Inspection on 02/03/07 for Collinson Court

This inspection was carried out on 2nd March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Collinson Court 18/09/07

Collinson Court 31/05/06

Collinson Court 21/12/05

Collinson Court 20/06/05

Collinson Court 20/12/04

Collinson Court 05/05/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Collinson Court 56 Longton Road Trentham Stoke-on-trent Staffordshire ST4 8ND Lead Inspector Ms Wendy Jones Key Unannounced Inspection 2 March 2007 10:00 Collinson Court DS0000008324.V332267.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 Collinson Court DS0000008324.V332267.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. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collinson Court Address 56 Longton Road Trentham Stoke-on-trent Staffordshire ST4 8ND 01782 658156 01782 643103 collinson.court@craegmoor.co.uk 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) Autism Tascc Services Limited Miss Annette Sparkes Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: Collinson Court is a purpose-built care home, registered to provide accommodation for 10 adults. The home provides a specialist service to people with an autistic spectrum disorder. Service users’ primary diagnosis must be learning disabilities although they may have a dual diagnosis of a mental health condition. The property provides ground floor accommodation divided into four areas, each with its own entrance. These consist of two four-person apartments, two single-person flats, a staff office, training area, activity room and gym. Each apartment and flat has its own garden area and the gardens to the rear of the property are secure. The home is located off the main Trentham to Longton road; it provides off-road parking and shared drive access. The building is single-storey, providing access to wheelchair users. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of this service during the period 01/04/0631/03/07. The purpose of this visit was to assess compliance with previous requirements and breaches of the regulations relevant to registered Care Homes, known as the Care Homes Regulations 2001. The visit took place on 02/03/07 over a period 8 hours, separate feedback was given to the manager 05/03/07. The lead inspector was accompanied by the Pharmacist Inspector on behalf of the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? What they could do better: The management arrangements for the safe administration and review of medication must be revised, there were significant shortfalls in this area, that have affected the overall outcome of the report. Some of the environmental work is outstanding but not significantly so, being primarily the minor amendments to work already carried out. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 6 There was evidence that residents had purchased large items of furniture such as sofa’s for the lounge area. There was no evidence that these purchases had been discussed and no audit trail for the decision-making. This is considers inappropriate use of residents funds and must be revised, and where appropriate individuals should be reimbursed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The service provides information to ensure that prospective residents and the people who use the service know what sort of service it is and the type of facilities and care provided. This means that they can be sure that the service can meet their needs. EVIDENCE: The service has a Statement of Purpose and Service User Guide. This is information for prospective and residents, to inform them of the aims of the service, terms and conditions of residency and the facilities, staffing and management arrangements of the home. Efforts have been made to produce some of the information into a format that is more user friendly. Since the last inspection amendments have been made to both documents. A final version has yet to be provided to residents. No new residents have been admitted to the home for some time, a sample of assessments details showed that pre admission assessments had been carried out by the manager of the home and in conjunction with other professionals ie social workers and health workers. A settling in period was agreed prior to admission and a review then carried out to assess the success of the placement. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 9 All residents are funded by the local authority, some have additional health funding. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of care planning was of good quality, ensuring the residents could be confident that their care needs could be met, further work is required to implement person centred approaches. The management of resident finances should be reviewed to ensure that purchases made are appropriate. EVIDENCE: Care plans are in place with very detailed accounts of the preferred lifestyles of each individual. The information available includes a 24 hour plan of care which from the sample seen gave an explicit account of service users day to day routine. This is particularly important in this area of speciality. There was evidence that some care plans had been reviewed on a regular basis and there were behavioural management strategies in place that related to behaviour and autism. The manager confirmed that a number of staff had received training in autism and that other such training was planned. