Inspection on 02/06/05 for 25-27a Alexandra Road

This inspection was carried out on 2nd June 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

25-27a Alexandra Road 27/11/07

25-27a Alexandra Road 12/06/06

25-27a Alexandra Road 31/01/06

25-27a Alexandra Road 16/03/05

25-27a Alexandra Road 07/09/04

25-27a Alexandra Road 27/01/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 25/27a Alexandra Road Weymouth Dorset DT4 7QQ Lead Inspector Sophie Barton Unannounced 02 June 2005 10:00 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 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 Stationary 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. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 25/27a Alexandra Road Address Weymouth, Dorset, DT4 7QQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 760663 01305 770236 Dorset County Council Daniel James Crone Care Home only 23 Category(ies) of PD - 3 registration, with number SI - 2 of places LD - 23 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. Date of last inspection 16 March 2005 Brief Description of the Service: 25/27a Alexandra Road is a care home providing a service to adults who have a learning disability. The home is located in Weymouth, a short distance from the town centre, and is owned and operated by Dorset Social Care and Health Directorate. Alexandra Road was built in the late 1970s and can accommodate up to 23 people, usually offering 21 permanent and 2 short-term care places. The home is split into units, accommodating between 4 and 9 service users in each unit. Each unit has a lounge, dining room, kitchen and their own bathroom and toilet. Each service user has a single bedroom.There is a garden to the rear of the property. Staffing is provided 24 hours a day. However staffing levels are reduced during the day, therefore the majority of service users attend local day service establishments during the week. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place between the hours of 11.30am and 6:30pm on the 2 June 2005. During this time the Registered Manager was present. The Inspector spoke privately with four staff members. The Inspector spent time with service users in one unit during their evening meal, visited service users in two other units, observing interaction between the service users and staff and chatting informally with the service users. This day also involved examining a range of documentation (e.g. complaints log, fire log, rotas, medication administration records, staff personnel files), and going through three service users’ care files and daily diaries. Comment Cards from service users and other professionals have also been used to inform judgements and provide evidence about the care provided by the home. What the service does well: What has improved since the last inspection? Opportunities for service users to partake in more household tasks and improve their independent living skills have increased over the past six months. Staff are more proactive in ensuring service users are encouraged to be as independent as possible. The staff and management team have a clearer focus and interest in person-centred care planning, but due to staffing restraints true person centred plans cannot be implemented yet. The Manager is also more aware of and committed to meeting the Care Home Regulations, particularly in relation to admitting service users and ensuring the home is able to meet their needs. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 6 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. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 Some improvement has been noted in ensuring that the home accommodates only those service users who’s needs can be met within the home. The admissions procedures remain poor however, with the home having very limited records of the service users’ needs and aspirations. EVIDENCE: A service user had recently been admitted to the home as an emergency. The manager had requested a Care Management Care Plan and Assessment but one had yet to be obtained, although the service user had been in the placement for nearly a week. The home had not developed their own care plan. There was no evidence provided to show that this service user had been informed of any potential restrictions on choice and freedom that the home was likely to impose. The home does not have their own referral or initial assessment proformas and therefore the information they receive on prospective service users is variable and limited. In discussion with the Manager he is clear however on the range of needs the home can accommodate and showed evidence to the inspector that several new referrals had been turned down due to the service users needs being high, and the home’s lack of staffing hours to meet these needs. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 There is no clear or consistent assessment and care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users’ needs. Goals and aspirations are recorded, but too many of these are not being met by the home, leaving many unmet needs. The home’s risk assessment management strategies are not robust enough, leaving service users at risk of harm, and restricting rights and independence. EVIDENCE: The Inspector examined three care files in detail, of three randomly selected service users. Each file contained a document called ‘Establishment Task List’ which is used as an assessment and care plan document detailing the needs of service users and should state how staff are to meet these needs. However the ETL’s seen were very limited in detail. For instance for one service user the only details under ‘health’ was “good”, but the daily notes made for this service user stated that she was becoming increasingly confused, and had dry skin that needed creams. The ETL’s had not been updated or reviewed for over a year. Each service user also had an Individual Service Plan (ISP). This is a review