CARE HOME ADULTS 18-65
Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU Lead Inspector
Lowenna Harty Unannounced Inspection 2nd December 2005 09:30 Carrick DS0000009100.V268845.R01.S.doc Version 5.0 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 Carrick DS0000009100.V268845.R01.S.doc Version 5.0 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. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Carrick Address 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU 01872 864657 01326 371099 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) Spectrum Mr Michael John Cross Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 5 adults with a learning disability (LD) Total number of service users not to exceed a maximum of 5 Date of last inspection 10th May 2005 Brief Description of the Service: Carrick is a home providing accommodation and personal care for up to five adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist care for people with autistic spectrum disorders. Spectrum employs a manager and a team of staff to care for the service users living in the home. The aim is to provide them with specialist support in a homely environment. The home is situated in the village of Playing Place, on the outskirts of Truro. It has vehicles for providing transport for service users and there is accessible local public transport. There is a village shop within easy walking distance of the home. The home is a single storey building, set in its own grounds, slightly off the main road. All the service users have their own bedrooms. There is ample communal space, including a large lounge/dining room, a second lounge and a conservatory. There is a separate kitchen, a laundry room and sufficient bathrooms, although none of the rooms have en suite facilities. There is a lockable office and separate room for staff to sleep in over night. The home has a large garden with parking space at the front. There is level access to the building, which could be adapted to meet the needs of people with physical disabilities, if necessary. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 2 December 2005 and lasted for approximately six hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The inspection focused on an inspection of the premises, examination of care, safety and employment records and discussion with the home’s manager and senior staff. There were opportunities to observe the daily life of the home and staff interaction with the service users. The principle method of inspection was case tracking, which involves reviewing the care records for selected service users in detail and following this through with interviews with them and staff working with them. Two service users were case tracked at this inspection. The home provides an improving standard of care to the service users placed there, which they confirmed during the interviews and was apparent in the records held in the home to support good care practices. What the service does well:
No new service users have been admitted to the home since the previous inspection and those living there currently are very familiar with the services provided to them. They all have written statements of the terms and conditions of their placement in the home. Service users have detailed written care plans, which are shared with them and their representatives. These address all their personal; health and social care needs, including their religious and cultural backgrounds. They are formally reviewed at least once every six months. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 6 Service users are consulted about their lives in the home during reviews of their care plans, which consider their abilities to make decisions for themselves and set out goals for them to achieve in the short, medium and long-term. They are encouraged to develop their skills and confidence by taking part in shopping, cleaning, cooking and menu planning for the home. They are encouraged to contribute to their daily care records and all keep daily diaries, with help from staff, if they need it. Service users have detailed written risk assessments, which set out what staff need to do to manage risks and ensure service users and others are kept safe. Service users go out and spend time in the local community on a regular basis. The home provides them with transport so that they can go out on day trips to places of local interest, access colleges and day placements outside of the home and other local facilities. The home is situated in a small village, within easy reach of a shop and has good transport links with local towns and the City of Truro. Staff always accompany staff when they go out, in accordance with their individual risk assessments. Service users have a choice of leisure activities in the home. There are two lounges and a conservatory so they can participate in individual pastimes or spend time as a group, depending on their preferences. Both the lounges have televisions and music centres. There is sensory equipment and a stereo in the conservatory. Service users are able to participate in gardening during the summer if they wish and were taken on holiday to Bude this year. They participate in a variety of leisure activities in the community, including trips out to local places of interest and local walks. Service users’ rights and responsibilities are set out in their individual statements of terms and conditions, which are shared with their placing authorities and families. The home’s statement of purpose contains information on how they can access advocacy services and one service user currently has an independent advocate, who visits them at the home so that someone independent of Spectrum oversees their interests. Service users enjoy healthy, home prepared meals, which they are encouraged to help choose and cook, so that they can develop their skills and independence. Their food likes and dislikes are recorded and there are always alternatives available if they do not like the main menu choice. At the time of the inspection some of the service users were taking part in a cookery session with staff and those who were interviewed, said that they are well fed. Service users are helped to look clean, fashionable and smart. There are enough bathrooms for staff to help them in private, if this is necessary and they are encouraged to take care of their own personal care needs as far as they are able to. Service users’ views and those of their representatives are taken account of during their care plan reviews, which take place at least every six months. They are encouraged to maintain contact with relatives and/ or advocates from
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 7 outside of the home so that they have someone from outside of Spectrum to oversee their best interests. The home’s formal complaints procedure is published in the service users’ guides, which are circulated to service users and their representatives. Service users said that they feel safe and are well cared for in the home. Staff were observed interacting with them respectfully and affectionately. The home’s environment is comfortable and safe. It was well decorated and furnished throughout at the time of the unannounced inspection. It is well situated to enable service users to access the local community, but set slightly off the main road, to ensure their privacy. Service users have individual bedrooms, which they have personalised according to their own tastes. They are lockable and service users are provided with keys, depending on their individual needs and risks. All bedrooms are comfortably furnished. Staff have written contracts that set out their duties and responsibilities clearly. They are either qualified or working towards achieving formal qualifications to provide service users with a good quality of care. They have good access to ongoing training and training is planned ahead to ensure that they have the knowledge and skills they need to work with the service users effectively. There are records in place and this was confirmed by a staff member at the time of the inspection, to demonstrate that they are provided with regular supervision, both group and individual, by the home’s manager to ensure that their working practices and training needs are kept under review. The home’s manager is experienced and qualified to run the home, and has been previously registered with the Commission in respect of another Spectrum home. What has improved since the last inspection?
