Inspection on 19/12/07 for Blunt Street (9)

This inspection was carried out on 19th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blunt Street (9) 23/12/08

Blunt Street (9) 11/01/07

Blunt Street (9) 13/02/06

Blunt Street (9) 06/09/05

Blunt Street (9) 14/02/05

Blunt Street (9) 12/08/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Blunt Street (9) Stanley Common Ilkeston Derbyshire DE7 6FZ Lead Inspector Tony Barker Unannounced Inspection 19th December 2007 09:40 Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blunt Street (9) Address Stanley Common Ilkeston Derbyshire DE7 6FZ (0115) 9323508 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) None United Response Christine Coates Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four (4) persons (of either sex) in the category adults with learning disabilities / adults with physical disabilities. 11th January 2007 Date of last inspection Brief Description of the Service: 9 Blunt Street is a detached house in a small village development. Service users are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Home offers personal and social care to people with a severe learning disability with associated conditions that include autism, sensory and physical disability and challenging behaviour. Activities are planned to meet individual needs. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The time spent on this inspection was 7.25 hours and was a key unannounced inspection. The Manager and the Senior Support Worker with Additional Responsibilities (SSWAR) were spoken to. The service users had high levels of dependency and therefore were not able to contribute directly to the inspection process, though they were observed working with and being cared for by staff. Records were inspected and there was a tour of the building. One service user was case tracked so as to determine the quality of service from their perspective. Survey forms were posted to the relatives of the three service users accommodated at the time of this inspection, five staff and two social workers – none had been received back at the time this report was written. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last inspection. The pre-inspection, Annual Quality Assurance Assessment (AQAA), questionnaire was reviewed prior to this inspection. The Manager stated that the service’s fees ranged from £1400 to £1800 per week. A copy of the last inspection report, from the Commission for Social Care Inspection (CSCI), is available to service users and visitors in the office. What the service does well: What has improved since the last inspection? What they could do better: Care planning records relating to individuals’ behaviour management must be kept up-to-date and accurate, consistent and up to date records of medication must be kept. Staff must be provided with accurate, consistent and up to date written guidance on medication administration and they must follow this. Staff Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 6 must accurately record any controlled drugs administered to service users and returned to the pharmacy. The Commission must be notified of any event which may adversely affect the safety of any service user. Staff must not be employed to work at the Home unless the information and documents specified in the Regulations are in place. All staff who work night shifts must be provided with fire training twice a year. Opinions as to the quality of the service must be sought from service user’s relatives, and external professionals, through questionnaires. Records required by regulation must be kept up to date through regular monitoring. Regular Health & Safety audits must be undertaken. 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. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual written needs assessments were in place before people were admitted to the Home so that their diverse needs were identified and planned for. EVIDENCE: The service’s Individual Charter included a space for fees but did not contain details of the amount of fees currently payable. Other aspects of Standard 1 were not assessed on this occasion. The most recent admission to the Home was in 2002. This service user’s file contained a range of pre-admission assessments, as assessed at a previous inspection. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ plans of care were not up to date which meant that their health, personal or social care needs may not be met. EVIDENCE: The case tracked service user’s care plan documents were examined and found to be holistic with some elements, such as the ‘Pen Picture’, being very person centred. This document included sections such as ‘Things that are important to me’ and ‘Routines’. It was also noted that care plan reviews were person centred. However, the Care Plan and Behaviour Management Plan were dated, respectively, February 2002 and September 2006 and the need to maintain up-to-date records was discussed with the Manager - as at the previous inspection when this matter was raised as a requirement. The importance of this was illustrated within the Behaviour Management Plan where there was reference to the use of haloperidol 5mg ‘prn’ (as and when required) medication. The Manager said that this medication had not been prescribed for this person “for some time’. An ‘Urgent Action Letter’ was issued to the Provider on this issue. Some examples of unprofessional phrases were found Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 10 in one week’s daily logs for the case tracked service user. Also, only one member of staff had signed entries during that week. The benefit of providing staff with training on good recording practices was discussed with the Manager – as at the previous inspection. The Manager noted, on the AQAA, that staff were not always recording service user–related matters that reflected learning experiences. The Manager confirmed that service users were all encouraged to make decisions about the food they eat. They were either able to verbally respond or staff took them to the larder to choose an alternative to the meal on the menu, for instance. She said that two service users were able to choose their own clothes in the morning, with some prompting. Service users’ files each contained a person centred and generic risk assessment newly developed from a previous range of risk assessments. These new documents still contained a section headed ‘What are the benefits from taking the risk?’ – an indication that staff were being encouraged to support service users to take responsible risks. Staff spoken to at previous inspections had give examples to support this. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provided activities and services that were age-appropriate and valued by service users and promoted their independence. EVIDENCE: Each of the service users had a mix of day services and ‘personal days’ spent at, and around, the Home. Day services comprised a local authority day centre, for one service user, or was based in or around the Home. The staff spoken to considered that service users were being offered activities that were valued by them and were fulfilling. The Manager described significant improvements in the case tracked service user’s relationship with support workers since the person’s move from external day services to Home-based activities, and a resultant improvement in behaviour. The week’s activities programme for the case tracked service user was comprehensive and indicated that, of the 21 sessions over seven days, 18 were spent with staff out of the Home. This reflected the person’s preferences which include a particular love of shopping. The Manager spoke of considering an opportunity for the person Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 12 to shop for local elderly people, with staff support. She also said she had registered all the service users, across the three care homes she manages, on a web site that links volunteers on a ‘time barter’ basis. The Manager and SSWAR spoke about a number of activities undertaken by the service users in the local community. These included pub lunches, local walks and visits to parks, shops and supermarkets. The case tracked service user is well known in Derby ‘Morrisons’ and the person’s first name is used by check-out staff. The Manager described how a street party had benefited relationships between the Blunt Street care homes and neighbours and spoke of one service user periodically walking a neighbour’s dog. Each service user had family involvement to varying degrees. The case tracked service user’s family involvement had been very limited but this had changed following a holiday in 2007, with staff, to a place near to a close relative. During this holiday there was daily contact with the relative, which was captured on video tape, and this had led to weekly telephone contact since. Additionally, another service user went on holiday with a close relative and staff, in 2007, and this was described by staff as the best holiday this person had had. The Manager considered that a number of the service’s routines promoted service users’ independence. For example, service users put away their laundered clothes, with staff support, and select their clothes and choice of toiletries. Two of the service users had individual bank accounts although they were unable to understand bank statements. Staff opened this type of mail but more personal mail, such as greetings cards, were given to service users to open. A varied and nutritious three-week rolling menu was seen. The Manager said that she was developing a menu in picture form, or photographs, as recommended at the previous inspection. The menu included ‘take away’ meals and meals eaten out during ‘personal days’. The evening meal was taken between 6 and 7pm and there was differing involvement by service users in its preparation. All the service users were encouraged to take their plates to the sink after meals. Also, all were involved in food shopping - with the case tracked service user particularly enjoying making a food shopping list, with staff help, and then shopping in the supermarket. One service user enjoys a baking activity. Food stocks were assessed – these were at a good level and included fresh fruit and vegetables. The kitchen was clean and tidy. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 & 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Poor and unsafe medication recording practices mean that service users may not be given their prescribed medicine. This potentially puts them at risk of harm. EVIDENCE: There was written evidence on the case tracked service user’s file of how the person communicates and there was a person centred description of personal likes, dislikes and preferences. Most staff had been trained in Makaton (sign language) and there were two on-site Makaton trainers. The Manager stated that “We support (service users) only when necessary regarding personal hygiene...to prevent deskilling”. One service user has been provided with a shower seat and an electrically operated bath seat and the case tracked service user uses a wheel chair, when out. These were examples of how the service was helping to maximise people’s independence. Examples were provided of how service users’ privacy needs were being met, for example during baths being taken. For the two female service users there was always a female member of waking night staff on duty, the Manager stated. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 14 Consistent records were being made of service users’ appointments with health professionals and these were being kept up to date. There was evidence of a range of health professionals involved with service users, including chiropodist, dentist, optician, physiotherapist, speech therapist and members of the local Community Learning Disability Team. Service users also attended the Well Man/Woman Clinic. ‘Report Feedback’ sheets were being used to detail health appointment outcomes in a constructive and detailed way. ‘Health Action Plans’ had been introduced since the previous inspection. The case tracked service user’s copy had been well completed and was appropriately person centred. All service users were registered with the same GP practice. The service’s stock of medicines, and medication records, were examined. Poor practices, found at the previous inspection, had been dealt with. For instance the service was using a ‘Returned Medication’ duplicate pad in response to a requirement made. However, we found other concerning issues at this inspection... • there was a discrepancy between the daily dose of 5mg of Diazepam, recorded on the case tracked service user’s ‘Medication Profile’ dated 12/11/07, and the 2mg of Diazepam recorded on the Medication Administration Record (MAR) sheet, • the rear of the person’s current MAR sheet listed the reasons for administering paracetamol PRN (as and when required) on three separate occasions. The reasons were, “agitation, withdrawn and crying”. However, none of these reasons were listed on the ‘Directions for giving paracetamol PRN Medication’ (PRN Protocol), • the only PRN medication currently in use for this person was paracetamol although the PRN Protocol listed paracetamol, Diazepam and procyclidine and the ‘Medication Profile’ listed paracetamol and chlorpromazine. Therefore, staff guidance was not being kept up to date and was inconsistent, • there were two gaps in the controlled drugs register relating to the administration of Temazepam to a service user on two days in September. Also, the final entry in the register was for 15 tablets left but, in the ‘Returned Medication’ pad, the entry was for 13 tablets. These were serious discrepancies and the Commission had not been notified. These discrepancies indicated that staff were still not following United Response written procedures on the safe use of medicines - as at the last inspection - and an ‘Urgent Action Letter’ was issued to the Provider on these issues. Photographs of service users were filed with the medicine records and a staff specimen signature list had been compiled, although there were five staff initials still to add. Service users and staff were well supported following the sudden death, in May 2007, of one of the four service users. Staff had been with this service user most of the time during the four hospital stays leading up to the person’s death. All service users had attended the funeral and two expressed a wish to Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 15 pay their last respects at the chapel of rest. Staff were provided with bereavement counselling by an external professional. On each service user’s file was a comprehensive and person centred list of the person’s needs, behaviour, likes and dislikes to be used in the event of going into hospital. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures for handling complaints and abuse were in place, ensuring that service users were fully protected. EVIDENCE: United Response had a robust procedure for dealing with complaints. A copy of the service’s complaints procedure was displayed – this made appropriate use of symbols so that service users could better understand it. The Manager reported that no complaints had been received during the 12 months previous to this inspection. There was no record of informal complaints/concerns from service users and the benefits of this were discussed with the Manager. She stated she was having monthly meetings with a local resident spokesman provided good feedback on noise levels and opportunity to remind staff about closing windows. Also, in response to these complaints, rooms had been fitted with sound-deadening material and windows fitted with triple glazing. The Manager said that consideration was still being given to finding independent advocates for the service users to ensure that their needs were being fully met. The Manager confirmed that all staff had received ‘Safeguarding Adults’ (adult abuse) training and SCIP (non-physical intervention) training. There had been no ‘Safeguarding Adults’ investigations during the 12 months previous to this inspection. The template used to record any restraint of a service user had not been reviewed to ensure it guides staff to include details of the physical hold used, part(s) of the body held or duration of hold, as recommended at the previous inspection. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were living in a comfortable and safe environment that was clean and hygienic. EVIDENCE: A number of improvements had been made to the premises since the previous inspection - including new sofas in the two living rooms, redecoration of rooms and new cushion floor covering in the case tracked service user’s bedroom. This person had chosen the colours for the wall paint and window blind. The maintenance items that needed attention at the previous inspection had been addressed. The Manager said a walk-in shower was still being planned for the ground floor bathroom – this is in addition to the existing first floor bath. In the ground floor bathroom peeling paint was making the wooden bath panel unsightly – a plastic replacement was awaited the SSWAR said. In the first floor bathroom there was a broken shower curtain rail ceiling fixing and the vanity unit had rot in its base – this was awaiting replacement. Bathroom wall tile transfers helped to make the room look homely. There was no shade on the ceiling light in the WC. The three bedrooms were well-personalised and Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 18 fitted out with equipment to meet individual needs. Two service users’ bedrooms had been swapped to provide a larger room for one and a room with an improved view for the other. This had addressed the assessed needs of these two people. There were several photo-collages in the Home. One was in the bedroom of a service user who had helped create it. Standards of cleanliness and hygiene at the Home were satisfactory. The washing machine had a sluicing programme and the support worker spoken to described good practice regarding the transportation of infected materials around the Home. There were no unpleasant odours within the Home during this inspection. The Manager was unaware of the Department of Health’s ‘Infection Control Guidance for Care Homes’, June 2006, and was advised to obtain a copy. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service’s level of staff training, and quality of recruitment, fell short of fully safeguarding the welfare of service users. EVIDENCE: Seven (58 ) of the twelve care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above, including two staff who had achieved an NVQ at level 3. Additionally, two staff were working towards this qualification. This met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The file of a member of care staff appointed in July 2007 was examined. It was found to contain all but one of the elements, required by current Regulations, regarding recruitment practices. There was no explanation of four gaps, of two to three years each, in the person’s employment history. The Manager stated that service users were involved in staff recruitment in so far as she observes candidates interactions with them. She added that the three service users’ needs and wishes are embedded in the job specifications for new staff. There was good retention of staff: no one had left the service within the previous 12 months. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 20 There was evidence of this same member of staff being provided with induction training to Skills for Care Common Induction Standards, as recommended by Standard 35. Training records showed that all staff had been provided with mandatory training in Basic Food Hygiene and First Aid. However, three staff had not had recent Moving & Handling training and no member of staff had had any fire training sessions within the previous 12 months – although three staff had been provided with a one-day course in ‘Health, Safety, Fire and Handling Loads’ in October 2007. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ best interests were not being promoted by the systems in place and their health and safety could be compromised. EVIDENCE: The Manager had achieved a NVQ in Care and Management at level 4 and had been in this post for four years. She had worked with people with learning disabilities for 20 years. She spoke of being involved in United Response’s Leadership Management Development Programme – comprising monthly conference calls. She was also undertaking periodic training to maintain her knowledge and competence to manage the Home. For instance, she said she was attending training in Person Centred Planning, ‘The way we work’ and ‘Dealing positively with challenging behaviour’. The service’s quality assurance measures included… Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 22 annual observational visits from a member of the United Response Practice Development Team – whose assessment is discussed with the Manager and her line managers, • a Quality Assurance Manual, • ‘The way we work’ training, when the values of the Home and United Response are explored. There had been no surveys of opinion from service user’s relatives for some time. The Manager said these were planned for the New Year as well as questionnaires to be sent to external professionals, too. There had been no progress on this matter since the previous inspection. The Manager said that United Response send out annual quality assurance questionnaires to staff. There had been no monthly independent audit visits to the Home in 2007, on behalf of the Registered Provider, until 19 November. There was no written