document, used by the Day Centres, and details the service user’s needs and strengths and individual goals. The home’s policy is to review the goals each month but there was no evidence that this had happened. On all 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 10 files seen there was no evidence that all of the goals had been met by the home (unmet needs were seen in relation to social outings, contact with family, swimming and holidays). A risk assessment seen stated the service user was at risk of burns or scalding when using the cooker, and at risk of choking, but there was no evidence of how this decision had been reached and was not detailed in the service user’s ETL. Risk assessments did not consider the benefits of the activity for service users or whether it was the service user’s right to take responsible risks. For service users where risks have been identified (wandering / confusion, aggression towards others) there were no clear behaviour plans seen detailing how staff are to manage and minimise the risks. Following discussions with the manager and staff members the Inspector considered that for instance even though there is no record of how a service user’s specific health needs are to be met, staff are taking appropriate action and meeting the needs. A staff member confirmed that a service user was regularly being taken to GP, and her weight and diet being monitored. Another staff member was able to verbalise how a service user who is aggressive is constantly monitored and behaviour modification implemented by focusing on positive behaviour. However due to the number of agency and temporary staff used the practice of minimal care planning documents allows for the potential for needs to be unmet. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 17 Links with the community remain limited, affecting service users real choice in taking part in enriching social and educational opportunities. Progress has been made in increasing service users’ opportunities for personal development within the home. Dietary needs of service users are well catered for, but the home’s practices inhibit service users’ independence in planning and preparing their own meals. EVIDENCE: In discussion with staff and by examining daily records it was evidenced that service users are now involved in doing their own laundry, cleaning, shopping for personal items, and collecting and managing their own money, with support from the staff working in their unit. Some service users told the Inspector that they had cooked their own meal recently. This practice is still limited and irregular. Service users do make their own breakfasts and lunches however. The service users all attend a Local Authority Day Centre during weekdays. At the Centres the service users do a range of activities, and links have been made with some Adult Education groups (textiles, drama). Although informal 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 12 arrangements are now made for service users to have the occasional day off from the centre to either stay at home or to go out with their key workers, this choice is not formalised or readily available to service users, as the home is not staffed sufficiently during the day. There was no evidence provided in care files to show that service users have been fully consulted about what employment/training or leisure activities they would like to partake in. Daily diaries showed that service users were not taking part in a range of community activities. In a two week period a service user had only been out twice (to Portland and to the local pub) another service user to the local shop twice and pub once. Very few opportunities for pursuing outside hobbies was evidenced – no evening classes, sports, social clubs. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, and 19 Personal care needs are documented ensuring staff have information about how to guide and support the service users. Insufficient recording of health needs has the potential for causing some needs to be missed by staff, and arrangements for ensuring service users have regular health checks ups are poor. EVIDENCE: The ETL’s seen detailed the service user’s needs in relation to personal care (toileting, eating, drinking, sleeping etc). Although the information was limited it was sufficient to ensure that staff were aware of any particular needs. The Inspector interviewed three members of staff and they all clearly articulated how they do promote independence, dignity, privacy and the importance for service users to have their own control over their care. The care files seen showed that referrals had been made to community nurse, occupational therapists and speech and language therapist as necessary. There was no health planning documentation (see Standard 6). Although daily records showed that service users had been supported to attend GP appointments when necessary there was no evidence of service users having regular checks at the dentist, optician or having hearing tests. The medication file confirmed that a service user was prescribed prn (when needed) pain relief, but nowhere in his notes did it inform staff of guidance for when this medication should be given. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints system with some evidence that service users are promoted to raise concerns and that their views are listened to and acted upon. Service users are safeguarded by staff’s knowledge of adult protection procedures and written policy. EVIDENCE: Resident meeting minutes seen evidenced that service users are given the opportunity in these meetings to raise concerns or complaints. In discussion with staff they were also all clear about how to highlight whether a service user is unhappy and how to support service users in raising complaints. The staff members confirmed that they are aware of the whistle blowing policy and that they felt competent and able to raise concerns with the management team. The complaints log evidences that complaints are acted upon appropriately. It continues to be advised that the home provides service users with more user-friendly information on complaints. There have been no formal complaints made about the home or any adult protection concerns raised. Staff were able to show understanding of adult protection procedures, including the need to refer to statutory agencies. The Manager confirmed that staff have attended relevant training in adult protection. The home’s policies and practices regarding service users’ money has now improved, with evidence now seen that records of withdrawals are being cross referenced with bank statements. Where service users have previously paid for staff to have lunch or join them in an activity the Manager has agreed for this to be refunded. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The standard of the décor, furnishings and fittings within this home is acceptable, but further changes are needed before the home can be assessed as being homely and fully suitable for the service users living there. EVIDENCE: The premises comprise of four different living units (four to nine service users accommodating a unit). Each unit has a small kitchen, dining room, lounge and bathroom and are made to look homely with suitable furnishings. The Manager has made these units more independent from each other, and encourage the service users to not access another unit without permission. However there is still a centralised non-domestic kitchen and laundry area. Service users are not allowed access to the main kitchen at any time, and the individual kitchens are not used to store food or cook main meals. The premises remain unsuitable for wheelchair users. The largest unit still accommodates short-term service users as well as long-term residents, and has a small lounge which does not allow for all service users to sit in this area comfortably. The staff and Management team consider that the service users would prefer not to share their accommodation with short-term residents. To access an upstairs unit, one needs to walk through the communal area of another unit. People also access the garden via a communal area of another unit, therefore the unitisation is still not adequate or ideal. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34 and 35. Only limited progress has been made in addressing staffing shortages and as a result service users do not receive consistent or appropriate care and support. The home has not followed safe recruitment practices and has therefore placed service users at risk. The service users benefit from a staff team who have suitable qualities and attitudes and who promote the aims and values of the home. However staff do not have the knowledge or trained sufficiently to meet the specialist needs of service users who have a learning disability and associated difficulties. EVIDENCE: The Inspector examined three personnel files for new members of staff. Criminal Record Bureau certificates were not received by the home prior to these members of staff starting working in the home. Although the staff members did not do personal care they were not supervised at all times. The Manager also did not know whether POVAFirst checks were completed. For one new member of staff there was no proof of identity documentation. Discussions with four staff evidenced that staff are clear about the ethos and aims of the home, and all showed commitment and interest in service users. Their attitudes were commendable. All the comment card replies from service 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 17 users confirmed that the staff treat service users well. Health and Social Care professionals also stated that staff have a clear understanding of service users’ care needs. However, there has not been sufficient training provided to staff. Staff have not had ready access to the Learning Disability Award Framework Training. A member of staff who started in the home a year ago, has still not been on this training, is not NVQ 2 qualified and had no specialist training in autism, epilepsy, old age or challenging behaviour. In discussion with the manager and by examining worked rotas, the home continues to be under staffed in relation to the Department of Health staffing calculation guidance (by approx 200 hours per week). In practice it is also clear that the home is understaffed, with only one member of staff working in each unit, and some designated hours for one-to-one support work as required. This means that staff are restricted in spending uninterrupted time with service users, and in taking service users out of the home in a flexible way. The Manager continues to be aware of the need to increase staffing and confirmed that he is currently liaising with the Directorate about ways to increase the staffing. The Manager stated that the use of agency staff has reduced considerably over the past few months 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The home’s systems for reviewing its performance is poor, with no formal quality assurance systems and no formal consultation with service users, staff or relatives. There are appropriate health and safety checks undertaken in the home to ensure the welfare of service users. However the home’s practices in relation to incidents and accidents within the home are inadequate with service users being left in potentially harmful situations. EVIDENCE: The accident log evidenced that since January there has been three accidents involving a service user receiving an injury, and one incident where a service user had assaulted another service user. These had not been notified to the Commission and there was no evidence that risk assessments or care plans had been reviewed to see how the risks of further injury could be minimised. The Manager confirmed that the safe working practice risk assessments have been reviewed and that fire checks had been undertaken regularly. Water temperatures are also monitored. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 19 The manager confirmed that no progress has been made on a development plan for the home that reflects consultation with service users, their representatives or staff. There are no formal quality assurance systems in place and although service users have been consulted about the care provided by the home, these views have not been collated or analysed in terms of improving the care provided. 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 3 2 1 2 x x 2 Standard No 31 32 33 34 35 36 Score 3 1 1 1 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 25/27a Alexandra Road Score 3 1 x x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 1 x D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 14, 15 Requirement Timescale for action 01.08.05 2. 13 16 3. 19 13 4. 32 18 The Registered Manager must ensure that all assessments and care planning documents (ETLs) are completed in more detail, depth and in consultation with others. Assessments and care plans must be regularly reviewed and kept up to date (Previous timescale of 01.01.05 not met) There must be evidence that the 01.08.05 staff have consulted with service users about their social interests, and made arrangements to enable them to engage in local, social and community activities on a regular and flexible basis. (This requirement was first made in August 2003) The Registered Manager must 01.09.05 ensure that all service users are enabled to have regular check ups from health care professionals. The home must provide training 01.10.05 to staff on autistic spectrum disorder. (Previous timescale of 30 August 2004 not met) 50 of care staff must have at least an NVQ 2 qualification in care, all staff should be encourged to be working towards Version 1.40 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Page 22 5. 33 18 6. 34 19 7. 39 24 this qualification and be enabled to undertake the Learning Disability Award Framework training. The Registered Provider must increase the staffing levels to allow for increased opportunities and needs to be met for individuals. (Previous timescale of September 2003 not met) No person must start work in the care home until a satisafctory POVAFirst check has been received. Persons working in the home without a full CRB check must be supervised at all times by a designated person/s. The Regsitered Manager must develop quality assurance methods based upon seeking the views of service users and other interested parties, to ensure success in achieving the aims and objectives of the home. An annual development plan must be produced reflecting the outcome of the consultation. (Previous timescale of September 2003 not met) 01.09.05 15.07.05 01.09.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations There should be evidence that potential restrictions placed on service users right to freedom and choice have been discussed and agreed with the service user and/or their representative. The home should ensure that Care Management Assessment and Care Plans are obtained within 5 days for all emergency placements, and that the home completes their own care plan of how they are to meet the service users needs. D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 23 25/27a Alexandra Road 2. 6 3. 9 4. 12 5. 14 6. 7. 8. 9. 17 19 20 24 The Registered Manager should ensure that there are firmer procedures for referrals and admissions to the home, ensuring that appropriate information is sought on the service users needs. The homes care plan should cover the areas detailed in Standard 2.2. As per the homes procedures there should be monthly recording on how the service users goals are being met by the home. The care plans should be developed in a suitable format to the needs of the service users. (These recommendations have been brought forward from the inspection report dated August 2003) Where risks have been highlighted on risk assessments there should be clear evidence of how this decision has been reached. The home needs to ensure that it allows service users to take responsible risks and encourage independence. The Registered Manager should ensure that all risks identified (particularly health, behaviour) are assessed and recorded in full, highlighting how staff are to minimise the risks (This recommendation is brought forward from the inspection report date March 05) Service users should be given a choice and range of options in relation to the day activities they partake in (education, employment, training). This recommendation is brought forward from the inspection dated August 2003. Service users should be enabled to have a holiday outside of the home. Service users should also be given the opportunity and encouraged to pursue a variety of leisure interests and activities outside of the home. This recommendation is brought forward from the inspection dated January 2004. Service users should be able to shop, prepare and cook their meals each day. This recommendation is brought forward from the isnpection dated September 2004. There should be considerably more information recorded on service users health needs and how the home is to meet these needs. There should be clear guidance on each service users file for when and why they should be given their prn medication. The home should be made more suitable for the service user who is a wheelchair user. The home should not continue to offer a short term care service as the communal areas cannot be seperated from the living areas of the permanent residents. D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 24 25/27a Alexandra Road Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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 25/27a Alexandra Road D55 S32045 Alexandra Road V216294 020605 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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