CARE HOME ADULTS 18-65
Bromhall Road 110 Bromhall Road Dagenham RM9 4PH Lead Inspector
Ms Rhona Crosse Key Unannounced Inspection 16th May 2006 10:00 Bromhall Road DS0000060787.V295132.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 Bromhall Road DS0000060787.V295132.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. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bromhall Road Address 110 Bromhall Road Dagenham RM9 4PH 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) 020 8308 2900 020 8308 2999 The Avenues Trust Limited Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29 March 2006 Brief Description of the Service: 110-112 Bromhall Road are 2 bungalows linked via a corridor. 4 service users live in each bungalow. The home is situated in a residential area of Dagenham close to local shops and transport links. There are ample parking spaces to the front of the building and the garden to the rear of the property laid to lawn and flower borders. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced therefore the home did not know the inspector was coming. The inspector arrived at 10.00 and spent the whole day at the home. The acting manager was not at the home. The senior support worker made contact with another manager from the Avenues Trust homes and she came to the home and assisted with the inspection. The weekly fees are £1,719.91p. Due to some staff information not being available the inspector arranged a return visit for 30/5/06 at 09.30 to look at staff files. Two service users went out to day centres (these are all day visits and they returned at approximately 16.30). It was one service user’s birthday and the staff were in the midst of planning to shop for party food and took another service user out with them to help with the shopping. The dining room was to be decorated for the party later that afternoon. The Community Nurse was visiting the home at the time of the inspection and the inspector had an opportunity to be able to discuss with her the progress that had been made since the last inspection. What the service does well:
The home has drawn up a document in pictorial form to ascertain the wishes of service users at the time of death. The forms that have been completed have shown an understanding of the needs of the service users. The information is touching to read as it identifies what is important to service users. As a result of this work this standard has a score of 4 which means it has exceeded the standard required. However the home must now complete the documents for the remaining service users. Medication administration records were appropriately signed for the service users tracked as part of the inspection process. Staff are receiving formal written supervision and training has been provided this year covering a wide range of topics relating to the care of the service users. Further training for 2006/2007 is booked and recorded for individual staff members. This is seen as good practice. Staff meetings take place and minutes are kept of these meetings. Due to the improvements made in the operation of the home the staff received a ‘team of the month’ award from Avenues Trust. This boosted morale within the home and is well deserved for the efforts made to improve the standards of care and record keeping.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Although there has been great steps forward taken, there was some evidence of records requiring greater attention to detail. For one service user who has behavioural guide lines relating to verbal abuse, it was established from further documents that at times there could be challenging behaviour. There is no risk assessment for this type of behaviour. This must be put into place. Although the home encourages service users to assist with household tasks there is no record of goals set for long or short term achievements. This needs to take place with goals set that are realistic and achievable for service users to improve their skills and reach their potential. Medication practice was good. However staff who are deemed competent after training by a community nurse to administer rectal Diazepam, some staff not all have their names and signatures recorded in the medication file. These staff signatures must be added and the list updated, (some staff have now left the home but their signatures remain on the form). Daily records are now in picture format with written information below. Whilst this is an improvement it was difficult to track the needs of service users without looking at every other piece of documentation held as the daily records are not always fully completed. The daily records should hold all information about how the service user has spent their day and if there are any concerns about their wellbeing. From cross referencing other documentation the inspector found that a service user had had several seizures but there was no record of this made in the daily records to alert staff of this. One service user now requires a fluid chart to be completed since his return from hospital. The fluid chart did not record the actual amount of fluid
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 7 accepted but only recorded - one mug, one cup drunk therefore this information is of no use. The chart should show the actual amount of fluids taken in millilitres (200mls, 400mls) and at the end of the 24 hours a total should be recorded of the amount of fluids consumed. Advice from the community nurse about the maximum and minimum fluid intake the service user should be provided with to ensure appropriate hydration should be sought. Menus identify meals provided, but do not identify the pureed or soft diets provided. Since the date of the first inspection visit this has now been achieved. Some foods were observed to be shown in a pictorial form in a service user’s file. However the food ‘Okra’ is not provided to service users and should therefore not be shown in picture form. Only vegetables that services users eat should be in picture form in their records. An inspection of service users money held in safekeeping was made. It was observed that some receipts were totalled together and deducted as one entry. Each receipt must be separately recorded with clear information of what has been purchased. On inspecting the money held in