CARE HOME ADULTS 18-65
The Nak Centre Sundial House Coosebean Truro Cornwall TR4 9EA Lead Inspector
Lynda Kirtland Unannounced Inspection 24 September 2008 09:00
th The Nak Centre DS0000009157.V362687.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 The Nak Centre DS0000009157.V362687.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. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Nak Centre Address Sundial House Coosebean Truro Cornwall TR4 9EA 01872 241878 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) Mrs Anne Elizabeth Barrows Position Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25 September 2007 Brief Description of the Service: The Nak is a home providing accommodation and personal care for up to six adults with learning disabilities. It is owned and managed by the registered provider, who is in active daily charge of the home. A small team of care staff and a cook assist her. Residents live in a large, detached property with extensive grounds, in a semirural situation. The house is located on the outskirts of Truro, the centre of which is a few minutes drive away. The house has two floors, the upper floor being reached via stairs. There is one bedroom on the ground floor with en suite facilities and four on the upper floor. One of the bedrooms is currently a shared room. There is an additional bedroom for staff to sleep in at night. There are two bathrooms on the first floor. There are two lounges on the ground floor, with a very large entrance hall with additional seating. The home has a spacious kitchen, separate laundry facilities and an office on the ground floor. Fees range from £618.00-£694.27 per week, according to information supplied at the inspection. The registered provider said that additional, variable charges are made to service users for their personal toiletries and they are charged £10.00 per week to attend specific activities in the local Community. The Nak Centre DS0000009157.V362687.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.
An unannounced visit to the home occurred on the 24 September 2008 when we met with people who use the service, staff and the registered provider. The key inspection lasted for approximately seven hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people who use the service placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with people who use the service and opportunities to directly observe aspects of their daily lives in the home and staff interaction with them. Staff were interviewed, as was the Registered provider. We received two surveys from relatives. All were positive about the care that their relative received, the level of contact between them and the home is regular, felt staff were skilled in meeting the people who use the service needs and that they could not identify any areas for improvement in the home. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered provider, who also manages the home. The principle method used was case tracking. This involves examining the care notes and documents for a select number of people who use the service and following this through with interviews with them, where possible, and staff working with them. This provides a useful, indepth insight as to how their needs are being met in the home. At this inspection, two people who use the service were case tracked. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completed. The AQAA describes the services and facilities that The Nak provide and identify what areas they do well in and where they want to make further improvements. The inspector’s wishes to thank the people who use the service, staff and registered provider for their assistance in completing the inspection. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The registered provider has developed the care planning process further and is now combining the Mulberry care planning process with The Naks’ care plans. By combining these care documents they cover all physical, emotional, social
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 7 and specialist care needs and take into account the persons diverse needs. The care plans inform, direct and guide staff in their interventions with People who use the service to ensure a consistent approach in managing their care needs. In discussion with staff they said that the care plans were easy to understand and gave them ‘good information’ on how to provide care in a consistent manner. Where specialist input to address a particular care need has been identified guidance has been issued to staff in how to monitor certain behaviours and how to record them. This will then feed into the review of the care planning process. Health Action Plan documentation has also been introduced so that an individual’s health needs are accurately recorded. The risk assessments have been developed further and clearly link with their care plans. Staff have clearer guidance on what action to take if there was a risk to an activity they engage in / or management of challenging behaviour in the community, for example. The registered provider and deputy manager have attended ‘elder abuse’ course and have booked new staff to attend the Multi Agency Adult Protection training. The registered provider needs to make a minor amendment to the Nark’s adult protection procedures All staff have attended Boots Pharmacist medication training and are in consultation with specialist services to gain training in the administration of rectal diazepam Staffing levels have increased in the home. The registered provider has employed 2 permanent carers. She is in the process of employing a third carer and a housekeeper. This has meant that there is a consistent staff team that know the people who use the service well. Two staff members are on shift up till the evening when it reduces to one person who sleeps in. Staff said they felt staffing levels were sufficient. In addition the registered provider has now got more time to undertake management responsibilities. With the recruitment of new staff the registered provider has ensured that they have attended some mandatory training and other training has been booked. A minimum of 50 of staff have achieved NVQ level 2 so that People who use the service can have confidence in their skills. The carpet in the bathroom has been replaced with washable flooring to again prevent cross infections. The kitchen has been refurbished. The registered provider has reviewed some of the homes policies and procedures and is in process of reviewing others to ensure that they are up to date with recent legislation and work practices. