CARE HOME ADULTS 18-65
Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU Lead Inspector
Lowenna Harty Unannounced Inspection 25th May 2006 09:30 Carrick DS0000009100.V295533.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 Carrick DS0000009100.V295533.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. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 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 Christopher John Halford Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st December 2005 Brief Description of the Service: Carrick is a care home providing personal care and accommodation for up to 5 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, who is registered with the Commission and a team of staff to provide care to the service users living in the home. The aim is to provide them with specialist support in a homely environment. The home is located in the village of Playing Place, which is within easy reach of the city of Truro. It has vehicles for providing transport to service users and there are accessible local bus routes. 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. The home has ample communal space, including a lounge/dining room, further lounge and conservatory. There is a spacious kitchen, a separate laundry room and an adequate number of bathrooms. Staff have a small office and separate sleeping in accommodation. The home has a large garden with space for parking. The home has level access and could be adapted to provide for service users with physical disabilities if necessary. Current service users do not require specialist equipment or adaptations and are able to readily access all parts of the premises. Fees range from £813.00- £7084.00 per week, according to information provided by the Registered Manager to the Commission, which was received on 15 May 2006. There are additional charges made to service users for personal items such as toiletries, newspapers and magazines. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which was unannounced. It took place on 25 & 30 May 2006 and lasted for approximately nine 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 included interviews, with each of the service users and telephone contact with a social worker representing of two of them. A member of staff was interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records, discussion with a representative from Spectrum’s management team and the registered manager. The principle method of inspection was “case tracking”. This involves interviews with a select number of service users; staff caring for them and their representatives, where possible and examination of records relating to their care. This provides a useful impression of how the home is working for service users overall. Three service users were case tracked at this inspection. Service users and their representatives expressed continuing satisfaction with the care and services provided to them at the home and improvements to the service are ongoing. What the service does well:
All of the service users have lived in the home for several years and are very familiar with the services provided to them. They are a settled group, who know each other well and there are no plans to change this. They all have written statements of the terms and conditions of their placement in the home. They have detailed written care plans so that they know what the aims of their placements in the home are. These are shared with their representatives, where necessary and regularly reviewed. Their care plans take into account their individual and diverse needs, including their age, religion, physical and sensory abilities, cultural background, sex and sexual orientation. Service users are helped to make decisions about things that are important to them such as the activities they take part in and staff were observed helping them to make choices during mealtimes and when assisting them with their personal care so that they can develop their skills and independence. Service users interviewed at the time of the inspection were able and very confident about expressing their views.
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 6 Service users are encouraged to take risks in a safe way, so that they develop their skills and independence. A representative of two of them remarked on how impressed they were with what the home does for service users in this respect. Service users have active lives in and out of the home and are encouraged to maintain contact with their families and friends. Examples of recent activities include a trip to the Hall for Cornwall to see a show and parties at other Spectrum homes. Service users are informed of their rights and responsibilities, for example about what is expected of them in relation to household tasks in the home, so that they are clear about them and they are fair. Mealtimes appear to be relaxed and enjoyable for service users and they confirmed that they liked the food served in the home. They are able to make snacks and drinks for themselves or with staff to help them if they need it. Staff work with service users to prepare healthy, home cooked meals that they all like. Service users are helped and encouraged to dress smartly and appropriately and to keep themselves clean and tidy. Where possible staff encourage them to be independent, whilst assisting them with specific tasks if they need help. Service users are encouraged to maintain good physical and mental health and are helped to access external NHS healthcare providers such as doctors, dentists and opticians when they need to. Their medicines are mainly managed safely for them. They have good information on how to make complaints about the service and are actively encouraged to make comments about it, so that improvements and developments will be based on their needs and views. All of the service users said that they feel safe in the home and there are systems in place to protect them from harm and abuse. The home’s situation, as an ordinary domestic dwelling in a small, rural community, is conducive to enabling service users to develop their skills and independence in a safe and comfortable way. At the time of the inspection, which was unannounced, it was clean and tidy throughout. Staff are recruited fairly, in accordance with good employment practices and on the basis that they are suitable to work with vulnerable adults in a care setting. They are provided with good initial and ongoing training to ensure that they develop and maintain the skills they need to work effectively with service users. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
