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Inspection on 21/06/05 for Aspinden Wood Centre

Also see our care home review for Aspinden Wood Centre for more information

This inspection was carried out on 21st June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

One relative said `very grateful for the caring attitude of staff`, another that `the home is clean and the staff lovely`. A professional who arranged for someone to be placed at the home said `hostel staff are skilled`, another that their client `has never been as well`. The home knows what service users needs are, and have assessments completed by professionals from the authorities paying for the service. Where service users agree care their needs are met. Service users are able to feel at home, sometimes for the first time. Service users are confident to complain if they feel things are not right or they are not happy. Staff are generally trained to understand the needs of service users.

What has improved since the last inspection?

A professional who placed one of the service users says the service has improved significantly, staff always being aware of what is happening with individual service users, and quick to make contact if there are significant changes to a service users wellbeing. The home has been refurbished and decorated. Service users are now kept safe from the risk of fire with regular drills and checks of the fire alarm system.

What the care home could do better:

The home has not been able to put right problems and gaps in the administration of medication to service users and must do this immediately, to manage risks to service users. When the home have difficulty agreeing with service users, or within the staff team, about how to support them, there are significant gaps in health and personal care support that must be put right. The home has not planned for the growing mental health and health needs and increasing non-compliance of service users admitted. This means that staff numbers, the structure of support and call bell systems have not changed, presenting gaps in support and some confusion between staff as to how to respond. Service users need to be able to make more decisions about how they are supported, including their right to take acceptable risks. Service users feel they are not listened to enough. Examples are the failure of the home to formally check if service users are happy with the outcome of complaints they have made, and dissatisfaction of service users with the ability of staff to empathiseand understand their needs, particularly where they have significant mental health needs. The home needs to check all staff references and other recruitment checks, even where they have previously worked at the home.

CARE HOME ADULTS 18-65 Aspinden Wood Centre 1 Aspinden Wood Road London SE16 2DR Lead Inspector Mark Stroud Announced 21 June 2005, 10:00 st 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. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Aspinden Wood Centre Address 1 Aspinden Wood Road, London SE16 2DR 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) 020 7237 0331 admin@awc.equinoxcare.org.uk Equinox CRH Care Home 24 Category(ies) of A Alcohol depend/past/present 16 registration, with number A (E) Alcohol depend over 65 8 of places Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 eigth of the service users may be over 65 Date of last inspection 25th January 2005 Brief Description of the Service: Aspinden Wood Centre is a providing personal care and accomodation to 24 people with past or present alcohol dependence. The home is part of the Equinox Care project, a voluntary organisation. The home is two-storey with a passenger lift between floors. It is located in Bermondsey, South London, close to local shops, social and leisure facilities, and public transport links. The home has off street parking. There is a garden It has several well-maintained garden beds around the home.The home’s objective, as set out in its’ Statement Of Purpose, is to provide a safe, controlled and supported alternative environment for homeless people with dependency on alcohol, whom would otherwise be drinking on the street.The home also offers a care planning and key worker system, plus links with and support from various agencies, including health and social services. On the day of the inspection there were no vacancies. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulation Inspector and one Pharmacy Inspector visited the home, spoke with service users, staff, and the manager, examined records, and made observations of the support provided. Service users, relatives and staff completed comment cards about the service before the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home has not been able to put right problems and gaps in the administration of medication to service users and must do this immediately, to manage risks to service users. When the home have difficulty agreeing with service users, or within the staff team, about how to support them, there are significant gaps in health and personal care support that must be put right. The home has not planned for the growing mental health and health needs and increasing non-compliance of service users admitted. This means that staff numbers, the structure of support and call bell systems have not changed, presenting gaps in support and some confusion between staff as to how to respond. Service users need to be able to make more decisions about how they are supported, including their right to take acceptable risks. Service users feel they are not listened to enough. Examples are the failure of the home to formally check if service users are happy with the outcome of complaints they have made, and dissatisfaction of service users with the ability of staff to empathise Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 6 and understand their needs, particularly where they have significant mental health needs. The home needs to check all staff references and other recruitment checks, even where they have previously worked at the home. 