Inspection on 28/02/07 for 10 Chapel Street

This inspection was carried out on 28th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 Chapel Street 29/07/08

10 Chapel Street 07/02/06

10 Chapel Street 01/03/05

10 Chapel Street 31/01/05

10 Chapel Street 11/03/04

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 10 Chapel Street Quarry Bank Dudley West Midlands DY5 2DN Lead Inspector Jayne Fisher Key Unannounced Inspection 28th February 2007 10:00 10 Chapel Street DS0000024960.V330932.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 10 Chapel Street DS0000024960.V330932.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. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Chapel Street Address Quarry Bank Dudley West Midlands DY5 2DN 01384 411153 01384 560210 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) Black Country Housing and Community Services Group Vacant Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user (male) identified in the variation report dated 16.12.04 may be accommodated at the home in the category of PD. This will remain until such time that the service users placement is terminated. 7 February 2006 Date of last inspection Brief Description of the Service: 10 Chapel Street is a purpose built detached property sited in Quarry Bank and within walking distance of a range of facilities including shops, health services and churches. The building is within its own grounds and has wheelchair access to the ground floor. There are two communal areas (lounge and dining room) and all service users have a single room. Some aids and adaptations are present as needed for the current resident group. The registered provider, a not for profit social landlord, offers long stay accommodation at Chapel Street to adults with a learning disability. The provider does not offer short term or emergency care at this home. The home does have its own minibus although there is access to local public transport links through the nearby shopping centre. Whilst the home only has limited parking there is a car park sited opposite for public use. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels were provided in December 2006 by the manager which are between £328 - £335.50 per week. There are additional charges for hairdressing, chiropody and toiletries. 10 Chapel Street DS0000024960.V330932.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 first key inspection for the 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 Inspector arrived at 9.00 a.m. and left at 6.00 p.m. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager and two support staff. Three relatives completed comment cards. There are currently four residents living at Chapel Street and all were seen during the inspection. Formal interviews were not appropriate therefore the inspector relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and residents. Four comment cards were received from residents; however staff had completed these on behalf of residents, and it was not possible to determine whether or not they were a true reflection of residents’ views. Therefore they were not solely used to determine judgements. A number of records and documents were examined, a tour of the building was undertaken, a meal was seen being prepared, and three residents’ care was case tracked through interviews with staff and examination of relevant documents. Since the last inspection the registered manager has left employment; the deputy manager was appointed as manager on 12 February 2007. What the service does well: Daily routines are flexible and residents’ privacy and dignity is respected by staff. The atmosphere was relaxed and friendly, staff were overhead laughing and joking with residents who looked comfortable and happy in their surroundings. There are no restriction upon residents’ movement around the home; they were seen to spend time relaxing on their own, chatting to staff in communal areas and clearly regard the home as their own, opening the front door to welcome other residents and visitors. Staff support residents to maintain contact with families thereby promoting important relationships. All relatives made positive comments about the home and in particular regarding the staff including “all residents have a wonderful, comfortable happy and homely environment, with caring staff”. The home was brightly lit, warm and decorated to a good standard. Bedrooms are decorated and furnished in different colour schemes and contained lots of residents’ own personal possessions. There is a competent, caring and well qualified staff team who know residents’ individual likes and dislikes. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 6 There are systems in place so that residents can raise concerns if they wish and in order to safeguard them from abuse. What has improved since the last inspection? 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. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. There is an informative statement of purpose and service user guide although both need slight expansion to provide residents with more information about the service. Assessment tools need to be further developed in order for prospective and existing service users to be reassured their aspirations and needs will be met and kept under review. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Upon perusal the statement of purpose is a comprehensive document. Only slight expansion is necessary in order to comply with the Care Homes Regulations 2001 as there is no information regarding the registered provider’s experience and qualifications. There is a pictorial service user guide. On examination this is clear and easy to read. There are some omissions which need to be included in order to comply with the Care Homes Regulations (Amendments) 2006. For example, the address of the Commission for Social Care Inspection (CSCI), details of fees and arrangements for payment plus additional charges. A copy of the most 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 9 recent inspection report must also be included (or information as to how to obtain a copy). Chapel Street remains fully occupied. There has been no vacancy at the home since 1996. As identified at previous inspections an assessment tool needs to be developed in order to not only assess prospective residents, but also to enable assessment of existing residents’ needs. The manager was able to demonstrate that some progress is being made. For example, there is a new tool for assessing resident’s tissue viability (using a Waterlow score). Although this has not yet been fully implemented. Nutritional assessments have been carried out using the Body Mass Index (BMI) calculation. As discussed with the manager, assessment tools need to be expanded to cover all of the subjects recommended by the National Minimum Standards (NMS) 2.3. A system must then be established for the periodic reassessment of existing service users’ needs as required by the Care Homes Regulations 2001. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. All residents have a range of care plans and risk assessments in place. However these need more detail for staff to follow which would enhance current systems further, and reflect more accurately the level of support and care given to residents by staff. More efforts at person centred planning would also encourage residents’ participation in decision making and in identifying their wishes and aspirations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three case files were examined and interviews were held with staff and management in order to determine progress towards meeting the outstanding requirements. The manager states that in order to improve care planning, a quality assurance tool is being introduced which includes a new template for care plans. As yet the implementation is in very early stages, although the manager was able to demonstrate that one service user’s care plan had been partially completed using this template. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 11 Examination of existing care plans identified a number of deficiencies which have been highlighted at previous inspections. A key worker was interviewed who confirmed that she participated in the drawing up of care plans as is good practice; she was able to demonstrate familiarity with the care planning system. During interviews the key worker gave detailed information as to how she supported residents, this level of information however was contained within the care plans. For example, one resident is incontinent but the corresponding care plan did not include the strategies described by staff for managing his continence. The resident suffers from epilepsy but there was no care plan in place as to guide staff how to manage this condition. There was no care plan regarding tissue viability, yet one resident has a range of pressure relieving equipment in place and according to his key worker night staff assist with change of position. The care plan regarding ‘nutrition’ only gave a brief description of the resident’s likes and dislikes and did not include the detailed knowledge demonstrated by the key worker regarding his dietary preferences. Care plans are not reviewed on a six monthly basis and as discussed with the manager these reviews must include the service users, significant professionals, families and advocates. Not all care plans were dated or signed. One resident’s care plan was established in April 2005 and had not been reviewed. Support staff stated that they thought it had been reviewed but the updated version was computerized and not accessible. The new care planning system which is about to be implemented is more person centred although it is recommended that different person centred styles are explored depending upon the communication and cognitive needs of the individual service user, for example essential life style planning, person futures planning. Care plans contain some information regarding how service users communicate. Staff reported that they have received training and will be developing communication ‘passports’. All residents require support to manage their finances, some more than others. Care plans need to be more descriptive. For example, one resident’s care plan gave details as to how she is supported to manage her finances but did not include sufficient information and had not been updated. It still made mention that she was paid a weekly ‘wage’ from her day centre when this practice ceased over twelve months ago. Since the last inspection clearer procedures have been introduced to ensure that any requests made by residents at their regular meetings receive action. Some policies have been reproduced in pictorial formats to aid understanding. Upon examination risk assessments need expansion and updating. For example, one resident’s risk assessment with regard to epilepsy stated that he requires two hourly checks during the night when he actually receives hourly checks according to records and interviews with staff (see further comment in standard 18). A risk assessment for continence management states that he 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 12 has a toileting programme which is no longer in place and makes reference to a safety helmet which he does not require. Some risk assessments had not been reviewed since they were established in November 2005. There were generic assessments in place for some risks such as drowning, eating and drinking. All risks must be individually assessed to the person. There were risk assessments in place for bedrails which did not sufficiently assess all of the risks posed by entrapment and the control measures which need to be considered. Risk assessments for wheelchairs made no mention of health and safety or maintenance checks and identified posture belts as a risk but did not examine all of the risks involved in using this equipment. Further information including medical device alert notices were given to the manager to assist in risk management. Detailed risk assessments need to be developed for residents who exhibit challenging behaviour. 10 Chapel Street DS0000024960.V330932.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 good. Residents enjoy a stimulating and varied lifestyle, although they would benefit from slightly more flexibility in accessing the local community. Staff support residents to maintain important links with their families and ensure that residents’ rights are respected with regard to their privacy and dignity. Residents are offered a healthy and nutritious diet although different strategies could be explored further to encourage residents to exercise choice over their diet. This judgement has been made using available evidence including a visit to this service. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 14 EVIDENCE: Three residents attend external day centres during the week. Staff are supporting a fourth resident to access a different day centre following the closure of her original centre last year. There is a activity programme which is planned on a weekly basis according to staff’s knowledge of residents’ preferences and requests made at residents’ meetings. Care plans contain some information regarding service users’ favourite activities. It is recommended that a pictorial activity programme also be introduced to assist residents in making their preferences known. On examination activity programmes would benefit from being more varied and detailed. For example, one resident’s planned activity during one afternoon was described as ‘optician visiting’. A planned activity for both the Saturday afternoon and evening was watching a television programme entitled ‘dancing on ice’. Daily reports gave a little more information as to how residents spend their social and leisure time but there was limited information regarding independent living skills contained within the reports or included in the activity programmes. Observations and interviews with staff suggests that residents do enjoy more varied lifestyles than depicted in their care plans, activity programmes and daily reports. The manager acknowledges that recording systems need improvement and has a template to introduce some changes to recording methods. It is also recommended that activities are evaluated to ensure that they meet residents’ preferences, and that there is an explanation as to why planned activities do not take place. On examination of daily records and activity programmes there are planned community based activities. For example during a two week period, one resident had been to the cinema, visited church, been on a walk and went to the pub. However, there is one service user who now requires two staff members to support her in the community and as there are only two staff on duty at weekends and in the evenings, this can limit opportunities for other residents. Whilst the manager will roster in a third member of staff to facilitate planned outings from time to time, this does not allow for spontaneous activities to occur and residents generally have to go out in groups rather than as individuals. (See further comment in standard 33). As required following previous inspections, staff are able to evidence that residents can choose their own annual holidays. Last year three residents when to Ibiza and one resident went on holiday to Devon. However, it was noted in a recent residents’ meeting that management had stated that residents could not go on holiday abroad this year. During interviews the manager stated that this was due to a number of reasons including cost, staff cover and providing companionship for the resident who is unable to travel abroad. This does not represent a person centred approach and different options were discussed with the manager who agreed to consider these. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 15 Interviews confirmed that staff continue to support residents to maintain important links with their relatives. There is an improved recording system which demonstrates that regular contact is made with families. Care plans also contain goals with regard to social contact. All three relatives who completed comment cards stated that they were made to feel welcome by staff when visiting and that they could see their family member in private if they wished. One person stated “staff always make you feel welcome and keep in touch”. As observed, daily routines are flexible and geared towards residents’ individual needs and preferences. Service users were greeted warmly by staff upon their return from their day centres. Prior to having their evening meal they were seen to spend time either sitting in the lounge, chatting with staff in the dining room, singing songs or spending time alone. Care plans contain details of service users’ preferred form of address and whether they are happy for staff to open mail on their behalf. Residents are given the choice of holding their own bedroom door keys and records are maintained of their wishes. Staff were observed to interact positively with service users through out the day; they demonstrated a caring and thoughtful approach when helping one resident who frequently became distressed. There is a six weekly rolling menu which on examination is varied and well balanced. There is an emphasis on freshly cooked foods rather than convenience meals. For example, for the evening meal staff had made a fish pie and this looked and smelt appetizing and was served with vegetables. There is only one choice depicted on the menu per lunch and evening meal. However, examination of resident’s individual food records and the menu plan demonstrates that residents are able to have alternatives if they wish. Since the last inspection there has been improvements in nutritional screening and residents are having regular weight checks. Only slight improvements are needed. For example, one resident has a high BMI score although this was not mentioned in her associated care plan (although staff are attempting to encourage her to follow a lot fat diet). Care plans contained only limited information regarding residents’ preferred likes and dislikes, therefore it was not possible to determine whether the current menu plan wholly reflects their preferences. It was pleasing to see that menus are discussed at residents’ meetings. Some residents are unable to verbalise their preferences and more strategies need to be developed to aid them in exercising control over their diets rather than only relying upon staff’s knowledge. Interviews with staff and examination of records confirmed that residents are not able to participate in food shopping. This was said by the manager to take place occasionally if residents were on holiday from their day centres but can’t be facilitated regularly due to insufficient staffing. 10 Chapel Street DS0000024960.V330932.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 good. Personal support in this home is generally offered in such a way as to promote and protect residents’ privacy, dignity and independence. Service users’ physical and emotional health needs are well met with only slight improvement needed with regard to health care screening. There are safe systems in place to manage residents’ medication with only a couple of areas requiring attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ wishes with regard to bathing, getting up and going to bed times are fully recorded in their care plans. All relatives who completed comment cards stated that they were satisfied with the overall care provided and that they were kept informed of important matters. One person stated “the residents are always well dressed and clean”. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 17 Three items were identified as requiring attention. It was noted from records completed by night staff that all residents receive hourly checks during the night. Whilst there are care plans regarding ‘sleeping and rest patterns’ none make reference to the need for this level of monitoring. As discussed with the manager night time checks can compromise residents’ dignity in addition to disturbing sleep. There must be a justified medical (or behavioural) reason for this level of monitoring and recorded in a care plan and risk assessment. This must then be discussed and agreed with the service user or within a multidisciplinary team. In order to promote equality and diversity, service users’ wishes regarding whether they would favour male or female staff to support them in various aspects of personal care must be obtained and recorded in their care plans. One service user has a physical disability. It was reassuring to hear from staff that they had recently accessed support from an Occupational Therapist (O.T.) because of concerns regarding moving and handling. As a result a portable hoist has been ordered. Other specialist equipment includes a specialist Parker bath and level access shower plus hand grips. There is no overhead tracking in the communal bathroom or drying table. The manager explained that the resident is transferred to a portable shower chair in the bedroom and then taken into the bathroom. Following a shower the resident then has to be taken into the bedroom to be dried and dressed. It was stated by the manager that the resident usually has a shower because with only two staff on duty it is not always possible to assist the resident to utilize the bath. As discussed, an assessment is required from an O.T. with regard to the current bathing facilities to identify whether further aids and equipment is necessary. There was ample evidence to confirm that the health needs of residents are monitored by staff and access to appropriate treatment is sought when necessary. For example, there was a good system for recording routine health checks required through out the year. These demonstrated that residents receive regular appointments with dentists, doctors, community nurses, psychiatrists and ophthalmologists. Specialists are accessed as and when required. For example, the intensive support team – I.S.T. (psychologists) are involved with a number of residents in drawing up management behavioural guidelines and giving advice to staff. At previous inspections a requirement has been made to ensure all residents receive a routine hearing check. The manager states that this has been mentioned to the doctor who feels this is unnecessary. As discussed, this must be recorded on the care plan and regularly reviewed at the annual health checks undertaken by the district nurse. Following a recent assessment by the I.S.T. it is suggested that one resident needs a hearing check and as discussed with the manager, this must be followed up with the doctor. There are no care plans in place with regard to screening and monitoring from potential complications such as breast, cervical and testicular cancer (for 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 18 example attendance at well person clinics and observations by staff when assisting with personal hygiene). The Priority for Health Screening Tools booklets have not yet been completed by the relevant agencies. Interviews with the manager confirms that some residents have access to occasional screening for potential complications from breast and cervical cancer. However, although all residents attend an annual health check, there is no evidence that this includes an examination for testicular or breast cancer. As discussed with the manager, a more formal process needs to be established for health care screening; any issues relating to capacity to consent must be discussed with the doctor and recorded. Medication practice was evaluated and found to be generally good. Staff were seen to appropriately administer medication. The drugs cupboard was clean and tidy with no overstocking. Overall the medication administration record (MAR) sheets were correctly completed with only a couple of gaps. Staff have received accredited training in the safe handling of medication. Copies of prescriptions are held on individual files and there are regular audits undertaken by the local pharmacist. Good practice is maintained with regard to the recording and administration of Controlled Drugs. Since the last inspection, there are up to date medication profiles in residents’ case files and risk assessments have been completed for the ‘covert’ administration of medication. Only slight improvements are needed as discussed with the manager. Medication is administered ‘covertly’ with food mainly due to aid ingestion rather than because of refusals. This must be discussed with the pharmacist in order to ascertain whether any other preparations may be more suitable and records maintained. If this practice needs to continue, care plans must be established and agreed as part of a multi-disciplinary team. The majority of medicines received into the home are checked and recorded although a couple of items received mid-cycle such as a short course of antibiotics had not been receipted. It is also recommended that a running balance of medicines which are not dispensed in the monthly monitored dosage system (M.D.S.), is routinely checked and recorded. The keys to the drugs cupboard are not held by the sole person in charge. This practice needs to be reviewed to ensure that the current system is safe. Any other items discussed during inspection of these standards are included in the Requirements and Recommendations section of this report. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 19 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 good. There is a comprehensive complaints policy which ensures that users’ views are listened to and acted upon. There are procedures in place to safeguard service users from abuse only slight improvements are necessary with regard to physical intervention guidelines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received by the home during the last twelve months. In addition the Commission for Social Care Inspection have not heard from any complainants. All relatives who completed comment cards stated that they were aware of the complaints procedure. There is a pictorial complaints procedure and information regarding complaints is contained with the service user guide and statement of purpose. There have been no allegations of vulnerable adult abuse. Staff have received training in vulnerable adult abuse awareness. During interviews they gave good accounts of how they would deal with potential incidents and understood the principles of Whistle Blowing. There is a copy of the Local Authority multiagency vulnerable adult abuse procedures available in the manager’s office. Staff have also received training in understanding and managing challenging behaviour. At previous inspections concerns were raised regarding the physical intervention guidelines which had been established by a trainer on behalf of 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 20 one service user. These advocated the use of ‘holding wrists firmly’. As previously stated this would seem to conflict with the Department of Health ‘Guidance for Restrictive Physical Interventions’ and the British Institute of Learning Disabilities (BILD), code of practice for Trainers in the use of Physical Interventions. The manager stated that she has recently emailed