Historical information, about how service users came to be placed in the home is now in place for most of them, having been brought across from where it was held, at Spectrum’s head office. This is important information for staff working with them so that they can monitor their progress in the home. Information about the service users’ terms and conditions in respect of their placements in the home has now been provided to them in pictorial formats, which they can access directly, so that they are better informed of their rights and responsibilities. Whilst service users’ care plans have not been translated, there was improved evidence at this inspection, that the key aspects have been communicated to them, so that they can understand the reasons for their placements in the home. One service user was interviewed with his care plan and said that he was familiar with it. His social worker confirmed that he is invited to reviews of his care plan at regular intervals. Service users’ written risk assessments are now up-to-date and demonstrate that they are encouraged to take risks to develop their confidence and skills, with support from staff where necessary. Any restrictions necessary to protect their welfare or the safety of others are included and copies are sent to their representatives for their agreement. Service users appear to have access to an increased range of activities outside of the home, including individual activities. They have regular trips out with staff on their own to do things they particularly enjoy or need to do in order to achieve their personal goals. The registered manager has attended local multi-agency training on the protection of vulnerable adults from abuse so that he is better informed about how different organisations and agencies work together to protect service users from harm through abuse. There have been improvements to the home’s environment since the previous inspection with the provision of new furniture in the communal areas and improved security arrangements for the protection of service users. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 8 The registered manager has completed training in infection control so that he is now better informed about how to maintain good hygiene in the home for the protection of service users and staff. The home’s staff team now consists of over 50 who are qualified to NVQ level 2 or above, which is in excess of the proportion set out in the National Minimum Standards, so that service users and their representatives can be confident of the competence of staff working with them. The home’s manager has been registered as a fit person to manage a care home, since the previous inspection, so that service users and their representatives can have confidence in the authority and status of the person in charge of the home. The registered manager has formally consulted with service users and their representatives so that the future development of the home can be linked to ensuring their views and preferences are taken into account. The registered manager had completed a review of the home’s environmental risk assessment, signed and dated it, since the previous inspection towards ensuring that the home is kept safe for service users, visitors and staff. What they could do better:
Background information still needs to be brought across from Spectrum’s head office for one service user so that staff are as well informed about their needs as they are about the other service users. Service users and/or their representatives should be provided with more detailed information about how their personal contributions towards of the cost of their placements in the home are calculated so that they are fully informed of their welfare rights. One service user was completing a care plan using pictorial symbols so that they are clearly very involved in setting their own goals for their placement in the home. This should be considered for other service users who would benefit from the opportunity to participate more fully and meaningfully in the care planning process. Service users should be provided with increased opportunities to make decisions about how their personal finances are managed for them and be offered with choices at each of their main meals so that there is an alternative available to them if they prefer it. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 9 Staff who manage service users’ medicines for them should be provided with improved training so that they are better informed and service users are better protected from medication errors. The home’s written procedures that guide staff on how to protect service users from harm and abuse continue to need to be reviewed, so that they have clear and up-to-date information on best practice with regard to the protection of vulnerable adults. Further improvements are needed to make the home comfortable and safe for service users including carpets in the hall and conservatory, which appear worn and stained and a review of the home’s health and safety systems to protect service users from environmental risks in the home. Further improvements are needed to improve hygiene and protect service users and staff from infection risks, including provision of adequate laundry facilities for heavily soiled materials and suitable hand washing facilities in all of the toilets. A permanent solution should be found to eradicate the smell of damp in service users’ bedrooms so that they have a pleasant living environment at all times. Staffing levels need to be continuously reviewed to ensure that service users are always able to access activities outside of the home in accordance with their needs and expectations. One service user was recently prevented from attending their college course when there were insufficient staff to take them after another refused to attend. Record keeping in the home needs specific improvements, including ensuring that there are sufficient records available to show how service users are assisted to make choices about how their personal income is spent and what meals are served to them and when. Confidential records relating to individual service users need to be kept confidential and not displayed publicly on the home’s notice board in the lounge. 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.V295533.R01.S.doc Version 5.2 Page 10 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.V295533.R01.S.doc Version 5.2 Page 11 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 for new service users is based on assessment so that they 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, although they should be given more information about their welfare rights. EVIDENCE: There have not been any recent admissions to the home and all of the current service users have lived there for several years. Those that are living there are very familiar with the services that the home provides. The registered manager stated that there are no planned changes to the service user group. Initial assessment information for most of the service users is now held at the home, so that people working with them can review current care plans against their needs when they were initially admitted. Assessment information for one service user still needs to be brought across from Spectrum’s head office, where it is currently located. The timescale on the outstanding requirement for this has been extended to enable full compliance. 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 and they now been provided with versions translated into pictorial formats so that they can