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 11 Risk assessments were detailed, gave an account of the level of risk presented and the action to be taken to limit any identified risk. At previous inspection visits the introduction of person centred approaches have been discussed the manager indicated that this and health action plans would be introduced as soon as practicable, delays have occurred due to the building works. A sample of resident financial records were inspected and showed that transactions on their behalf were dated at the time, and two staff signatures obtained as evidence that the balance had been checked and verified. Information in the records revealed some residents had purchased some types of furniture, for example one resident had purchased two sofas for the lounge in apartment 1 at a total of £928.00. Another resident had purchased a new armchair for the same apartment at a cost of £500.00. A resident in one of the single person flats had also purchased a new sofa at the cost of £439.87. It was of concern that individuals’ monies were being used to replace furniture in the home when these items are clearly the responsibility of the provider as a minimum requirement of the Care Homes Regulations 2001. It was not established during this visit if these purchases had been made following consultation with the advocates or carers of the individuals involved, or if, there was an agreed policy on seeking approval, for the cost of items over a certain amount. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Residents are offered a range of activities to participate in, although this can be limited, the effect for residents can mean that they spend long periods of time engaged in passive activities. EVIDENCE: Since the last key inspection the service has employed an additional activity co-ordinator or DSF. The two staff meet to plan a 4 weekly programme of activities for individuals which includes a combination of activity in and outside of the home. At the time of the inspection one residents’ opportunities to access the community remained limited as a result of a delay in the replacement of safety equipment for use in the vehicle in which the resident travelled. It was of concern that this equipment had not been available for some time. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 13 One resident had quite a full lifestyle attending college placements approximately three times per week and going out to social events that he is known to enjoy for the rest of the week, including meals out and theatre trips. From a sample of records there was evidence that some residents were engaged in regular outings out of the home. These trips were usually to a safe or known location the individual enjoyed and not necessarily intended to enhance the community presence or participation of the resident. One of the DFS’ said that when planning the timetable they tried to allocate equal time for individuals over the four-week period. Clearly there were some constraints for some individuals as identified previously. The DSF’s were in the process of re establishing a sensory room for the benefit of residents. The plan is for a programme of relaxing and therapeutic sessions for those residents who would benefit or be interested in this type of activity on a one to one basis. The DSF’s had spent some time observing the use of such a facility in a specialist community based service. It is recommended that each DSF receives some training or instruction in the use of the equipment and the therapeutic purpose of the sessions they hope to introduce. This should be linked to quality audits of the effects and benefits of the sessions. Environmental changes to the home have resulted in the de commissioning of the central kitchen in the home and each of the domestic kitchens in the apartments has been re-provided and equipped so that all meals are now prepared and cooked in these areas. This was reported to improve the food choices available to residents and had also improved resident participation in preparing and cooking meals. Samples of menu’s provided evidence that a varied diet was enjoyed by residents. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that the current systems for the administration and review of medication and for monitoring health care needs are robust enough to ensure their welfare. EVIDENCE: Health checks and health issues were discussed with the manager and some concern was expressed regarding the monitoring of residents health. There was little evidence of well man appointments for those residents deemed to be at high risk. It was advised that the health care facilitator would be contacted to support the home to access regular health checks. One resident appeared to have put on quite a bit of weight, this was confirmed by staff spoken to and attributed to a lack if opportunity to access the community due to limits set by risk assessment relating to transport. (referred to in the previous section). This means that the resident has not been able to go our for once regular walks or cycle rides in the local community parks. The manager was asked to discuss healthy eating options for this resident and to Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 15 seek advice from dietetic services. As stated previously it is now hoped that this resident can re establish the cycle rides and walks now the transport problems have been resolved. The Pharmacist Inspector also formed part of the inspection team and was asked to review the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received into the home. The inspection comprised of examining the home’s policies and procedures, the medication storage areas, the records kept and discussions with the care staff. The policy and procedures document for the safe handling of medicines had been reviewed at previous inspections of other services within the Craegmoor group. Craegmoor