the trainer to discuss a review of these guidelines but has not yet received a response. This still needs to be undertaken. Another resident has physical intervention guidelines (detailing safer techniques). However, there were no details of who had completed these guidelines, their role or date. The manager stated that these had been established by the community learning disability nurse. The same service user also has recently been assessed by the intensive support team. Recommendations for managing behaviour have been made in a letter dated 6 December 2006. As discussed, these need to be transferred to a behavioural management support plan. As previously highlighted, all guidelines with regard to physical interventions and behavioural management support plans must be discussed and agreed within a multi-disciplinary forum including the service user. There are good systems in place for supporting service users to manage their finances. For example, there are records maintained of all financial transactions and a running balance maintained. However it is recommended that two signatures are obtained for transactions which are carried out and recorded on the personal expenditure sheets. A sample of records examined balanced accurately. It was noted that residents are charged a weekly rate of £5.00 towards the cost of fuel for the minibus. On one occasion a resident had also had to pay £4.00 towards the cost of a taxi as the manager explained that there had been insufficient drivers available for the mini-bus. However, it was stated that one person’s contributions had recently ceased because they had not been accessing the minibus. According to the manager there is no formal written agreement in place regarding this contribution and on examination this additional charge was not mentioned in the service user guide. As discussed this additional fee must be agreed and discussed with the service user, Local Authority commissioners (or social worker). Records must be maintained in individual case files and details included in the service user guide together with a written protocol to ensure equality and fairness. Management act as appointees for three service users. It is noted that regular audits are carried out by senior management. However, it is recommended that independent auditors carry out this task at least on an annual basis as suggested by the CSCI in guidelines regarding corporate appointees. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 21 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 good. The standard of the environment within this home is good providing service users with an attractive and homely place to live. Adequate systems are in place to promote infection control with only slight improvements necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was undertaken. The communal areas are bright and airy with comfortable and homely furnishings. All bedrooms are decorated and furnished to a high standard and individualised with personal possessions, photographs, televisions and stereo equipment. It is pleasing to see that colour schemes, décor and furnishings reflect service users’ individual tastes. Some bedrooms contained sensory and tactile equipment. One relative who completed a questionnaire made additional comments stating “the house is always clean and tidy”. Since the last inspection a maintenance and refurbishment programme has 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 22 been established. There is only one outstanding item from the last inspection which relates to the bathroom tiles. The manager states that a new border has been ordered. There was only one new item identified. One service user’s bedroom carpet was badly stained. The manager stated that this had been professionally cleaned in June 2006. Other than vacuuming the carpets are not cleaned or washed on a regular basis. Staff use a stain remover to eradicate any marks. It is recommended that a steam cleaner is obtained in order for those carpets which are subject to heavy usage to be effectively and frequently cleaned. Another resident’s bedroom carpet was seen to be stained to a lesser degree. The manager immediately asked staff to clean the affected area. The premises were clean and hygienic throughout with no offensive odours. The laundry area was tidy and clean with a washable floor and part tiled walls. There is now an infection control policy available. However this is somewhat basic and it is recommended that a copy of the Department of Health infection control guidelines in care homes is obtained for further reference. Only a couple of items were identified as needing attention and these are contained within the Requirements section of this report. For example, the communal bathroom and toilet does not contain any communal waste bins. The manager states that staff use plastic carrier bags to transport any clinical waste through the premises to the clinical waste receptacle located outside. As discussed, this is not acceptable particularly as they cannot be sealed and may have perforations. Appropriate bags must be obtained for this purpose. Communal items must not be used by service users such as plastic jugs for rinsing hair in the bath. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. There is a competent and well qualified staff group providing support to residents. Staffing levels need review as at present there is insufficient staff to meet all of service users’ needs. The recruitment and selection procedure has some good elements although a full evaluation could not take place due to records not being maintained on the premises. Although staff are well supported, the frequency of formal supervision needs improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager states that five support staff are qualified to NVQ II or above which equates to half of the staff team and therefore meets the National Minimum Standards. During interviews staff were very positive regarding the training opportunities offered and confirmed that they had received training in varying disciplines which was evidenced on sampling of training certificates. Since the last inspection some staff have received training in Autism 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 24 awareness. One person has been trained in Makaton and it is recommended that all staff receive some training in this subject. On examination of the duty rota there are two staff on duty per shift and the manager is supernumerary (although occasionally covers shortfalls in the duty rota). In addition agency staff are also utilized to cover annual leave or sick leave. Five staff have left during the last twelve months. New staff have been recruited. The manager states that there are currently 21 vacant hours. All staff who were interviewed made comments regarding the staffing