Inspection on 25/10/05 for Forest House

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest House 15/04/09

Forest House 11/04/07

Forest House 08/05/06

Forest House 10/05/05

Forest House 11/11/04

Forest House 15/06/04

Forest House 10/02/04

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

CARE HOME ADULTS 18-65 Forest House Church Square Newnham Road Blakeney Glos GL15 4AA Lead Inspector Mr Richard Leech Unannounced Inspection 25th October 2005 09:30 Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Forest House Address Church Square Newnham Road Blakeney Glos GL15 4AA 01594 516825 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) Parkcare Homes (No. 2) Limited To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Forest House is registered to provide care for up to eight adults with a learning disability. The Statement of Purpose indicates that service users may also have a stable associated mental health disorder, although their primary needs would relate to learning disability. The home is operated by Parkcare Homes, which is a subsidiary of the Craegmoor Healthcare group. The home is in the small village of Blakeney in the Forest of Dean. The building is a renovated and refurbished stone cottage. Whilst this gives the home character, it also means that there are low ceilings and doorways, fairly steep staircases and steps to many of the rooms on the ground floor. The home provides 24-hour staffing. All residents have single rooms, some of which have en-suite facilities. The residents have access to a communal lounge and dining room. Outside there is a patio and stepped access to the garden. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began at 09.30 in the morning and lasted until late afternoon. Most of the service users were spoken with, along with five members of the staff team and the acting manager. Records checked included samples of care plans, risk assessments and health notes. Requirements from the last report were revisited as well as most of the recommendations. Two inspectors were present for this inspection. The summary below reflects the relatively limited areas considered during this inspection, and should be read in conjunction with the previous report for a fuller picture of the home. What the service does well: What has improved since the last inspection? Care planning and risk assessment has improved significantly, though there remains scope for further development. Service users’ routines are more flexible, and their activity programmes have become more diverse. Staff are being supported to take NVQs in care and there have also been improvements to other types of training offered. In general service users appeared happier than in previous inspections. For example, one person said, “ I really like living here”. Where people are less happy they are given support to look at other options. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 6 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. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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 Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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): 2 The acting manager has an understanding of the appropriate steps to take in the event of an admission to attempt to ensure that only service users whose needs can be met are admitted. EVIDENCE: There have been no new admissions since the last inspection. The acting manager described the steps that would be taken if there were a vacancy. This included a needs assessment, considering compatibility with other service users and obtaining background information from family members, professionals and others involved in the person’s care. The organisation has an admissions policy. In the event of a future vacancy admissions material will be checked for compliance with the National Minimum Standards and Care Homes Regulations. The team was actively supporting one person to look at moving on since they had expressed a wish to live in a smaller home in a different location. There was evidence that the person was being supported well with this goal. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 9 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 & 10 Care planning in the home has substantially improved, although there is scope for further development to ensure that service users’ views and objectives are fully at the heart of the process. Ongoing shortfalls in the handling of personal information seriously compromise service users’ confidentiality. EVIDENCE: Two people’s care plans were checked in more detail. It was clear that considerable work had gone into improving care planning. Files viewed included draft skills and opportunities assessments, likes and dislikes and life histories (in some cases written by the service user). There were also person centred care planning documents such as essential lifestyle plans and personal planning books, again written by the service user in some instances. These contained excellent information about the person’s views, wishes and goals. They were not fully completed (for example, photographs had not been added), indicating either that the person had done all that they wanted to or that they remained work in progress. This will be checked in future inspections. More standard care plans covering different areas of need remained in place, though in some cases the service user had begun to write these also. These Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 10 were more wide-ranging and individualised than in the past. There was evidence of monthly reviews, although the service users’ input into this process was less evident. This could be further developed. Some areas were noted as requiring further attention. For example, one person’s care plan about finances did not describe how the person would actually be supported to manage their money. Instead it talked about systems in place for receipts and auditing of records. There was no indication of the person’s own objectives in this area and of how progress towards these would be recorded and assessed. Some care planning material was not dated. Care plans about the management of challenging or unsettled behaviour are in place. These are written in conjunction with an external professional. The manager had attended training about care planning in June 2005. She had also obtained a detailed pack and templates for care planning, as well as downloaded some person-centred material from the Internet. The manager understood that all service users were claiming their maximum benefit entitlements, including DLA (mobility). Following the inspection a copy of an internal financial audit from May 2005 was forwarded to CSCI. This included a check on service users’ finances. Four recommendations were made. An internal action plan provided evidence that these were being