Inspection on 08/01/07 for 1-5 New Street North

This inspection was carried out on 8th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-5 New Street North 21/01/08

1-5 New Street North 02/04/07

1-5 New Street North 01/06/06

1-5 New Street North 17/01/06

1-5 New Street North 05/07/05

1-5 New Street North 23/03/05

1-5 New Street North 02/12/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1 - 5 New Street North West Bromwich West Midlands B71 4AQ Lead Inspector Jayne Fisher Key Unannounced Inspection 8th January 2007 10:00 1 - 5 New Street North DS0000004798.V326146.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 1 - 5 New Street North DS0000004798.V326146.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. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 - 5 New Street North Address West Bromwich West Midlands B71 4AQ 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) 0121 553 1755 0121 553 4254 Lonsdale (Midlands) Limited *** Post Vacant *** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st June 2006 Brief Description of the Service: 1-5 New Street is a care home for 8 younger adults who are learning disabled and require additional support due to presenting behaviour that may challenge. The proprietor of the home is Lonsdale Midlands Ltd which is due to change in the near future, and the service was first registered by Sandwell Health Authority in June 2001 The home comprises of 8 single rooms, a domestic style kitchen, 2 bathrooms, laundry, 2 lounges, an activity area, sensory room and a dining area. A lift services the first floor. Entrance to the home is via a coded door lock at the front, leading to the porch area. The home is situated on a slip road just off the main road adjacent to Dartmouth Park in West Bromwich. West Bromwich town centre is within walking distance and parking space is available at the front of the home. There is a lawned area to the front of the building and a small patio area located to the rear. The service has its own transport and regularly accesses local facilities. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was provided on 5 May 2006 which range between £1,100 - £1,600 per week. There are some additional charges for toiletries and hairdressing. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second key inspection for this inspection period 2006 – 2007. As it was a key inspection this means that all core National Minimum Standards were assessed. This inspection was unannounced meaning that no one received prior notification. The inspection took place over two days with the inspector arriving at 10.00 a.m. and leaving at 7.00 p.m. on the first day. On the second day the inspection started at 9.00 a.m. was finished by 3.00 p.m. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager and 5 members of staff. A number of records and documents were read, a tour of the building was undertaken and three residents’ care was case tracked through interviews with staff and examination of records. One meal time was observed and staff were seen administering medication. There are currently eight residents living at New Street and all were seen during the inspection. Formal interviews were not appropriate therefore the inspector relied upon brief chats with 2 residents, observations of body language and gestures, and interaction between staff and the remaining 6 residents. Since the last inspection the previous manager has left and a new manager started at the home 27 October 2006. What the service does well: Daily routines are flexible with residents able to get up and go to bed when they wish. They can decide whether they wish to spend time alone in their bedrooms or can sit in the communal lounges. Staff support residents to maintain important links with their families and friends. Visitors are warmly welcomed by staff. Relatives are encouraged to telephone the home whenever they wish in order to receive regular updates about their family member. Staff also help residents make their own phone calls. The health needs of residents are closely monitored by staff and any concerns are dealt with by seeking prompt medical attention. There is a clear complaints procedure which staff understand and support residents to access if they wish to raise any concerns. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care plans and risk assessments do not provide staff with all of the information needed to provide support to residents. As a whole, more effort needs to be made in enabling residents to make their own choices for example with regard to how they want to be supported, the food they wish to eat and the activities they want to participate in. At present there are not always enough staff to support residents in enjoying stimulating and therapeutic activities. This aspect needs more careful planning, monitoring and evaluation. In the past there has been a lack of training, support and guidance for staff. The new manager is trying to start to address this, and staff are optimistic that improvements will be made. Serious concerns were raised that required urgent action: there was an offensive smell in some parts of the home and the infection control procedures were inadequate. Temporary staff are employed without evidence to confirm that they have received the appropriate clearance checks and training. Despite serious concerns raised at the last inspection, which initially were starting to be addressed, there is a deterioration with regard to the arrangements in place to protect service users from abuse. These include staff failing to identify potential abuse situations, failing to take appropriate action and follow correct procedures, a lack of staff training and inappropriate management of challenging behaviour with a lack of effective care plans and guidelines. In addition there are poor recruitment and selection procedures. A new timescale for compliance has been issued and further enforcement action will be considered by the Commission for Social Care Inspection. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 7 The manager and provider were already starting to address some of the above issues before the inspection was completed. 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. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide needs reviewing as it does not give accurate information to residents about the services offered by the home. Assessment tools need to be developed in order for prospective and existing service users to be reassured their aspirations and needs will be met. Advice must be sought from various other professionals to ensure the specialist needs of service users are met. EVIDENCE: There have been various changes experienced by the service during the last twelve months which have not been incorporated into the statement of purpose or service user guide. For example, on examination the service user guide does not detail the change in ownership and refers to senior management who are no longer in employment. There are no details of fees or other information as required by the Care Homes Regulations 2001, Regulation 5. As nursing support is no longer provided this also needs to be included into the relevant documentation. The manager discussed her intentions to provide a service user guide in a format suitable for residents as is good practice. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 10 On examination service users’ case files contained no assessment tools in order to demonstrate that existing residents’ needs are periodically reassessed and reviewed as previously required. Service users’ have recently been reassessed by social workers at the request of the provider in order to progress an application to the Commission for Social Care Inspection (CSCI) to remove the nursing category of registration. Unfortunately, outcomes from review meetings and reassessments have not yet all been received at the home. From observations made during the inspection, interviews with staff and examination of documentation, the service is continuing to fail to meet all of the specialist needs of the residents as demonstrated through out this report. For example, there are no details of assessments undertaken by specialists such as incontinence advisors or communication packages devised with speech and language therapists. Where advice has been sought, this has not been incorporated into care plans, and as a result is not always being adopted by staff. For example, one resident received a sensory assessment from Occupational Therapists (O.T.’s) last year in view of his autistic spectrum disorder. There was no sensory care plan with regard to the recommendations made, and neither was there any care plan in respect of his autism, and how this affects his daily life and the support required. 1 - 5 New Street North DS0000004798.V326146.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 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments do not provide staff with all of the information they need to satisfactorily meet the needs of service users. EVIDENCE: On examination care plans remain basic in content and do not cover all aspects of personal and social support or health care needs. For example, only one resident was seen to have a care plan in place regarding nutrition and listing their likes and dislikes. Another resident was seen to have a care plan regarding continence management but which gave no details of incontinence equipment or aids. Not all residents had care plans in place with regard to how they are supported to manage their epilepsy or with regard to their mobility (despite needing the assistance of a wheelchair and/or bath hoist). There has been slight improvement in respect of one resident who now has more care plans in place as required at the last inspection. However, there were no behavioural management guidelines in place. Neither was there a 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 12 care plan regarding his challenging behaviour. Psychologists have been involved but recommendations made in October 2006 have not been incorporated into any care plan or guidelines. Another resident was seen to have two different care plans in place regarding managing challenging behaviour which were established 10.3.06 and 27.3.06 respectively. Interviews with support staff confirmed that they were unfamiliar with the content of residents’ care plans. One person admitted that they had not read care plans or management behavioural guidelines for the resident for whom they were a key worker. There was no evidence that service users had participated in the drawing up of the care plans. There have been no improvements in introducing person centred planning approaches or recognised systems such as Essential Life Style Planning. Care plans are not reviewed on a six monthly basis (or sooner if necessary), and therefore do not reflect resident’s changing needs. There is either limited, or no information with regard to how staff provide assistance for residents with communication thereby enabling them to make decisions. Care plans fail to demonstrate how residents are supported to make choices for example with regard to meals and mealtimes, clothing, personal care. All residents require varying levels of support to manage their finances but there were no care plans in place to identify how they encouraged with money recognition skills or other methods of support. On examination risk assessments are varied in quality and content. For example, one resident was seen to have only one risk assessment in place with was with regard to bike riding. There were no risk assessments in place for challenging behaviour, social inclusion including travelling on transport or independent living skills tasks. Another resident had more risk assessments in place but these contained no review dates and were unsigned. Whilst there was a risk assessment in place for wheelchair use, this did not adequately identify all the risks involved (such as posture belts) or include control measures (such as maintenance checks, staff training). Although some residents require assistance with bathing there were no risk assessments in place. As identified at previous inspections, more efforts need to be made to allow residents to participate in the running of the home and affecting service delivery, for example holding residents’ meetings. 1 - 5 New Street North DS0000004798.V326146.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 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are limited opportunities for residents to participate in a range of stimulating and therapeutic activities. Staff support residents to maintain important links with their family and friends. There is insufficient evidence to demonstrate that menus are designed to consistently offer service users choices of healthy and balanced meals. Further improvements are needed to enable residents to exercise choice over their diet, and to ensure that their specialist nutritional needs are properly assessed and met. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 14 EVIDENCE: Five residents attend day centres or college on varying days of the week. Three residents do not attend any form of external day care provision. During interviews one resident stated “I like going to college” but added that he was sometimes ‘bored’ when at home. Examination of case files confirms that no progress has been made towards establishing either written or pictorial activity programmes for residents. Activity record sheets are completed retrospectively by staff (but not always consistently or in sufficient detail) making auditing and monitoring difficult. One service user who was case tracked spent the majority of their time ‘relaxing’ according to the record sheet. Interviews with staff and observations made indicate that activities are largely unstructured and unco-ordinated with no periods of ‘intensive interaction’, evaluation or monitoring. There are no assessments or care plans to demonstrate that activities which do take place meet the preferences and needs of the resident. Staff report that service users rarely use the sensory room located on the first floor and on inspection bedrooms and communal areas contain little sensory or tactile equipment. During interviews staff commented that staffing levels and the use of agency staff have impacted upon opportunities for activities and social inclusion. The manager acknowledges that this requires improvement and has started to introduce some initiatives such as gathering feedback from key workers about residents’ preferences and purchasing some aids and equipment. Staff strive to support residents to access the community. One resident chatted about looking forward to going out to meet a friend. A befriender has been employed for one service user who has facilitated regular outings and community based activities. Staffing levels particularly at weekends however do not always allow for residents to undertake individualised rather than group outings. One resident who was interviewed said “I can visit my family if I want”. Records demonstrated that some residents went to see their families on Christmas day. A family visitor called and staff were seen to welcome him warmly into the home. As observed, relatives maintain telephone contact and are given regular updates and information regarding their family member. Daily routines are flexible. Residents were seen to spend time alone in their own bedrooms or in communal areas according to their preferences and needs. One resident said “I can go to bed when I want I don’t need help from staff”. During the inspection staff were overhead calling residents, visitors and other staff members by varying forms of address including ‘sunshine’, ‘luv’, ‘mate’ and ‘darling’. Only service users’ preferred forms of address must be used as recorded in their care plan. As identified at previous inspections records must 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 15 be maintained of service users consent for staff to open their mail, preferred forms of address, and withholding of bedroom door keys. There has been no improvement with regard to residents’ nutritional screening tools which not been reviewed since 2005 and which fail to adequately identify specialist nutritional needs. Only one person was seen to have a care plan in place regarding nutrition. On examination staff were failing to follow the care plan in order to reduce ‘weight and prompt healthy eating’. For example, food records (which are not consistently completed by staff), demonstrated a largely high fat diet. On one day the resident had a lunch of cheese burger and chips followed by evening meal of burger, spaghetti and chips. There was only one meal provided during the week which had contained vegetables and no evidence of fresh fruit be offered as per his care plan. On examination the menu requires review in order to provide a more healthy and balanced diet. The current emphasis is upon pasta, red meats and convenience foods with little evidence of fresh fruit or vegetables. For instance on one day the lunch choice consisted of: beans and sausage on toast, or a bacon sandwich. During interviews one resident stated “yes I can choose my own food”. However examination of food records demonstrate that most residents have the same meal option. In the absence of any care plans and records relating to their preferred likes and dislikes, it is unclear as to how the majority of residents, (who have increased communication needs), are enabled to make their choices. Staff are not using any strategies such as pictorial menus or taster sessions. One resident for instance was given boiled potatoes, bacon, eggs and gravy for his lunch time meal; on another occasion residents were given potato and spaghetti. Any other items discussed during inspection of these standards are contained within the requirements and recommendations section of this report. 1 - 5 New Street North DS0000004798.V326146.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): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed in order to ensure that residents receive personal support according to their preferences and needs. There are good systems being operated to ensure residents’ health care needs are recognised and treated only slight improvements are necessary with regard to screening. There are safer systems in place for residents with regard to medication although these could be enhanced slightly further. EVIDENCE: During interviews one resident said that he liked the staff who supported him and there was positive interaction observed between residents and staff. As previously identified, care plans fail to demonstrate residents’ preferences regarding times they would like to go to bed, get up and bath times. There were no records seen that demonstrated whether residents’ had been consulted whether they would like male or female staff to support them At the last inspection a requirement was made to review the half hourly checks carried out on all service users during the night time. As a result residents are now receiving hourly checks instead. As discussed with the manager, any 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 17 monitoring at night time must be based on clinical good practice as to whether there is a justified medical or behavioural reason for this level of monitoring, (and recorded in the care plan and risk assessment). This must be discussed and agreed with the service user or within a multi-disciplinary team. Nursing staff are still carrying out clinical procedures despite the recent change in the home’s registration category. This must cease or be discussed and approved by the primary care team with regard to individual service users’ needs with records maintained. Three residents require wheelchairs to negotiate long distances. The manager has already identified that residents are ‘sharing’ communal wheelchairs and there are no mobility assessments carried out by Occupational Therapists (O.T.’s). Assessments must be pursued. There are good systems in place to meet residents’ health care needs with a range of charts and monitoring tools. Records demonstrate that residents are regularly seen by their doctor and hospital consultants. Staff react in a prompt manner upon identifying any potential complication as observed when one resident was taken to hospital on the first day of the inspection. As identified at the last inspection, health care screening needs to be arranged with regard to potential complications from breast, cervical and testicular cancer