levels and how this can impact upon residents’ lifestyles and personal support needs as already indicated in this report. One relative also commented that they thought there were not always sufficient staff on duty. This requires review. It is also recommended that active pursuit of the recruitment of male staff is undertaken in order to reflect the gender composition of the service user group. A personal file of a new member of staff was examined. There was no application form available so it was not possible to determine if a full employment history had been obtained, or whether appropriate referees had been contacted, although two written references had been obtained. The health declaration had not been completed prior to commencement of duties. There was no criminal record bureau (CRB) disclosure check. The manager was able to ensure that this was sent from the head office before completion of the inspection. Proofs of identification had been obtained. It was pleasing to see that confirmation of police clearance checks had been obtained for agency staff employed at the home. The manager states that CRB checks are held on the premises for some of the staff group, but not all. As discussed, if the organisation wishes to retain information and documents at their head office then they must seek approval from CSCI as detailed in the policy and guidance for CRB checks published by CSCI in January 2007. There has been a long outstanding requirement to provide staff with induction and foundation training by an accredited learning disability awards framework (LDAF) provider. The manager states that one person is undertaking this training. New staff have not yet undertaken LDAF. As discussed, even if staff have a vocational qualification this should not prevent them from undertaking LDAF which is designed to provide staff with specific knowledge regarding learning disabilities. There is a central staff training matrix which demonstrates a range of training has been carried out. It is recommended that a training and development assessment and profile is established for each member of staff as required by the National Minimum Standards. Improvements are needed in the frequency of formal supervision sessions for staff. For example, one member of staff only received one formal recorded supervision session during the last twelve months. Another member of staff had received only two sessions in twelve months as opposed to the six recommended by the National Minimum Standards. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 25 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 good. Residents benefit from a well run home with the manager and staff demonstrating an awareness of their roles and responsibilities. Quality assurance systems require development so that residents and other users can be confident their views underpin the development of the service. With a few minor omissions, the health and safety of service users are generally very well promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous registered manager has recently been promoted to a senior position within the organisation. The deputy manager who has worked at the 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 26 for at least eight years was appointed as manager two weeks ago. Ms. Edwards states that she has an NVQ IV in management and is hoping to complete the Registered Manager’s Award in the near future. Staff who were interviewed were motivated and enthusiastic about their work. They stated that they were felt supported by the management at the home, comments included “if I have any problems I’ll ask” and “it’s a great place to work”. During the inspection Ms. Edwards demonstrated a professional and calm approach; residents were not discouraged from entering the office to seek comfort and make requests. At the last inspection in February 2006 the manager had purchased a quality assurance tool to help assess and respond to the quality of the service provided. This is slowly starting to be implemented in the form of new care planning formats, Waterlow assessment templates, weight record templates and needs assessment proformas. Other elements need to be included such as consultation with service users, families, stakeholders and other professionals and the formulation of an annual development plan. It is suggested that rather than staff aiding residents to complete questionnaires, people independent of the service should carry out this task to obtain a more objective view. The manager ensures that events affecting the well being of service users are now reported to CSCI. For example, there has been one hospital admission during the last twelve months and this was reported accordingly. A sample of maintenance and service records were examined and found to be largely up to date. For example, there is weekly testing of the fire alarm system and monthly checking of the emergency lighting. The fire alarm and fire safety equipment has received a regular service and inspection. Since the last inspection the fire alarm system has been upgraded as previously recommended. The majority of staff have received mandatory training in the required disciplines. Accident reporting is good with a system in place for monitoring accidents by management in order to identify any patterns or trends. Only a small number of accidents have occurred in the last twelve months. Only a couple of items need attention. As discussed with the manager, regular health and safety checks and records need to be established for wheelchairs and bedrails. Hydraulic beds need to be serviced on a regular basis. There are good systems in place regarding food hygiene practice. There were only two exceptions with regard to checking and recording of cooked food temperatures and ensuring that action is taken (and recorded) when fridge temperatures exceed safe limits. 10 Chapel Street DS0000024960.V330932.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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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(1)(c) Shed 1(2) 5 Timescale for action To expand the statement of 01/07/07 purpose to include the relevant qualifications and experience of the registered provider. To expand the service user 01/07/07 guide to include: the address of the Commission, a copy of the most recent inspection report (or how to access), details of fees and arrangements in place for charging and paying for any additional fees. To continue to establish and 01/07/07 introduce an assessment tool to which meets the requirements of standard 2.3 of the National Minimum Standards for Younger Adults - in order to assist in the assessment of new service users, and to assist in the periodic reassessment of existing service users’ needs. Multidisciplinary reviews of care plans must take place for all residents every six months. (Previous timescale of 2004 is not fully met). 