Plans to translate key information, such as statements of terms and conditions and service users’ individual care plans are well underway. The home’s manager has obtained a computer programme, which will translate documents into pictorial formats, so that service users can understand them more fully.
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 8 There is some improvement in individualised activities for service users, particularly in the house, although there needs to be further improvement in this, to ensure that service users’ individual care plans are fully carried out. There have been notable improvements to the home’s systems for managing service users’ medicines so that they are better protected from harm due to medication errors. This includes improved storage facilities, new written procedures, which allow for service users to manage all or some of their own medicines if they are able and improved systems for recording medicines administered by staff. The home’s manager has obtained copies of the multi-agency procedures for the protection of vulnerable adults from abuse from each service user’s placing authority so that staff have better information on what to do if they suspect a service user is being abused or neglected. There have been some improvements to ensure that service users are protected from the risk of infection. There is a stock of dissolving sacks so that soiled laundry can be safely transported through the home to the laundry area. The home’s manager has training in infection control and has included this on the future training plan for staff. There has been less turnover of staff since the last inspection, so that service users benefit from a more stable team, who are familiar with their individual needs. There are now records available in the home through a computerised system to show that staff are recruited on the basis that they are suitable and safe to work with vulnerable adults in a care home setting. There are also records of new staff induction training to demonstrate that they have been instructed on how to care for service users effectively. Spectrum’s senior manager’s visit the home on a regular basis and now submit reports of these visits to the Commission more regularly, as evidence that there is some external monitoring of the quality of services provided within the home by the registered provider. There have been improvements to make the home safer for service users, particularly in respect of protecting them from risks due to fire. There are now records to show that staff are trained, equipment tests are done regularly and the home’s fire safety risk assessment has been completed. What they could do better:
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 9 Although there is some background information on all of the service users in the home, copies of their initial assessments were not available for all of them. Copies of documents currently stored at Spectrum’s head office need to be held on service users’ files so that staff working with them can effectively evaluate their current care plans against their initial placement needs. There are some problems with the equipment for translating key documents into alternative formats for service users, which the manager is working to sort out, in order to be able to provide them with their own copies of key documents about their placements in the home. Service users’ risk assessments in relation to specific activities need to be reviewed and amended, as some are out-of-date and may not be relevant any longer. They and/ or their relatives must be invited to sign their written risk assessments and management plans, particularly where they may include restrictions to protect them or other people. Service users continue to mainly take part in whole house or joint activities when they are outside of the home and they should be provided with more individualised activities, so that they can fully achieve the goals set out in their care plans. Whilst there have been major improvements to systems for managing service users’ medication and staff have been provided with some training, they should undergo training in the safe handling of medicines so that they are better informed about how to prevent service users being harmed by medication errors. Spectrum’s internal written procedures for the protection of vulnerable adults from neglect, self harm and abuse need to be updated so that staff are better informed about what they should do if they suspect this is happening. The home’s manager should attend multi-agency training on the protection of vulnerable adults from abuse so that he can train staff on how the various local agencies work together to protect service users from harm. Further improvements are needed to protect service users from the risk of infection, including training for staff in infection control and suitable facilities for heavily soiled laundry to be disinfected. Whilst staff turnover has improved, there are occasions, when there are insufficient staff on duty to enable service users to safely undertake a full range of activities, particularly at weekends. The home’s manager needs to be registered with the Commission as fit to manage this home, having recently transferred to it from another Spectrum home, so that service users are confident about the authority and responsibilities of the person in charge of the home. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 10 Service users and their representatives should be formally consulted about the quality of the services provided to them in order that their views can contribute fully to the home’s annual development plan, which the manager has commenced, but needs to complete. Whilst the home appears to be mainly safe for service users, the environmental risk assessment should be reviewed, signed and dated so that the manager is clear about when it needs further review and is able to clearly maintain a safe environment in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 11 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 Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 12 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 Admission to the home is based on assessment so that service users can be confident it will be suitable for them. Service users have individual statements of the terms and conditions of their placements in the home, so that they are aware of their rights and obligations. EVIDENCE: There have not been any recent admissions to the home and all of the current service users have lived there for several years. The home’s statement of purpose provides information on the admission process, which includes an assessment of their needs. Initial assessment information for some of the service users is currently held at Spectrum’s head office and copies of this should be held on service users’ files in the home so that people working with them can review current care plans against their needs when they were initially admitted. All of the service users have written statements of the terms and conditions of their placements in the home. Copies of these are held on their individual files, with evidence that they have also been sent to service users’ representatives and relatives. Some of the service users are able to access the information contained in the documents, through verbal explanations by staff. Progress has been made to translate them into alternative formats, including installation of a computer programme in the home that will do this. There are still some problems with this, however, with the home’s manager is currently dealing with, before they can be provided to service users.
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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 & 9 Service users have written care plans, with clear goals, but they need to be more directly accessible to them so that they are as fully informed about the purpose of their placement in the home as possible. Service users are helped to make decisions about matters that are important to them. Risks are considered as part of the care planning process, but improvements are needed so that they are kept up-to-date. EVIDENCE: Copies of service users’ written care plans are held on their individual files. They are detailed and cover every aspect of their personal, health and social care needs, including needs relating to their religious and cultural backgrounds. Service users and their representatives are invited to attend formal reviews, which are held at least every six months. They are invited to sign their care plans as evidence of their participation and agreement. Plans to translate them into alternative formats so that service users can access them directly still need to be implemented. Service users’ abilities to make decisions for themselves are considered as part of the care planning process. They have goals set out in their care plans to encouraged them to develop their skills and achieve plans in the short,
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 15 medium and long term. Service users are encouraged to contribute to the preparation of their daily care records and all have individual diaries, which they update daily, with staff assistance, if they need it. They are encouraged to participate in household tasks, such as shopping, cooking, cleaning and menu planning on a day-to-day basis. There are detailed written risk assessments on service users’ personal files to address specific activities and general risks relating to their assessed needs. The former need to be reviewed and amended, as they were out of date for the service users whose cases were tracked. The main risk assessment document must be signed by service users and/ or their representatives, as evidence that they agree with them, particularly, where staff may need to take action to protect them and or others. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 16 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): 12, 13, 14, 16 & 17 Service users need to have more opportunities to take part in individual activities, particularly outside of the home, so that they can fully achieve the goals laid out in their care plans. Service users regularly access the local community. They engage in a range of leisure activities in and out of the home. They are informed of their rights and responsibilities and are well fed so that they are physically healthy and enjoy their mealtimes. EVIDENCE: Daily care records show that service users have improved access to individual activities, rather than group based ones most of the time. Service users interviewed confirmed that they enjoy the activities provided for them and they were observed to engage in different activities in the home at the time of the inspection. There is evidence that they are achieving most of the goals set out in their care plans, but not all, particularly in relation to their taking part in individual activities. There is still need for improvement, particularly with regard to activities that take place outside of the home and at weekends, when service users still tend to go out together as a group. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 17 Service users are assisted to access a range of facilities in the local community. They often go out for walks, locally or further away from the home. They attend colleges, make use of shops and go to cafes and restaurants. The home has suitable transport to take them out and daily records set out what they have done. There is a range of leisure facilities available to service users in the home, including two lounges, with televisions and music systems. Service users are also able to make use of musical and sensory equipment in the home’s conservatory and engage in gardening projects during the summer. There are records of their taking trips out for walks and activities during the week. Service users were observed taking part in different activities during the course of the inspection. Some were listening to music or doing puzzles and some were helping staff to do baking in the kitchen, for example. Service users’ rights and responsibilities are set out in their individual care plans and service users’ guides, which also function as statements of their terms and conditions. These have been shared with them, their relatives and placing authority representatives. Service users have information on how to obtain independent advocacy and one currently has an advocate, who visits them at the home. Service users interviewed at the time of the inspection said that they enjoy their meals at the home. They are encouraged to develop their skills and confidence by taking part in shopping, menu planning and cooking. Most meals are eaten as a household, in the dining room, together with staff, so that they are social occasions. Service users also have opportunities to go out for meals, according to their daily care records. Their dietary needs and preferences are set out in their individual care plans. Service users are encouraged to eat healthily and take exercise so that they remain physically well. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 18 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 & 20 Service users’ personal care needs are taken care of appropriately, so that they appear clean and presentable and are encouraged to develop their abilities to attend to their own needs. There have been notable improvements to ensure that service users are better protected from medication errors, although a further specific improvement is needed. EVIDENCE: Service users’ individual care plans set out their personal care needs and there are detailed instructions for staff for each of them. There are sufficient toilets and bathrooms for service users to attend to their personal care and hygiene in private. All of the service users appeared well dressed and smartly presented and staff guide and assist them as necessary. Spectrum has introduced new systems for managing service users’ medicines, including new written procedures, recording systems and training for staff. There are improved storage facilities for medicines and the new procedures provide for service users to undertake all or part of their medicines management themselves. The home’s manager has undergone training in the safe handling of medicines. This should be extended to staff working in the home so that they are well informed about how to prevent service users being harmed by medication errors.
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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): 22 & 23 Service users’ views are heard in a variety of ways and acted on, where necessary. There are systems in place to protect service users from abuse, neglect and self-harm, but these should be improved so that they are given as much protection as possible from this. EVIDENCE: The home’s formal complaints procedure is communicated to service users and their representatives through the home’s service users’ guide. Service users interviewed at the time of the inspection stated that they are happy and well cared for and there have not been any formal complaints made since the previous inspection. Service users are encouraged to maintain contact with relatives and/ or advocates from outside of the home, so that someone from outside of Spectrum oversees their care. Their relatives and placing authority representatives are invited to attend their care plan reviews, which set out their needs and goals at least every six months. Spectrum’s internal procedures for the protection of vulnerable adults from abuse need to be reviewed and updated to be more informative to staff. There are now copies of the multi-agency procedures for each of the authorities placing service users in the home. The home’s manager should attend multiagency training and cascade this to all staff working in the home so that they are fully informed of the action they should take if they suspect a service user is being abused. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 21 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): 24, 26 & 30 The home is comfortable and safe so that service users can develop their skills and independence in a homely environment. They have individual bedrooms that meet their needs. Some improvements are needed to improve hygiene in the home and prevent the spread of infection. EVIDENCE: The home was well decorated and furnished throughout, and provides service users with a domestic, homely environment. It is well situated, within reach of local community resources, but set slightly off the road, to ensure privacy. Service users have individual bedrooms, which are lockable. Service users are able to have keys to their bedroom doors, subject to their individual risk assessments. Their bedrooms are furnished according to their individual needs and risks and they are encouraged to personalise them to make them according to their own tastes. The home was clean and tidy throughout at the time of the unannounced inspection. There are some systems in place to prevent the risk of infection spreading, such as dissolving sacks for the transport of soiled laundry through the home and written procedures to guide staff on how to prevent infection. The home’s manager has undertaken training in infection control and the
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 22 home’s training plan provides for staff to do it as well. Suitable facilities must be arranged for the disinfection of heavily soiled laundry. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 23 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): 31, 32, 33, 34, 35 & 36 Staff have clear guidance on how to support service users. They are qualified or working towards achieving formal qualifications to at least NVQ level 2. Most are experienced in working for Spectrum and able to work effectively with the service users in the home but there must be sufficient staff on duty at all times to ensure that service users’ needs are met. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have good access to ongoing training and are well supported and supervised. EVIDENCE: Staff have clear written contracts, which state the terms and conditions of their employment. These are held on their personal files in the home. They are also given copies of the GSCC code of practice. Three staff are qualified to at least NVQ level 2 and the rest are working towards achieving qualification to at least this level. There is a more stable staff team working in the home and usually in sufficient numbers to ensure that service users can undertake a variety of activities in and out of the home. Staffing levels, particularly at weekends, need to be maintained at sufficient levels at all times to ensure that service users are able to undertake more individualised activities, should they wish to do so and are
Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 24 safe. According to one recent staff roster, the home was left in the charge of a single member of staff on one occasion recently, albeit for a short period of time. Spectrum has introduced a computerised record system to demonstrate that staff are selected and recruited on the basis of fair, safe and effective policies and practices. Copies of staff records are now fully available to show that they are suitable and safe to work with vulnerable adults in a care home setting. Staff have good access to ongoing training. There is a whole team training plan in place and there are records of induction training for new staff. Staff confirmed that they undergo 1:1 supervision with the home’s manager every six weeks. There are regular staff meetings with minutes kept and records show dates for individual supervision sessions booked ahead for each staff member. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 25 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, 38, 39 & 42 The home’s manager is qualified and competent, but needs to be formally registered with the Commission. The home’s quality assurance programme needs improvement. Some improvements are needed to protect service users from risks to their health and safety. EVIDENCE: The home’s manager is very experienced and was previously a registered manager at another Spectrum home before moving to this one, recently. He is qualified to NVQ level 4 and undertakes regular training to update his knowledge and skills. He now needs to be registered with the Commission, as fit to manage this home. The home’s philosophy and ethos is clearly laid out in the home’s statement of purpose and translated into action on a day-to-day basis by the home’s manager. Senior managers from within the Spectrum organisation regularly visit the home and submit copies of their reports of these visits to the Commission more regularly, following the previous inspection. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 26 There is some evidence that service users have been consulted on the quality of the services provided to them, but not of a systematic analysis of this, including formal consultation with external stakeholders such as relatives, advocates and placing authorities, linked to an annual development plan for the home. This needs to be done so that service users and their representatives can be confident that their needs are paramount in the ongoing planning and development of the home. The new manager has commenced work on preparing an annual development and business plan for the home and this needs to be completed. There have been notable improvements to ensure that service users are better protected from risks due to fire including staff training, with records kept, regular testing and servicing of alarms and fire safety equipment and completion of the home’s fire safety risk assessment. Staff have good access to ongoing training so that they know how to keep service users safe. There are records of tests of electrical equipment in the home to demonstrate that the home’s electrical wiring and appliances are safe. There is an environmental risk assessment in place, but it needs to be reviewed, signed and dated. Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 X X X 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Carrick Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000009100.V268845.R01.S.doc Version 5.0 Page 28 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. 2. Standard YA2 YA9 Regulation 17(1)(a) 12(2) Requirement Copies of service users’ initial assessment documents must be retained in the home. Service users and/ or their representatives must be asked to sign their individual risk assessments. Spectrum must update its written procedures to guide staff on how to protect service users from abuse and ensure that they are trained and aware of their responsibilities in relation to the local multi-agency procedures. Staff must be provided with training in infection control and facilities set up to ensure that heavily soiled laundry is disinfected. The registered provider must ensure that there are sufficient staff on duty in the home at all times. Spectrum must appoint a registered manager to run the home. There must be a formal review of the quality of the services the home provides based on service users’ views and those of their
DS0000009100.V268845.R01.S.doc Timescale for action 01/01/06 01/01/06 3. YA23 12 & 13 01/04/06 4. YA30 13(3) 01/04/06 5. YA33 18(1)(a) 01/01/06 6. 7. YA37 YA39 8 24 01/04/06 01/04/06 Carrick Version 5.0 Page 29 representatives. This requirement was previously set to be achieved by 30/04/05 and 01/07/05. It has been re-set to enable the home’s new manager to achieve full compliance, in light of other improvements already made. 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. 5. 6. Refer to Standard YA5 YA6 YA9 YA12 YA20 YA39 Good Practice Recommendations Key documents such as service users’ guides should be translated into formats that they can access directly. Key aspects of service users’ care plans should be provided to them in translated formats that they can access directly. Individual activity risk assessments should be reviewed and amended, where they are out-of-date. Service users should be provided with improved access to individual activities outside of the home, particularly at weekends. Staff should undergo training in the safe handling of medicines to supplement the briefings they have already received on the new medication systems in place. The home’s annual development plan should provide more detail and be based on a formal review of the quality of services provided, including consultation with service users and their representatives. The home’s environmental risk assessment should be reviewed, signed and dated. 7. YA42 Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carrick DS0000009100.V268845.R01.S.doc Version 5.0 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
