Inspection on 06/03/06 for David Lewis Centre Frederick Harwood House

This inspection was carried out on 6th March 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

David Lewis Centre Frederick... 28/09/06

David Lewis Centre Frederick... 11/08/05

David Lewis Centre Frederick... 02/02/05

David Lewis Centre Frederick... 15/06/04

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Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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

CARE HOME ADULTS 18-65 David Lewis Centre Frederick Harwood House David Lewis Centre Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector Helena Dennett Announced Inspection 6th March 2006 09:30 David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 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 David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 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. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Frederick Harwood House Address 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) David Lewis Centre Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640014 01565 640206 David Lewis Organisation Mrs Gillian Dyson Care Home 31 Category(ies) of Physical disability (25), Physical disability over registration, with number 65 years of age (6) of places David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 31 service users to include: * up to 6 adult service users over the age of 65 years, suffering from epilepsy for long term care. * Up to 21 service users’ between the ages of 18 and 64 years, with chronic physical disabilities suffering from epilepsy and require long term care. * 4 service users aged 19 years and above suffering from epilepsy who require nursing care with an acute illness. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered manager must obtain a nationally recognised qualification, at Level 4 NVQ or equivalent, in management before 1st March 2005 11th August 2005 2. 3. Date of last inspection Brief Description of the Service: The David Lewis Centre for Epilepsy opened in 1904. Its benefactor was the department store pioneer, David Lewis (1822-1885). The centre is set in 170 acres of land and has a village atmosphere. The facilities on site consist of a swimming pool, gymnasium, workshops, school college and social club. Frederick Harwood House, a single storey unit that comprises of four wings, is one of the original buildings of the centre. There are 28 single rooms with shared toilet facilities between each pair of rooms, and one double room with an en-suite bathroom. There is an observation bay with two double rooms and two single rooms with wash hand basins fitted. This area has its own lounge. There is a large dining room and kitchenette, three separate lounges, one of which is designated for residents who smoke. There is an enclosed garden and patio area. The residents’ primary needs are due to epilepsy and physical disability. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home was inspected as part of an announced co-ordinated inspection of all the DLC services registered with CSCI. The purpose of this approach was to evaluate the effectiveness of the Centre in supporting each unit to improve outcomes for the people who live there. The co-ordinated inspection took place over five days and involved a team of eight inspection personnel from CSCI, including a service inspector, a regulation manager, a pharmacist and regulatory inspectors. The inspection also focused on how national minimum standards were being met across the registered services and what progress had been made to meet requirements from the last round of inspections carried out in the period from April to August 2005. As part of the preparation for the inspection, the management staff at the David Lewis Centre produced self - assessment reports which summarised practice in the individual registered units and for the whole of the service. Before the start of the inspection, the inspection team carried out a number of surveys with placing agencies, parents, carers, service users and staff. During the inspection, the service inspector and regulation manager carried out a schedule of interviews with representatives of the Trustees, senior staff, operational managers and staff responsible for clinical, administrative and technical support to the centre. The inspection process included: tours of the premises; discussions with service users and their carers; meetings with senior centre managers and staff; visits to the centre laundry, transport and the central kitchen; meetings with clinical staff; and included an evening visit. The process enabled the inspection team to obtain a clear understanding of the factors influencing development and from the evidence gathered the team were able to form judgements on the quality and effectiveness of the services provided and the outcomes for those receiving services at the David Lewis Centre. What the service does well: Residents and relatives were complimentary about the staff team and the care they receive. Comments such as ‘staff are excellent’ were made. Visitors are welcomed into the home at any reasonable time. Several of the questionnaires that were returned said that the friendly, professional staff is the best thing about the home. There was plenty of staff available to meet the needs of the service users. Additional staff are rostered for service users who require 1:1 care. Staff have the skills and ability to conduct a series of investigations at the home in order that the correct treatment may be given. Tests such as EEG David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 6 (Electroencephalogram) and AEEG (Ambulatory EEG) are done. There is also the provision of a psychological assessment if needed. The laundry provision was found to be excellent with good systems in place to make sure that residents’ clothes are well cared for. What has improved since the last inspection? What they could do better: The statement of purpose needs to be changed to ensure that it accurately reflects the registration of the home. There appears to be a policy of admitting service users from the other social care houses after a stay in hospital to Frederick Harwood House before they can go back to their own house. The reason for the admission is not always clear. An assessment is not always carried out