Inspection on 23/10/06 for Daneswood

This inspection was carried out on 23rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Daneswood 29/01/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Daneswood Cuck Hill Shipham Somerset BS25 1RD Lead Inspector David Kidner Key Unannounced Inspection 23rd October 2006 09:30 Daneswood DS0000064546.V303473.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 Daneswood DS0000064546.V303473.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. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Daneswood Address Cuck Hill Shipham Somerset BS25 1RD 01934 843000 01934 843006 caremanager@daneswood.org www.daneswood.org Appleford School Ltd 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) Mr Jeremy Brown Care Home 11 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Sensory impairment (0) of places Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users requiring the use of a wheelchair can only be accommodated in bedroom nos. 1, 2, 3, or 4. Date of last inspection Brief Description of the Service: Daneswood is a large detached property located in the village of Shipham, near Cheddar, Somerset. The service was first registered with the Commission for Social Care Inspection (CSCI) on the 14th June 2006. The home provides a service to eleven service users. The Registered Manager is Mr Jerry Brown and Appleford School, Ltd owns the home. The home is located in an elevated position with outstanding countryside views. There is a steep winding driveway up to the home. All bedrooms are of single occupancy and have full en-suite facilities. The bedrooms are arranged over two floors and there is a passenger lift to access these areas. There are a number of communal areas and conservatory areas that offer lounge, dining and recreational facilities. The home also has an indoor hot tub. All areas of the home are maintained and decorated to a high standard. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection conducted by the Commission for Social Care Inspection. This inspection was a Key Unannounced Inspection and was conducted by one Inspector. The inspection lasted one day (7.75hrs). Daneswood admitted the first service user in August 2006. There are currently four service users living at the home. This key inspection has taken into consideration that the home has been providing a service for approximately nine weeks. The Inspector met all of the service users currently living at the home and spent time interacting with two service users. Due to the complex needs of the service users it is difficult to verbally obtain the views of the service users. However, the service users looked very happy and well cared for. Care practices were also observed. Staff were observed to be acting in a very professional manner, service users were being spoken to respectfully and were being encouraged to engage in a variety of activities and social interaction. The Inspector spoke to three care staff in private and met the relatives of one service user. The Registered Manager was present throughout the inspection. As part of the inspection process records in relation to care and support plans, health and safety, medicines, risk management and staff recruitment were viewed. The Inspector toured all communal areas and viewed the bedrooms that are currently occupies. Feedback has been obtained from two relatives and one GP. Feedback received was very positive. The Inspector would like to thank the service users and the care team for making the inspector feel welcome at the home and for their contribution in the inspection process. As a result of this inspection the home had six requirements and five recommendations. What the service does well: Daneswood provides spacious accommodation that is furnished and decorated to a high standard. Service users have a variety of communal spaces to access including an indoor hot tub with overhead tracking. The home is well maintained and was clean and hygienic at the time of the inspection. The home is situated in a rural setting with outstanding countryside views. Care and support plans are in the process of being developed. However, the pre-admission assessments and transition process includes detailed information as to the individual care and support needed. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 6 Service users who have the use of a wheelchair can access all areas of the home. Service user’s bedroom reflected individual needs. The home is very proactive in addressing equality and diversity. Staff are very friendly and caring. Through discussion staff demonstrated a good knowledge and understanding of the service users individual complex needs. The home provides service users with individual dietary needs that are wholesome and nutritious. All food products purchased are organic. The home is pro-active in promoting health and safety. What has improved since the last inspection? What they could do better: 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. Daneswood DS0000064546.V303473.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 Daneswood DS0000064546.V303473.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1245 The quality outcome group is Good. The home has a detailed statement of purpose and service user guide but should be in a more accessible format. The home conducts detailed Pre admission Assessments and makes every effort to ensure that the transition process is designed to meet service user’s individual needs. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. The Statement of Purpose is detailed and contains the required information as listed in Schedule 1 of the Care Homes Regulations 2001. It is recommended that the home develop these documents in a more accessible format to meet the needs of the service users. Fees vary to assessed need. The Inspector viewed the Pre admission Assessments for two service users. The assessments were comprehensive and detailed. All service users previously lived at a residential special school. The Registered Manager had conducted the assessments t the school and had sought views from parents, health care professionals, teachers and other appropriate persons. