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Inspection on 23/12/08 for Blunt Street (9)

Also see our care home review for Blunt Street (9) for more information

This inspection was carried out on 23rd December 2008.

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

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.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Blunt Street (9) Stanley Common Ilkeston Derbyshire DE7 6FZ The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Barker Date: 2 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Blunt Street (9) Stanley Common Ilkeston Derbyshire DE7 6FZ (0115)9323508 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Christine Coates Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 4 0 0 care home 4 learning disability physical disability Additional conditions: Four (4) persons (of either sex) in the category adults with learning disabilities / adults with physical disabilities. Date of last inspection 1 9 1 2 2 0 0 7 A bit about the care home 9 Blunt Street is a detached house in a small village development. People living here are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Service 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. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over one day. The last key inspection at this service was on 19th December 2007. The Commission had requested the Service to complete an Annual Quality Assurance Assessment (AQAA) before this inspection. We had also received one completed survey form from staff, one from a relative and two from Social Services care managers. The information provided in these documents is included in this report. The people living at the Service all 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. One particular persons experience of the quality of the service was focussed on, through their personal records and discussion with staff. The Acting Manager, the Senior Support Worker with Additional Responsibilities (SSWAR) and one senior support worker were spoken with at this inspection and records were inspected. There was also a tour of the premises. The weekly fees at the time of this inspection ranged from £1251 to £2065. What the care home does well Individual written needs assessments and plans of care were in place showing that peoples health, personal and social care needs were being met. The Service provided activities, personal support and other services that were valued by people and promoted their independence in a person centred way. Procedures for handling complaints and abuse were in place ensuring that people were fully protected. People were living in a comfortable and safe environment that was clean and hygienic. What has got better from the last inspection The Home had been redecorated and new carpets had been fitted to the hall, stairs and landing. Medicine records and quality assurance procedures had improved. The Service was taking a person centred approach to the people living here. What the care home could do better People’s medicine records must be completed clearly and accurately to ensure that they receive the correct levels of medication prescribed for them. Less use must be made of agency, relief and other temporary staff to give continuity of care for people. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The Services 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. 2002 was the last date that a person was most recently admitted to the Service. This persons file contained a range of pre-admission assessments, which were assessed at a previous inspection. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the Service had individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: The care plan of the person case tracked was examined. It was holistic, person centred and up to date with associated Behaviour Support Plans, Individual Support Profile, person centred pen picture, Likes and Dislikes list, risk assessments and notes from the last annual person centred review meeting held in September 2008. These documents were dated and signed. They gave staff a guide as to how to meet the persons individual needs and the review meeting notes included Action Plan goals. However, there was no record of outcomes or progress on meeting these goals and both the Acting Manager and SSWAR were unclear as to the action actually taken following this review meeting. The Acting Manager pointed out that neither he or the SSWAR were in post at the time of this review. One Social Services care manager, who completed our pre-inspection survey, stated that person centred reviews (are something the Service does well). The monthly in-house care plan review system had ceased although the Acting Manager plans to resurrect these. This will ensure that regular monitoring of the needs, and preferences, of people living at the Service, is taking place. There were many gaps in recent daily records and the Acting Manager said that a new daily recoding system was starting that week. He accepted that this system had been in a state of flux. He added that there had been discussion with staff, at a team meeting in June 2008, about improving recording practices. Information supplied by the Acting Manager before the inspection stated that, The people we support ...are more in control of their own lives...are more involved in the Evidence: running of their home. Our assessment at this inspection was that staff are involving people living at the Service in day to day matters as well as in significant events in their life. The senior support worker spoken with gave examples of people making decisions and choices about the clothes they wear each day, for example, through one word cues. There was a good range of up to date, recorded risk assessments. These showed that the Service was aware of potential risks to which people were exposed and indicated ways of managing these risks. The senior support worker spoken with showed an understanding of the concept, and use, of responsible risk taking in order to increase peoples independence: for instance, recreational activities by the person case tracked at this Inspection. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: The Acting Manager stated, in the pre-inspection questionnaire, that, tasks and activities are structured into a timetable to ensure the needs and wishes of people we support are met and to maximise predictability and consistency. The senior support worker who was spoken with was the key support worker for the person we case tracked. He showed good insight into the persons individual needs and what prompted the persons behaviour. He gave examples of the case tracked person being involved in valued and fulfilling activities - particularly those that reflected the persons fondness of animals and people. These activities include time spent in farms and stables. One Social Services care manager, who completed a pre inspection questionnaire, felt that another person living at the Service, who is funded by their Local Authority, was provided with limited activities and social life and would benefit from improvements to staffing levels and consideration of the behaviour of other people living at the Service. The Acting Manager said these matters were being reviewed - including an increase in staffing from January 2009 which will enable more swimming for leisure. Records were examined that showed activities in place for this person, including time in a sensory environment and a new activity of swimming. The Acting Manager spoke of this person also receiving intensive interaction with staff - a practical approach to interacting with people with learning disabilities who do not find it easy communicating or being social. This staff intervention was not being recorded, so may not have been Evidence: fully incorporated into periodic reviews of the persons needs. The senior support worker also gave examples showing that the case tracked person had a positive involvement in the local community. This included using local shops and supermarkets, post office and pub as well as taking walks and playing football in the park. The senior support worker said that a lot of people say hello to (the case tracked person). On the day of this Inspection all people were out with staff at varying times, with the case tracked person being out all day. The Acting Manager stated, in the pre-inspection questionnaire, that people living at the service had regular visits and contact with family and friends. He added that contact with family and friends, as well as with external professionals, had improved since person centred review meetings had started. The senior support worker gave examples of how routines, at the Service, are flexible to meet peoples individual needs and circumstances. He said, Routines reflect individuals needs and wishes. The senior support worker also spoke of how routines promote peoples independence. He said the case tracked person enjoys attempting to be as independent as possible regarding personal hygiene and domestic routines. A varied and nutritious two-week rolling menu was seen. Two further columns had recently been added to the menu showing the meal preparation activities each person was involved in. There was no record of what people eat each day. The Acting Manager spoke of plans to photograph plated meals to further help people to choose and understand what they will be eating. All people living at the Service were involved in food shopping - with each person going out with staff, on a one-to-one basis, to buy a proportion of the weeks shopping, at least once a week. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Unsafe medication recording practices mean that people who live at the Service may not be given their prescribed medicine, so potentially putting them at risk of harm. Evidence: The senior support worker spoken with gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, staff encourage people living at the Service to close bathroom and bedroom doors if they are undressed. There was evidence of equipment in place that maximised peoples independence. For instance, two people have wheel chairs; there are hand rails beside toilets and baths together with a bath board and electric bath chair; and the sink in the ground floor bathroom is of an adjustable height. Two of the people that live at the Service have an independent advocate supporting them at their person centred care plan review meetings. Additionally, the case tracked person has been allocated an Independent Mental Capacity Act Advocate (IMCA) as a result of safeguarding adult meetings, initiated by Social Services, set up to explore allegations of abusive behaviour by care staff at the Service. There is further discussion of this matter in the Concerns, Complaints and Protection section of this report. One pre-inspection survey, completed by a Social Services care manager, stated, United Response are committed to a person centred approach. This professional was the care manager for the person case tracked and they went on to say, I feel that permanent staff are committed to (the case tracked person)...it is reassuring to see that (United Response) is putting (the case tracked persons) needs first. Each person living at the Service had a My Health File in place that was well laid out in person centred terms. However, this document was not being well used as a means of monitoring the health care needs of the case tracked person. For instance, the persons last dental appointment was in October 2007 and a further appointment was Evidence: overdue. Also, the case tracked person had had an eye test during 2008, the SSWAR said, but this had not been recorded on the My Health File. There was evidence of involvement of a range of external health professionals, including psychologist, psychiatrist, community nurse for people with learning disabilities and district