01/07/07 Requirement 2. YA1 3. YA2 14(2) 4. YA6 15 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 29 Care plans must be drawn up with evidenced involvement of service user, family, advocate and relevant agencies. (Previous timescale of 31/3/05 is not fully met). Care plans must be reproduced in formats that the resident understands. (Previous timescale of 31/3/05 is not met). To continue to review and expand service user plans to include goals and objectives relating to all aspects of personal and social support and health care needs (with detailed guidelines for staff). For example with regard to: continence management, tissue viability, nutrition, support to manage finances, epilepsy and autistic spectrum disorder etc. 5. YA9 13(4)(c) To expand and introduce individualised written risk assessments for all aspects of service users lives which pose a risk, for example: wheelchair use and posture belts, challenging behaviour, bed rails etc. 01/06/07 6. YA14 15 12(3) 7. YA17 The manager must ensure that residents are meaningfully involved where possible in choosing and planning their annual holiday and that this is evidenced. How residents are supported to make choices must be included in each resident’s plan of care. (Previous timescale of 2005 is partly met). 17(2),Sch4 The menu must offer daily (13) choices to meet residents’ likes DS0000024960.V330932.R01.S.doc 01/07/07 01/07/07 10 Chapel Street Version 5.2 Page 30 and dislikes, daily preferences and needs as determined by the care plan. (Care plans must contain more details regarding residents’ specific likes and dislikes). (Previous timescale of 31/3/06 is partly met). Decision making processes for residents who are non-vocal must be recorded within individuals care plans. (Previous timescale of 31/3/06 is not met). To ensure that all service users are offered opportunities to plan, shop, prepare and serve meals. Care plans and risk assessments must be completed. To review the practice of hourly checks undertaken during the night for all service users. (If this level of monitoring is deemed necessary due to medical or behavioural reasons 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 service users’ preferences (through discussion or observation) with regard to same or opposite gender care. Outcomes to be recorded in individual care plans. To ensure that an assessment is carried out by a suitably qualified person (e.g. O.T.) with regard to one service user (who has decreasing mobility) in relation to improving accessibility to bathing facilities and equipment. For example to 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 31 8. YA18 12 01/07/07 9. YA19 13(1)(b) ascertain whether overhead tracking would be beneficial, drying table, cradle shower chair etc. Outcomes of assessments and action to be held within the care plan. The option of routine hearing 01/06/07 tests must be provided for all residents. (If the G.P. advises that this is not necessary,then this decision must be recorded in the individuals’ care plan and kept under review). (Previous timescale of 2004 is not fully met). To pursue a hearing test for the identified service user as recommended by the intensive support team service in their recently established behavioural support plan. To establish care plans with regard to specific health care screening in respect of breast, testicular and cervical cancer. All refusals and consent issues must be discussed within a multi-disciplinary forum including the General Practitioner and outcomes to be recorded in the care plan. 10. YA20 13(2) To undertake the following 01/07/07 improvements to the control and administration of medication: 1) To either obtain written consent from individual service users with regard to administration of medication or to discuss as part of a multidisciplinary team at forthcoming reviews and record outcomes in individual service user plans. 2) To discuss with relevant 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 32 professionals (such as the local pharmacist) whether the administration of medication with food (jam, lemon curd etc.) to aid ingestion, is appropriate or whether alternative preparations are more suitable. Care plans must be introduced with guidelines for staff and discussed as part of a multidisciplinary team. 3) To ensure that all medication received into the home is checked and the quantity recorded including medications which are not dispensed in the monitored dosage system such as short courses of antibiotics. 4) To review the current key holding policy - to ensure drugs keys are held by the sole person in charge (or to carry out a written risk assessment if keys are not held by the person in charge identifying suitable control measures to minimize risk). 5) To ensure all medicines with an expiry date are labelled with the date of opening (such as tubes of ointment). 11. YA23 13(6) All restraint techniques (as detailed in individual service users’ physical intervention guidelines) must be discussed and agreed in a multi disciplinary forum, including the resident where possible. (Previous timescale of 2005 is not met). The wording in ‘Restraint guidance’ in respect of a named service user which states ‘hold 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 33 01/07/07 wrists firmly’ must be reviewed. (As suggested, following discussion and written confrimation from the trainer). (Previous timescale of 2004 is not met). To ensure that all written physical intervention guidelines for individual service users contain the name of the specialist who has established the guidelines, their role, signature and date. To ensure that the behavioural management guidelines as detailed in a letter from the Intensive Support Team dated 6 December 2006 on behalf of one identified service user, are included and transferred into a detailed behavioural management care plan. To discuss and obtain written consent from service users towards the weekly charge of £5.00 towards the fuel costs of the mini-bus. This must also be discussed and agreed with Local Authority commissioners (or social workers). A written record must be maintained and a protocol established, details must included in service users’ contracts and the service user guide. The manager must include the replacement of the damaged tiles in the ground floor bathroom in a planned programme of maintenance and renewal and must inform the Commission for Social Care Inspection of a planned date for their replacement. (Previous timescale of 31/5/05 is not DS0000024960.V330932.R01.S.doc 12 YA24 23(2)(b) 01/06/07 10 Chapel Street Version 5.2 Page 34 met). To ensure that the heavily stained carpet in the identified service user’s bedroom is either suitably cleaned or replaced. 