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. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 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 Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 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 Service users needs are known and understood. EVIDENCE: The home knows what service users needs are, and have assessments completed by professionals from the authorities paying for the service. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 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, 7 & 9 Most service users know their needs will be met, but need to be able to make more decisions about how they can take acceptable risks. EVIDENCE: Service users have plans that describe the care they will receive. These include the areas of need identified by social and health care professionals. Staff meet regularly with service users and record what was discussed. Strategies to meet service users’ needs, described in plans, need to be more detailed. An example of current planning for instance states ‘to encourage to get into clean clothes’ rather than saying how this should be done. During the inspection, staff discussed the need to be clear how to support one service user. Also, without more detail, it is not possible for service users to know they will be supported in the way they want, so that staff support the skills they already have, and they are really involved in the running of the home. Plans were not signed in all cases to show agreement. One service user said they didn’t agree to the way they were described in their plan. Access to the kitchen is currently restricted to certain times of the day, and this is not described in individual plans for care. This means the restriction has been applied arbitrarily, without reviewing it regularly for each individual affected. Within the second kitchen area, the home have used other measures to manage risk, including switching off appliances at agreed times. A similar Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 10 approach needs to be taken for the main kitchen, recording why other measures have failed, and what other measures have been considered first. Preventing free access can undermine service users’ right to an ordinary life in a homely environment, and undermine the independence of service users which the home is trying to maintain and develop. Service users have also said they have to wait for access to food in the mornings on some days, when items have been removed or run out. The manager said they were considering installing lockable food cupboards for service users. The home do assess the risks to service users in other areas, and keep these up to date to make sure service users can take acceptable risks. Service users enjoy regular meetings with each other and staff, where they can express their wishes and feelings. While minutes are recorded, service users don’t receive a copy and aren’t clear what’s been agreed, and who will do what. One relative requested the home were informed about a service users financial entitlement and this was passed onto the home who said they were aware. The manager confirmed that one service user has been compensated following a recent burglary. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 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) 12, 13, 15, 16 & 17 Service users feel secure and at home, but need to be listened to more. EVIDENCE: Service users said that they felt at home, and were much happier living at the home than they were previously. One professional said the service user they placed at the home is not able to leave the home as regularly because staff support in the home has decreased. Staff described support to service users away from the home. Staff said that more service users need support to leave the home safely now and that this is difficult to provide. Some service users said they have to wait in the morning to get food after supplies are taken or have run out during the night. The manager said she will talk to service users about putting lockable food storage for each of them in the kitchen area. One service user said that food is good, but that their request for more salads in the hot weather has not be acted on yet. Food provided by the home’s cook is freshly prepared, wholesome and nutritious. Service users have regular contact with their family and staff encourage this. Most interaction between service users and staff happens in and around the office. The home needs to think about this, in order to respect the dignity and privacy of service users. Clear agreements about the consumption of alcohol, and support with finances are Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 12 kept. Service users are not always happy about this but understand the reasons for it and agree to it so that they can remain well, and continue living at the home. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 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, 19, 20 & 21 The home has made limited progress with regard to the arrangements for administration of medication since the last medication inspection. This potentially places service users at risk. There are significant gaps in the support of service users’ personal and health care. EVIDENCE: Staff and the manager realise that the majority of service users need considerable support with their personal care. Staff described the significant progress they have been able to make with some service users, who are now laundering their own clothes. A number of service users were dressed in clean clothes and looked well cared for. One service user said they had been supported to buy new clothes recently. However, one service user needs considerably more support for their personal care and was confused how they could get it. Staff clarified this, but recognised they needed to do more to provide alternatives which might be more acceptable. One service user with a visual impairment described how they kept themselves safe in the building and found their way, but plans and the comments of staff did not describe how this is supported by the home. The home has call points for service users to get help from the office if they are in trouble in corridors, but these have not been fitted in bathrooms and toilets yet. This was recommended by an Occupational Therapist before the last inspection. The home recently experienced communication problems with a London hospital, where it was unclear they were accepted as responsible for a service Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 14 users care. The home needs to record the handover of care to hospitals, and include their role and contacts. The home also needs to review the frequency of contact with service users admitted to hospital and what to do if this becomes difficult. Staff described support for service users to attend health checks, where they might be reluctant. An optician comes to the home twice a year, and sees all service users every year. Staff need to ensure plans are clear for service users to attend well men and women checks and other health checks, and what to do if this is declined. One service user has lost a considerable amount of weight and staff were concerned. Plans and a risk assessment to maintain and increase the service users weight were unclear and their weight was not consistently recorded. Service users need more support to make decisions and arrangements in the event of their death, including wills. The previous medication inspection report was received in February 2005. Several requirements were made but these have not yet been actioned. Staff record when they have given medication, but not when medication is returned to the pharmacy. An immediate requirement was left to start a Returns Log immediately, as no returns have been logged since December 2003. Recording on Medication Administration Record (MAR) charts requires improvement. There were a significant number of missing signatures. Some residents regularly miss doses, either when they are not at the home, or when they don’t come to the office to receive their medication. The reasons for missed doses must be documented and staff must actively prompt residents to take their medication, or arrange with the GP to change dosing times, or frequencies to ensure medication is received as prescribed. Double checks on all administration are still being done by photocopying the original MAR chart and a second member of staff signs the photocopy. This is causing problems as signatures are sometimes missing on the original and/or the photocopy, and this should not be necessary if staff have received appropriate training. The Manager advised that staff have now received medication training. The home must have an authorised signature list of those members of staff who have received training and are authorised to administer medication. A requirement was made to obtain Patient Information Leaflets for each dispensed item, this must be done and staff must use these to familiarise themselves with the medication they are administering in order to monitor any change in condition which may be due to medication. This is important, as medication reference books at the home are several years old. As the home does not have a separate medication fridge, prescribed items must be kept in a locked box within the main home fridge. Service users sometimes self-administer, and this needs to be developed, particularly for those moving out to less supported accommodation. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 15 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 & 23 Service users know they can complain, but are not always able to say if they are unhappy with the response and know that they will be listened to. Service users are kept safe, except where posts are kept open for staff who leave the home’s employment temporarily. EVIDENCE: The home record formal complaints, but do not currently have a system to keep complaints as informal. This means that a lot of paperwork is always produced, where the matter could have been resolved more quickly. In all cases they look into complaints, and investigate where necessary. In one case service users were not happy with the outcome, but the manager was not aware of this. The home needs to make sure complainants are happy with the action taken, and think about what to do if they aren’t happy. The manager agreed to look into the complaint again. Staff have received training regarding the protection of service users from abuse, know what to watch out for, and what to do if they are worried. The home does check for any criminal record or convictions and staff’s previous employment record. However, one staff member whose post was kept open for a year, was not re-checked before returning, and should have been. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 16 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, 26 & 30 The home is comfortable, but requires further adaptations for the safety of service users. EVIDENCE: The communal space is good, allowing service users space to sit in a ‘dry’ area where they choose not to drink and to sit in a lounge where they can drink and they know others will be. New flooring has been fitted in the day room (dry area), drinking room and some bedrooms. Bedrooms have seating to sit alone or with friends and there are two separate kitchen areas with seating for dining. The home has garden space around it, with service users often sitting outside the entrance. The grassed area to the side of the home should have seating and shade so that service users can make more use of this in the summer. The home accommodates 24 service users, making it a large service. This must be reviewed before April 2007 to ensure plans for no more than ten service users to share facilities and staff. This will mean service users can have more choice about who they live with and be more likely to get to know staff, who will in turn be able to understand their wishes and feelings better. One service user had a hole in their bed sheet, and one service user’s bedroom walls were very dirty and in need of redecoration. There is no hot water to the first floor bathrooms. This makes it more difficult to meet the needs of service users who enjoy a bath and need support to remain clean. An Occupational Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 17 Therapist assessed access around the home last year. Some of their recommendations have been followed, but the home need to respond to the remaining recommendations, making changes, and/or being clear why they haven’t. Service users wash their own clothes in the laundry room. Cleaning in service users’ rooms has improved since the last inspection and service users are happy with the support they get from cleaning staff. There is less food hording than at the last inspection and evidence of good support in this area. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 18 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) 32, 33 & 35 Staff are trained, but numbers of staff have not changed to reflect the growing and more complex needs of service users. EVIDENCE: Staff interact with service users with clear structure, often in or around the office. There are clear written agreements about the responsibility of staff and service users, particularly regarding the amount of alcohol consumed and budgeting. As a group, service users feel staff are not so aware of their needs, particularly where they concern a combination of alcohol dependency and mental health needs. Staff themselves and the manager recognise that an increasing number of service users have significant mental health needs, and are trying to address these, but that older ways of working may no longer work. Service users feel they get different messages from different staff about what they can or can’t do, for instance when they can have a drink. This makes it feel more personal when some staff say no. Service users also said they felt not all staff understand their need for a drink first thing in the morning. Service users were concerned about a service user whose mental health had deteriorated and, they felt, not been responded to quickly enough by staff. Staff said themselves that one service user was not being supported consistently by staff and agreed to talk about it in the next staff meeting. Most service users need significant support with daily personal care. Current staffing levels may not reflect this and the manager must review staffing against the current needs of service users. Current staff are following National Vocational Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 19 Qualification awards in care, a nationally recognised qualification for care staff to show they are able and confident to meet service users needs. Staff are also trained to safely prepare and serve food, move service users, and provide first aid. Staff have also followed training to help motivate service users. A team day is planned for staff to review the way they support service users, planned for 1/7/05. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 20 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 & 42 The home does not plan changes in the service with service users. Service users are kept safe from the risk of fire. EVIDENCE: The home does not currently have a development plan. This means they are not able to record a plan for the service, which service users can see and give ideas for. This means that the change in needs accepted by service users and staff cannot be planned for, to make sure support is still appropriate and sufficient. The home have regular fire drills and alarm tests, so that service users know what to do in the event of a fire. Service users smoking triggers the fire alarm at the home. Since smoking is allowed, this takes away from service users privacy, and dignity. The home need to review the sensors that are installed with the fire authority to see if this can be avoided. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 21 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 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 2 3 Standard No 31 32 33 34 35 36 Score x 3 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Aspinden Wood Centre Score 2 2 2 2 Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6, 18 Regulation 15 Requirement Timescale for action 31/08/05 2. 7 12(2)(3) 3. 8 16(2)(m) The home must support the existing skills and interests of service users by working in patnership with them, supporting them to draw up their Service User Plan in sufficient detail for service user and staff, and sign it. This must inlcude the plan for the service user with a visual impairment. The risks to service users 30/10/05 entering kitchens must be assessed for each individual, showing that their needs ar emet, and decisions, wishes and feelings are acted on, within a risk management framework. The registered manager must 31/08/05 ensure that service users care plans include statements of how each individual service user will be offered opportunities to be involved in the activities of the day to day running of the home, and that there are adequate monitoring and recording systems in place to demonstrate that these opportunities are being offered, taken up or refused. Where there are any restrictions placed on individual Version 1.30 Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Page 23 4. 12 & 33 18(1)(a) 5. 17 16(2)(i) 6. 17 16(2)(i) 7. 18 & 29 23(2)(n) 8. 18 12(2)(3) 9. 