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Inspection on 19/08/08 for Attwoods Residential Care Home

Also see our care home review for Attwoods Residential Care Home for more information

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Poor service.

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

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

There are systems in place to support people in social activities, including accessing their local community.

What has improved since the last inspection?

There is now a statement of purpose available to people to provide them with information before they move into the home and to help them in making a choice. People`s care plans and medication records now hold a photograph of them to assist with identification and to reduce the possibility of errors with their care. The medication practices within the home have improved and people now receive the correct support in receiving their medication and in these needs being met. The complaints procedure now includes the contact details of the CSCI, providing people with additional contacts and possible support with their complaint. The home is now much cleaner and offers the people who live there a pleasanter environment to live in. This includes that the walls of the laundry have been received attention to help make sure that they are impermeable and do not pose a risk of cross infection. The fire system has recently been tested by a suitable person, helping to keep people safe. The fire doors have now all been made safe and do not pose an additional risk to people should a fire occur in the home. Staff records now include details of a Criminal Records Bureau check that reflects that the person does not hold a criminal conviction that may prevent them from working with vulnerable people. The registered person now records their monthly visits to the home were they undertake quality auditing to help to make sure that people`s needs are being met.

What the care home could do better:

They could be more pro-active about addressing improvements and developing the home. This will help to make sure that peoples health and welfare is promoted and people are safeguarded.The assessment and care planning practices always need to include peoples identified needs and how these are going to be met to make sure that staff are aware and follow these in order meet people`s needs. People must be as far as possible protected from the risk of harm through a risk assessment and practice base. Risk assessments must be completed for individuals. Practices to support people with the issues of harm and safeguarding must be improved to help to make sure that people are kept safe. The maintenance of the home and risk assessments must be completed and up to date to help to keep people safe.

CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Sarah Rodmell Key Unannounced Inspection 19th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Attwoods Residential Care Home Address 46 Northgate Cottingham East Yorkshire HU16 4EZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01482 841133 01482 876110 Mr Ateeq Rehman Miss Rebecca Dawn Dixon Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2008 Brief Description of the Service: Attwood’s is a care home providing personal care and accommodation. It is registered for older people and also for older people with dementia. The home is situated in Cottingham within easy reach of the village centre and local amenities; a bus stop is outside the door and the railway station is nearby. The home is a large detached house arranged on two floors. Three bedrooms are on the ground floor and all other bedrooms, which are located on the first floor, can be accessed by the stairs or stair lift. There are six double and seven single bedrooms, however, some of the double rooms are used as singles. There are two lounges and a dining room on the ground floor; the kitchen is located directly off the dining room. A paved courtyard is situated to the rear of the building, which has full access for wheelchair users and all other residents. Car parking is to the front of the home on the main road. The current charges for the residing in the home were provided by the manager on 19/08/08. These are £300 per week with additional charges for private chiropody, hairdresser, magazines and newspapers. The resident or their family provides toiletries although the home does keep a small stock. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last visit to the home, including information gathered during a visit to the home. Since the last visit the CSCI has received information about the home from the registered provider; there have been no letters or complaints to us from other people. The site visit took place on 19th August 2008, beginning at 09.30 am and ending at 4.00 pm. The pharmacy inspector Mr Steve Baker assisted with this visit and he assessed National Minimum Standard 9 – Medication. Mrs Rosalind Sanderson a member of the Regional Enforcement Team also assisted with this visit to help with the assessment of the previous requirements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The provider was told in advance of the date or time we planned to visit. The manager was available for this entire visit and we spoke to the manager, the registered person, people living in the home, their representatives, and staff during the visit. We looked around the home including people’s rooms and the shared areas of the home, and we inspected records of people’s care, staff files, health and safety documents. We also took some documents from the home and used them to form our judgements. There were no relatives available at the time of the visit and only limited numbers of people who live in the home who were available to speak to us. The registered person and registered manager have undertaken a considerable amount of work to meet the requirements from the last visit to the home and this is reflected in the reduced number of requirements; however some of the remaining requirements have been outstanding for some time and affect the health and safety of the people in the home. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: They could be more pro-active about addressing improvements and developing the home. This will help to make sure that peoples health and welfare is promoted and people are safeguarded. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 7 The assessment and care planning practices always need to include peoples identified needs and how these are going to be met to make sure that staff are aware and follow these in order meet people’s needs. People must be as far as possible protected from the risk of harm through a risk assessment and practice base. Risk assessments must be completed for individuals. Practices to support people with the issues of harm and safeguarding must be improved to help to make sure that people are kept safe. The maintenance of the home and risk assessments must be completed and up to date to help to keep people safe. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to people to help them to make a choice about moving into the home although the assessment of needs does not make sure that their needs will always be met. EVIDENCE: The statement of purpose was available within the home. This provides prospective service users with the information they need to make an informed decision before moving into the home. We looked at the files of three different people who live in the home. These files all included copies of the new assessment package completed by the manager of the home. The assessment covered the needs of the individual Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 10 including their health, personal and social care needs. However needs identified within the assessment were not always transferred to the care plan so that the person could be supported with the meeting of these needs. For example one person had a moving and handling need identified in the assessment but there was not any information within the plan of care to detail how this was going to be met. The assessment document should be the basis upon which care and support is planned, but this is not currently always the case. The registered manager told us that the home does not provide intermediate care. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s medication needs are now met in the home. However practices in care planning of care and practice do not make sure that peoples health and personal care needs are fully identified and met. EVIDENCE: We looked at the files of three people in the home. All of the files included a plan of care and photograph of the person. Each file had different assessments of the individual for example, a moving and handling assessment or a mental health assessment. The assessment would at times reflect that the person had a need in an area but there would not be management plan, comments or an identified support package in the care plan for this need. When we spoke to the care staff they knew the people who living the home well and could identify the needs of each individual. However without the needs being Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 12 identified within the plan of care, being monitored and reviewed there could be no guarantee that these needs were being addressed and met. At present there are only 12 people living in the home, as these numbers increase it will be more difficult for staff to memorise the needs of each individual and highlights the importance of having a formal method of identifying needs and their