13. YA30 13(3) To cease using communal items for service users such as a plastic jug for rinsing hair. To cease using plastic shopping bags for transporting clinical waste through the premises, suitable sealable bags must be used. All staff must be provided with training in Autism Awareness. (Previous timescale of 2004 is not fully met). 01/07/07 14. YA32 18(1)(c) 01/07/07 15. YA33 18(1)(a) The Manager must undertake an 01/07/07 up to date review of staffing ratios and service users dependency levels. To forward proposals to the Commission for Social Care Inspection. Sufficient staff must be allocated to provide service users with more flexible opportunities for community based activities and to meet personal support needs. A medical questionnaire (and/or health declaration) must be obtained in respect of the member of staff identified at previous inspections (as detailed in the inspection report of 1/3/05). (Previous timescale of 18/3/05 is not met). To demonstrate that there is a rigorous recruitment and selection process – all preemployment checks must be undertaken as detailed in 01/07/07 16. YA34 19 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 35 Regulation 19, Schedule 2 of the Care Homes Regulations 2001 (including a health care declaration and full employment history). Copies to be held on the premises. If the registered provider wishes to store information and documents such as Criminal Record Bureau disclosures and other pre-employment checks somewhere other than at the care home, a written request must be sent to the Commission for Social Care Inspection as detailed in their policy and guidance issued in January 2007. 17. YA35 18(1)(c) The provider must ensure that a decision is made in respect of how the home is to meet the Standard for the provision of Induction training to the required Standard. (All staff must receive structured induction within six weeks and foundation training within six months to Sector Skills Council specification and provided by a LDAF (Learning Disability Award Framework) accredited trainer. (Previous timescale of March 2005 is not fully met). All staff must be provided with disability and race equality training. (Previous timescale of 2004 is partly met). To improve the frequency of formal recorded supervision sessions (which should take place at least six times a year with a senior / manager). 01/07/07 18. YA36 18(2)(a) 01/07/07 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 36 19 YA37 9 To ensure that an application for Registration of the manager is forwarded to CSCI for processing by 1 June 2007. To establish and forward an individual personal plan for the manager of Chapel Street to CSCI by the date given (which includes training such as the Registered Manager’s award). 01/06/07 20. YA39 24 The Manager must develop an annual development plan for the home based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. (Previous timescale of 2003 is not met). 01/07/07 21. YA42 13(4) Systems must be in place to ensure quality monitoring (these must include consultation with service users, families, advocates and stakeholders etc . (Previous timescale of 2004 is not met). To undertake the following 01/07/07 improvements to health and safety: The Manager must ensure that full COSHH assessments are drawn up from data sheets available for all Hazardous substances used and stored in the home. (Previous timescale of 31/3/06 is not met). To ensure that the 2 hydraulic height adjustable beds are routinely serviced (at the frequency specified by the manufacturer). 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 37 To introduce regular health and safety checks (with records maintained) for bedrails and wheelchairs. 22. YA42 13(4)(c) To ensure more consistent checking and recording of cooked food temperatures 01/05/07 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 Good Practice Recommendations The service user guide should be expanded so as to include: service users’ views of the home. To consider implementing different person centred planning styles such as Essential Lifestyle Planning, Life Story books, Personal Futures Planning, MAP and PATH. To introduce pictorial activity programmes. To introduce a monitoring and evaluation system for activities undertaken by service users to ensure that they meet their individual preferences and needs. To continue to implement an improved system for the recording of activities which have taken place, records should also be maintained of why activities have not been undertaken including refusals by residents. To provide more flexible opportunities for service users to participate in the local community through outings and structured activities on an individualized basis. Menus could be made available in different formats with pictorial options produced using photographs etc. 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. 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 38 YA6 3. YA12 4. YA13 5. YA17 6. YA20 In order for a full audit to be carried out - it is recommended that a running balance of all medicines which are not included in the Monitored Dosage System such as PRN medication, is maintained and recorded. (For example carried forward onto the new MAR sheet). It is recommended that PRN guidelines are expanded to include the maximum consecutive days that medication can be administered, before seeking further medical advice. To consider checking and maintaining a record of the temperature of the drugs cupboard in order to ensure that this does not exceed the safe limit of 25 oC. To ensure that there are two signatures recorded on personal expenditure sheets (either 2 staff and/or the service user) to confirm all financial transactions carried out. It is recommended that an audit of service users’ finances is carried out by someone external to the organisation at least on an annual basis. To consider purchasing a steam cleaner for the regular deep cleaning of carpets and to include on the cleaning schedule. To obtain a copy of the infection control guidelines issued by the Department of Health (2006). To consider providing all staff with training in Makaton. It is recommended that the employment of male staff is actively pursued to provide choice and reflect the gender composition of service users. To establish an individual training and development assessment and profile for each member of staff. It is recommended that records are maintained to evidence what action has been taken when fridge and freezer temperatures exceed safe limits. 7. YA23 8. YA30 9. 10. 11. 12. YA32 YA33 YA35 YA42 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 39 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 10 Chapel Street DS0000024960.V330932.R01.S.doc Version 5.2 Page 40 - 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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