safekeeping, one service user’s cash was incorrect being 5 pence over the amount recorded. Greater care needs to be taken when totalling and checking cash held on the service users behalf. Further inspection showed that a service user had purchased sensory equipment. If this service user is deemed to require this equipment this should form part of the service users assessed needs relating to his health and wellbeing. The home should provide this sensory equipment as it would for a hoist or specific bed or other specialist equipment. The service user should be refunded for the cost of this equipment. Staff files inspected had information missing in relation to two new staff employed. A further visit had to be made to the home to access this information. All information relating to staff employment should be held at the home and be available for inspection at any time. A quality assurance questionnaire should be sent to relatives and health professionals and views gained from the service users about the operation of the home. Once this information has been gained an analysis should be undertaken and the results should form part of the Service Users Guide. This should be completed annually. 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.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 &5 The quality outcome area for is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. A pictorial contract should be considered, this would enable some of the service users to have some understanding of their rights in relation to their accommodation. Service users with very complex needs may not have any understanding of this process. EVIDENCE: The majority of service users were admitted from long stay hospitals and information provided on admission was thorough. There have been no new admission to the home for some time and there are currently no vacancies. Prior to a service user being admitted to the home an assessment is completed to ensure that the home can meet the needs of any prospective service user. Service users are able to visit the home prior to admission to see if they like the home and get to know the other service users living there. All service users have a written contract, although none of the current service users would be able to have an understanding of what the contract entails. The
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 10 home should look at ways of providing pictorial contracts or reasonable efforts made and recorded to explain what rights the service users have in relation to their ongoing accommodation. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. The majority of information was well documented. However attention to detail when completing some documentation needs to be more thorough to ensure the wellbeing of service users and evidence the care being provided at all times. EVIDENCE: Since the last main inspection (8 December 2005) the home has worked hard to ensure that care plans hold all the appropriate information needed to ensure the needs of service users are being met. These are on the whole being reviewed and updated as changes occurred. Therapeutic needs are now being addressed which were found to be lacking at the previous main inspection. One service user is now having physiotherapy and another service user has been assessed for a more appropriate wheelchair. New specialist footwear is also being updated via the Orthopaedic clinic.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 12 One service user’s care plan did not have the appropriate information in relation to the amount of fluids that they should consume in any 24 hours. Advice should be sought from the Community Nurse who visits the home to establish what the minimum amount of fluid any individual would require where it is deemed necessary to monitor that service user’s fluid intake. For another service user an entry relating to the food supplement ‘Ensure’ was recorded as being provided 4 times a day, however from discussion with staff it was established that this had been changed to ‘when necessary,’ the care plan had not been changed to reflect this. It is the policy of the home to ensure that service users are offered as much choice as they are able and that they participate in activities in the local community. Due to many service users having little or no speech the staff have to get to know the service user’s body language and known verbal sounds. This way they identify their individual needs and wishes. It was clear from the rapport between the service users and staff that there is a good understanding of their needs. Risk assessments and reviews of these documents were observed to be completed appropriately for the majority of service users. One service user tracked as part of the inspection process has a risk assessment and behavioural guide for any verbal abuse aimed at staff or anyone in the community. These are to enable all staff to deal with the situation in the same way. This was observed to be completed and updated as necessary. However from observation of other records for the same service user, it was established that the service user also has times when challenging behaviour maybe threatened or may actually take place. There was no corresponding information to ensure that all staff follow specific guide lines should this arise. A risk assessment and intervention guidelines must be written up for this challenging behaviour. Service users finances were inspected. It was observed that several receipts had been added together and the total amount had been recorded as one entry. All expenditure should be recorded as individual purchases. During a count of money held in safekeeping and the records of expenditure it was found that for one service user the entry was incorrect, being 5 pence over the amount recorded. All entries must be correct at all times. For a further service user it was observed that the person had purchased sensory aids from their personal allowance. If a service user is deemed to need sensory aids of any kind this should form part of their assessed needs and the Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 13 home should be purchasing these items. The home should refund the service users money spent on sensory aids. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. Service users should be encouraged to reach their potential by developing goals both long and short term with skills they already have being recognised and maintained. EVIDENCE: Although the home has developed well since the last inspection, goals and skills are not being recorded. Both long and short term goals should be recorded. This work needs to take place to enable the service users to reach their potential and the home to evidence that they are working towards meaningful goals and achievements that will enrich the daily lives for all service users. One service user was observed assisting staff to vacuum the floor. It was stated that he also assists to fill the dishwasher and take out the household rubbish to the dustbins. These activities should form part of the goals that are already achieved. New goals can then be set in line with the service users capabilities and aspirations.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 15 Activities are now taking place more frequently both in house and external activities. Each service user has a 2 weekly activities plan. Activities undertaken are in line with service users likes and wishes. Service uses were seen to go out shopping with staff and others went out to ten pin bowling assisted by staff. Trips out for meals to local restaurants and to the cinema also take place. Services in the community are used as much as possible. An adventure holiday has been booked for the service users. This holiday is designed for people with physical disabilities and learning disabilities where they are supported by qualified staff to undertake various adventurous activities such as canoeing and absailing. Services users were observed to be given choice in relation to daily living. One service user likes to spend time alone in his bedroom and this is respected. Times to rise and go to bed are also taken into consideration. In discussion with one service user he stated that he was happy living at the home but did not want to continue the conversation as he wanted to go into the dining room to join the birthday party that was being organised. Relatives and friends are able to visit at any time and no restrictions are place on visiting times. No relatives were visiting at the time of the inspection. Meals are recorded on a daily form and there is a menu set for each week. The menu does not state what the pureed diets or soft diets consist of, this needs to be recorded on the menu. Since the inspection this has now been added to the menu record. It was also observed that ‘take away’ was recorded for one day each week. The menu should state what type of ‘take away’ was purchased. During the inspection of one service users documentation the vegetable Okra was shown in a picture form and corresponding writing. When staff were asked if Okra was provided to the service user they said no. Pictorial information must relate to the actual meals, vegetables provided. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. Attention to detail is required in some documentation to ensure the health and well being of service users. EVIDENCE: As one service user has a medical condition that requires an accurate record of fluids consumed, the fluid chart must record the actual amount of fluids drunk by the service user (200mls, 400mls, or whatever the amount is consumed at any one time). This chart should be totalled at the end of each 24 hour period to ensure that the person has accepted sufficient fluids during that period of time. Advice should be sought from the Community nurse in relation to the maximum-minimum amount of fluid any one person is likely to consume to remain appropriately hydrated. The daily record form has been reviewed and is now in pictorial form as well as written form. However it was difficult to cross reference information as often the information was not recorded on the daily record but found in another record such as an epileptic seizure chart. It is necessary for all current information to be recorded in the daily records as this is a running reference of
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 17 how the person spent their day and any concerns the home has about their well being. It would be beneficial if this form was extended to allow greater detail to be recorded. Service users were observed to be dressed very individually in clothing suitable for their needs, personalities and age. Staff take service users shopping and through a process of elimination purchase clothing on their behalf. Medication administration records were observed to be appropriately completed. The signatures of staff who are able to administer medication need to be updated and some signatures removed as the staff are no longer working at the home. The form identifying staff that have been assessed by a nurse to be competent to administer Rectal Diazepam (in an emergency) needs to be updated. There are staff who appear on the staff rota and their names have not been added to the list as being competent to administer this medication although they have achieved this training. Health care needs are being met with referrals to health professionals as necessary. Documentation inspected showed that referrals to the GP, speech and language therapist, dietician, orthopaedic clinic, physiotherapist, optician, dentist and chiropodist are all made and were recorded. Standard 21 has been given a score of 4 as the information gained for service users wishes at the time of death is an excellent example of what can be achieved. Great care has gone into the production and completion of this information that is both pictorial and written. These documents now need to be completed now for all of the service users. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. Staff are encouraged to monitor the moods of service users to establish if their wellbeing is met and that their environment remains a safe place to live. EVIDENCE: It is difficult to establish whether service users views are acted on in relation to complaints. There are few complaints made. The home has a pictorial complaints procedure for service users and this is displayed in their bedrooms. Due to the dependency level of service users it is unlikely that the majority would have the understanding of how to make a compliant. In discussion with staff it was stated that the service users who have no speech would show displeasure with something or someone by body language or known verbal sounds that they use for communication. In the care plans it was observed to recorded how service users would show displeasure or how they would communicate about something they did not like. Staff stated that they would act on their behalf and that they do monitor service users moods closely. As there are no advocacy services in Barking and Dagenham the opportunity for outside input into the home is limited. Two service users visit the day centre so there is opportunity for them to seek assistance from outside the home. The Community nurse who visits the home has a good rapport with the service users accommodated and would also raise any concerns if she had any after her visits.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 19 Relatives would raise any concerns they had and the complaints book is appropriate. Detailing the date of the complaint, the complainant, what the complaint is, the action taken to rectify the complaints and whether the complainant was happy with the outcome of the homes investigation. A thank you letter was observed to be pinned in the complaint/compliments book from a family who were very happy with the care shown to their relative when he was unwell. A staff member had written in the complaints book in relation to a staff issue. This book is not the place for such an entry. The manager has spoken to the staff member about this. Staff have received training in the protection of vulnerable adults and there are policies and procedures for staff to refer to at any time in relation to making complaints or reporting any suspected abuse. Newly appointed staff are placed on courses after they have completed their probationary period. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. The home is comfortable and well appointed and this enhances the well being of service users. EVIDENCE: The home was clean and free from odours throughout. Bedrooms were individually decorated and are now filled with personal possessions. Several service users have bought personal items for their bedrooms. The belongings inventory for one service user should be updated to ensure all purchases are recorded. All bedrooms have en-suite showers and toilets. It was observed that one toilet seat is no longer impervious to urine. It was stated that this toilet seat has already been reported to the estates department for replacement. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 21 The communal areas were bright and clean. One wall behind the chairs in 110 requires the wall repairing and decorating as the chair backs have left marks on the wall. There is specialist lifting equipment in bathrooms to ensure the safety of service users. Hoists and lifting aids and pressure relieving aids are used as necessary. An inspection of bathrooms found that these areas are being used as ‘storage’ for items no longer used or items that should be stored elsewhere. The items observed were moved from the bathrooms by staff at the time of the inspection. However due to the same thing happening again at this inspection, (this was first raised at the December inspection) a requirement will be made from this inspection. The garden has had a lot of work undertaken on it since the last inspection with plants and flowers added to newly shaped borders making the garden more attractive. Unfortunately due to the wet weather the grass has not been cut recently. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. Although the home has no registered manager, the acting manager has brought about changes that have benefited the service users and brought the standard of the home up to an good level. EVIDENCE: The home does not have a registered manager. The current acting manager has made improvements in the operation of the home and this is to her credit. The staff team have also worked hard since December 2005, after the last main inspection to improve their standards of care and associated care records. Since that inspection there has been a meeting with the providers Avenues Trust and a further unannounced inspection that has shown that the home has continued to progress. The home received a ‘team of the month’ award from Avenues Trust due to the hard work and commitment the staff have shown. These changes have been brought about by a strong management approach and appreciation of staff when achievements have been made. In discussion with a staff member it was stated that the staff are now working as a team and everyone appears to be more focused in their roles.
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 23 From discussion with the Community nurse it was stated that staff are more efficient, are taking more responsibility and will seek advice more appropriately now from the Community Learning Disability Team. From observation of the atmosphere of the home and the way staff are interacting more with service users, the home is a place where service users appear much happier and staff are seeing the results of their work. Staff training is to be updated and there is a training record of training that is booked for 2006/2007 such as Epilepsy, visual impairment, sexuality, mental health, breakaway techniques, personal and empathic care, care of the dying, nutrition, loss and bereavement, report writing, rota planning and Minimum Care Standards. Staff employment records were inspected. There was no information held in the home for two newly appointed staff. Records must be available for inspection at any time and there must be systems in place to allow access. For other staff there was a form completed by the human resource department of the head office that gave the start date of employment, the CRB disclose reference number and date of the return of the disclosure. Other information was also provided in line with the Care Home Regulations. However there were no dates of when the references were returned to the company (only a record of how many references were applied for and returned). This was raised with the acting manager and will also be raised with the Provider Relationship Manager of the Commission for this company. Training that has already taken place this year is: introduction to learning disabilities, adult protection, management of aggression, basic first aid, equality and diversity, food hygiene, Autism, de escalation/diffusion techniques, person centred planning, risk assessments, fires safety and health and safety training, including refresher courses and also report writing. Staff supervision is taking place and all staff are having set formal supervision sessions. Of the care staff employed, 4 hold NVQ level 2 training a further 2 staff are working towards achieving this qualification. 