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 9 As previously stated Daneswood was first registered in June 2006. The Registered Manager and care team spent many weeks visiting the service users at their previous home in order to develop and build relationships with the service users. The service users have complex needs and it was felt extremely important that the care staff spent as much time as possible with the service users prior to their admission. The care team at their previous placement were also very pro-active in this and also accompanied the service users on planned visits to the home, as individual needs required. Parents were actively involved in the transition process. Service users visited the home for agreed periods of time and longer visits were arranged as needed. Overnight stays and longer visits were also encouraged and supported. The care staff spoken to confirmed that the transition process has enabled them to understand the service users individual needs in detail prior to being admitted to the home. The Registered Manager also confirmed that the home wish to ensure that the transition process for all service users is planned to meet individual needs and where needed this process will occur over a number of weeks/months. The home has documented service users individual transition process. The home does not accept emergency admissions. The Inspector viewed the contracts that had been developed between the home and the placing authority. Daneswood DS0000064546.V303473.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 9 10 The outcome group is Good. The interim care plans are detailed. Risk assessments need to be conducted to identify and minimise hazards therefore further promoting health and safety. Service user information is stored correctly. EVIDENCE: The Inspector viewed two care and support plans. It was noted that both files contained detailed documentation provided by the previous placement relating to the complex needs of the individual service users. There was a large amount of guidelines, review meetings and assessments. The home had developed a detailed interim care plan based on the known needs of the service user from their previous placement and through transitions. Detailed information was viewed in relation to eating and drinking needs, dietary needs, moving and handling and personal care. The care plan had been signed and dated by the Registered Manager. A four weekly review meeting had been conducted. Daily running records are completed to reflect Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 11 the care and support given. One service user’s care plan had been developed in more detail than the other. This was due to the other service user recently moving to the home. Staff spoken to demonstrated their awareness of the service users individual needs. Staff commented that the long transition period had benefited in getting to know service users. Staff stated that service users are given as much choice as possible. At the time of the inspection the Inspector observed choices in activities being offered. The Registered Manager stated that at present none of the service users are able to manage their finances. As the service users have recently moved to the home the opening of individual bank/building society accounts is still being pursued. The parents are currently managing the finances of their son/daughter with the exception of one service user. The Registered Manager stated that at present no individual service users risk assessments have been conducted as the home due to service users settling in. It was noted that one service user has the use of bed rails. A detailed risk assessment must be conducted to support this so as to identify and minimise any risks. Service user information is kept safe, secure and confidential. Service users and their families have access to the home’s policies and procedures in relation to confidentiality. Daneswood DS0000064546.V303473.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 17 The quality outcome group is Good The home encourages service users to partake in a variety of activities. The home promotes and encourages contact with families. The menus are well balanced and diets are provided to meet service users specific dietary needs. EVIDENCE: The Inspector was advised that one service user is accessing college three days per week and is supported by the home to attend college. On the fourth day the service user attend a day centre facility unsupported. Currently no other service users are attending further education facilities, voluntary jobs or work placements. The care staff spoken to confirmed that the care team support the service users to access a variety of local facilities and to access a variety of leisure facilities. The home has developed an individual activities programme and all activities undertaken are individually recorded. At the time of the inspection Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 13 one service user went to college for the day and all the service users went swimming in the afternoon. Throughout the day of the inspection the Inspector observed service users being involved in activities such as music, floor games and storytelling. One service user was being encouraged to assist with polishing. Religious needs are taken into consideration and service users will be supported to attend church if so wished. The home has very good communication with all family members. Service users regularly visit their families at weekends and stay for varying periods of time. Families have been fully involved in transitions and have been involved as much as possible in choosing the colours and soft furnishings for bedrooms. The Inspector has received very positive feedback from relatives. The Inspector was advised that the registered manager and the care team are very welcoming and they are overall satisfied with the care provided. Families are encouraged to visit their relative at any time. The service users who live at Daneswood have very individual complex needs. The care team are aware of their individual needs. The Inspector observed staff interacting with service users in a very friendly and professional manner. Staff were encouraging service users to partake in activities and to have quiet time if so wished. At present there are no restrictions imposed on any service users. The Registered Manager stated that if this were to be the case this would be detailed in individual care plans and supported by risk assessments and regularly reviewed. Service users are offered keys to their bedrooms. Daneswood has a four-week menu. The menus appeared nutritious, varied and balanced. All food purchased at the home is organic. This includes cereals, oils, dairy products, fruit, vegetables