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 8 What they could do better: 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. The Nak Centre DS0000009157.V362687.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 The Nak Centre DS0000009157.V362687.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): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to some written information about the home and are familiar with what it provides, this has been updated and reflects accurately the services the home provides. There is assessment information relating to People who use the service so that their changing needs can be monitored over time. EVIDENCE: Records indicate that all of the People who use the service have been placed in the home for some time. The most recent admission was in 1997 thus all of the people are aware of what the home provides through their ongoing experience of living there. The registered provider has a Statement Of Purpose and service users guide, which was inspected at the previous inspection and viewed as satisfactory. The registered provider is considering the presentation of these documents so that they are in a format that People who use the service can access more easily. Records of people who use the service initial assessments are held on their personal files, so they can be referred to, when reviewing their current needs. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service personal care plans have been developed further and now cover the person’s physical, social, emotional and diverse care needs in greater detail. They are reviewed twice a year. People who use the service are helped to make some decisions about aspects of their lives that are important to them. Risk assessments now link with care plans. Personal information relating to People who use the service is securely stored to protect their confidentiality EVIDENCE: The registered provider has developed the care planning process further and is now combining the Mulberry care planning process with The Naks’ care plans. By combining these care documents they cover all physical, emotional, social and specialist care needs and take into account the persons diverse needs. The care plans inform, direct and guide staff in their interventions with People who use the service to ensure a consistent approach in managing their care needs. In discussion with staff they said that the care plans were easy to understand and gave them ‘good information’ on how to provide care in a consistent manner.
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 12 Where specialist input to address a particular care need has been identified guidance has been issued to staff in how to monitor certain behaviours and how to record them. This will then feed into the review of the care planning process as the staff and external professionals agree a way forward, with the person and their representative, to meet this care need in a consistent manner. Minutes of people who use the service annual review were inspected and demonstrated that where possible they, their representative and other relevant professionals involved in the care of the individual participated in this meeting. Care plans are provided in hand written formats only. A professional review of the service stated ‘the needs of each Service user appear to have been taken into full consideration by the propertier and staff. The support, love and understanding given to xxxxx and peers in this home are of a high standard’. People who use the service are provided with some choices, depending on their levels of ability. Staff and a person who uses the service were heard to discuss what they were doing that day and choosing where to go for a walk. This is also reflected in the individuals care plan as it cites the individuals’ abilities and promotes their level of choice. The risk assessments have been developed further and clearly link with their care plans. Staff have clearer guidance on what action to take if there was a risk to an activity they engage in / or management of challenging behaviour in the community, for example. Information held about People who use the service is stored securely and therefore kept confidential and safe. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are assisted to access a range of activities in and out of the home, individually and together so that they enjoy a good quality of life and are not isolated in the home. Some maintain relationships with their families. People who use the service rights were respected during the inspection. They are provided with home-cooked, healthy meals so that they enjoy their food and stay well. EVIDENCE: People who use the service care plans and daily care records indicate that they take part in a range of activities in the home and in the local community, in accordance with their individual needs and preferences, so that they develop their skills and independence and enjoy a good quality of life. This was observed during the inspection and confirmed during discussions with people who use the service and staff members. People who use the service were observed to go for a walk and involved in craft activities in the lounge with staff. The registered provider is aware that