with care plans established. Upon evaluation of practice and records improvements have taken place with regard to medication. Staff were observed to appropriately administer medication and complete medication administration record (MAR) sheets. Medication is checked and recorded upon receipt into the home and any changes or handwritten instructions entered onto MAR sheets are witnessed and signed by two staff. There are detailed guidelines regarding ‘as and when required’ (PRN) medication. Service users have detailed medication profiles in place and the manager has arranged for all residents to have medication reviews carried out in the next couple of weeks. Arrangements have also been made for the supplying pharmacist to carry out an audit. The drugs cupboard was clean and tidy and medicines were seen to be stored and labelled correctly. There are a few improvements still necessary however. For example, a couple of gaps were seen in the MAR sheet during the previous two days of administration. It was later found that medicines had been administered but not signed for by a member of staff. Last week a tablet was found to be missing and the manager demonstrated that she has taken action to improve auditing systems currently in place. Other items needing improvement include: ensuring that keys to drugs cupboards are held separate to any other master keys and ensuring that staff receive training. Any other issues discussed are contained within the requirements and recommendations section of this report. 1 - 5 New Street North DS0000004798.V326146.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): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a clear complaints policy so that residents can be assured their views are listened to. There remains a lack of robust systems in place in order to offer sufficient safeguards to service users in protecting them from abuse. EVIDENCE: There is a clear complaints procedure for service users and their relatives to access if necessary. There have been no complaints received by CSCI about the home during the last twelve months. On examination of the complaints log no formal complaints have been received by the home. During interviews staff gave good examples of how they have dealt with concerns expressed by service users in the past and were able to demonstrate that they acted upon issues raised proactively with written records maintained. A copy of a pictorial complaints form was seen in service users’ case files. There were serious concerns raised at the last inspection with regard to the lack of appropriate procedures in place to protect service users from abuse. Since 2 June 2006 a total of 15 incidents have been reported to the Local Authority via their multi-agency procedures. The majority of these were relating to minor injuries sustained by service users as a result of challenging behaviour. A number of strategies were implemented by the provider in order to minimize risks to service users. For example issuing protocols to staff and training. However these are no longer all in place. Examination of records and interviews with staff have identified that three incidents of potential abuse have recently occurred and that staff have failed to follow the correct 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 19 procedures in reporting these to the relevant authorities who are responsible for carrying out investigations. Not all staff have received training in vulnerable adult abuse awareness and according to records not all agency staff employed have received training in non-violent physical crisis intervention (N.V.P.C.I.) training. Not all service users have management behavioural guidelines or care plans in place with regard to challenging behaviour. Some service users have two different types of management behavioural guidelines in their case files compiled by different managers, the latest written in April 2006 which is said to be ‘an initial’ plan. There is no confirmation that these management strategies have been discussed or approved within a multi-disciplinary team. Both sets of guidelines were seen to contain different resident’s names suggesting that they are generic rather than individualised. On the first day of the inspection three staff were seen to attempt to manage one resident’s challenging behaviour using unsafe techniques which could have resulted in injury to both the resident and individual staff members. The management behavioural guidelines were not followed. During interviews staff disagreed with one another as to how they should have managed the situation; they also raised issues with some of the management strategies which are currently in place which they feel are ineffectual. Improvements are also needed in the management of service users’ finances. At the last inspection it was noted that one resident had paid for their own meal whilst out in the community; as this was a replacement meal it should have been paid for by the home. On examination of financial records the service user was reimbursed as required in July 2006. However, examination of residents’ current personal expenditure sheets reveals that they are once again paying for their own meals whilst in the community on a regular basis. In addition they are also being charged for items which are normally included as part of their basic contract fee such as replacement of worn bedding and duvet covers. Residents must be reimbursed for these items following discussion with the commissioning authorities. A sample of monies and records balanced accurately on auditing however it is recommended that two staff members sign the record sheets to confirm transactions. The manager agreed that staff should be itemizing purchases in more detail where there is no receipt or where receipts are non-specific. 1 - 5 New Street North DS0000004798.V326146.