6 staff have been put on the waiting list for places to take NVQ level 2 qualifications. Approximately 25 of staff hold the NVQ level 2 qualification. However 50 of the staff team (8.8 of the staff employed) must achieve NVQ level 2 qualifications. The current training records do not identify which staff have achieved NVQ training or who is currently undertaking this training. It is recommended that this is added to the training records. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 The quality outcome area is good. This means that there are more strengths than weaknesses. This judgment has been made using available evidence including a visit to the service. The newly employed manager must apply for registration with the Commission to enable continuity of management and offer stability for service users and staff. EVIDENCE: There is an acting manager working at the home. Interviews have taken place and an applicant has been offered the post. A date to commence duties is still to be set. The newly employed manager must apply for registration with the Commission. As stated in previous standards the home has improved greatly over the past 6 months. This standard must be built on and it is important that the new appointed manager strives to improve further the operation of the home. All records are held securely. Service uses would be able to have access to their records. Due to the complexity of needs that the current service users
Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 25 have it is difficult to establish if they have sufficient or any understanding of their individual records. Staff explain to service users what they are writing about them and daily records are in picture form as well as written form. An annual quality assurance review should take place of the opinions about the operation of the home from service users (where possible), relatives and any health professionals involved in the care of the service users. This quality audit should be analysed and the findings should form part of the Service Users Guide. All accidents are recorded and service users are monitored for any ill effects after any accident. Induction training for new staff is being achieved. Health and safety checks and the associated records were appropriately completed in line with the regulations. In the kitchen the fridge/freezer door requires repair or replacement. The manager stated a new fridge freezer was on order, this has arrived since the inspection. Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 26 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 3 5 2 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 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 4 2 x 2 x 3 3 x Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 27 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 12 (1) & 15(2)(b) 17(2) schedule 4 9 17(2) schedule 4 9 16(2)(c) Requirement Care plans must be up to date and hold all information relating to the needs of service users. Money spent on behalf of service users must be correct at all times (5p over the amount recorded was held). Receipts should be individually deducted and recorded. Several receipts should not be added together and deducted as one entry. Service uses should not have to purchase sensory equipment that is deemed necessary for their needs/wellbeing. One service users inventory of items purchased needs to be updated. Risk assessments must cover all aspects of care needs (behaviour guide for physical aggression). Goals both long and short term should be set for all service users to enable them to reach their potential. Menus must show the content of pureed and soft diets provided. Timescale for action 30/06/06 2 YA7 30/06/06 3 YA7 30/06/06 4 YA7 30/06/06 5 6 7 YA7 YA9 YA11 17(2) schedule 4 9 13(4)(c) 14(2)(a) & (b) 17(2) schedule 4 13 30/06/06 30/06/06 30/08/06 8 YA17 30/06/06 Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 28 9 YA19 17(1)(a) schedule 3 (k) 10 YA20 11 12 13 YA24 YA27 YA34 14 YA37 15 YA39 Fluid charts must identify the actual amount of fluids consumed in any 24 hour period (600mls, 1,500mls) as appropriate for each individual who requires a chart completed. 13(2) All staff deemed competent to administer rectal Diazepam should have their signature identified and a copy held in the medication records of the home. 23(2)(c) & Repair the wall in the lounge and (d) make good the decoration in house 110. 23(2)(l) Bathrooms should never be used as storage areas. Appropriate storage must be used/found. 17(2) Information relating to staff schedule employment and recruitment 4 6(f) must be available for inspection at any time. 8&9 The organisation must put forward a manager for registration with the Commission. This is an outstanding requirement from the last inspection. 24(1)(a) Commence a quality assurance & (b) review. This should take place annually and the information once analysed must be added to the Service Users Guide. 30/06/06 30/06/06 30/08/06 30/07/06 30/06/06 31/07/06 30/09/06 Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 29 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 3 4 Refer to Standard YA5 YA17 YA17 YA32 Good Practice Recommendations Contracts should be in a format that is appropriate for each service users needs or reasonable efforts made to explain the contract to the service users. Only vegetables that are provided to service users should be used in a pictorial form (Okra is not provided to service users). Record the type of meal purchased that ‘take away’ is currently being recorded as. NVQ training and the level achieved should be identified on the training plan (for training undertaken and planned training to be achieved). Bromhall Road DS0000060787.V295132.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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