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 12 access the information directly, which they have signed, as evidence that they have seen them. Information in service users’ guides includes the amount service users are expected to contribute towards the cost of their placements and the amount of personal allowances they are entitled to, but they should be provided with a more detailed breakdown so that they are provided with clear and transparent information on how their benefits are made up, as Spectrum acts as appointee for all of them. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 13 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 & 9 Service users are provided with detailed written care plans, which fully address their personal, health and social care needs, although they would benefit from improvements to make them more person centred. Service users are supported to make some decisions for themselves although they should be provided with more opportunities in this. They are assisted to take risks in a safe way to enhance their skills and the quality of their lives. EVIDENCE: A service user interviewed during the inspection confirmed that he is aware of his care plan and attends reviews so that he is fully involved in the process. His social worker confirmed this. Service users’ care plans are detailed and fully address their personal, health and social care needs, including needs relating to their age, religion, physical and sensory abilities, cultural and ethnic backgrounds, sex and sexuality. One service user has been provided with an additional care plan using a person centred format, which should be considered for the others because it is very accessible, encourages a high degree of user participation and sets out more detailed and specific goals. Service users’ care plans consider their abilities to make choices for themselves. Their daily care records demonstrate the choices they have made, for example between different activities offered to them. Service users
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 14 interviewed during the inspection were able to express their opinions and preferences quite clearly and staff were observed helping them to make choices during mealtimes and about the activities available for them to participate in. The home’s written procedures in respect of managing service users’ personal finances currently assume that Spectrum will act as DWP appointee for all service users, which precludes the options for them to manage some or all aspects of their finances for themselves or appoint an alternative appointee if they wish. There were insufficient records of service users’ personal finances retained in the home to demonstrate how service users are assisted to make choices with regard to their personal finances. Service users have clear, written risk assessments, which are shared with their representatives. These address specific activities, in such a way as to enable service users to take risks to enhance their skills, abilities and the quality of their lives. Any restrictions necessary to protect service users and/ or others are clearly documented and shared with their representatives. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 15 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, 15, 16 & 17 Service users take part in a range of activities in and out of the home and maintain contact with their families and friends. They are informed of their rights and responsibilities so that they are clear about what is expected of them. Some improvements are needed so that service users are provided with choice at mealtimes. EVIDENCE: Daily care records have improved so that they more clearly demonstrate that service users access activities in and out of the home that are planned around their individual needs, goals and preferences. Service users interviewed confirmed that they enjoy the activities provided for them and they were observed taking part in a range of different activities at the time of the inspection. Their ages and cultural backgrounds are considered as part of the care planning process so that activities are suitable for them. Service users’ daily care records show that staff help them to access a variety of resources in the local community. They often go out for walks, locally or further away from the home. They attend local colleges, make use of shops and go to cafes and the theatre, so that they are not isolated.. Service users were observed going out in the home’s transport during the inspection and confirmed that they go out of the home regularly.
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 16 Daily care records show that service users maintain contact with their families, or in the case of one service user, with their independent advocate, which they confirmed in interviews. They have opportunities to socialise with service users at other Spectrum homes and a party was planned for shortly after the inspection. The registered manager confirmed that senior Spectrum staff provide advice and assistance in relation to service users wishing to form and develop relationships, where necessary. Service users’ individual care plans and service users’ guides provide them with information on their rights and responsibilities so that they are clear about what is expected of them in the home. Their service users’ guides have been provided to them in translated formats so that they can access the information directly. They have been provided with information on independent advocacy and records show that one has an advocate who regularly visits them. Service users said that they enjoy their meals and staff were observed assisting them to choose between various items during breakfast and to make drinks and snacks for themselves. Their dietary needs and preferences are considered as part of the care planning process and they are encouraged to eat healthily. Meals tend to be prepared and eaten as a household and service users are involved in menu planning, shopping and preparing meals so that they develop their skills and independence. There should be a stock of alternative meals retained so that they can be offered a choice of main meal if they prefer and records of food provided to them should be clearly dated so that their ongoing nutritional intake can be accurately monitored. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 17 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 Service users are provided with the support they need to maintain their personal care, so that they appear well looked after and to access healthcare services necessary to ensure they maintain good health. Specific improvements are needed with regard to staff training to protect them from medication errors. EVIDENCE: Staff were observed assisting service users with their personal care according to their needs and abilities. There are detailed records and instructions to staff on how to care for them so that they are able to maintain and develop their skills and independence. Service users said that staff look after them well and they all appeared smart and fashionably dressed. Service users’ individual care plans, backed up by daily and healthcare records provide evidence that they are assisted to access a range of healthcare services in the local community. They are registered with local NHS providers and assisted to access specialist healthcare services where necessary, so that they maintain good physical and mental health. Service users’ risk assessments indicate that they need assistance with their medication. The home has written policies and procedures to ensure their medicines are safely stored and managed. There are suitably secure storage facilities and accurate records are maintained of medicines provided to service
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 18 users. The home’s manager has undertaken training in the safe handling of medicines, but the home’s staff have not undertaken training beyond that provided in house by Spectrum. They should be provided with access to safe handling of medicines training so that they are more able to protect service users from medication errors. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 19 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): 22 & 23 Service users’ views are listened to and taken account of so that the service is responsive to their concerns. There are systems in place to protect them from harm and abuse but further improvements are needed so that Spectrum’s internal guidance to staff reflects best practice. EVIDENCE: Service users are provided with the home’s complaints procedure in a translated format as part of their service users’ guide. During interviews they said that they are satisfied with the care and services provided to them and a representative of two of them confirmed that the home provides them with a good standard of care. The home’s manager has now introduced a quality assurance system, which has involved consulting service users and their representatives about the service and including their views in the home’s annual development plan. Service users said that they feel safe in the home, which was backed up by the placing officer for two of them. Staff appeared to be confident about the steps they should take to protect service users from harm and abuse. The home has copies of the local multi-agency procedures for the local and service users’ placing authorities and the manager has undertaken multi-agency training so that he is informed on how different agencies work together locally to protect vulnerable adults from abuse. Records show that the home’s recruitment practices include checks to ensure that staff are suitable and safe to work with vulnerable adults in a care setting. Spectrum’s internal written policies and procedures, which guide staff continue to need updating so that they reflect and guide staff on best current practice. Carrick DS0000009100.V295533.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): There is evidence of ongoing improvements to the home to make it comfortable and homely for service users but further improvements are needed. Improvements to hygiene and to prevent the risk of the spread of infection in the home are still needed. EVIDENCE: The home is an ordinary domestic dwelling, which has been suitable adapted to meet the needs of the service users placed there, so that they benefit from an environment that has been designed to promote their integration with the local community and independence. Since the previous inspection there has been investment in the fixtures and furnishings and improvements to the home’s security so that service users are safer and more comfortable. Some of the carpets still appear worn and stained and need replacing, most notably in the hall and the conservatory. At the time of the inspection an immediate requirement was made that the electrical wiring should be made safe in the conservatory, as this was very unsafe. The home’s manager took immediate action but action is needed to ensure that situations like this do not recur. The home appeared clean and tidy at the time of the inspection. Staff have some equipment to maintain hygiene in the home and the registered manager has undertake training in infection control. Staff are guided by written
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 21 procedures so that they have information on how to prevent the spread of infection. Fewer bedrooms smelt damp although it continues to be persistent in one of them and further action is needed to improve this. Further improvements are needed with regard to hygiene, including the provision of suitable facilities for laundering heavily soiled materials and paper towels in all toilets, to encourage good hand washing. The option of providing service users with anti-bacterial soap in suitable dispensers should also be explored, so that they can be less dependent on staff to access it. Carrick DS0000009100.V295533.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, 33, 34 & 35 Staff are qualified so that service users can have faith in their competence to work effectively with them. There are not always sufficient staff on duty to ensure that service users’ individual care plans are always carried out. New staff are recruited on the basis of fair, safe and effective recruitment policies and practices. They have access to induction and ongoing training so that they have the knowledge and skills to provide good care to service users. EVIDENCE: The home’s records show that over 50 of them are qualified to NVQ level 2 or above. Staff on duty and the home’s manager said that there has been quite a low turn-over of staff recently, so there are sufficient numbers of qualified and experienced staff on duty to ensure that service users receive continuity of care and duty rosters verified this. The placing officer of two service users said that staff are helpful and informative. Daily care records for one service user indicated that there had been occasions recently when they had been unable to access their college placement in accordance with their care plan. The home’s manager said that this was because there were insufficient staff on duty to take them there when another service user who goes with them refuses to attend. The home’s records indicate that staff are recruited fairly and safely, in accordance with good employment practice, and on the basis of their suitability