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): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is varied with some areas more comfortably furnished and well maintained than others. The home is generally clean and tidy although there are insufficient infection control measures. EVIDENCE: A tour of the premises was undertaken and residents’ bedrooms were accessed with their consent. There was evidence of on-going maintenance and redecoration. There are three communal lounges. Two lounges were seen to be comfortably furnished and decorated to a good standard presenting a homely atmosphere. However, residents and staff confirmed that these rooms are seldom utilized. As observed, residents prefer to congregate in the third lounge area which is sparsely decorated and furnished and could be made more comfortable and homely. The settee in this area was slightly torn and the television cabinet broken. As with communal areas, residents’ bedrooms contained little or no sensory or tactile equipment, some items of furniture were broken and walls require redecoration in areas. There is a sensory room 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 21 on the first floor however this is rarely used according to staff as residents prefer the ground floor. Bathrooms on both floors remain austere and uninviting. The ground floor bathroom has an assisted bath with a fixed hoist. However this is a small space and as the bath itself is adjacent to a wall there is no room for staff to manoeuvre around the bath in order to adequately assist service users. There is no space for residents’ to store their personal belongings whilst bathing. There were serious concerns raised with regard to infection control measures. There was a strong offensive smell of urine in the first floor corridor and in one resident’s bedroom. The carpet was badly stained on the stairs and first floor corridor. Staff reported that a new vacuum has been purchased for washing the carpet although they are still awaiting parts. It was also stated that new cleaning products have been purchased and that the housekeeper is cleaning this area and residents’ floors on a regular basis. However, these tasks are not included on the cleaning schedule. The housekeeper has been on leave during the last two weeks and there was no evidence to confirm that washing or mopping of carpets and floors had taken place in her absence. During interviews staff were unclear as to how often these areas should be washed and cleaned. Other areas of concern identified included: no liquid soap in the staff toilet communal nail brushes in all toilets and bathrooms a stained plastic communal jug in the ground floor bathroom no paper towel dispensers in communal bathrooms and toilets staff failing to use clinical waste bags or receptacles for disposing of personal protective clothing the bath mat in the ground floor bathroom had been stuck to the wall to dry (although at the time it should have been in the bath which was about to accessed by a service user). plastic wall panels in the bathroom are damaged and broken grouting around the ground floor bath is stained staff observed wearing disposable gloves whilst escorting residents onto the minibus the kitchen ceiling is stained and discoloured inadequate training for staff in infection control no incontinence assessments for service users and inadequate care planning with regard to continence management beds and coverings which do not promote good infection control or continence management 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not receiving the vocational, specialist or mandatory training required in order to support residents. Staffing levels are slightly improved although there are insufficient staff to meet all residents’ needs. Recruitment and selection processes do not offer safeguards to protect residents from abuse. EVIDENCE: At the last inspection there were fourteen support staff employed only four of whom were qualified to NVQ II or above. There is no up to date central staff training assessment. The new manager is in the process of gathering this information in order to produce a training matrix and programme. However, from training certificates sampled and interviews held with staff it was apparent that there has been little improvement. Staff complained that they had not been supported by former management to undertake further training but they were hopeful that this would now improve. Training is still required in epilepsy, autism awareness, disability equality and Makaton. Three staff have received training in autism since the last inspection but as this was provided by a children’s unit, they felt that this was not entirely appropriate for the service user group at New Street. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 23 As required following the last inspection, staffing levels were reassessed and proposals forwarded to CSCI which demonstrated that an increase was needed. These have not yet been fully implemented due to funding issues. For example with regard to an extra member of staff to assist with day activities. Some increases have taken place however and there is now an extra 20 hours per week provided by a dedicated ‘housekeeper’ and a befriender employed to support one resident. Due to changes in residents’ dependency levels and the registration category, staffing levels now need to be reviewed and proposals forwarded to CSCI. On examination of the duty rota bank staff have now been employed in order to reduce the dependency upon agency staff. However, agency staff are still covering a number of shifts. For example during one week in December a total of 7 different agency staff were employed to cover 10 shifts. Examination of one resident’s antecedent behavioural consequence (ABC) charts confirmed that agency staff are a contributory factor to his challenging behaviour. The manager needs to include her hours on the rota. Examination of a staff personnel file confirms that improvements have not taken place with regard to recruitment and selection. For example, there was an inaccurate and incomplete employment history with no written explanation of a gap in employment. There was only one written reference (addressed to ‘whom it may concern’). There was no reference from the last employer neither was there a recent photograph. There was evidence that a criminal record bureau (CRB) disclosure check had been obtained with details of a reference number but no date of validity. There were serious concerns raised with regard to the lack of clearances and confirmation of training for agency staff. There was no evidence on the premises that these had been checked and the manager confirmed that there was no protocol in place to do so. On the second day of the inspection details were forwarded regarding some agency staff, but not all. It was also seen that one agency worker had not received a CRB or Protection of Vulnerable Adult (POVA) check within the last twelve months and there was no confirmation of NVPCI training. Staff are still not receiving induction and foundation training by an accredited learning disability awards framework (LDAF) provider. In addition there was no evidence of an ‘in-house’ induction programme seen for one new member of staff. The frequency of formal and structured supervision of staff still requires improvement. For example, one member of night staff has only received one recorded supervision session (in April 2006). Another member of staff who commenced employment in 2001 had only four recorded supervision sessions. There is no annual appraisal system. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The many changes in management have resulted in inconsistent leadership, guidance and direction to staff. This has had an impact upon continuity of care, which has resulted in practices which do not safeguard the health, safety and well being of persons using the service. EVIDENCE: There has been no registered manager in place since November 2005. A new manager was appointed but left in July 2006. A further new manager commenced employment on 27 October 2006 who has yet to make an application for registration; in the interim a senior manager visited the home on a daily basis to offer support. Of the 25 outstanding requirements from the last report none of these have been met in full although there was evidence that some improvements had taken place in order to attempt to 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 25 address issues (such as staffing levels, systems for safe handling of medication, attempts to improve the premises and beginning to develop care planning for one resident). Staff commented during interviews that they had not been supported by their former manager, that there was no structure within the staff team which was felt to be disorganised and they complained about the lack of training. However, all staff were optimistic that the new manager would bring about positive changes and were complimentary about her open style of management and dedication towards the service users. During this inspection Ms. Willington demonstrated that she was already attempting to implement constructive changes such as establishing a programme of supervision for all staff, allocating responsibility of specific tasks to staff and trying to reduce sickness levels of staff. Ms. Willington needs to obtain her NVQ IV in care and management. A personal development plan must be submitted to the CSCI to demonstrate how she will be supported in achieving this qualification. A comprehensive quality assurance system is still in its infancy. There is no annual development plan or evidence of consultation with service users, families, advocates and stakeholders. The manager stated that a quality assurance inspection has been recently carried out by the provider which examined documentation but she had yet to receive a report of the findings. Concerns regarding the health, safety and welfare of residents have already been highlighted such as inappropriate physical interventions when trying to manage challenging behaviour, the lack of safeguards with regard to protecting service users from abuse and poor infection control measures (at the last inspection only 4 staff had received training in this discipline). There was no up to date training assessment or plan although the manager is trying to source trainers and had obtained information about forthcoming courses. From records sampled and interviews with staff it was evident that not all staff have received, (or have up to date), training in food hygiene, health and safety, moving and handling and first aid. Other issues identified included unsecured substances hazardous to health, wheelchairs in use which the manager stated had not received an annual service or inspection, and no regular health and safety checks. Food hygiene practice has improved with all high risk foods stored and labelled correctly and more consistent checking of fridge, freezer and cooked food temperatures. However, on examination the fridge temperatures have been consistently low (for example, 1.9°c and 2.3°c) with staff failing to identify this as an issue or taking appropriate action. Water temperatures are checked and were seen to be within safe limits. The accident report book was examined and staff are now recording more information. However, there still needs to be a system in place for monitoring and analysising data in order to reduce the level of minor injuries sustained by residents. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 26 Any other items discussed during inspection of these standards are contained within the requirements and recommendations section of this report. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 1 4 X 5 X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 1 X 1 X X 1 X 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4, 5 Requirement The Statement of Purpose and Service User Guide must be kept under review and must accurately reflect the services provided. (Previous timescale of 30/06/06 is not met). Timescale for action 01/05/07 2. YA2 14 3. YA3 14 Service Users’ needs 01/05/07 assessments must be kept under review and revised at any time/ as part of a multi agency approach with other professionals. (Previous timescale of 31/10/05 is partly met). The registered person must 01/05/07 demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home, and to further demonstrate it offers care based on current good practice and reflects relevant and clinical guidance (Previous timescale of 30/11/05 is not met) 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 29 4. YA6 15 1) To reproduce care plans 01/05/07 in a format suitable for service users. 2) To introduce effective evaluation, monitoring and reviews of service users’ plans which must be sufficiently detailed to reflect the changing needs of service users, and the objectives set. (This must be carried out at least six monthly). 3) Ensure that the care plans are compiled with the service user and/or their representative, (and significant professionals), and are dated/signed. (Previous timescale of 30/11/05 is not met). To generate a care plan for latest service user admitted from an holistic assessment of need which covers all aspects of personal, and social support and health care needs as set out in the National Minimum Standards 2. (Previous timescale of 1/9/06 is not fully met). To carry out a review and expand all service users’ care plans in order to ensure that all aspects of personal, social support and healthcare needs are fully detailed. 5. YA7 15 To ensure that service users are supported to manage their own finances and that care plans contain goals and objectives with regard to the assistance and supervision DS0000004798.V326146.R01.S.doc 01/05/07 1 - 5 New Street North Version 5.2 Page 30 that is needed. (Previous timescale of 01/9/06 is not met). 6. YA8 12 To demonstrate ways in which service users are involved in the day to day running of the home and are consulted on issues affecting the service provision. (Previous timescale of 31/10/05 is not met). To expand current documented risk assessments and risk management strategies with all Service Users, especially relating to their personal safety to be held on their individual plans. (Previous timescale of 1/9/06 is not met). The home must ensure that the activity plans are reviewed and staff can demonstrate that opportunities for day care and education have been explored. Records of consultation and outcomes should be available and opportunities for service users at the home to take part in valued and fulfilling activities should be in place. (Previous timescale of 30/06/06 is not met). To ensure that all service users are enabled to be politically active if they so wish. (Previous timescale of 1/9/06 is not met). 