before the service user is admitted to the unit. Care planning practices in general are in need of improvement. There were instances where the care plan did not fully identify the service user’s needs and so the service user could be at risk. Some information had also been recorded inaccurately so there could be a risk of service users’ needs not been fully identified as a result. There is a lack of clarity in adult services at the Centre regarding the use of an approved model of physical intervention to promote the welfare of service users and staff. Two of the showers in Frederick Harwood were out of use. One was found to contain workman’s tools; the second was in the process of being refurbished, and was found open on the day of the inspection. Stanley knife blades were found on the floor of this bathroom which could have been a risk to service users. Although the recruitment practices were satisfactory in the main, there was no evidence that staff had checked registered nurses PIN numbers with the Nursing and Midwifery Council before starting employment. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 7 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. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. The home’s statement of purpose could be misleading, as it does not accurately reflect the conditions of its registration. Although pre-admission assessments are carried out for most of the service users, there was no evidence that these had been carried out for people who are admitted to Frederick Harwood from hospital for short periods before they go back to their own care home at the Centre, so there is a possibility that all of their care needs may not be met. EVIDENCE: The statement of purpose for Frederick Harwood had been updated in February 2006. It includes a list of services provided by the home but this is at odds with the current category of registration. The statement of purpose identifies that staff at the home provide a service to the terminally ill, however this is not listed in their category of registration. It also states that they can provide services for 27 male or female aged 40 and upward in long stay beds. This is not in line with the home’s condition of registration. The home is registered to provide nursing care for up to 21 service users between the ages of 18 to 64 and up to six service users aged 65 and above. The Commission for Social Care Inspection’s address in the statement of purpose is incorrect. In the statement of purpose it is identified that service users can only be admitted to the home following a referral to the house consultant. This will then be discussed with the multi disciplinary team and a home visit arranged. A written report including recommendations is then presented at the next David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 10 consultant ward round when the decision is made whether the service user can be admitted to the home. Pre admission assessments are not always carried out for service users who may be admitted to one of the four acute beds. Some service users from other registered care homes on the David Lewis Centre are admitted from hospital to Frederick Harwood, before they move back to their own home. The reason for the admission to Frederick Harwood is not always clear. See Requirement 1 & 2. Recommendation 1. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 There were care plans in place for all of the residents but as not all of them were accurate and up to date, there is a risk that their needs will not be met properly. Although there were risk assessments in place, the findings of these should be included in a plan of care so that residents are not placed at risk. EVIDENCE: Each resident had a care file which contained their care plan, daily records and risk assessments. The care plans were standardised on pre-printed forms with some being added to so that individual needs could be addressed. However on examination there was evidence that staff are not recording individual needs in a robust manner. For example: • One resident’s care file that was examined did not contain a plan of care for his medical condition. Staff from the Primary Care Trust (PCT) had previously raised concerns about this service user’s condition, and assurance had been given by staff that a plan of care was in place. This resident had a catheter but the plan of care did not identify the full hygiene needs of the resident including specific catheter care. The plan of care for the resident’s hygiene stated ‘wash the resident with aqueous cream’, which is not an appropriate intervention for this resident. DS0000018770.V277738.R01.S.doc Version 5.1 Page 12 David Lewis Centre Frederick Harwood House The plan of care for eating and drinking did not identify the risks of burning and the action staff should take to minimise this risk. A letter recently written by the unit manager stated that staff were using a fire blanket when this resident had a cigarette due to the risk of burns. This was not identified in the plan of care. When the inspector spoke with the resident he confirmed that a fire blanket was used but staff could not find it. A risk management form with the date of assessment 01/03/05 was in place. The date of assessment was crossed out and reassessed written beside it. The risk assessment for falls was dated 25/10/05; a second date indicating a reassessment was entered as 28/1/06 but there was no indication on the outcome of the reassessment. • A second service user’s notes were examined. These contained a personal profile and pen picture giving life history and health problems, dated February 2006. Care plans were in place dated 1/3/06. A care plan which read ‘reduced mobility and care of peg site’ was in place. These should be two separate care plans. Under the aim, the plan did not mention the maintenance of healthy skin. One of the interventions on the plan stated ‘Kyle sheet on the mattress’ there was no mention of the type of mattress that was used. An evaluation sheet was available; however there were a number of entries on the sheet and which plan was being evaluated was not identified. A care plan for communication dated 07/08/04 was in place; the date was crossed out and changed to 01/03/06. The name of the service user’s named nurse was deleted and a new name entered. • A third service user’s record was looked at. This