knew the inspector’s comments on the contents of this document. The issue at Collinson Court was that not all of the care staff involved in the handling and administration of the residents medicines were aware of the contents of this document. The Manager must ensure that all members of staff are aware of the policy and procedures for the safe handling of medicines and adhere to them. The home was using Medicine Administration Record (MAR) charts to keep a record of the current prescribed medication and of the compliance for each resident to take the medication. Reviewing a sample of these charts highlighted a number of issues, which could potentially be affecting the health and welfare of the residents: • The MAR charts were being used to record the receipt of medication each month but it was seen that not all quantities received were being recorded, there were inaccuracies in the amounts being recorded and the balances remaining from the previous month were not being taken into account therefore audits to check whether medication has been administered as prescribed could not be proven. Some medication had been prescribed with variable doses and it was seen that the home had no record of what circumstances would result in the higher doses being given and visa versa. The home was also not recording which particular dose was given on the MAR charts. Some medication had not been entered on the MAR charts at all and therefore there was no record of whether the medication had been given or not. Case tracking the residents using the MAR charts identified a number of issues, which included: o A resident prescribed Lithium was having their serum lithium concentrations measured every three months and their thyroid Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 16 • • • o o o o o function every six months. The resident was not, and the home was not aware that the renal function should be measured every six to twelve months. The home was not aware of the importance of maintaining a good fluid intake and avoiding dietary changes, which could increase or decrease sodium intake. A resident had been prescribed two antihistamine tablets and the staff did not appear to be aware of this. A number of residents had been prescribed laxatives, which in some cases were not being administered as prescribed, to alleviate the problem of constipation. The prescribed medicines did not appear to be working in some cases because the home were buying and administering Ortisan cubes rather than referring the problem back to the prescriber. These Ortisan cubes contained Senna (one of the service users had already been prescribed Senna) and the long-term use of these could make the bowel lazy and the service user reliant upon stimulant laxatives to go to the toilet. Lactulose solution being used on a when required basis when its mode of action requires it to be given on a regular basis. A resident had been prescribed Salbutamol modified release capsules 8mg and according to the protocol one capsule was to be administered when the resident was experiencing an acute asthma attack. The mode of action of the modified release capsules would result in the Salbutamol taking a long time to work and thus would be inappropriate to use under the circumstances that the home are using the capsules for. Further concern was expressed when it was observed further on in the protocol that the residents condition could deteriorate rapidly requiring emergency medical treatment. The home must arrange for a review of the residents asthma treatment without delay. A resident had been prescribed Imodium 2mg capsules and Loperamide 2mg capsules and both appeared on the same MAR chart. The home did not appear to be aware that the Imodium was a brand name for Loperamide and with each preparation having different administration instructions there was the potential that the resident may have received more than the maximum daily dose. The home had developed protocols for a number of the “when required” medicines, which detailed the initial dose to be given and when, the time interval between doses and the maximum daily dose. On examining the protocols it was seen that a proportionate number of them contradicted the prescribers directions displayed on the dispensing labels. The home must establish with the prescriber what the administration directions are and must arrange for the information i.e. the protocol or the dispensing labels to be amended accordingly. With the home opting for fixed medication cabinets, the home had adopted the practice of preparing the medication at the cabinet and then walking around Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 17 the home with the medication insecurely contained in a medicine pot. It was admitted that medication had been lost due to this practice. This practice was viewed as unsafe and the home must adopt a different approach to administering the residents’ medication. A number of possibilities were discussed with the medication lead. It is recognised with this type of home that the residents will spend some of the time away on social leave, for example visiting relatives. It is also recognised that the home will have to secondary dispense the residents’ medication into other containers when the service users go on short notice social leave. Looking into the processes of how this was achieved the inspector expressed a number of concerns. Concerns were expressed because the home had no written protocol on how to perform this process safely and had no double check when the secondary dispensing process had been completed. It was also seen that the recording of this process was poor and did not take into