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 14 some of the activities that people who use the service are involved in can be viewed as ‘age inappropriate’ but from observations it was evident that People who use the service were choosing and enjoying participating in these activities. Community activities include attendance at college, art clubs, day care and having weekends with family. From records inspected they confirmed that close contact is maintained with their relatives via telephone, letter contact or by visiting them during the holidays. From surveys received by relatives one commented ‘ the range of activities made available for our son to participate in is far wider than we are able to provide at home and the support and care has been instrumental in promoting his development and maturity far beyond our expectations’. People who use the service have close friendships with each other, according to the registered provider and staff, as they have lived together, almost as a family for many years. There are written policies and procedures to guide staff with regard to supporting people’s individual needs around sexuality and relationships. As stated in the previous section the registered provider has developed the risk assessment process for People who use the service, they are now more specific to the activity and highlight what risks are attached to the individual participating in it. These risk assessments are now tailored to the individual and incorporated in the care planning process People who use the service care plans consider their dietary needs and they are provided with healthy, home-prepared meals according to the home’s menu. The cook said that she sources fresh local ingredients. The cook prepares all main meals and prepares items for tea from Monday to Friday. At weekends care staff prepare the meals. Some People who use the service can access the kitchen independently, depending on their individual abilities and this was observed during the inspection. People who use the service were observed to be given choices at breakfast time and the mealtime appeared to be an unrushed and social occasion. The kitchen has been refurbished and in consultation with the Environmental health agency, no issues where identified. All relevant documentation regarding cleaning schedules, fridge and freezer temperatures and the introduction of the Safer Food better Business pack is in place and completed appropriately. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported with their personal care needs so that they appear to be well cared for, smart and appropriately dressed. There is consideration of their healthcare needs and referral to health professionals regarding specialist needs and appropriate behavioural management is occurring. There is a system to ensure that medication is stored and administered safely. Further improvements to ensure that loose mediations are accounted for need to be implemented. EVIDENCE: The home has sufficient toilets and bathrooms, including facilities, which they may use in private, so that they can attend to their personal care needs, with staff support and assistance if necessary. Their care plans consider their needs and abilities with regard to personal care issues such as dressing and maintaining their personal hygiene. People who use the service appeared smartly and appropriately dressed at the time of the inspection and staff were observed assisting those that required help, appropriately and respectfully. People who use the service care plans plus the ‘health action plan’ document, which is in pictorial format, consider their healthcare needs. There are records of their attendance for regular, routine healthcare checks at local NHS resources. The registered provider has contacted relevant health professionals
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 16 to ensure that specialist input is provided via psychologists in the management of challenging behaviour. The advice they receive is being acted on and incorporated in the care planning and risk assessment process. Medication is stored in a locked cupboard. The mediation policy is in the main satisfactory but would benefit form expansion in the areas of PRN medication and administration of rectal diazepam and homely remedies. The Nak uses the Monitored Dose System (MDS) to receive, administer and dispose of medication. Documentation demonstrated that medication is administered and disposed of appropriately. There are no controlled drugs on the premises. When medication is received by the home this is recorded in a medication book, advise was given that to assist with case tracking of medication (especially loose medicines) that it is also recorded on the MAR sheet so that when a tablet count is undertaken this will then cross reference with the MAR sheets, as this was not the case. It is acknowledged that the home manages minimal medication and therefore this will remain a recommendation as identified at the previous inspection especially as the deputy manager took immediate action to rectify this. The medication in blister packs tallied with MAR sheets. All staff have attended accredited medication training with Boots pharmacy in May 2008. The registered provider and deputy manager have attended previous training in the administration of rectal diazepam, they state this has not been used for approximately a year. The registered provider showed evidence that she has attempted to organise a refresher course on the administration of rectal diazepam for all staff and is waiting for dates. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a standard written complaints procedure, and views are sought from People who use the service and their representatives on the quality of the services the home provide. Training in the area of adult protection has occurred so that staff are aware of and recognise signs and symptoms of abuse including institutional abuse and what action to take if they suspect abuse is present. The adult protection policy would benefit from minor amendment to ensure staff know what action to take if a suspicion of abuse is identified. EVIDENCE: People who use the service were observed to be relaxed in the care of staff and relative’s surveys stated they had no concerns about the care that was being provided. No formal complaints have been made since the previous inspection. The complaints policy is satisfactory. There are written procedures to guide staff on what they should do if they suspect abuse of a service user. The policy was good at describing the signs and symptoms of abuse and what actions could be taken if abuse is suspected The policy would benefit from expanding the section in informing staff what they are expected to do if they suspect abuse is occurring i.e. they are told to inform the manager but it does not then clarify the safeguarding process. The registered provider has a copy of the relevant multi-agency procedures, which set out how different agencies should work together to protect vulnerable adults from abuse, neglect and self-harm. She has applied for her new staff team members to attend this course. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 18 The registered provider and deputy manager have attended ‘elder abuse’ training recently as they were unable to gain spaces on the multi agency course, which is over subscribed. It is recommended that the registered provider and deputy managers attend the multi agency adult protection ‘investigators course’. It is evident that staff are properly checked prior to working at the home so that people who use the service can be confident that they are suitable to work with vulnerable adults in a care setting The registered provider is the only person who manages People who use the service monies. She has a sound recording system that evidences when monies have been deposited and withdrawn with receipts. She ensures that people’s monies are appropriately banked. She has no policy regarding this and it is recommended that one be made to ensure accountability. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides service users with a comfortable, homely and safe place to live in so that they benefit from a non-institutionalised environment. It is kept clean and hygienic so that they are protected from cross-infection. Updated information on infection control to ensure that the home is meeting current guidance is recommended EVIDENCE: Visual inspection of the home provided evidence that it is well maintained, spacious, attractively decorated, well furnished and homely. People who use the service said that they are satisfied with their private accommodation, which is personalised to reflect their tastes and preferences. Two People who use the service have chosen for many years to share a bedroom, all other people in the home have their own accommodation. People who use the service looked comfortable and settled in the communal areas. The home appeared clean and tidy throughout, with adequate facilities and guidance for staff to maintain good hygiene without compromising on the
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 20 family-style domestic setting of the home. This includes separate laundry facilities and suitable facilities for effective hand washing, for example. People who use the service currently eat in the kitchen area, environmental health inspection were made aware of this and did not comment on it. The cook and registered provider are aware that they need to be vigilant regarding infection control, especially as food is eaten in the kitchen area. The cook has a sound knowledge in the promotion of infection control and has ensured that aprons, gloves and paper towels are available to assist with this. The previous recommendation to remove a bathroom carpet and replace with waterproof flooring has been complied with to promote infection control. The registered provider has had plans approved to build a further 5 en suite bedrooms with communal and kitchen space on the premises. The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The registered provider has recruited new staff. All relevant CRB/POVA checks and references are gained via the agency before a person commences employment at the home. Formal training is available for staff. The home’s recruitment policies are being followed so that staff are recruited using fair, safe and effective practices and are suitable to work in a care setting. Supervision of staff needs to be formalised. EVIDENCE: On arrival at the inspection the registered provider was on duty with the deputy manager and cook due in. The registered provider has attempted to recruit new staff via the job centre but with limited success. She has now used a care agency and from this she has employed on a permanent bases two staff members with a third in progress. The third person is still employed via the agency 2 days a week and therefore there is continuity of staff in the care of the People who use the service. The registered provider stated that in the day there are two members of staff on duty, in the evening this reduces to one and at night one person sleeps in. The rota in the main diary evidenced this. It is recommended that a separate
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 22 duty roster be devised so that it is easier to see who is on duty and when for accountability which the registered provider agreed to do. As the staff were initially employed by the home as agency workers before being applying for the posts permanently, the registered provider has relied on the references that were gained form the agency (were dated within a year). However the registered provider is aware that in future she should apply for references herself to ensure the persons credibility. The registered provider did ensure that updated CRB/POVA checks were applied for and staff did complete an application from. Due to the staffing crises in the home we understand the reasons why references from Mrs Barrows were not applied for but in future all new employees must have this completed. The registered provider is in the process of appointing a part time housekeeper, which will take some duties away from, care staff. A part time maintenance person is also employed at the home. The registered provider has focused on staff training and all have attended