service user had been admitted from one of the houses on the centre. There was no pen picture/history included on file. This would give the staff greater knowledge of the person, more conversation points and an understanding as to why they were accommodated at David Lewis. The inspector had a discussion with the manager of the house the resident normally lives in, enquiring why this service user was discharged to Frederick Harwood House. The manager said that the service user required more 1:1 staffing. It was not clear why this staffing could not have been provided on the service user’s own house. Daily recordings made by staff needed to be more informative and specific. Wherever possible, they should also include the view of the resident themselves. Eg: ‘All personal hygiene needs met’, does not explain how this has been achieved given that the resident had a plaster cast on her leg from below her knee. Different key workers were identified on different plans. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 13 A consent form for adult age 18 and over who is unable to consent to investigation or treatment was in place. The form stated that consent was given by parents to medical intervention; this consent was not seen in the records. One entry in the daily records made on 17.2.06 stated ‘had a good wash due to there only being one bathroom and a big queue’. Another entry indicated that staff had identified a medical problem for the service user; there was no evidence that this was referred to the doctor. Completed CSCI service user questionnaires indicated that staff involve the service user and relatives as appropriate in decisions regarding the service user’s care and that staff listen to their views. See Requirement 3 & 4 David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 &17. There were enough activities offered around the centre to meet the needs of the residents. Visitors are made welcome to the home so that residents could keep good contact with family and friends. There is a marked improvement in the catering service and the standard of food provided to service users to enable them to maintain a healthy, balanced diet. EVIDENCE: There is a range of activities at the David Lewis Centre that service users can access. Several of the service users attend the Centre’s day resource centre, which provides a number of varied activities. Service users spoken with said that they could choose which activity they take part in. One service user said that he has not been out very much and would like to go out and about more. The questionnaires returned indicated that service users enjoyed the activities available on the site. There is a chapel on site that holds regular services. Advocacy services are available for residents should they wish to use them. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 15 Visitors are welcomed into the home at any reasonable time. Comments from relatives/visitors questionnaires indicate that good relationships exist between visitors and staff. The Centre’s new catering manager had made changes to the central catering operation and meals have improved since the last inspection, with 95 fresh produce being used and more choice provided. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Residents have access to various health professionals to meet their needs. However, because two bathrooms were out of use, there is a risk that residents’ personal hygiene needs may not be met in full. EVIDENCE: Frederick Harwood Care Home accommodates service users who have epilepsy. Many of the service users have complex health needs. The manager of the unit confirmed that all the service users were registered with a GP service. In one service user’s file the name of the unit doctor, who inspectors were informed was not a GP, was identified as the resident’s GP. Multidisciplinary support, including speech therapist, dietician and physiotherapist, is available for service users. A consultant carries out two ward rounds per week. A medical physician is in attendance daily and is also on call. The unit operates on good staffing provision with some of the service users requiring 1:1 assistance. Staff have the skills and ability to conduct a series of assessments/ investigations at the home in order that the correct treatment may be given. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 17 Tests such as EEG (electroencephalogram) and AEEG (ambulatory EEG) are done. There is also the provision of a psychological assessment if needed. Service users said that staff meet their needs. The returned questionnaires also identified that staff meet service users needs. However, some concerns were raised regarding the provision of a bath/shower. One questionnaire identified that there were problems with one of the shower rooms; another stated they would like more bathrooms in the home. An entry in the daily records of one resident stated: ‘‘Had a good wash due to there only being one bathroom and a big queue”. Another entry indicated that staff had identified a medical problem for the service user; there was no evidence that this was referred to the doctor. For one resident admitted from one of the registered care homes on the centre it was noted that the staff who normally provide care for the resident or the manager had not been invited or attended any of the medical rounds regarding her. Therefore, the staff who usually provide her care had no knowledge of her current condition nor had been able to make any contribution to future planning. There was evidence of other professionals input into the care records. For example, in one service users plan there was a specific risk assessment identifying the use of a shower chair. The physiotherapist had completed this. There was also evidence of reference to a nurse specialist regarding the residents PEG feed. It was recorded that the peg site be treated with hydrocortisone cream; this was not incorporated into the plan of care. Also the resident was prescribed atropine drops, which were not recorded in a plan of care. The David Lewis Centre new Medicines Management Policy was approved and implemented on 6th September 2005. The CSCI pharmacist within the inspection team has recently studied the policy and a number of areas for change and improvement are currently under discussion. See Requirement 5 & 6 and Recommendation 2. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Although there are arrangements in place for safeguarding service users, these were found to be unsystematic, and the arrangements for safeguarding service users’ personal finances needed to be developed further. The centre’s complaints policy and procedure need revising to ensure the systematic management and handling of complaints so that service users’ concerns are seen to be fully addressed. There is a lack of clarity in adult services about the use of an approved model of physical intervention to protect service users and staff. EVIDENCE: Some complaints records did not contain evidence of acknowledgement letters to the complainant providing details of how the complaint would be addressed or who would lead the home’s investigation. The responding letter from a consultant to the purchasers is addressed to the manager on the unit and not the complainant. Some complaints records were incomplete and so the outcomes were uncertain. A number of issues in the letters of complaint are alleged neglect by carers. There is no evidence that these issues were considered for adult protection elements by the on site social work department. The complaint policy in the statement of purpose was different from the Centre’s policy as the Centre’s policy listed the different stages. The list of complaints handed to the inspection team did not include details of concerns passed to Frederick Harwood regarding another service user, which were logged in the unit’s complaints file. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 19 Following discussion with the manager of the protection and social work department, it was clear that there is a lack of clarity in distinguishing between issues of adult protection and concerns. Discussions with the Senior Behavioural Support Advisor and the Clinical Psychologist provided evidence that a new behaviour management strategy is being developed to be introduced throughout the Centre. Currently, staff caring for adults at the centre have received training in different models of physical intervention. Staff members in some of the houses for adults have received breakaway training in the past. There was no recent evidence of training in this area. In other houses for adults at the David Lewis Centre, staff members are using control and restraint methods which are not appropriate in social care settings. The centre has an official and approved appointee for a large number of service users across the site. There is lack of clarity regarding the capacity of some individuals to receive and manage their own finances. There is no clear guidance to staff members regarding the need to refer service users for support via Power of Attorney, Guardianship and Court of Protection. See Requirements 7, 8, 9 10, 11, 12 & 13. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30. Improvements have been made to the physical environment. Further work needs to be done to make sure that it is a pleasant and safe environment for residents to live in. Two of the bathrooms were out of commission due to refurbishment and so there is a risk that residents’ needs may not be met. Although the home has adequate communal lounge space one lounge is not always available for residents to use and so visitors may not have a private/quite area in which to visit residents. EVIDENCE: Improvements have been made to the environment in Frederick Harwood since the last inspection. The floor in the kitchenette has been replaced. Curtains have been placed in the dining room. On the day of the inspection the corridor carpets were in the process of being replaced with laminate type flooring. This caused a disruption for the residents on the unit. New curtains were being replaced in the bedrooms. Two of the showers were out of use. One was found to contain the workman’s tools, the second was in the process of being refurbished, and was found open on the day of the inspection. Stanley knife blades were found on the floor of this bathroom which could have been a risk to service users. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 21 Service users on the respite unit have access to separate day space and facilities. These consist of a small sitting area, three double rooms and three single rooms without en-suite facilities. However, the shower facility was not available for use as this was being upgraded. Service users were using the general bathing facilities in the interim. One of the service users admitted for short stay said she was not happy with sharing a bedroom with someone else. She said she felt embarrassed having to use a commode in the room. A designated smoking lounge is available for service users. This requires redecoration as a large piece of plaster is missing from the wall. There is also a quiet lounge that service users should be able to use. On the day of the inspection a member of staff was observed carrying her lunch into there. The following comment was made on a relative’s questionnaire: “There is not a private room that we as a family can enjoy each others company and have a private conversation. There is a room, but on many occasions the doctors are having a meeting or staff eating their meal in there”. The clinical room on Frederick Harwood is currently used to treat service users from around the site when the clinic area that is registered by the Healthcare Commission is shut. See Requirement 14, 15 & 16. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 There were plenty of staff to meet the needs of the residents. However, all staff have not attended mandatory training and so there is a risk that residents needs may not be met. Although recruitment practices were satisfactory in the main, improvement was needed to the system of checking the registered nurses PIN numbers to ensure that these were up to date. EVIDENCE: Service users were complimentary about the staff team. Several questionnaires that were returned to CSCI said that the friendly, professional staff are the best thing about the home. There were plenty of staff available to meet the needs of the service users. Additional staff are rostered for service users who require 1:1 care. Nursing staff have responsibility throughout the Centre to attend to emergencies or deal with any problems that may arise in the evening and at night. An additional registered nurse is rostered to cover this