account a check of what medication, if any, was returned. The home must improve their management of preparing medication for residents who wish to stay away from the home for various lengths of time in order to ensure that the risks to the service users are reduced to a minimum. The home must also ensure that where leave away from the home is on a regular basis or per planned that, the medication is packed into appropriate containers by the Community Pharmacist. It was seen that the home had been using a number of homely remedies and until recently had no authorised protocols in place for their use. Protocols authorised by the residents GP had just been returned to the home. On examination of these protocols it was found that they were not fit for purpose because i) there was no indication to which ailment they were to be used for, ii) there was no information as to what dose should be administered in the first instance, iii) there was no information about dose intervals and iv) there was no information about the maximum daily dose to be administered. The protocol also lacked information on where to record the administration of homely remedies and how to distinguish the homely remedies from prescribed medication. There was also concern that there were products around the home that were not listed on the newly arrived homely remedies protocol. The home also appeared unsure of how to tackle the wishes of a resident who wanted to take a specific homely remedy that was not on the protocol other than to allow the service user to take it. The home must improve their homely remedies protocol and have it reauthorized for each resident. The home must also set out a written protocol on how to deal with resident wishing to take other homely remedies other than those listed of the protocol. The medication lead for the home informed the inspector that all of the staff that were involved in the administration of the service users medication had received the Boots Monitored Dosage System (MDS) training. The inspector informed the lead that this training only showed the staff how to use the MDS system. It did not constitute a safe handling of medicines course, which would Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 18 give the staff i) a basic knowledge of how medicines are used and how to recognise and deal with problems in use and ii) underpin the principles behind all aspects of the home’s policy on medicines handling and records. It was seen that the homes poor knowledge on the handling of medicines and what they had been prescribed for was potentially affecting the health and wellbeing of the residents. The home must enrol all members of staff involved in the administration of medicines to the residents on a safe handling of medicines course. The home was informed that the completion of training was not the end of the story and the home needed to introduce a consistent programme of monitoring and ensuring that the staff were competent to handle and administer medication to the residents in the correct manner. The residents that had been prescribed rectal diazepam each had a protocol for the administration of the rectal diazepam. On observing the protocols it was seen that there were instructions for the staff depending on whether they had received training on how to administer the rectal diazepam or not. Those staff who had not received the training were instructed to phone for an ambulance immediately and use their first aid knowledge to support the resident. On observing the information about the training it appeared that this training had taken place over 12 month ago and therefore the staff needed to attend a refresher course and be reassessed for their competency. At present therefore all members of staff should be phoning the ambulance services when one of the residents experiences a seizure. The home also need to decide whether their approach to supporting service users during a seizure is to phone the ambulance and give first aid or to administer rectal diazepam at the appropriate time. If the home decides to opt for administration of rectal diazepam then enough staff need to be trained and assessed as competent so that there is a member of staff on every shift able to carry out this procedure. At the time of the inspection none of the residents had been prescribed any Controlled Drugs. The home did not have a Controlled Drugs cabinet or a Controlled Drugs register. It was recommended to the home that the home obtain both a cabinet and a register just in case one of the residents is prescribed a Controlled Drug in the future. The home consisted of two apartments and two single occupancy flats. The residents’ medication was stored in three medication cabinets. Two of the cabinets were located in each of the apartments and the third was located in one of the single occupancy flats. The medication for the resident in the other flat was kept in the medication cabinet, which was located in the apartment adjacent to the flat. It was recommended that a fourth medication cabinet should be located in this flat so that the resident is then totally independent. Each of the cabinets were examined during the inspection and the following issues were raised with the staff member responsible for over seeing the handling of medication: Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 19 • It was pleasing to see that each of the cabinet had been organised so that each resident’s medication was kept together but separate from the other residents medication. Although the home was monitoring the temperatures of the medication within each cabinet, the temperatures were being taken at approximately 8am in