19 13 service users being offered particular activities, this must be reflected in the care plan and agreed with the placing authority and with the service user(timescale of 31/05/05 not met). The registered provider must ensure the home is adequately staffed at all times to help ensure service users receive the required support according to their assessed needs.This requirement was made at the last inspection. (timescale of 30/10/04 not met. Enforcement action may be taken.. The registered provider must ensure that the menu is regularly reviewed in consultation with service users(timescale of 31/05/05 not met).. Service users who want food outside of meal times must have access to food, unless agreed otherwise, agreed in the Service Users Plan.. The registered provider must ensure that the disused call alarm system is removed and a new one fitted, including pull cords in toilets and bathrooms and call points in each room (timescale of 31/07/05 given at last inspection). The service user described must be consulted about how to support their personal care, and record this in their Service User Plan, arranging for any items to be purchased, in consultation with the funding authority. The home must clearly assess the risks of service users losing weight, and refusing health checks, maintaining safe systems of monitoring and 31/08/05 31/07/05 31/08/05 31/07/05 31/08/05 31/08/05 Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 24 10. 20 14(2) 11. 20 18(1)(c)(i ) 12. 20 13(2) 13. 20 17(1)(a) 14. 20 17(1) 15. 20 13(2) 16. 20 17(1) review involving the purchasing authority, and health professionals. A report of current progress regarding the service user discussed must be sent to the CSCI, Southwark office. The registered manager must ensure that a planned selfadministration programme is put in place for all service users due to leave the home to move into less supported accommodation. The registered manager must ensure that an authorised signature list is maintained of all staff who handle or administer medication, have received appropriate training, and have been assessed by the manager as competent in this area. The registered manager must ensure that all medication, including returns and medication for disposal, is stored securely within a locked cupboard. The registered manager must ensure that a log is kept of all medication returned to the pharmacy The registered manager must ensure that reasons for missed doses are documented and staff actively prompt residents to take their medication, or arrange with the GP to change dosing times, or frequencies to ensure medication is received as prescribed. The registered manager must ensure that all prescribed items which require refrigeration are kept securely locked within a separate container in the main fridge as the home does not have a separate medication fridge. The registered manager must ensure that recording of 31/10/05 31/08/05 31/10/05 Immediatel y 31/08/05 31/08/05 31/08/05 Page 25 Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 17. 20 13(2) 18. 23 19 19. 24 23 20. 21. 22. 26 27 39 16(2)(c) 23(2)(j) 24 administration is carried out on a single MAR chart, and the process of photocopying MAR charts for a second signature is discontinued as this is not necessary if staff have received appropriate training. The registered manager must ensure that an up-to-date medication reference book e.g. BNF is provided for the home. The policy and procedure regarding employees returning from secondment or special leave must include safe systems of rechecking CRB and other references before they return to the home. The home must plan with service users and other stakeholders includig funding authorities for the home to be reorganised so that no more than ten people share a staff group, a dining area and other common facilities by April 2007. The service users bed sheet must be replaced, and service users room made good.r Hot water, according to risk assessments, must be supplied to upstairs bathrooms.. The home must draw up an annual plan for the service, showing how the growing mental health needs of service users, and the break down of existing contracts around drinking, will be met. 31/08/05 31/08/05 31/12/05 30/09/05 30/09/05 31/08/05 23. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 26 No. 1. 2. Refer to Standard 8 19 Good Practice Recommendations Service users should be given minutes of meetings they attend, with clear action points and timescales. The home should review procedures for handover of care to hospitals, ensuring information is recorded as necessary, and that the home provide appropriate support to service users, whether by phone, or directly through visits. The home should support service users to make clear plans in the event of serious illness and death, inlcuding any legal arrangements such as a will, or where they are worried their wishes may not be respected. It is recommended that the Manager obtains Patient information leaflets for all items kept at the home, and that the staff use these leaflets to familiarise themselves with all medication administered, side-effects etc. in order to carry out effective monitoring. Complaints should be addressed informally unless this is not possible, and check whether complainants are happy about the outcome.. More furniture should be inlcuded in the garden so that service users can use this space. Service users should be consulted and involved in the training of staff, so that they know they will be supported according to their wishes and feelings, and staff are able to work with them in partbnership.. The home should review the fire precautions in service users rooms with the fire authority to prevent false alarms, and uphold the dignity of service users 3. 21 4. 20 5. 6. 7. 22 24 35 8. 42 Aspinden Wood Centre G52-G02 S7058 Aspinden V226974 210605 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 03H 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. 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