medication, fire and food hygiene. All are booked to attend courses via Ultimate training for first aid, equality and diversity, adult protection. It is recommended that individual staff training profiles be created so that the registered provider can ensure that all staff attends regular mandatory training within timescales and any specialist courses that are needed to benefit their work with People who use the service. The registered provider wishes for all staff to have update training in epilepsy and dementia. At last fifty percent of the staff have a minimum qualification of NVQ level 2. The registered provider has gained the Registered Managers Award Staff records were not able to evidence that completed formal induction training had occurred. But templates of this were seen at the previous inspection. The registered provider stated that all new staff had a 6-8 week induction and that they shadowed either her or the deputy and deemed to be competent before they were rostered to undertake sleeping in duties. The registered provider acknowledged that formal recorded staff supervision has not occurred, mainly because of the staffing shortages, so again discussions have taken place with staff but theses are not able to be evidenced The Nak Centre DS0000009157.V362687.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider is qualified and experienced in running the home. Formal consultation with People who use the service and their representatives with regard to the quality of the services the home provides has improved. There are systems in place to protect the health, safety and welfare of People who use the service and their individual risk assessments have improved. Policies and procedures in the home need to be reviewed amended where appropriate and updated. EVIDENCE: The registered provider has completed her NVQ 4 in management and recent adult protection and fire training. With the recruitment of new staff it has allowed her some more management time to focus on developing care planning, risk assessments and daily management tasks. Despite the staff shortages and the amount of cover she has provided, she has worked hard to
The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 24 achieve compliance in two of the statutory requirements, and has started reviewing the homes policies and procedures so this requirement will revert to a recommendation. Mrs Barrows has also ensured that four out of six recommendations have also been met; a minor amendment to the adult protection policy and continued monitoring of medication recommendations remain in process. From surveys received plus discussion with staff it is evident that all believe that the home is run in the ‘best interests of the residents’ and that their care needs have been prioritised. All have stated that they can approach Mrs Barrows with any concerns or ideas to improve the service. The registered provider said she has ‘mini meetings’ with staff these would benefit from being recorded to evidence what they have discussed in order to continue to improve the service. The registered provider is due to undertaken her annual Quality assurance survey, which will include gaining the views from People who use the service, their representatives, visitors and other agencies. The previous quality assurance process was complimentary about the care that the home provides. The registered provider completed her AQAA within timescales and informs us of any incidents as per the requirements of the Care Standard Act. There are records of fire safety equipment tests and checks and staff training in fire safety. A recent fire inspection in July 08 did not highlight any issues. PAT testing was completed in September 08, and electrics tested in June 08. There are written procedures to guide staff on how to ensure that People who use the service are kept safe in the home. Written risk assessments relating to individual people have been developed further and are satisfactory. The registered provider agreed that she has started to review some of The Naks’ policies and procedures, and is gradually working her way through them to ensure they are updated. It is understandable that this has not been done due to staffing levels in the home. The Nak Centre DS0000009157.V362687.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 X 2 3 3 X 4 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 3 3 X The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 26 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 YA20 Good Practice Recommendations The registered provider should ensure that an audit trail of PRN/ loose medication is implemented so that they are aware of all medication that the home holds. The medication policy would benefit from expansion for example in the areas of PRN medication and homely remedies so that staff are aware of their expectations The adult protection policy should be expanded further and written in line with the local multi agency adult protection guidelines. A policy and procedure in respect of Service users monies should be introduced so that staff are aware of their role and expectations. Staff should not commence employment until references have been gained by the registered provider to ensure their credibility,
DS0000009157.V362687.R01.S.doc Version 5.2 Page 27 2 YA23 3 YA34 The Nak Centre 4 YA35 The registered provider should introduce: A individual staff training programme so that all staff are kept up to date with mandatory and any specialist courses that will expand care practice for the benefit of service users : Induction should be evidenced to demonstrate that staff understand the way the home operates and its philosophy : A formal duty roster should be implemented so that staff accountability is more transparent : Staff meetings should be minuted to again create accountability All staff should receive a minimum of six formal recorded supervisions a year. 5 YA36 The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Nak Centre DS0000009157.V362687.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