9. YA16 12 The home must demonstrate 01/05/07 how daily routines and house rules promote independence, DS0000004798.V326146.R01.S.doc Version 5.2 Page 31 01/05/07 7. YA9 13(4)(c) 01/05/07 8. YA12 12,15,16 01/05/07 1 - 5 New Street North individual choice and freedom of movement, and are subject to restrictions only as agreed in the individual Plan and Contract. Individual working records should clearly set out residents preferred routines, likes/dislikes etc The home must evidence and demonstrate that service users rights are respected and routines are flexible to suit the needs of individual service users. (Previous timescale of 31/10/05 is partly met). 10. YA17 12(1)(a)16(2)(i) Nutritional assessments must be undertaken for each service user, kept under regular review and must be acted upon where risk is identified. (Previous timescale of 1/9/06 is not met). To ensure that where service users are identified as having increased dietary needs due to health complications, that either specialist menu plans are established or this is reflected in the existing menu plan, which is closely adhered to, and that staff are more familiar with their dietary requirements. (Previous timescale of 1/9/06 is not met). To ensure that there is more consistent recording of residents’ daily food intake. (Previous timescale of 1/9/06 is not met). 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 32 01/05/07 11. YA18 12 To carry out a review of the current menu plan (obtaining specialist advice from a dietician if necessary), in order to ensure that service users are offered a range of suitably nutritious, varied and balanced dietary options to meet their needs. To ensure care plans contain 01/05/07 service users’ preferences with regard personal support including getting up and going to bed and bath times, opposite or same gender care. (Previous timescale of 1/9/06 is not met). To review the practice of hourly checks undertaken during the night for all service users. (If this level of monitoring is deemed necessary it must be discussed and agreed as part of a multi-disciplinary team). Outcomes and guidelines for staff to be documented in individual care plans. To obtain assessments by a suitably qualified professional (for example an O.T.), for three service users who are currently using ‘communal’ wheelchairs. Individual wheelchairs must be obtained if these are deemed necessary. A copy of the assessment must be held in the service user file. 12. YA19 12 To establish care plans with 01/05/07 regard to specific health care health care screening in DS0000004798.V326146.R01.S.doc Version 5.2 Page 33 1 - 5 New Street North respect of breast, testicular and cervical cancer screening. (Previous timescale of 1/9/06 is not met). To ensure that any clinical practices (such as wound care, Depo Medrone injections etc.) are no longer carried out by qualified nursing staff employed by the home, unless they have been formally discussed and agreed (in writing) with the primary care team on an individual basis. Outcomes to be held in service user care plans. The issue of consent to medication needs to be further explored, either with the individual or their representative, or as part of a multi disciplinary review. (Previous timescale of 31/05/06 is not met). To carry out the following improvements to the systems for the control and administration of medication: 1) To ensure that all staff receive accredited training in the safe handling of medication. 2) To ensure that keys to medication cupboards are held separate to any other master keys. 3) To clarify any ‘as directed’ dosages with the prescriber and record on individual MAR sheets. 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 34 13. YA20 13,17 01/04/07 Handwritten instructions on MAR sheets must be expanded to include all administration details with regard to creams/ointments. 5) To improve record keeping with regard to MAR sheets – all gaps must be explored and fully explained. Certificated evidence for all 01/04/07 staff that have been provided with training in Adult protection is required to be held on staff files or training provided. (Previous timescale of 31/10/05 is not met). To ensure that there are appropriate systems in place to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse – Urgent Action letter with 28 days of this inspection (6 February 2007). To review management behavioural guidelines for all service users to ensure that that are individualised and contain appropriate management strategies (approval and advice must be sought where necessary from other professionals and agreed within a multidisciplinary team). Staff must be fully trained and adhere to management behavioural guidelines at all times. To undertake a documented liaison with Local Authority Commissioning Departments 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 35 14. YA23 13,18 to establish the exact nature of what the basic contract fee covers in terms of service users expenditure. To fully reimburse service users for any items for which they have been inadvertently charged within a timescale agreed by the Local Authority, for example worn bedding, meals etc. Records must be held on individual service user files. 15. YA24 23 (2)(b) To undertake the following improvements to the premises: 1) To repair torn settee in main lounge area. 2) To repair or replace all broken furniture in communal areas or service users’ individual bedrooms. 3) To carry out redecoration of all communal areas or service users’ bedrooms where wallpaper or paint is damaged or worn. To undertake following improvements to infection control practice: 1) To carry out a written audit of all infection control practice and procedures in order to produce and implement an improvement plan in liaison with appropriate professionals (such as an incontinence advisor). To forward to CSCI. Urgent Action – by 23 January 2007. 2) To take appropriate measures to eliminate 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 36 01/05/07 16. YA30 13(3) 23/01/07 malodour from communal areas and service users’ bedrooms. Urgent Action – within one day of the inspection and ongoing. 17. YA30 18(4) To ensure that all staff 01/05/07 receive a copy of the code of conduct set by the General Social Care Council with staff signatures maintained to evidence that they have received individual copies. (Previous timescale of 1/9/06 is not met). All staff must receive all mandatory and specific training to support their existing skills and knowledge of service users’ individual and specialist needs e.g. epilepsy, autism awareness, disability equality and Makaton. (Previous timescale of 1/9/06 is not met). To ensure that all agency staff have received sufficient training in order to meet the needs of the service user group including non-violent physical crisis intervention. Documented evidence to be held on the premises. (Previous timescale of 1/9/06 is not met). 