to be upgraded within the next few months which will greatly enhance people’s experience. The kitchen had posters, designed by the people is the home, on healthy eating. Looking at the fridge it needed to be cleaned. The staff had developed some food diaries and personalised menu books for some of the people in the home. Staff respect people’s right to choose what they wish to eat. It is recommended that a way of recording people’s diet is kept so as to be able to reflect with the people on their diet and ensure that it is nutritious and balanced. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their healthcare needs which are recorded and monitored. The home has good medication policy and procedures which they follow well. The manager and staff have worked well in creating ways to support those people who would like to quit/ cut down on smoking. EVIDENCE: ‘I was really looked after when I wasn’t well. The staff were really good’ ‘The staff helped me cut down my smoking from two pouches of tobacco a day to just 2 cigarettes a day. I feel so much better’ Quotes from residents All four residents spoken with said that they were well supported by the staff. The care plans reviewed had good information about peoples physical and mental and healthcare needs and the actions required to support them. One Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 16 person now needs some support with personal care. The staff will create a specific plan together with them to ensure that they are supported in a consistent and way best for them. Staff work closely with local care teams and healthcare colleagues. Every person is registered with a local GP and the staff support people with prompting or accompanying them to health appointments. Since the legislation banning smoking in public places Hazel House have been working closely with residents giving information and support around smoking and what help is available to stop smoking. The person quoted above was justly very proud of their ability to cut down their smoking so dramatically to virtually stopping. They said that they felt all the benefits in their health as well as financially. The manager and staff have produced a questionnaire for residents who smoke which includes asking if they would want to join a stop smoking group and if there was anything staff could do to support the resident in quitting/ cutting down on smoking. The manager said how they are now compiling one for people who do not smoke with regard to the ‘smoking’ lounge. The manager said they have spoken to the residents and invited residents from another turning point home to help facilitate questionnaires and polling residents about managing smoking within the home. The home uses a Monitored Dosage System supplied by Boots and prescribed medication is delivered in blister packs every 28 days. There were policy and procedures in place that were being followed by good practice. Medication is stored in a lockable metal cabinet in the staff office. All medication is dispensed from the office. The Medication Administration Record (MAR) sheets for nine people were checked. The records were well maintained and up to date. The Manager stated in their AQAA that they have introduced internal medication audits. Also that they plan to increase residents health awareness through a health and wellbeing group Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home say they feel they are listened to. They know what to do if they are unhappy EVIDENCE: ‘If I was unhappy about anything I would talk to my key worker. I could really talk to any of the staff’ Quote from resident All the people spoken with who live in the house said they would speak to their key worker or any member of staff if they were unhappy about anything or wished to make a complaint. Two of the people spoken to said that they have never had to complain. There is a suggestion box in the corridor and information is also available about how to make a complaint. There is a system to review and record complaints and compliments. Any complaint has been dealt with. The staff were aware of safeguarding people who lived in the home and the procedures to follow in the event of any incident. None of the people who live in the house currently have an advocate. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 18 Information about advocacy services was available throughout the home. The Manager is planning to promote the services of external organisations offering advocacy, advice, and support’ by inviting representatives to the monthly service user meeting to promote awareness among service users of available resources.’ Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides spacious accommodation though all of the home is in need of redecoration and an increase in the level of cleanliness. EVIDENCE: Hazel House is a large terraced building on a busy main road, close to the shops and transport links in Earl’s Court. It is not accessible to people with mobility problems, as there are steps to the front door and internal stairs to all bedrooms. However the Manager said that they are currently looking into the possibility of putting in a lift to make the home accessible. This has just been decided following a length of time of consultation which included looking into other premises and options to ensure accessibility for all. The home shares an enclosed, well-maintained garden/ park that offers a restful space to relax. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 20 A tour of all the communal parts of the home was undertaken as well as being invited to visit two residents’ bedrooms. The home provides spacious accommodation though all of the home is in need of redecoration. As mentioned previously the lounge for smokers is in urgent need of being cleaned, redecorated and refurbished. Where repairs have been made in the home they have not been ‘made good’ , some points had been put out of use but the surface left uncovered and parts of the home look unsightly and in need of redecoration. One of the bedrooms seen was in need of a good clean. This room the person had been supported to maintain their room every other day. However the fan and window ledges were dirty and in need of a wash. The linen was old, unclean and with a cigarette burn in the pillow case and with no cover on the duvet. The person smokes and only had a very small ashtray. There were burn marks all over the floor covering, the bedside locker and line. The provision of a larger ashtray with a lid and an urgent review of their risk assessment for their own and others safety is required. The kitchen, whilst needing an urgent refurbishment which is due in September was in need of a clean. The level of cleanliness of the fridge was unacceptable. Hazel House is on a major through route. However the front of the house looked neglected with dying plants, dirty front door and windows and ledges. A discussion was held with the Manager about using a simple hose to clean the front of the house. It is understood that there is not a power hose but it is still possible to clean. The home has a cleaner who comes in Monday to Friday for t=five hours a day to clean the communal areas. Staff are supposed to maintain hygiene in the kitchen fridges and support people to clean their room. The Manager said that they will ensure that a check list of what cleaning needs to be undertaken is completed. At an Annual Service Review of the home mentioned was made of the poor ventilation in the main office which is situated beside the ‘smoking’ lounge. This still needs to be attended to. There are enough bathrooms and toilets for residents’ use these are very bare and would benefit from being made more comfortable and homely. There is an office for the Manager, for the part-time administrator, a main office for staff as well as a second office which also acts as the staff sleep over room. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a stable and well qualified staff team who understand the support needs of the people who live in the home. Staff are supported and supervised. The staff and people who live in the home EVIDENCE: ‘It’s a friendly homely environment’ Quote from staff ‘It’s a good team, we all work well together’ ‘Rigorous recruitment process in place …Ongoing organisational and external training available to staff. All staff have undergone induction and core training provided by Turning Point and an ongoing training and development programme is in place. Equal Opportunity recruitment procedures are in place. Extract from the Managers Annual Quality Assurance Assessment (AQAA) Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 22 Time was spent talking with the Manager and two of the staff on duty. They were positive about their working experience. Observation of staff interaction with the people in the home showed that there was mutual respect and an understanding of their roles. The feedback from the people who live in the home was positive about the staff and the support they offer. On the day of the inspection the Manager was leading the induction of a deputy Manager. It was their first day. There were two other staff on duty and a further two staff came on duty after lunch. There is always a minium of two staff on duty. At night there is one waking night staff and staff member who sleeps in the home and would be available for emergencies. Staff confirmed that the staffing levels were good and that they felt supported in their roles. They said that they have regular supervision sessions which are then recorded. There are regular staff meetings which are minuted and agreed by staff. All staff were up to date with their core training and said that the level of training was good both in house and external. Most of the staff are either completing or have finished their National vocational training Level 3 (NVQ3) Staff maintain their own staff development files. These were seen and they were in need of being updated. The Manager said that they have just completed a review of staffing and are beginning a restructuring. The impact on the staffing level will be that there will be an increase of one support worker with the reduction of a project worker post. The support workers always do the waking night duty whereas the project workers only cover the night time as a sleep in. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hazel House benefits from having an experienced and committed Manager. They are focused on the needs of the people who live in the home and in developing the service. People who live in the home are able to give their views and are consulted in the running of the home. EVIDENCE: ‘The approach of the registered Manager is progressive and inclusive, creating a positive, enabling environment for staff and service users. Service user involvement is a particularly high priority at the Home, with regular satisfaction surveys, house meetings and active service user representation underpinning this principle. Service User views and choices are also central to the Homes individual service user care plans and person centred risk assessment, which are monitored and reviewed regularly’ Extract from the Managers Annual Quality Assurance Assessment (AQAA) Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 24 ‘The Manager is good and supportive’ Quote form staff The Registered Manager has an NVQ level 4 and is also UKPC registered psychotherapist. They have worked qt the home for four years and is both experienced and committed to working with people with a mental illness. Turning Point have been in discussions about the future of the home due in part to the lack of accessibility for people with mobility needs as well as part of a wider restructuring of care home and supported care units. The commission was not involved in any consultations but have been told by the Manager that the issue is now resolved. The management structure will remain the same and the home will be made accessible with a lift being planned. People in the home confirmed that they are consulted on the running of the home. This is also seen in the regular house meeting and the satisfaction surveys carried out. All people who live in the house will be consulted about the future of the ‘smoking’ lounge. The Manager has enlisted the help of people who live in another care setting to facilitate the consultation. A selection of records were seen all the health and safety records were up to date though care needs to be taken by staff to ensure they sign the records they complete. The accident and incident books were well completed with clear follow up actions which were dated and signed. Mention is made in other parts of this report to the lack of adequate recording of weekly sessions and also adequate fire risk assessments. There is an internal quality assurance system which involves the staff in monitoring the various aspects against the minimum standards. The manager has developed a good detailed continuity plan in the event of any emergency. Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 25 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 n/a 2 3 3 x 4 3 5 n/a 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 2 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 26 Turning Point Hazel House DS0000026015.V376235.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 Requirement Staff must improve the management and recording of the weekly support sessions for residents so that there is always continuity with action plans in place which are followed up. To ensure residents own and others safety risk assessments for all residents who smoke in their rooms need to be further developed with clear details and action plans. The lounge used by residents who smoke must be cleaned, redecorated and refurbished so that residents may live in a clean homely and safe environment The home needs to be decorated and repairs made good so as to enable residents live in a homely, clean and bright environment. The general cleanliness of the home must be improved both inside and outside. All surfaces, fittings must be cleaned. The kitchen and fridges need to be kept clean and hygienic. DS0000026015.V376235.R01.S.doc Timescale for action 31/07/09 2. YA9 13 (4) 31/07/09 3 YA24 23 30/09/09 4 YA24 23 30/11/09 5 YA24 23 31/07/09 Turning Point Hazel House Version 5.2 Page 27 Resident’s bedrooms need to be cleaned and bed linen changed regularly. 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 YA1 Good Practice Recommendations The assessment of risks specific to people living in the home involves a number of different forms. Combining and simplifying the forms might ensure a more comprehensive overview of each person’s safety issues. Resident’s diets need to be monitored and recorded so as to ensure each person has a balanced healthy diet. The manager and staff need to further develop social and community activities to enhance resident’s experiences. Resident’s bed linen needs to be renewed when it is worn . Staff development files need to be updated. 2. 3. 4. 5 YA17 YA12 YA26 YA35 Turning Point Hazel House DS0000026015.V376235.R01.S.doc Version 5.2 Page 28 Care Quality Commission National Enquiry Line: 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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