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 23 to work in a care setting. They confirmed this during interviews as part of the inspection. The home’s records provide evidence that staff receive induction and ongoing training linked to meeting service users’ needs. Staff interview3ed at the time of the inspection confirmed this. Carrick DS0000009100.V295533.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 home is competently managed for the benefit of service users. There are systems in place to ensure that service users’ views are included in the ongoing planning and development of the home. Record keeping needs to improve so that personal information about service users is kept confidential to them. Further improvements are needed to ensure the promotion of health and safety in the home, as previously mentioned in this report. EVIDENCE: The home’s manager has been registered with the Commission since the previous inspection. There is evidence that he has undertake training to update his knowledge and skills and he has made improvements to the home for the benefit of service users. This included taking immediate action in respect of an immediate requirement set on the first day of the inspection. There have been improvements to the ways in which service users and their representatives are consulted about their satisfaction with the care and services provided to them in the home. The home’s annual development plan includes consideration of their needs, views and preferences so that ongoing
Carrick DS0000009100.V295533.R01.S.doc Version 5.2 Page 25 development of the service is clearly linked to improving outcomes for service users. Service users confirmed that they are satisfied with the care and services provided to them and a representative of two of them confirmed that there are good arrangements in place to ensure regular consultation so that service users’ needs are met. Record keeping in the home needs further improvement, as previously mentioned in this report, particularly with regard to providing evidence that service user’ rights are promoted and protected. Storage also needs to be improved so that their personal records are kept confidential to them. Some interim care plans (also known as IPM forms), which contain personal information about individual service users, were attached to a notice board in the main dining room. These should be kept locked away so that private information about service users is kept private. There are written risk assessments relating to individual service users and the registered manager has completed, signed and dated the home’s environmental risk assessment. Staff receive essential training to ensure their own health and safety and that of the service users as part of their induction and ongoing training. The registered manager has completed the home’s fire safety risk assessment. Despite this, there was an obvious risk of severe injury as a result of electrical wiring and appliances in use in the conservatory. In light of this the home’s current systems for maintaining health and safety need to be reviewed to ensure they are suitably robust to ensure similar situations do not arise in the future. Carrick DS0000009100.V295533.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 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 1 X Carrick DS0000009100.V295533.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 YA2 YA41 Regulation 17(1)(a) Requirement Copies of service users’ initial assessment documents must be retained in the home. The timescale for this requirement has been extended from 01/01/06 in light of progress made towards achieving full compliance. Copies of records relating to the expenditure of service users’ personal money must be retained in the home. Records of food provided to service users must be kept accurate and up-to-date. Spectrum must update its written procedures to guide staff on how to protect service users from abuse. The timescale for this requirement has been extended from 01/04/06 in light of progress made towards achieving full compliance. Timescale for action 01/08/06 2. YA7 YA41 17(2) 01/08/06 3. 4. YA17 YA41 YA23 17(2) 12 & 13 01/08/06 01/08/06 5. YA24 & YA42 13(4)(a) The registered manager must 01/08/06 review the systems for maintaining health and safety in the home to ensure that they are suitably robust to protect service users and staff from obvious
DS0000009100.V295533.R01.S.doc Version 5.2 Page 28 Carrick 6. YA30 13(3) risks, with particular regard to electrical appliances and cables. Hygiene in the home must be maintained. This includes providing facilities for the disinfection of heavily soiled laundry and ensuring that service users have suitable hand washing facilities in all toilets at all times. The timescale for this requirement has been extended from 01/04/06 in light of progress made towards achieving full compliance. The registered provider must ensure that there are sufficient staff on duty in the home at all times. This requirement has been re-notified and the timescale extended from 01/06/06. It is of concern to the Commission that compliance has not been achieved. Records containing personal information relating to individual service users must be stored so that their confidentiality is maintained. 01/08/06 7. YA33 18(1)(a) 01/08/06 8. YA41 17(1)(b) 13(4)(a) 01/08/06 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. Refer to Standard YA5 YA6 YA7 Good Practice Recommendations Service users should be provided with more detailed information on their personal contributions towards the cost of their placements in their individual contracts. Person centred care plans should be extended to all of the service users in the home. The home’s written policies and procedures for the management of service users finances should provide
DS0000009100.V295533.R01.S.doc Version 5.2 Page 29 Carrick 4. 5. 6. 7. 8. YA17 YA20 YA24 YA30 YA30 more detailed guidance to staff and ensure that service users are assisted to exercise choice with regard to the management of their personal finances. Service users should be provided with a choice of main meal every day. Staff should undergo training in the safe handling of medicines. The carpets in the hall and conservatory should be cleaned or replaced. Service users should be provided with access to soap in suitable containers to encourage them to maintain good personal hygiene independently. Further improvements should be made to ensure that all bedrooms are kept free of the smell of damp permanently. Carrick DS0000009100.V295533.R01.S.doc Version 5.2 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
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