nurse. The Medication Administration Record (MAR) sheets, of the people who live at the Service, were examined and found to be satisfactory, except that... * there were gaps beside each of the four items of medicine administered to the case tracked person the day before this Inspection. The tablets were missing from the blister pack and so staff had forgotten to sign, * two items of another persons medication had not been administered recently and no record could be found to explain this. The SSWAR said this mistake was known and she had asked staff to record this in an incident sheet. The overall standard of medication recording had improved since the previous inspection though these mistakes show that the Service must continue to focus on good recording and administration practices. Photographs of the people living at the Service were filed with their individual medicine records and there was a record of staff signatures/initials to ensure that signatures can be cross-referenced against staff names. Medicines were securely stored. No controlled drugs were prescribed. Most staff had received training in the safe use of medicines within the past three years. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Procedures for handling complaints and abuse were in place ensuring that people were fully protected. Evidence: United Response had a robust procedure for dealing with complaints. A copy of the Services complaints procedure was displayed - this made appropriate use of symbols so that people who live at the Service could better understand it. The Acting Manager reported that no complaints had been received during the 12 months previous to this Inspection. The Service had a written policy and procedure on prevention of abuse linked to the statutory procedures and prepared by United Response. The senior support worker spoken with showed good awareness of these procedures and the Services whistle blowing policy. The staff training matrix showed that all care staff but one had been provided with training, on the subject of Safeguarding Adults, within the past three years. Also, staff received training in Timian - a system of managing challenging behaviours through focussing on early non-physical intervention - during August/September 2008. This training was aimed at addressing the two Safeguarding Adults incidents during the 12 months previous to this Inspection. Additionally, the Behaviour Support Plan of the person living at the Service, who had been the subject of unsafe and inappropriate staff behaviour, had been revised. This revision had been undertaken by an external consultant and communication charts had also been developed. The senior support worker spoken with thought that staff, and the people living at the Service, would be safe if staff follow this revised Behaviour Support Plan. The template used to record any physical restraint of a person living at the Service had been reviewed since the last Inspection to ensure it guides staff to include details of the physical hold used, part(s) of the body held or duration of hold. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were living in a comfortable and safe environment that was clean and hygienic. Evidence: The maintenance issues, raised at the previous Inspection, had been dealt with. Also, the Acting Manager stated in the pre-inspection questionnaire, The Home has been recently redecorated with input from the people we support. We saw the evidence that new carpets had been fitted to the hall, stairs and landing. An area of vinyl floor covering in the kitchen was missing and carpets in some other rooms were showing signs of wear. The Acting Manager spoke of plans to replace floor covering in all areas needed. The three bedrooms were well-personalised and fitted out with equipment to meet individual needs, including items to visually stimulate. Some parts of the premises were not particularly homely and possible ways to address this were discussed with the Acting Manager. From the tour of the premises there was evidence of satisfactory standards of cleanliness and hygiene, with no unpleasant odours. The senior support worker spoken with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. The questionnaire completed by the Acting Manager referred to all staff having completed Infection Control training. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Services level of training, supervision and consistency of staff fell short of fully safeguarding the welfare of people who live here. Evidence: The Acting Manager stated, in the pre-inspection questionnaire, that four of the nine care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. This did not meet the National Minimum Standard to maintain a staff group with at least 50 qualified staff and was less than at the last inspection. The questionnaire also indicates that there was no staff member working towards an NVQ at level 2 or above. The staff member who completed the pre-inspection survey stated that there had been, high staff turnover...therefore staff are less confident and people we support are less secure and settled. Both Social Services care managers who completed the pre-inspection questionnaire were also concerned about the staff turnover. One said, A lot of changes in the staff group have caused a problem within the services provided. The other care manager thought that, The employment of agency staff has not helped with communication. The Acting Manager agreed there had been high staff turnover as well as high levels of staff sickness and he planned to address this - see the Management section of this report. The Acting Manager showed us new shift plans that help to clarify staff roles. The current staff rota showed one agency staff member on duty, on their own, for half an hour on two consecutive weekend days - 13th and 14th December. However, the SSWAR then spoke to this agency staff member who said there had been two members of