the morning and therefore the monitoring did not take account of the temperature rises during the day. The recording of the temperature at this time showed that there was no problems maintaining the temperature at below 25°C, however during the inspection it was seen that the temperature did rise above 25°C during the afternoon period. The home was advised to obtain some maximum and minimum thermometers and measure the maximum temperature on a daily basis. Concern was expressed about the location of the cabinet in Apartment 2, which had been located next to a radiator and the home was asked to identify a more suitable location. One or two items (Salbutamol inhaler and Budesonide nasal sprays) found did not have a dispensing label attached and therefore the resident these items had been prescribed for could not be identified. The missing dispensing labels meant that under the Medicines Act 1968 the home did not have the legal authorisation to administer these medicines to the service users concerned. What was of greater concern was that the Budesonide nasal sprays had an expiry date of two months when opened and without the dispensing label or the date of opening written on the box the home had no idea whether these sprays were in or out of date. The internal and external medicines were not being stored separately. It was discovered that one of the residents had been prescribed a few months back some Daktacort cream, which had been stored in the service users wardrobe. Daktacort cream must be stored in the fridge when not being applied and therefore due to it being inappropriately stored the home would have been applying unsafe cream during the period the resident was prescribed it. There was some evidence that the home was decanting medication from one container to another similar container. This routine is seen as poor practice and could leave the home open to product liability. The home was told that this practice must cease. The home did not appear to be into the practice of dating creams and ointments upon opening. It was recommended that the home date all creams and ointment upon opening and discard tub after one month and tubes after three months. • • • • • • Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 20 • The home did not appear to be aware that Gaviscon Advance liquid had a three month expiry date upon opening and as a consequence the home was unsure whether the bottle found was in or out of date. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is familiar with the procedures agreed locally to safeguard vulnerable adults and has demonstrated that where necessary action if taken to promote the rights of residents. EVIDENCE: Since the last key inspection visit a Vulnerable Adults (VA) strategy meeting has been convened to discuss the recently escalation in resident on resident assault. The manager stated that a resident had frequently targeted other residents to hit and had also on occasions hit certain staff. She also stated that the individual frequently stated that they were not happy at the home and wanted to leave, this she said had been a feature of a number of reviews with the social worker in the past but no action had been taken. The recent major works to improve the physical environment of the home may also have had an unsettling effect on the resident that was not entirely unexpected. It was disappointing to note that Craegmoor had as a consequence sort fit to terminate the residents placement and had given notice to quit. The timescale given of 28 day’s notice ended on the day of the inspection. During the visit the inspector was made aware that the placing authority had not finalised a placement for the individual and it was reported to have declined an extension to the placement until a suitable alternative could be sought. Where the resident could be introduced over a period of time to ensure his needs could be met. The outcome of the day was less than satisfactory, with the manager receiving contradictory information from the Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 22 placing authority about the plans for the resident. Which resulted in unnecessary distress and confusion for the resident and relatives. The breakdown of the placement was discussed with the manager and a number of concerns made, relating to staff changes and staff training, these matters will be requirements and recommendations of this report. At the time of the visit the manager had not received a written notification of the conclusion of the VA discussions. In terms of complaints, none have been made to the CSCI since the last inspection visit. The manager stated that she had received some concerns/grumbles from a relative and had agreed a strategy with them to ensure that any time they had concerns they could speak to her directly. Records of these concerns were not inspected during this visit. A complaints procedure is on display in the main foyer of the home, and a copy is included in the Statement of Purpose and Service User Guide, it has also been produced in a more user-friendly format. It was noted that Craegmoor took it’s responsibilities under the Public Interest Disclosure Act seriously and had notices displayed in the home for staff if they felt unhappy with the any aspect of the service and care of residents. These “Whistleblowing” notices informed the staff that they could contact a named individual in confidence if they needed to. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides a safe, clean and comfortable environment, for the benefit of residents. EVIDENCE: Following discussions and meetings with the provider regarding outstanding environmental issues at the home, since the last key inspection. Major refurbishment of the home has been commissioned. At the time of this inspection visit the majority of the work had been completed, although it was understood from discussion with the manager that some more minor work and snagging was to be undertaken. The evidence of this visit showed a much-improved physical environment that provided residents with a more homely, clean and well-maintained environment in which to live. Improvements included, complete refurbishment and redecoration of bathrooms, showers and toilets in the shared apartments. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 24 The team leader for this apartment was quite positive about the progress made so far. As previously stated in the central kitchen for the home had been decommissioned and each of the domestic kitchens in the multi occupancy apartment had been refurbished and refitted. The ventilation in these areas had yet to be completed. It was noted that in apartment 2, a gate had been fitted to the doorway of the kitchen, this enabled residents to view the activity in the kitchen but not have immediate access. The team leader stated that this had been recently introduced in response to the behaviour of a resident. A review of it’s effectiveness would be undertaken and a risk assessment was to be completed. Redecoration of bedrooms and replacement carpeting or replacement flooring had been completed. Other work undertaken included the change of the central kitchen to a central laundry area, providing a much more hygienic and reliable facility. The previously used domestic type washing machines had been replaced with large more suitable washing machines and driers. This change should not prevent residents being included in laundering of their personal washing if they choose to. One member of staff gave examples of how service users were involved and felt that the facility was a tremendous improvement. Other works undertaken include the provision of a visitors WC, the re provision of the staff sleep in bedroom. Some work to the remove loose gravel from garden areas to the rear of the property and replaced with a more sturdy flooring. The entrance to the grounds has been fitted with a security gate, that is operated by pushing a button by visitors to the service and by a key pad when leaving the service. The manager was asked to ensure clear instructions are posted at the entrance. Works to be finally completed included the necessary improvements to the fire alarm system and the function of fire doors as advised by the Fire Safety officer in a visit to the home in June 2006, the improvement of ventilation in the home and action to resolve the areas seemingly affected by damp to the exterior of the property. A final inspection with the fire officer will be undertaken on 14/03/07. Matters arising from the works included an apparent return of some damp issues and bubbling of the flooring in the bathroom on apartment 2 and an offensive odour in the toilet in this apartment. A step /platform is to be provided in the shower room to ensure staff can safely support residents in this area. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, training and supervision mean that residents and their supporters can be sure that staff are provided in adequate numbers, are trained and received appropriate levels of supervision. EVIDENCE: The staff rota showed that appropriate staffing levels were provided on the day of this visit the manager and the deputy were supernumerary to the care staff numbers. A total of 9 care staff were on duty for the early shift (7.30-3pm) and 8 from (3pm-10pm), the service provides 3 waking and 1 sleep in staff. The 2 DSF staff were additional to this and the service has employed a maintenance person since the last inspection responsible for minor repairs, maintenance and garden areas. A sample of recruitment records showed that there were some gaps in the information relating to CRB checks, in 5 files there did not appear to be a check carried out or evidence that a satisfactory check had been received. The manager was asked to provide evidence that these checks had been undertaken. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 26 Training records showed some real improvement in the training provided for staff, but there remains some further work necessary to ensure that all staff are up to date with mandatory training such as manual handling, medication training and others; fire training had been scheduled for March 07. National Vocational Qualification (NVQ) records showed that 20 staff had achieved level 2 or above, or had an equivalent qualification, this is a lower staff ratio than the 50 of the workforce recommended as a minimum requirement. Additional training has yet to be arranged for staff in Autism awareness and must be given priority. Staff meetings are arranged periodically records showed that a general staff meeting had been held on 05/01/07 the previous one had been held in October 06. It is suggested that more frequent team meetings should be considered. A number of staff were involved in one to one discussions during this visit. One gave a satisfactory account of her experience at the home, confirming she had been properly introduced and inducted to the service, and had worked on a supernumerary level for the first week of her employment. She confirmed that she was working through an induction package and had mandatory training sessions planned. She confirmed that the manager of the home had supported her and had ensured that she felt confident in her ability to meet the needs of the residents with the rest of the staff team. Despite no previous care experience the care worker demonstrated a commitment to supporting and enabling residents to promote independence. The manager stated that staff supervision sessions were planned regularly; this information was not checked at this visit. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home were satisfactory, further work was required to ensure that fire safety systems were satisfactorily resolved, to ensure that residents could be confident that they could be evacuated from the home safely. EVIDENCE: Since the last key inspection the manager has been approved by the Commission for Social care inspection as a fit person and stated at interview that she is to be nominated for a degree course in autism. Ms Sparkes stated that she had yet to complete the Registered care managers award and NVQ level 4 in care but envisages that she will complete this by 2009. Daily and weekly fire alarm checks are carried out and recorded as are weekly fire equipment checks. A fire drill shad taken place in February 2007, Ms Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 28 Sparkes is asked to ensure that all staff are involved in at least 2 fire drills per year. Faire safety risk assessment had been completed in January 2007, this included an evacuation for days and nights and individual assistance required. An emergency contingency plan in the event of a fire had yet to be finalised. Some fire safety work was to be completed in line with the recommendations of a fire safety officer during a visit to the home in June 2006. The final work has been delayed due to the refurbishment of the home. Residents safety has not be compromised during this period. Quality Assurance: The manager stated that regular quality audits are undertaken at the home the last recorded was a Financial audit on 31/01/07. Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 29 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 3 2 2 3 X 4 3 5 x 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 3 X X X X 2 x Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? no 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 YA20 Regulation 13(2) Requirement The home must ensure that all staff involved in the administration of medication to the residents are aware and adhere to the current policy and procedures document for the handling of medication. The receipt of all medication, including Controlled Drugs, must be recorded immediately on arrival in the appropriate place. For all variable doses the home must seek information from the residents’ GP as to when it is appropriate to give the higher dose. The home must also start recording which particular dose was administered to the service users on the Medicine Administration Record (MAR) charts. The MAR charts must accurately exhibit all medication that the residents’ have been prescribed. All of the issues identified during the case tracking of the residents must be resolved by the prescriber who has responsibility for reviewing all of the residents’ medication and a report of the DS0000008324.V332267.R01.S.doc Timescale for action 30/06/07 2 YA20 13(2) 20/05/07 3 YA20 13(2) 20/05/07 4 5 YA20 YA20 13(2) 13(2) 01/07/07 13/06/07 Collinson Court Version 5.2 Page 31 outcomes must be sent to CSCI. 6 YA20 13(2) All “when required” protocols must support the directions given by the prescriber (directions displayed on the dispensing label). The home must ensure that all medication is kept secure right up until the physical administration of it to the residents. The home must ensure that medication required for social leave is prepared safely under a written protocol and records of the event are accurately kept. The home must ensure that the administration of homely remedies are carried out under authorisation from the residents GP. All members of staff involved in the administration of medication to the residents must be trained accordingly to ensure the safety of the residents. The home must develop a programme to assess and monitor the staffs’ competency in administering medication to the residents. All staff willing to administer rectal diazepam must be trained and assessed as competent by a competent healthcare professional. The home must also ensure that enough members of staff are trained so that there is a member of staff covering each shift. The home must ensure that the medication is stored at a temperature below 25°C at all times. Products that have a short shelf life when opened must be dated upon opening and discarded DS0000008324.V332267.R01.S.doc 24/06/07 7 YA20 13(2) 20/05/07 8 YA20 13(2) 24/06/07 9 YA20 13(2) 20/05/07 10 YA20 13(2) 20/05/07 11 YA20 13(2) 20/05/07 12 YA20 13(2) 20/05/07 13 YA20 13(2) 20/05/07 14 YA20 13(2) 20/05/07 Collinson Court Version 5.2 Page 32 after the specified time period. 15 YA20 13(2) Any medication that does not have a dispensing label attached to its container must be disposed of and a new properly labelled supply obtained. The decanting of medication from one container into another similar container must cease and all medication must be kept in the container it was received in from the pharmacy. The home must ensure that any medication requiring cold storage conditions are stored securely in a fridge, which has it temperature monitored on a daily basis using a maximum and minimum thermometer. The home must ensure that residents monies are managed in their best interests. 20/05/07 16 YA20 13(2) 20/05/07 17 YA20 13(2) 20/05/07 18 YA7 12 20/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Collinson Court DS0000008324.V332267.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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