report from this visit. The Manager stated that arrangements were now in place to ensure that monthly audit visits occurred consistently in the future. Records required by regulation were in place but these were not all being kept up to date - as identified in Standards 6 and 20 of this report. This indicated a lack of regular monitoring by the Manager. Cleaning materials were being securely stored in a locked cupboard. The preinspection AQAA indicated that equipment in the Home was being serviced and checked at appropriate intervals except that the Home’s five-year Electrical Wiring Certificate was dated November 2000. The Manager said this was booked with an electrician to be undertaken in January 2008. Fire alarm tests were carried out weekly and fire drills once a month – with night time ones twice a year. Accident records were in place and satisfactory. Environmental risk assessments were dated June 2004 and September 2006. There was no evidence of regular Health and Safety audits. The SSWAR indicated that extractor fans in the WC and the bathrooms had been cleaned in order to remove a potential fire risk. • Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 3 3 X 2 X 2 2 X Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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 YA6 Regulation 15(2)(b) Requirement The Manager must ensure that care planning records relating to individuals’ behaviour management are kept up-to-date, in order to keep service users and staff safe. (Previous timescale was 01/02/07) Accurate, consistent and up to date records of medication must be kept in all relevant service user documentation to ensure that people receive the correct levels of medication prescribed for them. Staff must follow the service’s written, up to date PRN Protocols to ensure service users’ health and safety. Accurate, consistent and up to date written guidance to staff on medication administration must be kept to ensure that people receive the correct medication prescribed for them. Staff must accurately record any controlled drugs administered to service users and returned to the pharmacy. This is to ensure that service users have received their medicines as prescribed. The Commission must be notified DS0000019939.V355409.R01.S.doc Timescale for action 14/01/08 2. YA20 13(2) 07/01/08 3. YA20 13(4)(c) 07/01/08 4. YA20 15(2)(b) 14/01/08 5. YA20 13(2) 07/01/08 6. YA20 37 01/02/08 Page 25 Blunt Street (9) Version 5.2 7. YA34 19 Schedule 2 8. YA35 23(4)(d) 9. YA39 24 10. YA41 17(3)(a) 11. YA42 13(4)(a) of any event which may adversely affect the safety of any service user, in order that adequate monitoring of the service may occur. For the safety of service users, staff must not be employed to work at the Home unless the information and documents specified in the revised Schedule 2 of the Regulations are in place. All staff who work night shifts must be provided with fire training twice a year to ensure the safety of service users is not compromised at night. Opinions as to the quality of the service must be sought from service user’s relatives, and external professionals, through questionnaires – in order that service quality is assured. Records required by regulation must be kept up to date, through regular monitoring, to ensure the health and safety of service users. Regular Health & Safety audits must be undertaken to ensure the health and safety of service users and staff. 01/02/08 01/04/08 01/03/08 01/02/08 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA6 Good Practice Recommendations The Individual Charter should include details of the amount of fees currently payable. Staff should be provided with training on good recording practices. (This was a previous recommendation) Training should make reference to the language used and to signing records. A menu in picture form or photographs should be DS0000019939.V355409.R01.S.doc Version 5.2 Page 26 3. YA17 Blunt Street (9) 4. 5. YA22 YA23 6. 7. 8. 9. YA24 YA30 YA35 YA35 10. YA39 11. YA42 displayed, where appropriate, for service users. (This was a previous recommendation) A record of informal complaints/concerns from service users should be developed and held in the Home. The template used to record incidents of restraint should guide staff to include details of the physical hold used, part(s) of the body held and duration of hold. Recording on a ‘body map’ is also recommended. (This was a previous recommendation) Maintenance items needing attention, as detailed in standard 24, should be addressed. A copy of the Department of Health’s ‘Infection Control Guidance for Care Homes’, June 2006, should be obtained. All staff should undertake Moving and Handling training. (This was a previous recommendation) The status of the one-day course in ‘Health, Safety, Fire and Handling Loads’ should be checked with the Fire Officer to see if it meets the requirements for formal fire training. Monthly independent audit visits to the Home, on behalf of the Registered Provider, should be made consistently. (This was a previous recommendation) A written report of these visits should be made and kept in the Home. The Home’s five-year Electrical Wiring Certificate should be renewed in January 2008 as planned. Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Blunt Street (9) DS0000019939.V355409.R01.S.doc Version 5.2 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. 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