and meat. The Inspector viewed the contents of the food cupboards and fridge/freezers. They were very well stocked. The food is purchased locally wherever possible. Other supplies come from a specific organic provider. Due to the specific needs of the service users the home provides meals based on avoiding certain food products. The needs of the service users in relation to diet are well documented. Where needed specialist menus are provided on an individual basis. Staff spent many weeks getting to know the service users needs in relation to diet. Staff spoken to demonstrated their awareness of the specific dietary needs of individual service users. There are no set meal times as the service wishes to be flexible to the needs of the service users. Presently, all service users and staff sit together at meals times around one large table. Alternative dining facilities are available if service users wish not to eat with everyone else. Daneswood DS0000064546.V303473.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 The outcome group is Adequate. The home ensures that privacy and dignity is promoted. Care staff are aware of service user’s needs in relation to personal care and support. Service users have access to a variety of healthcare professionals. The home needs to improve in some areas of the management of medicines. EVIDENCE: The care and support plans identify the service users needs in relation to the manner in which they prefer to be guided, moved or supported. Moving and handling assessments have been completed where needed. The home has hoists in bedroom and communal areas. Staff spoken to confirmed that hoists are used at all times. As all bedrooms have full en-suite facilities privacy and dignity is further promoted. Staff spoken to were able to demonstrate good practice in relation to promoting privacy and dignity. Staff commented that bedroom doors are always knocked before entering. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 15 Where specialist support and advice is needed the home will seek the advise of other health care professionals such as speech and language therapists, physiotherapists and occupational therapists. Such professionals have been consulted throughout the transition period. Service users were well attired and dressed in age appropriate clothing. Staff ensure that service users are wearing clothes that reflect their age and personal needs. Service users are in the process of registering with the local GP service. Other health care professionals have been involved in the care at the previous placement. Staff are currently following the advice and recommendations that such health care professionals have made. Service users currently have access to psychology and psychiatry services via Appleford School Ltd whilst alternative sources are accessed where appropriate. At the time of the inspection one service user went to the dentist. The home records all visits made to health care professionals. The Inspector viewed the arrangements for the management of medicines. The home has a Medicines Policy that has been viewed by the CSCI Pharmacy Inspector. The home has very minimal prescribed medicines at the home and uses a large number of homeopathic remedies. All medicines and remedies are safely stored. The Inspector viewed the MAR sheets. It is recommended that two staff signatures support all hand transcribed entries. It was noted that there are guidelines for the use of homeopathic remedies including the use of rectal pain relief. The Registered Manager stated that these guidelines have been agreed at the previous placement. However, some of the guidelines viewed were written in April 2003. All guidelines relating to the use of homeopathic remedies must be reviewed as part of a multi disciplinary approach and supported by the service user’s GP. This includes the protocols for the management of status epilepticus. Staff must receive the appropriate training prior to administering rectal medicines by a trained nurse and certificated for competency. The Inspector was advised that a Homeopathic Consultant would be visiting the home to talk to the staff team this is good practice. Eight of the care team have received medicines training; seven staff are identified to undertake this training. It is recommended that the Registered Manager should ensure that all staff have been assessed as competent to administer medicines with records kept. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 16 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 The quality outcome group is Good. The home has policies and procedure to protect vulnerable service users. EVIDENCE: The home has a Complaints Policy. Details of the complaints policy can be found in the statement of purpose and service user guide. The home has not received any complaints. Daneswood has an Adult Protection Policy and Somerset Safeguarding Vulnerable Adults Policy. Staff spoken to were aware of the Whistleblowing Policy. Presently the home does not need to train the staff in the use of breakaway techniques or physical intervention as the present service users do not present challenging episodes that may necessitate this approach. Where needed, behaviour management guidelines, risk assessments and behaviour analysis will be implemented. It was noted that staff have not received training in adult protection and abuse, however this is in the process of being addressed. This is addressed later in this report. The home has policies and procedures for the management of service users finances. As the service users have recently moved to the home the opening of individual bank/building society accounts is still being pursued. The parents are currently managing the finances of their son/daughter with the exception of one service user. The home is keeping records of personal spending for one service user. Records were examined and were satisfactory. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 29 30 The quality outcome group is Excellent Daneswood offers a safe and comfortable homely environment. There is ample communal space and service users bedrooms reflect individual needs and lifestyles. Bathing, toilet and washing facilities are very good. The home provides appropriate aids and adaptations where needed. On the day of the inspection the home was clean and hygienic. EVIDENCE: Daneswood is a large detached property situate in a rural setting close to the town of Cheddar and is located at the end of a steep driveway. It has installed ramps for wheelchair access in all parts of the home and installed a passenger lift. The premises meet the requirements of the local fire service and environmental health. Furnishings and fitting are of a good quality. There is a planned maintenance and renewal programme. As previously stated the home is situated in a rural setting therefore has limited access to public transport. However, the home has a vehicle to access local and community based facilities. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 18 The Inspector viewed the bedrooms that are occupied by the current service users. The bedrooms reflected the individual needs of the service users. They were clean and nicely presented. There were personal possessions including family photographs and pictures on the walls. Some service users have a television and CD player in their room. The Registered Manager stated that the service users, family members and where appropriate the care team, had chosen the colour of the bedrooms and soft furnishings. Due to the needs of one service user their bedroom has been painted using organic paint. All bedrooms have appropriate bedroom locks fitted and service users are offered a key. All service users have full en-suite facilities and also the use of the main bathroom that is located on the first floor. The bathroom is very large thus allowing easy access for service users. A specialist freestanding hydraulic bath has been installed with access at all sides. There is also a large walk in shower. The home also has adequate toilet facilities. Privacy locks are fitted to all toilet areas. It was noted that a couple of privacy locks were not working. The Registered manager stated that this would be addressed as soon as possible. There are a number of communal areas in the home that service users have access to. There is a large conservatory entrance that leads to the main lounge area and to the large hot tub that is located in a well-equipped room with nonslip flooring and overhead tracking and hoist. The main office is situated in between the main lounge and other smaller communal areas including two lounge areas, large dining room and another large conservatory that is used for arts and crafts. There is a small ‘butlers kitchen’ and a large well equipped kitchen. Laundry facilities are adequate and domestic in size. There are patio areas and gardens that service users can access. Due to the needs of the service users they are supported 1:1 at all times. As previously stated the home has aids and adaptations to meet the needs of the service users including assisted bath, walk-in shower and full disabled toilet facilities with adaptations fitted. On the day of the inspection the home was clean and hygienic. All areas were nicely presented. The home has a large washing machine with a sluice facility and an industrial type tumble dryer. All cleaning chemicals including the chemicals for the hot tub, are kept locked in a safe place. Foul linen and waste are addressed appropriately. Following discussions with the Registered Manager the home must provide staff with hand washing and hand drying facilities in service users bedrooms where personal care is provided. This will promote the control of infection. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 19 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 The quality outcome group is Adequate Staffing levels are good and are adjusted to meet the needs of the service users. The home has a training and development plan but must ensure that staff receive a structured induction training. Training in alternative methods of communication and eating and drinking should be considered. Staff recruitment procedures are not robust and protect residents. EVIDENCE: The Inspector observed the care staff interacting with the service users in a very caring and supportive manner. It appeared that the care team were aware of the complex needs of the service users. Staff were anticipating expected behaviours and reactions and responded to them in a very sensitive manner. The care team support the service users on an individual basis; support is 1:1 at all times with an additional member of staff available to support if needed. The care team appeared motivated and committed to providing a high quality service. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 20 The care team are aware of the cultural and religious needs of the service users and are very proactive in promoting this. The relatives of one service user confirmed this. Currently there is 14 care staff. Six care staff have an NVQ qualification resulting in 43 of the care team having an NVQ qualification. The home has an action plan to ensure that 50 of the care team has an NVQ qualification. The Registered Manager stated that all service users are funded for 1:1 support. On the day of the inspection there were five care staff on duty from 7.00am till 3pm and five care staff on duty from 2.00pm till 10pm with one waking person and one sleep in person from 10pm. The rotas viewed reflected this. The rota is adjusted to meet the needs of the service users as needed. The home demonstrated this at the time of the inspection. Staffing levels were amended for the next few days due to the needs of one service user. Care staff commented that they had adequate staff on duty. The Inspector was advised that a cook and a cleaner are to be confirmed in post in the very near future. The home employs a gardener/handyperson. The Registered manager stated that staffing levels would increase as needed where more service users are admitted to the home. The home accesses the support of other health care professionals as needed. The home has weekly senior care meeting and weekly team meetings. Staff commented that the meeting are very beneficial. Minutes to these meetings were not viewed at the time of the inspection. The Inspector sampled staff recruitment files. The Registered Manager must ensure that the files contain all items as listed in Schedule 2 of the Care Homes Regulations 2001. These were discussed at the time of the inspection. It is also recommended that the home obtains a full employment history and where convictions are noted, a risk assessment and documentation relating to this are kept. All staff had an Enhanced CRB disclosure. Daneswood has a Training and Development Plan and keeps a staff training analysis. The Inspector noted that the majority of staff had received training in food hygiene, health and safety, moving and handling, first aid, fire safety and some medicines training. Dates have been arranged for the following training; homeopathy, sensory integration, and oral health. Other training planned includes safe handling of medicines, infection control, nutrition and health and LDAF. However, the home should consider providing staff with training in alternative methods of communication and eating and drinking. The Inspector has seen evidence of the Registered Manager contacting a training provider to provide training in disability/equality and adult abuse awareness. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 21 Staff spoken to confirmed that they had received and induction. The Registered Manager confirmed this. However, there are no records to substantiate this and to confirm the training that has been given at induction. The Registered Manager must address this and ensure induction is recorded. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 22 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 42 The quality outcome group is Good. The home is well run. The home is very proactive in promoting health and safety, however some areas need addressing. EVIDENCE: The Registered Manager is Jerry Brown. Jerry has a Diploma in Social Work and an NVQ4 in Management and is applying to complete his Registered Managers Award. He has undertaken a variety of training throughout his career in working with people with a learning disability. National Minimum Standard 39 was not assessed at this inspection due to the home opening in June 2006. Fire Safety: The home’s Fire Risk Assessment is dated 04/09/06. The fire alarm system, emergency lighting system and fire fighting equipment had an annual service on 16/11/06. Emergency lighting is checked monthly and was Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 23 last tested on the 20/10/06 along with the weekly check of the fire alarm system. It was noted a fire drill had not been conducted and records are not kept in relationship to the maintenance of the torches. These issues must be addressed. All staff have received fire training. Legionnella/ Hot Water: The home has had an assessment on the 10/07/06 and is in the process of addressing the requirements made. The Registered Manager stated that the urgent issues had been addressed to ensure conforming and that the other requirements are scheduled as part of the homes maintenance plan. All hot water outlets have thermostatic valves fitted. Records are kept of monthly checks. Electrical Hardwiring Certificate: This certificate is dated 04/01/06. Portable Appliance testing was conducted in December 2005. Gas Safety Certificate: This is dated 06/01/06. Accidents: The Inspector viewed the accident records. It was noted that there had not been any service user accidents. The home has recorded accidents involving care staff. COSHH: The home has a policy in relation to this. All products are stored securely. Fridge/Freezer: The home keeps daily records of fridge and freezer temperatures. Risk Assessments: The home has a risk management policy. The home has conducted a variety of environmental risk assessments. Following discussions the registered manager stated that the format of the assessments would be reviewed. All Radiators throughout the home have been covered; all first and second floor windows are fitted with restrictors. First Aid: The vast majority of staff have received first aid training. Hoists: The home has 3 portable hoists. These were serviced on 15/08/06 and 21/08/06. The overhead-tracking hoist above the hot tub was newly installed on 28/09/06. Passenger Lift: This has been newly installed. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 24 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 “ ” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 4 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 1 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X X X X 2 X Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 25 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 YA9 Regulation 13 (2) Requirement Timescale for action 03/11/06 2. YA20 13 (4) 3. YA30 13 (3) The Registered Manager must conduct a detailed risk assessment in relation to the use of bed rails and records kept of the maintenance and checks of the bed rails. 30/11/06 The Registered Manager must address the following issues in relation to the safe administration of medicines; • Staff must receive training in the use of rectal medicines and deemed competent by a qualified health care professional. • Guidelines for the use of all homeopathic remedies and rectal pain relief must be reviewed in a multidisciplinary approach and agreed by the service user’s GP. The Registered Manager must 03/11/06 ensure that staff are provided with hand washing and hand drying facilities in service user’s bedrooms where personal care is delivered. This will assist to prevent the spread of infection. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 26 4. YA34 19 5. YA35 18 6. YA42 23 (4) (e) 13 (2) The Registered Manager must 05/11/06 ensure that staff recruitment files contain all items as listed in Schedule 2 of the Care Homes Regulations 2001. The Registered Manager must 30/11/06 ensure that staff receive structured induction training with record kept. The Registered manager must 24/11/06 ensure that regular fire drills are undertaken and records relating to the maintenance of the torches must be kept. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. 4. 5. Refer to Standard YA1 YA20 YA20 YA34 YA35 Good Practice Recommendations The Registered Manager should consider producing the Statement of Purpose and Service User Guide in a more accessible format such as symbols and photographs. The Registered Manager should ensure that all hand transcribed medicines and remedies are supported by two staff signatures. The Registered Manager should assess care staff as competent in the administration of medicines with records kept. The Registered Manager should obtain a full employment history and where convictions are noted, a risk assessment and documentation relating to this are kept. The Registered manager should consider providing staff with training in alternative methods of communication and eating and drinking. Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Daneswood DS0000064546.V303473.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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