Inspection on 25/07/05 for Warrington Community Living - Twiss Green

This inspection was carried out on 25th July 2005.

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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warrington Community Living -... 22/10/07

Warrington Community Living -... 28/09/06

Warrington Community Living -... 06/12/05

Warrington Community Living -... 25/01/05

Warrington Community Living -... 03/08/04

Warrington Community Living -... 02/12/03

Warrington Community Living -... 04/09/03

Warrington Community Living -... 11/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Warrington Community Living - Twiss Green 53 Twiss Green Lane Culceth Warrington, Cheshire WA3 4DQ Lead Inspector David Jones Unannounced 25 July 2005 13:30 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. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Warrington Community Living - Twiss Green Address 53 Twiss Green Lane Culceth Warrington Cheshire WA3 4DQ 01925 766982 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) Warrington Community Living Les Whittle (proposed) Care Home 4 Category(ies) of LD(E) Learning disability over 65 (4) registration, with number LD Learning Disability (4) of places MD Mental Disorder (1) Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 4 service users to include: * * 2 Up to 4 service users in the category of LD (learning disability not falling within any other category. Up to 4 service users in the category of LD(E) (learning disability over the age of 65) may be accommodated. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance that may be issued through the Commission for Social Care Inspection 3 Date of last inspection 25th January 2005 Brief Description of the Service: Twiss Green is a care home registered with the Commission for Social Care Inspection to provide personal care and accommodation for four adults with learning disabilities. The establishment is a domestic four-bedroom bungalow set within a residential area of Warrington and blends in with neighbouring properties. The premises have been adapted to accommodate the needs of people with a disability. There is level access throughout the bungalow. Preparations were being made at the time of the inspection to provide additional bathroom, toilet and sluice facilities. Residents have specially adapted transport enabling them to access the local community. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was a routine unannounced inspection. The inspection took place on one day over a four and a half hour period and a meeting was arranged on another day to provide feedback to the manager. In addition to the manager four members of staff, were spoken with during the inspection. Three of the four residents were also spoken with but discussion was limited due to communication difficulties. The inspector observed staff interacting with and supporting residents. The gardens and some parts of the building were looked at, as were some records including the case notes of three residents. What the service does well: What has improved since the last inspection? The management structure had been strengthened and arrangements for the day-to-day supervision of staff had improved. The manager was enthusiastic about the home’s new assessment and care planning systems. These had not been successfully introduced but the manger intended to focus his attention on these developments in the near future. The new system is designed to help residents to make choices about the way they are cared for and supported. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 6 All staff had received training in the administration of medication and the home’s NVQ training programme continues to progress satisfactorily. The majority of staff have achieved at least an NVQ level 2 in care or are preparing to register with an appropriate agency to gain the qualification. An appropriately qualified person had checked the home’s portable electrical appliances and plans have been drawn up to provide improved toilet, bathing and sluicing facilities. The gardens had been cut back and were looking tidier. What they could do better: The Statement of Purpose and Service User’s Guide must be updated and published. Without this information new and existing residents and their representatives are disadvantaged when making decisions about the home. Assessments including risk assessments and care plans must be reviewed and updated to make sure that residents’ needs are known and met. Records regarding contact made with health and social care professionals should be recorded on separate continuation records for easy access and review. Management must ensure that care staff are aware of the content of care plans and are clear as to how residents’ needs are to be met. Care practice must be monitored, evaluated and reviewed on an ongoing basis to make sure that care is provided in accordance with the agreed care plan and the needs of residents. Staff should be provided with scheduled supervision a regular basis and staff should be made clear about their role and responsibilities regarding care plans. Guidance provided by the speech therapist, on communicating with residents should be put into practice. Staff training records should be updated and staff must be given appropriate training in adult protection, moving and handling and the prevention of fire. Appropriate toilet and sluicing facilities must be provided and the recommendations of the Occupational Therapist to improve access to residents’ bedrooms must be addressed. Policies and procedures that are more than two years old should be reviewed and if necessary updated. A report on quality issues should be produced and given to residents, their representatives and the Commission for Social Care Inspection. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 7 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. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, and 5. Some progress has been made to address a previous requirement regarding the home’s Statement of Purpose and Service Users Guide which need further development and publication. Without this information new and current residents are disadvantaged when making decisions about the home. New residents are able to visit and familiarise them selves with the home before moving in. Assessment, risk assessment and care planning processes need further development to make sure that residents changing needs are identified and planned for. Residents have not been provided with terms and conditions relating to their placement at the home. Without this document residents and their representatives do not have confirmation of the their rights and responsibilities. EVIDENCE: The manager of the home had developed a draft Statement of Purpose and a draft Service Users Guide. Both of which were in the process of being finalised. See requirement 1. A new resident had their needs assessed by the placing agency and by the manager before moving in. The new resident had visited the home before moving in and a comprehensive assessment and care plan had been provided by the placing social worker. However, two staff members said they had not read this individual’s case records and they were unfamiliar with the contents of the assessment and care plan. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 10 Assessments introduced by the manager before the last inspection had not been completed for two of the three existing residents and none of the findings had been included in the care plans. See requirements 2. Residents were not provided with documents confirming terms and conditions of residence. See recommendation 1. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, and 9. Care plans, and care planning systems require further development to make sure that that residents’ needs are known and met. Risk assessments and arrangements to control identified hazards require review and further development to make sure that residents are safe. EVIDENCE: Care plans did not reflect the changing needs of residents. Two of the three care plans seen had not been reviewed since March 2005. See recommendation 2. Reading of residents’ daily diaries and discussion with staff confirmed that the needs of one of the residents had changed significantly but these changes had not been recorded in the care plan. There was evidence that the dietician had been consulted regarding a loss of appetite and advice had been provided as to how the individual’s diet may be supplemented if a meal was refused. This guidance was not detailed in the care plan and records confirmed that it had not been acted upon when the resident had refused a meal. The dietician had also recommended that the individual’s weight is monitored. The individual had been weighed on the 15/07/05 but not since. Staff spoken with were unclear as to how often the resident should be weighed, one said weekly and another said two monthly. This resident’s medication had been changed and a Community Psychiatric Nurse (CPN) had been consulted regarding changes in behaviour. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 12 These changes in circumstances and the advice provided by the CPN were not recorded in the care plan. See requirement 3. The manager had drafted a care plan regarding the hazards of a resident falling out of bed. This also addressed the hazard of the resident choking during the nighttime. Three members of staff were unfamiliar with this care plan and were unaware that the resident was at risk of choking during the nighttime. See requirements 3. The hazards of the resident falling out of bed or the effectiveness of the control measure put in place by staff had not been risk assessed. See requirement 4. The care plan also addressed the hazards associated with the resident having an epileptic seizure during the night. This indicated that a listening device should be used to alert staff if the resident had a seizure. Staff spoken with said that the listening device had broken and had not been used since January 2005. The care plan had been reviewed in March 2005 and it would appear that the fact that the listening device broken had been overlooked. See requirement 2. Staff advised that the completion of the new assessment documentation had not taken priority. They were of the view that the task of updating and developing care plans could only be done by the manager who was of site. Three members of staff said they were unfamiliar with certain aspects of the care plans. The care plans were not used as working documents and two staff had not read the care plan relating to a resident admitted in April 2005. See requirements 2 and 3. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13 and 14. Residents are able to take part in a number of activities in the home and in the local community. These provide opportunities for leisure, personal development and social inclusion. EVIDENCE: Discussion with staff, observation and reading of records confirmed that staff engage residents in the day to day domestic routines associated with running the home including cleaning and tidying the house and making shopping trips to the local community. In addition residents are escorted on outings for leisure and recreation with regular drives out in the mini bus and visits to cafes and other places of interest. Staff were seen to interact with residents on a frequent basis engaging them in two-way communication. No progress had been made since the previous inspection to explore and implement methods to help communication with residents. Assessments completed by a speech therapist had been filed with care plans but there was no evidence that the recommendations had been put into practice. There was evidence that staff were monitoring the way a resident communicated and responded to staff but this was not being recorded in accordance with the advice of visiting health care professionals. See recommendation 3. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 14 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, 19 and 20. Residents receive personal support according to their individual needs. Health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis. Medication is stored, administered and recorded appropriately. EVIDENCE: Discussion with staff and observation of their interactions with residents indicated that each individual’s personal preferences as to how they wish to receive personal care are known and complied with. The manager advised that that new care planning systems would seek to build on staffs’ combined knowledge of each individual’s personal preferences with a view to ensuring that all staff adopt the same approach to care. Reading of records and discussion with staff indicated that residents’ health care needs are monitored and contact is maintained with health and social care professionals on an ongoing basis. All residents are registered with a local GP. Records of visits to and from health care professionals were recorded in each resident’s daily diary along with information about other daily events. Whilst this provided a comprehensive record, analysis and review would be better if separate health care records were maintained. Information provided by the manager indicated that illustrated “personal health records” would be introduced. These were not being used in the home at the time of the inspection. See recommendation 4. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 15 Arrangements for the storage recording and administration of medicines were satisfactory. All staff had received training in the administration of medication within the previous 12 months. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 16 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) 23. Satisfactory Adult Protection Procedures are in place to protect residents from abuse, neglect and self harm. Staff need training in adult protection to make sure that they know what to do in the event of any suspicion of abuse EVIDENCE: A copy of the local authority’s policy and procedures document on adult protection is available in the home for the guidance of staff. Staff confirmed that they had not received guidance or training on putting these procedures into practice. See requirement 5. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 17 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, 25, 26, 27, 28, 29 and 30.The home provides comfortable, bright and cheerful accommodation of a design and layout that reflects the needs of the residents. Some progress had been made to provide appropriate toilet and sluice facilities. This work must be completed to ensure the safety of staff and the safety, privacy and dignity of residents. EVIDENCE: Twiss Green Lane is a bungalow in keeping with the local community. It provides comfortable, bright and cheerful accommodation that reflects the needs of the residents. Adaptations have been made to the building over time to meet the changing needs of residents, including the provision of overhead hoist tracking and level access throughout the home. It was noted that the recommendations of a visiting Occupational therapist had not been addressed in full. Particular attention needs to be given to the recommendation to fit a magnetic hold open devices to all bedroom doors. The manager said that arrangements were in hand to provide an appropriate device that will disengage in the event of a fire. See requirement 6. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 18 Residents’ bedrooms are comfortably furnished and decorated in styles that reflect their characters. A risk assessment conducted by a member of staff in January 2004 indicated that adjustable beds are required for three of the residents. Two of the residents had been provided with an appropriate bed and action was being taken to provide a suitably designed bed for the third person. See requirement 7. The home is equipped with an assisted bathroom with WC, overhead hoist and specialised bathing equipment. Unfortunately the only other WC in the home is in a resident’s on-suite facility. The manager said that appropriate toilet facilities would be provided by April 2006. See requirement 8. The home is clean and free from malodours. Clinical waste is collected and disposed of. The home is not provided with a sluice or sluice facility on the washing machine. See requirement 8. The manager said that appropriate sluice facilities would be provided by April 2006. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 19 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, 35 and 36.Staff are employed in sufficient numbers and skill mix to ensure the well being of residents. The home’s staff training and development programme needs further development to make sure that staff training needs are known and met. All staff are supervised as part of the management process. However, scheduled supervision needs to improve to make sure that staff understand their roles and responsibilities. EVIDENCE: Staffing rotas and discussion with staff and the manager confirmed that staff were employed in appropriate numbers in accordance with the assessed needs of residents. The staff team and management structure had been strengthened with the employment of a Senior Support Worker. Staff were unclear as to their responsibilities regarding the development and updating of care plans. Staff advised that the completion of the new assessment documentation had not taken priority. Assessment documentation introduced in 2004 had not been completed for three of the four residents. Staff were of the view that the task of updating and developing care plans could only be done by the manager who was based of site. Staff were unfamiliar with the content of care plans. These were not used as working documents. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 20 Two staff had not read the care plan relating to a resident admitted in April 2005. See requirement 2 and recommendation 5. The manager advised that support staff were expected to be involved in the development and maintenance of the care plans. He intended to clarify these matters with care staff at forthcoming staff meetings and by scheduled one to one supervision. A programme of scheduled supervision had started in 2005 but was not offered at least six times a year as recommended. Some staff had supervision once since January 2005 and others had not had supervision since October 2004. See recommendation 7. Of the eleven support staff employed at the home four had achieved NVQ level 3, one had NVQ level 2 and two were working towards NVQ level 3. Staff training records were seen but staff said that these were not up to date. See recommendation 6. Staff said that they had not had training in adult protection and one said they were unclear as to whether they had training in moving and handling within the last 6 years. None of the staff had training in mental health. The fire precautions records indicated that staff had not had training in fire prevention since October 2003. See requirement 5. The manager said that staff training needs were being identified and would be addressed. Arrangements were being made to further develop the NVQ training programme and training in adult protection and mental health would be provided by the local authority. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 21 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) 37, 39 and 42.New management arrangements have been made to make sure that staff are appropriately supervised. These have not been in place long and further action is required to make sure that the home’s assessment and care planning arrangements are monitored and evaluated as the needs of residents’ change. Some progress has been made with the homes quality assurance systems and the home’s policies and procedures were being updated. Fire precautions procedures and arrangements need further development to make sure that residents are protected in the event of a fire. EVIDENCE: Precautions The recently appointed manager is a Registered Nurse Learning Disabilities and an experienced manager and practitioner in the field of learning disabilities with many years experience. He has made an application to register with the Commission for Social Care Inspection and is pursuing qualification in care management to NVQ level 4. See requirement 9. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 22 The home’s management structure has been strengthened with the appointment of a Senior Support Worker. However, these arrangements have not been in place long and action must be taken to make sure that staff are aware of their roles and responsibilities regarding the maintenance and development of assessments and care plans. See recommendations 6 and 7. Progress had been made toward meeting the requirement made at the last inspection to establish a system for reviewing and improving the quality of care in the home. The manager had introduced a “residents’, relatives” and other interested parties satisfaction questionnaire. Information from the returned questionnaires had not been received. However, the manager intends to produce a report to confirm action taken to address quality issues raised by residents and other interested parties. See recommendation 8. Some of the home’s policies and procedures had not been reviewed in a number of years. See recommendation 9. Information provided by the manager confirmed that an electrician had checked the care home’s electrical wiring. Control measures had been put in place to control potential hazards of a service user falling out of bed. However, a risk assessment had not been drafted in this regard for the benefit of analysis and review. See requirement 4. An automatic closer fitted to a residents bedroom door had broken and been removed but not replaced and information in the fire book indicated that staff had not had fire precautions training since October 2003. See requirement 10. Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 23 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 2 1 x 3 2 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score 2 2 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Warrington Community Living Twiss Green Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 2 x 2 x F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 24 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 YA1YA5 Regulation 4&5 Requirement Timescale for action 30/09/05 2. YA3 14 3. YA11YA6 15 4. YA9YA26YA 42 13 (1) (4) The registered persons must ensure that the statement of purpose and Service Users Guide include all information and documentation required by the regulations. (Timescales 03/10/04 and 25/03/05 were not met) The registered persons must 05/09/05 ensure the assessment of residents needs are kept under review and revised at any time when it is necessary to do so having regard to any change in circumstances. The registered persons must 05/09/05 ensure care plans are updated to reflect changing needs. (Timescales 03/08/04 and 25/02/05 were not met) The registered persons must 30/09/05 ensure that risk assessments address all potential hazards and that appropriate control measures are put into place where required. (Timescales 030904 and 25/02/05 were not met) Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 25 5. YA35YA23 18 6. YA24 13 and 23 7. YA26 16 8. YA30YA27 23 9. 10. YA37 YA42 9 13 and 42 The registered persons must ensure that staff receive training appropriate to their individual needs and responsibilities including, Adult Protection. (Timescales 031004 and 30/03/05 were not met) and Fire revention and moving and handling. The registered persons must ensure a safe living and working environment for service users and staff and accordingly must address all recommendations made by the occupational therapist in this regard including the fitment of magnetic hold open devices to bedroom doors (subject to this action being in accordance with the advice of the fire officer). (Timescales 03/10/04 and 30/03/05 were not met) The registered persons must provide furniture and equipment suitable to the needs of service users. (Timescales 03/10/04 and 20/02/05 were not met) The registered persons must ensure that appropriate toilet and sluice facilities are provided. (Timescale 03/11/04 and 30/06/05 were not met) The manager must achieve the registered managers award by 30/03/06 The registered persons must ensure that the closeing device to a residents bedroom door is replaced. 30/11/05 30/09/05 30/09/05 30/04/06 30/03/06 05/09/05 Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 26 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 YA5 YA6 Good Practice Recommendations The registered persons should provide each service user with a written terms and conditions document. The registered persons should ensure that care plans are reviewed and updated at least once per month unless circumstances change and a higher frequency of review is required. The registered persons should disseminate guidance provided regarding “communication with service users” to all members of the staff team. The registered persons should maintain records of liaison made on behalf of service user with their respective health care professionals on a separate medical continuation sheets for the benefit of ease of access, monitoring and review. The registered persons should make sure that staff are clear about their roles and responsibilities in relation to the maintenance and development of care plans. The registered persons should make sure that staff training records are kept up to date. The registered persons should make sure that staff receive scheduled supervision at least six times per year. The registered persons should draft a report that confirms the findings of the residents survey and states what action has been taken to address quality issues. The registered person should ensure that any policies and procedures, which are more than two years old, are updated. Staff should be made aware of all policies and procedures. 3. 4. YA11 YA19 5. YA31 6. 7. 8. 9. YA35 YA36 YA39 YA40 Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 Warrington Community Living Twiss Green F51 F01 S27022 Twiss Green V228462 260505 Stage 4.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!