role. Some of the nurses have accessed additional training outside the centre to update their skills and enable them to care for service users with complex physical needs. For example staff have attended the hospital for training on the care of a central line. However there was no record/evidence of the David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 23 training or the competencies achieved held in the Centre. Mandatory training for resuscitation/life support was overdue for some members of staff. A sample of nursing staff personnel records were examined. There was no evidence that nurses’ PIN numbers are checked with the Nursing and Midwifery Council before employment. For one member of staff it was noted that the PIN number had expired. Although this had not previously been checked, this was done on the day of the inspection and it was found that the nurse had renewed her PIN number with the NMC. See Requirement 17 & Recommendation 3 David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 The induction and training of staff is well co-ordinated by the training centre so that staff are competent to provide care for the service users. However, not all staff have received their mandatory training so may not be aware of up to date practice in some of these areas, possibly putting themselves and service users at risk. EVIDENCE: The registered manager is a first level registered general nurse who has worked at the home for a considerable length of time. Staff meetings for nursing staff and care staff are held regularly. A policy on privacy was in place in the one of the service users files examined by the inspector. This policy stated that residents’ doors must be left ajar at night and that should a resident wish to have their door closed that consent from the resident must be obtained. This issue was identified at the last inspection as it could present as a risk to residents should a fire occur. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 25 Some of the staff have not attended mandatory fire and moving and handling training in the previous twelve months. The David Lewis Centre’s own training centre co-ordinates the induction and foundation programmes for all staff. The induction process has been developed into a two-week programme, which is relevant and comprehensive. See Requirement 18. David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 X 36 3 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 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 X X 3 X 3 X X 2 X David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 27 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement The statement of purpose must be changed to ensure that it contains up to date and accurate information on the services the unit provides that is in line with registration of the home. The registered person must ensure that all service users are assessed before admission and that the registered person has obtained a copy of the assessment. Service users’ care plans must be kept up to date and accurate and detail how their needs are to be met in respect of their health and welfare. The service users’ care plans must be reviewed regularly. Risk assessments must be kept current and accurate and updated as necessary. Staff must ensure that appropriate referrals are made to the GP if a medical issue is identified. Adequate bathing facilities must be provided to meet the needs of the service users. Staff must ensure that DS0000018770.V277738.R01.S.doc Timescale for action 31/05/06 2 YA2 14 01/05/06 3 YA6 15 31/05/06 4 5 YA6 YA19 17 13 31/05/06 01/05/06 6 7 YA19 YA24 23 23 31/05/06 01/04/06 Page 28 David Lewis Centre Frederick Harwood House Version 5.1 7 YA22 22 8 YA22 22 9 YA22 22 10 YA22 22 11 12 YA23 YA23 13 17 13 14 15 16. YA24 YA24 YA32 YA34 23 23 18 19 dangerous equipment e.g. knives and workmen’s tools, are kept securely, away from service user areas. The registered person must ensure that the complaints policy used on Frederick Harwood is the same as the policy used throughout the David Lewis Centre. The registered person must ensure that the Centre’s complaints policy includes information on the complainant’s right to approach their placing authority’s complaints officer The registered person must ensure that the centre’s complaint’s procedure includes the provision of an acknowledgement letter to the complainant with details of the officer dealing with the concerns Complaint records must be completed to identify the action taken by staff at the home to address any issues. The service must develop a consistent training strategy for physical intervention for adults. The registered person must ensure that the centre policy for money stored within the houses, refers to a maximum amount permitted within each unit. The wall in the smoking lounge must be repaired. Staff must not use service users’ communal lounges for their own purposes. The registered person must ensure that all staff attend mandatory training. All the necessary checks identified under this regulation must be carried out before a member of staff is employed to work at the home. Previous DS0000018770.V277738.R01.S.doc 01/05/06 01/05/06 01/05/06 01/05/06 31/05/06 01/05/06 31/05/06 01/05/06 01/06/06 31/05/06 David Lewis Centre Frederick Harwood House Version 5.1 Page 29 timescale not met. 17 YA42 23 The registered person must make sure that robust systems are in place for the prevention of spread of fire on the unit and that a fire risk assessment is carried out identifying all aspects of risk to residents on the unit, with appropriate action identified to minimise risks to residents in line with any advice given by the fire safety officer. 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA19 Good Practice Recommendations The reasons for placing someone in Frederick Harwood from hospital instead of discharging them to their own care home should be clearly stated on the file. If a resident from another house is placed in Frederick Harwood, a member of staff from that house should attend the house ensure that they have up to date information about that resident’s needs. A record of nurses’ additional training/competencies should be kept at the Centre. 3 YA32 David Lewis Centre Frederick Harwood House DS0000018770.V277738.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. 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