meeting. Information within the care plans included the details of an individuals health care needs, with diary notes including when someone had been seen my their GP and the reasons for this. There was no evidence that people have been offered annual flu injections as previously recommended, however these may not normally be offered at this time of year by the GP practice. The registered manager told us that currently there is no-one receiving additional support from the district nursing team. Other professionals are involved in people’s lives and this includes the optician and dentist. Although not everyone’s care plan identified if they were registered with an optician or dentist and one person’s optician had requested that they see their GP but nearly one month later this had not taken place. The registered manager told us that they were waiting for a reply from the GP practice. We observed that staff were provided with protective clothing; gloves, but that these were not changed regularly and that staff would complete several tasks wearing the same gloves. This does not protect people from the risk of cross infection. The new care packages purchased by the home also included risk assessments, for example, the risks associated with the moving and handling of people. These had been completed in part, but were inconsistent; as they would identify an area of risk but it was not always clear how this risk would be managed and what actions the staff should take to protect themselves and others. In addition some of the staff were observed to use incorrect practices in the moving and handling of people. When we spoke to some of the staff they had a good understanding of moving and handling, although not all of the staff have received training specific to this, and some of those that had had received this training some time ago. ‘Previously risk assessments were forwarded to the CSCI regarding the use of bed rails in the home. However on the day of the visit these assessments were not all in place in the people’s files we assessed at the time. The development of medication procedure documents needs to be given priority. Whilst improvements have taken place, the current procedures are not yet extensive enough to guide staff on all aspects of medicines management. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 13 Detailed procedures based on current best practice guidance mean that staff know exactly what is expected of them when handling and administering medicines. All medicines are now kept correctly at temperatures recommended by the manufacturer. Controlled drugs are now stored under conditions providing the extra security required for these medicines. This means that medication is at minimal risk of loss or diversion. The standard of medication record keeping in the home has improved since the last visit. For instance, medicines administration record (MAR) charts contain sufficient detail to demonstrate that medicines are given correctly. There is greater consistency in handwritten medication entries. The quantity supplied, the date of entry, the signature of the person making the entry and a witness signature are included in hand written entries. This makes sure that there is an accurate record of new medicines or any changes. The previous report recommended that regular checks be carried out to ensure medicines are given correctly and to improve medication practice. We found evidence that such checks are now being made. We observed that staff and the people living in the home have good relationships. Staff spoke appropriately to people and had a good manner. People who live in the home appeared relaxed and comfortable. Staff were observed to assist people with their appearance to help people to maintain their dignity. When we spoke to the registered person they understood about maintaining dignity. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s relationship and leisure activities are met in the home. Although dietary needs are not fully met. EVIDENCE: We looked at individual files and records. The files included the wishes of people relating to their social needs and in maintaining relationships with others. It also identified if the person had any religious needs, if they wished to attend regularly a religious service or as identified with one person they simply wished to watch this service on television. The records included that people had attended different activities within the home and that they could also go out into the local community. At the visit we observed that staff supported people to listen to different music and one person accessed their local community alone. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 15 People’s care plans included if they had contact with family and friends and if this was important to them. One person’s notes included that their spouse regularly visits them. We saw that people were asked if they wished to have a biscuit with their morning drink and there was a choice of meal for people at lunchtime. People are able to bring their personal possessions into the home and have these in their rooms. No information was available regarding the availability or use of advocacy to assist people with decisions in their lives. The lunchtime meal was observed to be of a good quality. Discussion with the registered manager was that there is not a planned menu in place. The menus are completed on a daily basis. The menu on display offered the main meal an omelette or a sandwich for lunch. This was on display in the entrance hall of the home. Without a planned menu and records of people’s dietary intake it is difficult for the manager to make sure that people are receiving a healthy balanced diet to maintain their health. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to support people to raise concerns. However current practice means that people are not fully safeguarded from the risk of harm. EVIDENCE: There is a complaints procedure held within the home that includes the contact details of the CSCI. No complaints have been received to the home or the CSCI since the last visit to the home. The Local Authority policy ‘ The Protection of Vulnerable Adults’ is held within the home and when we spoke to the staff team they were clear on the actions they would take in reporting any incidents or allegations of harm to the registered manager. However the registered manager and the staff team have not undertaken any training on the safeguarding of vulnerable people and one person’s records included the details of an incident that should have been reported under the safeguarding adults procedures but had not been actioned by the registered manager. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean and were the majority of safety checks are completed. Although the lack of some assessments and maintenance leaves them vulnerable to the risk of harm. EVIDENCE: We completed a tour of the premises with the registered manager. There is now a cleaner employed within the home and although the furnishings are nearing the time for replacement the home was found to be clean. There has been work undertaken in the bedroom were damp is present on the wall; this has improved greatly and the registered person told us that he is instructing further work to be completed to prevent the damp causing any further Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 18 problems. All of the rooms were personalised and people told us that they were happy with their rooms. People’s files included a document that details what equipment would be provided within their bedroom. There are 6 bedrooms that are identified as being ‘shared’ rooms, although at present some of these are used as single rooms. The rooms being used as ‘shared’ all had curtains that could be closed to allow privacy when personal care was being completed. All of the bedrooms had radiators, which are guarded to prevent people from being burnt, although one of the guards was loose and the registered manager is to address this. Towels were available throughout the home. A couple of the windows continue to pose a risk to people in the home as they open wide open and are not lockable. People would be able to climb or fall out of these windows and this matter is being addressed separately through the risk assessment process with the registered person. One person has the frame of a bed table against her bed and the registered manager told us that this person likes this in place as it makes them feel safe when they are in bed. There are no assessments in place regarding this, which identifies the need and safety of this, or the person or their representative’s authority for this and the registered manager and registered provider was advised as to the necessity for this to be completed. Some of the curtains required minor attention as additional or replacement curtain hooks were required so that when closed they were fully effective, helping to maintain people’s privacy and some were dusty. The registered manager told us that the floors had all been professionally cleaned and during the tour we found that the floor coverings were clean. There is a call system in place that each person can use in their own room should they require assistance from a staff member. One person had a belt from an item of clothing attached to the ‘lead’ of their call button, as it was not long enough to reach the person when they were sat watching television in their room. The main board of the call system is situated in the dining room of the home and only sounds here. This makes it difficult at times for staff to hear it and the registered person has already commenced looking at the replacement of this and the registered manager told us that providers of this equipment have already visited the home. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 19 The carpet on the landing adjacent to room 10 was flat to the floor but had not been secured and has the potential for lifting; becoming a potential hazard and this must be addressed. The walls of the laundry had been repaired and now appeared to be impermeable. A small piece of the floor covering adjacent to the washing machine was missing, showing bare concrete. As this is not impermeable this requires addressing so that in the case of a spillage, fluids would not be absorbed into the concrete with the potential for this contravening the homes control of infection procedures. There is a Control of Substances Hazardous to Health (COSHH) locked cupboard within the laundry room, and the registered person told us that the risk assessments for this are continuing to be developed. The kitchen was clean and adequately stocked. The Environmental health Officer had recently visited the home and made some requirements, which the registered manager confirmed had been addressed. The fire alarm system has recently been tested as safe and the fire fighting equipment has also been tested. The registered person discussed the fire risk assessment with us as a version of this is in place but is still being developed; this includes developing the plan of escape routes. A fire drill had recently been completed and the registered manager had ensured detailed records of this that showed how the drill had taken place, which room, the alleged cause of the fire and who was involved. The last formal fire training was in May 2007 and requires updating. The registered person told us that all of the doors had been adjusted in the kitchen and dining room areas to make sure that the smoke seals work effectively. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by adequate numbers of staff who are correctly recruited, but who’s lack of training impacts of the care and support provided. EVIDENCE: We looked at the duty rota in the home. There continues to be 2 staff on duty throughout the day and night shifts. There are no changes to this to allow for other busy times, for example, for people to complete activities in the community. The registered manager works full time in the home and she told us that this includes that she also works shifts supporting the people in the home. The cook and cleaner vacant hours have now been filled. Some of these duties are undertaken by care staff as extra shifts, when completing these the staff are undertaking this role only and do not complete this as an additional tasks to their care role. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 21 We looked at the recruitment files for four of the staff. These showed that staff complete an application form and undertake checks to help to make sure that they are suitable to work with vulnerable people. These checks include 2 written references and a CRB (Criminal Records Bureau) check, which would show if the person has a criminal conviction that may prevent them from working in a care setting. One member of staff had resigned from her post and then re-commenced has a bank worker for occasional shifts. It was unclear in the person’s records if this was a continuous employment and if new checks had been undertaken when she returned to the home. However discussion with the registered manager reflected that no break in employment had taken place. The employment records must accurately reflect the situation within the home so that the registered person and registered manager can be confident that people’s checks are up to date and people are not placed at the risk of harm. The registered person told us that people have completed induction training and that there are written records for this. We looked at the records for additional training for people. These had date entries but there were few certificates to confirm that people had undertaken training. Staff have not undertaken training in first aid or in The Protection of Vulnerable People (POVA). There has been in house medication training and back care training but not moving and handling training. There were not any clear records of their induction that people undertake or if it meets the Skills for Care requirements. When we spoke to people they told us that people work alongside a more experienced member of staff until they are competent in their role. The registered person and manager confirmed to us that if a member of start commences employment with a POVA first check, they do not work unsupervised until the full CRB check is in place. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in the home are improving but practice does not yet fully protect people or make sure that their needs are being met. EVIDENCE: The manager has now been registered with the CSCI and told us that they are continuing to complete a National Vocational Qualification at level 4 in management and care. They have worked in the home for a number of years and know the people living there and the staff team well. The manager has assisted the registered person in taking actions to meet the requirements of Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 23 the last visit to the home. Staff training continues to be required with staff having limited knowledge in some areas and practices; for example, safeguarding that does not make sure that people are protected from harm. In addition the manager has completed some but not all of the required assessments for people living in the home and some of these require additional work. When we talked to the registered person they had a clear understanding of equality and diversity for people and in relation to people’s needs as they age. Work to improve the home in this area is yet to commence and is something that the registered person agreed is to be completed in the future. There continues to be a quality assurance system within the home and the registered manager told us that they are starting to implement this. This has now been the case for some time and quality assurance is not being used as a tool for the development of the service with people’s views not readily being available for service improvement. In addition the registered manager told us that meetings with the people who live in the home have not taken place for some time. The registered person completes monthly visits to the home and writes a report about the quality assurance he has undertaken as part of this visit. There are systems in place for the handling of people’s monies. This includes the gathering of receipts for expenditure and the registered manager signs and dates all entries. There is not a second person auditing these records or any confirmation of the monies spent by the individual person or their representative and the registered person was advised of this as good practice. There are a variety of polices and procedures in place to assist the staff team and the registered person has recently purchased an up to date set of polices that are to be put in place in the near future. There are certificates in place that show that the electrical wiring and gas systems in the home have been checked and are safe to use. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 & OP7 Regulation 14,15 Requirement Timescale for action 01/10/08 2 OP7 OP8 OP19 13 The registered person must make sure that all identified areas of support are included in a person’s individual plan of care, with the details of how any support is to be provided. The registered person must 01/10/08 make sure that risk assessments are undertaken so that needs are identified and actions are in place to prevent the risk of harm to individuals and that people are protected. These should include the risks associated with: • Personal Care • Health • Moving and Handling • Equipment used in the home, including bed rails. • Cross Infection. 3. OP8 12&13 The registered person must make sure that people receive the correct support from health professionals and that any recommendations are followed DS0000064183.V370368.R03.S.doc 01/10/08 Attwoods Residential Care Home Version 5.2 Page 26 and actions completed. In order to make sure that needs are met. This should include the dentist and optician. 4 OP18 13 The registered person must make sure that staff understand and carry out their roles in the safeguarding process. This must include when to report incidents. The registered person must make sure through a risk assessment basis that the windows within the home meet current legislation and do not pose a risk to the people living in the home. This is an ongoing requirement with a previous compliance date of 30/05/08. 01/10/08 5 OP19 13 01/10/08 6 OP19 13 7 OP30 18,23 The registered person must 01/10/08 make sure that the requirements of the Regulatory Reform (Fire Safety) Order 2005 are met. The registered person must 10/10/08 make sure that they identify the training needs of staff. Once this training has been delivered they must make sure that the staff understand and are competent in each area of training. Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations It is good practice for residents to be offered the opportunity of having an annual flu injection and for arrangements to be made with the resident’s general practitioner. The registered person should develop further detailed procedures based upon current best practice guidance. So that staff know exactly what is expected of them when handling and giving medicines. The registered person should make sure that there is adequate planning in the provision of meals to ensure that people receive a healthy balanced diet. The registered person should make sure that there is information available to people about advocacy services which may support them in decision in their lives. The registered person should make sure that he assessment regarding products used in the home is completed fully. The registered person should make sure that the curtains are maintained to a standard that assists in the meeting of people’s privacy and dignity. The registered person should make sure that staff undertake and that there is evidence of a staff induction that meets the current requirements of Skills for Care. The registered manager should have a qualification at level IV NVQ (or equivalent) in management and care. The registered person should make sure that the practices for the safe handling of people’s monies includes a second person audit of records. 2. OP9 3. 4. 5. 6. 7. 8. OP15 OP14 OP19 OP19 OP30 OP31 9. OP35 Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Attwoods Residential Care Home DS0000064183.V370368.R03.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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