staff on duty. Therefore, the staff rota was not accurate. The Acting Manager stated, in the pre-inspection questionnaire, that a person we support was involved in the last recruitment process. At this Inspection, the Acting Manager said there had been no new members of staff recruited since the last Evidence: inspection though there were plans to appoint someone soon, he added. United Response has generally followed good practice regarding recruitment practices. The staff member who completed the pre-inspection survey said that induction training was good. The comment was: When I started I was given and shown a lot of information...I also shadowed a member of staff for two weeks so the service users could get used to me and I could get used to them and their needs. The senior support worker spoken with said he had received training in Fire Safety, Moving & Handling and Timian within the past 12 months. Training records showed that all staff had been provided with mandatory training in Basic Food Hygiene, First Aid and Moving & Handling, within the past three years, except for two staff in each of these areas. Three staff had not been provided with external Fire Safety training within the past 12 months. However, the Acting Manager confirmed that the four night staff had received in-house fire training in June/July 2008. The staff member who completed the pre-inspection survey said that, the last time I had supervision or appraisal was over a year ago. The Acting Manager agreed with this assessment and spoke of plans to restart staff supervision on a three-weekly basis from January 2009, including agency staff. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples best interests had not been promoted by the management systems in place and their health and safety could be compromised. Evidence: At the time of this Inspection the Service had had three managers within the previous eight months, including the current Acting Manager. He had 17 years experience of working with people with learning disabilities and had an NVQ in Care and Management at level 4. He had been in post for only 13 weeks before this Inspection and was not responsible for all the shortfalls found. He planned to make application to us to become the Registered Manager. The Services Senior Support Worker with Additional Responsibilities (SSWAR) had been in post for just 12 weeks before this Inspection. One Social Services care manager, who completed the pre-inspection questionnaire, said that there have been difficulties in relation to management and the lack of consistent leadership has not helped. The senior support worker spoken with was asked if he felt staffing levels were adequate and safe. He replied that he thought they had not been: there has been a lot of agency staff...it would be nice if there was a consistent staff team. He added that staff morale is low but getting better...structure has appeared since (the Acting Manager) has been in post...also (the SWWAR) is positive. The Acting Manager and the SSWAR stated, at the Inspection, that we have been putting in place improvements to address (the problems caused by staff turnover, sickness, poor communications and inconsistent leadership). Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were now taking place - an improvement from the last Evidence: inspection. The Services current annual Service Plan was in place. Quality assurance questionnaires were being sent to staff, relatives and external professionals, for their views on the quality of service provided. Good food hygiene practices were noted. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The pre-inspection questionnaire, completed by the Acting Manager, indicated that equipment at the Service was being maintained and good Health and Safety practices followed. However, although the electrical wiring at the premises had been checked in early 2008, according to the Acting Manager, the Certificate confirming this had not been received. Fire alarm tests were carried out weekly and regular fire drills were being held. Environmental risk assessments were up to date. No Health and Safety hazards were found at this inspection. Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 13(2) The medicine records of people living at the Service must be completed clearly and accurately. 01/05/2009 This will ensure that they receive the correct levels of medication prescribed for them. 2 33 18 8(1)(b) The use of agency, relief and other temporary staff must be reduced. 01/05/2009 This will ensure continuity of care for people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 7 8 9 10 11 12 1 6 6 12 17 19 23 32 33 35 36 38 Peoples Individual Charter should include details of the amount of fees currently payable. A monthly in-house care plan review system should be in place. A clear and meaningful daily recording system should be developed. Intensive interaction between staff and the people who live at the Service should be recorded. There should be a record of what people eat each main meal time. Peoples health care needs should be better monitored and consistently recorded. The Acting Manager should ensure that staff follow Behaviour Support Plans at all times. Unqualified staff, without an NVQ in Care at level 2, should be put forward for this qualification. The staff rota should always be an accurate record of staff hours worked. Mandatory training should be provided to those staff who have not received this. The Acting Manager should follow through his plans to restart staff supervision from January 2009. The Acting Manager should follow through his plans to address the problems caused by staff turnover, sickness, poor communications and inconsistent leadership. The Acting Manager should obtain the Certificate confirming that the Services Electrical Wiring was checked in early 2008. 13 42 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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