19. YA33 18(1)(a) The Manager must undertake an up to date review of staffing ratios and service users dependency levels. To forward written proposals to the Commission for Social Care Inspection. DS0000004798.V326146.R01.S.doc 18. YA32 18(1)(c) 01/05/07 01/04/07 1 - 5 New Street North Version 5.2 Page 37 Sufficient staff must be allocated on a daily basis to provide all service users with a range of stimulating activities and opportunities for personal development as well as meeting care needs. To ensure that the manager’s hours are recorded on the duty rota. To improve recruitment and selection procedures in order to safeguard service users from abuse and address issues identified within the inspection report National Minimum Standard 34 and in compliance with the Care Homes Regulations 2001. Schedules 2 and 4. (Previous timescale of 1/8/06 is not met). To cease the employment of any agency staff without written evidence to demonstrate that appropriate pre-employment and clearance checks have been undertaken (within the last twelve months) and that they have received appropriate training. Urgent Action – immediate and on-going within one day of the inspection. 21. YA35 17,18,19 To ensure that induction (within 6 weeks of commencement) and foundation training (within 6 months of commencement) is delivered, and is in accordance with guidance issued by the `Skills for Care` Organisation (NTO) DS0000004798.V326146.R01.S.doc 20. YA34 19(1) 01/04/07 01/05/07 1 - 5 New Street North Version 5.2 Page 38 To ensure that relevant staff are registered on a `Learning Disability Award Framework` accredited training course. (Previous timescale of 31/10/05 not met). To carry out a training needs assessment for the staff team and establish a written central training plan. 22. YA36 18(1)(d) To continue to progress plans to ensure that all staff received structured and documented supervision (a minimum of six times per year). (Previous timescale of 1/9/06 is not met). To introduce an annual appraisal system for all staff. 23. YA37 8,9 To establish and forward an individual personal plan for the manager of New Street to CSCI by the date given (which includes training such as the Registered Manager’s award). To ensure that an application for Registration of the manager is forwarded to CSCI for processing by 19 February 2007. 24. YA39 24 The Acting Manager must produce an Annual Development plan, which is based on a systematic cycle of planning-action-review and reflects the aims and outcome for service users (Previous timescale of DS0000004798.V326146.R01.S.doc 01/05/07 01/04/07 01/05/07 1 - 5 New Street North Version 5.2 Page 39 31/3/06 is not met). The service must adopt and evidence an effective system for Quality Assurance based on the outcomes for service users, in which standards and indicators to be achieved are clearly defined and monitored on a continuous basis. The home must explore ways in which the service users, staff and stakeholders can be included in the homes chosen quality assurance system. (Previous timescale of 30/6/06 is not yet met). 25. YA42 18(1)(c) To provide all staff with manadatory training in: 1) Infection control. 2) Food Hygiene awareness. 3) Moving and handling 4) First Aid awareness. 26. YA42 13(4)(c) To undertake the following improvements to promote health, safety and welfare of service users: 1) To ensure that all substances hazardous to health (COSHH) are held securely at all times. 2) To ensure that there is more consistent checking of fridge temperatures and that staff are aware of what action to take if safe temperatures are exceeded 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 40 01/05/07 01/05/07 or not reached. 3) To ensure that all wheelchairs receive an annual inspection and service. 4) To introduce regular health and safety checks for all moving equipment such as wheelchairs and bath hoist with records maintained. 27. YA42 13(4)(c) To improve accident reporting systems by ensuring that all accidents are more accurately detailed and to introduce a system for monitoring and analysis by the Acting Manager in order to identify potential adult protection, patterns and trends of accidents. (Previous timescale of 1/8/06 is not fully met). 01/04/07 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. 2. Refer to Standard YA1 YA2 Good Practice Recommendations To develop a service user guide in a format suitable for service users. To develop an assessment tool which covers all topics in National Minimum Standard (NMS) 2.3 to assist in assessment of potential service users, and periodic reassessment of existing service users’ needs. The home should begin to consider how it can implement a system of Person Centred Planning or similar, such as DS0000004798.V326146.R01.S.doc Version 5.2 Page 41 3. YA6 1 - 5 New Street North Essential Lifestyle Planning or Life Story books. 4. YA17 Menus could be made available in different formats with pictorial options produced using photographs to assist service users to make a choice. To provide staff with guidance regarding exploring different strategies for enabling residents to make choices from the daily menu and in menu planning, for example using objects of reference, taster sessions. To consider introducing a more comprehensive nutritional screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’) in order to identify issues relating to malnutrition and obesity and which utilizes a Body Mass Index scoring system. 5. YA20 To consider obtaining a Controlled Drugs Register (with numbered pages). To consider obtaining a larger drugs cupboard allowing for easier storage of Monitored Dosage System (MDS) cassettes and separation of external and internal preparations. To expand current ‘as and when required’ (PRN) guidelines to include the maximum days PRN treatment can be continued before seeking further medical advice. To ensure that there are two staff signatures obtained on residents’ personal expenditure sheets for all transactions. To itemize purchases made on behalf of residents on personal expenditure sheets (or petty cash vouchers). To provide a range of sensory and tactile equipment for service users’ bedrooms. The home should continue to work toward meeting Sector Skills Workforce targets of 50 of care staff having achieved an NVQ level 2 or above. To consider purchasing a larger or second fridge/freezer. To introduce a system for regular calibration of the food probe with written records maintained. 6. YA23 7. 8. YA29 YA32 9. YA42 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 1 - 5 New Street North DS0000004798.V326146.R01.S.doc Version 5.2 Page 43 - 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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