addressed. Risk assessments had also improved since the previous inspection. Examples seen covered relevant areas. For example, the team has assessed that some people required varying degrees of support and supervision with road safety when out in local community. One person-centred plan viewed had a section entitled ‘Keeping Safe’. This was not completed, but could be done as part of a person-centred risk assessment approach. There was evidence on file that risk assessments were being reviewed regularly. Although the standard of risk assessment has improved there is always scope for development. The manager should ensure that she and the rest of the staff team further improve their skills and expertise in the assessment and management of risk, for example, through ongoing training, literature, peer review and reflective practice. In the last two reports a requirement has been made for confidential information to be securely stored. During this visit personal material relating to service users was again found to be accessible in the storage area adjacent to the lounge. The Commission will consider what action to take to ensure compliance with this requirement. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Service users benefit from individualised activity programmes which reflect their needs and interests and which promote their involvement in the local community. Appropriate support is provided for service users to stay in contact with their family and friends. EVIDENCE: Service users spoken with expressed enthusiasm for their activity programmes. Discussion with service users, staff and the manager, as well as checking some care plans, provided evidence that programmes are continuing to become more individualised and based on each person’s wishes. Activities include vocational opportunities, community groups, attending a day centre, walks, shopping and horse riding. Service users described their involvement with the local community, for example, through their jobs or through using local shops and take-aways. Some people use buses to access local towns, either independently or with staff support. Some activity timetables in the same file did not correspond. As with all care plans, activity plans should be dated. Those no longer applicable should be archived rather than remaining in files. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 12 The manager confirmed that one person who prefers activities in smaller groups or individually has been offered a one to one holiday (in the past the only option had been going on holiday in a group). This is good practice. Staff spoken with felt that service users had made good progress recently in areas such as activities, confidence and independence. They also felt that service users were more relaxed and that their routines were more flexible and individual. Service users described their contact with family members. Care plans and family contact records provided evidence that the team supports service users to stay in contact with important people in their lives. Standard 16 refers to service users’ access to keys to their bedrooms and the front door. One person’s care plan indicated that they do not have a front door key due to being at risk on roads/in the community depending on their mental state. However, an evaluation entry for the same care plan stated that ‘[service user] continues to choose not to have a front door key’. The documentation therefore does not make it clear whether this is an agreed restriction or the person’s choice. The team should ensure that such ambiguities in documentation are addressed and that it is made clear whether a choice has been made or a restriction agreed. One person has lost a significant amount of weight since the last inspection. This was one of their identified aims. They confirmed that staff were providing appropriate support to enable them to eat healthily in the home and to access a local support group. Service users spoken with were positive about the food served in the home and confirmed that they could ask for alternatives if they didn’t like something. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 13 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): 19 Appropriate support is provided for staff to access routine and specialist healthcare services, promoting their wellbeing. EVIDENCE: A speech and language therapist was visiting on the day of the inspection to begin some work with a service user. Records provided evidence of regular input from the Community Learning Disability Team for a number of service users. In some cases there were protocols devised with the CLDT and GP about whom to contact in the event of mental health emergencies at different times of the day/week. One person was supported to attend the GP during the inspection. Another service user reported that they were visiting the GP the following day on their own. The manager indicated that work was continuing on health action plans with assistance from the CLDT. Selected health records provided evidence of service users being supported to access routine healthcare services. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 14 One person indicated that they administer and control their own medication and that they were happy with the arrangements. The manager confirmed this and said that the person has a safe and a sheet to sign in their room. Staff reported that service users’ medication dosages had reduced in recent months and attributed this to a more empowering person-centred culture resulting in service users feeling happier. There was scope to improve some of the documentation relating to medication. One care plan referred to PRN medication being necessary but did not make any reference to whether there was an ‘as required’ medication care plan. Also some information about people’s medications in their personal files had been amended without any indication of who had done this and when. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 15 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): 23 Shortfalls in understanding and recording in relation to physical intervention may place service users and staff at risk and lead to inconsistent practice. EVIDENCE: Since the last inspection there have been a number of notifications to CSCI of incidents of challenging behaviour. This has included some occasions when restrictive physical intervention was used, though this appears to have been in exceptional circumstances and proportionate to the situation. All staff (besides some newer recruits) have received training in this area by an organisation accredited by BILD. CSCI will continue to monitor the situation including the impacts on other service users, though staff reported that the frequency of incidents had recently reduced. In conversation with a staff member it transpired that restrictive physical intervention (a wrist hold) had been used during a recent incident (thought to be 07/10/05). Daily records did not indicate the nature of the incident or the use of restrictive physical intervention. This was relayed to the manager. Staff must adhere to guidance and protocols around the use of restrictive physical intervention, including recording and reporting such incidents in full. It may be that some staff are not clear about the definition of restrictive physical intervention (refer to Department of Health guidance 2002 http:/www.dh.gov.uk/assetRoot/04/06/84/61/04068461.pdf). One person’s care planning file included an assessment which talked about ‘unpredictable behaviours’ without defining them. Some information in the assessment appeared to be outdated. However, new assessments and recommendations have been made by a behaviour specialist and an Occupational Therapist. For example, there was reference to different types of Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 16 activity to offer in order to provide more meaningful activity and reduce incidents of challenging behaviour (June 2005 assessment). In some cases care plans did not yet seem to reflect these recommendations. Considerable work has taken place in conjunction with outside professionals to devise appropriate behaviour management plans for some service users. There is also work taking place with a more pro-active focus including ‘skill and opportunity reviews’. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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): 27 & 30 Inadequate laundry and bathroom facilities seriously compromise service users’ comfort, convenience, safety and independence. EVIDENCE: Some service users showed their rooms. They expressed general satisfaction, although one person pointed out that they could not use their shower since it caused flooding in a room below. This must be rectified. The handrail on the main stairs was coming away from the wall and was unsafe. This was secured during the inspection. However, it is concerning that this had not been picked up through routine in-house checks, and suggests that this needs tightening up in order that hazards are quickly identified, reported and rectified. Selected files included assessments from an Occupational Therapist stating that the communal bathroom (the only bath in the home) was inaccessible to some service users. The manager said that work is proposed to combine the bathroom with the adjacent toilet to make a larger space and to create accessible facilities. The bathing facilities must be made accessible in accordance with specialist assessments. The Commission will consider what action to take in response to the failure to implement this requirement (the Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 18 deadline for completion was 31/10/05. In a telephone call on 04/11/05 the acting manager confirmed that the work had not yet been undertaken). In the action plan following the inspection it was reported that aids had been loaned to the home in the interim and that the work would be completed by 20/02/06. The Occupational Therapist also recommended that the home promote service users’ mobility through diet and exercise given that the home does not easily lend itself to the fitting of adaptations related to physical disability. This should be incorporated into care planning. The first floor toilet did not have any paper towels. In the last report a recommendation was made about this which is repeated. At the time of the inspection the washing machine had been broken for a week. Laundry was being taken to a launderette in a local town. The room remained without adequate ventilation and the door was swollen and could not be closed. A requirement to undertake necessary work such that the laundry is fit for purpose had not been met (the deadline was 31/10/05. In a telephone call on 04/11/05 the acting manager confirmed that the work had not yet been undertaken). Further action will be considered by CSCI to ensure compliance. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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 & 36. Staff are becoming more competent and qualified to provide the support that service users need. Shortfalls in documentation need to be addressed for the home to demonstrate that staffing levels are adequate, that new staff receive appropriate induction training and that recruitment and selection procedures are being followed. Improvements need to be made to the frequency of supervision for some staff to promote good, consistent practice. EVIDENCE: Staff spoken with indicated that they were undertaking NVQs in care at level 2 or 3. One senior staff member reported that they were about to take NVQ level 4 in care. As noted in this and previous inspections, there have been significant improvements in the training provided to staff. Staffing rotas were checked. These indicated that a minimum of three staff were on duty for the daytime shifts (early and late). However, the diary was cited as evidence of the rota being worked as planned but on occasions only two staff had signed (for example, on 29/09/05 for the late shift). The manager started that agency staff may be forgetting to sign. The Care Homes Regulations require a record of whether the duty roster was actually worked. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 20 In the last report a recommendation was made to avoid staff doing long shifts. On the day of the inspection one person was undertaking a 14-hour shift. The rota indicated that on October 1st 2005 three staff worked from 08.00 to 22.00. Some new staff had just been taken on and more were due to join the team. Whilst accepting that this will ease the situation, the recommendation is repeated. The inspectors asked to see evidence of structured induction for the new staff. No evidence could be found other than a note indicating that they had been given one of the company’s induction booklets. There was no reference to ‘the staff member’ as defined in regulation 18 (2). The manager said that there was no LDAF-accredited work taking place and that induction was based around the company’s booklet, which was in turn based on the old ‘TOPSS’ framework. These have now been superseded and the manager was advised to check the ‘Skills for Care’ website for information about this. All staff in learning disability services should be accessing LDAF accredited training. The inspector understands that the LDAF framework for new staff would automatically cover the new induction units created by ‘Skills for Care’. Some staff had recently been taken on with a PoVA-First check in place rather than a full CRB check. The risk assessment relating to this was viewed. It referred to limitations in the duties the person could perform pending the CRB check. However, the following observations were made: • • The risk assessment was for two staff rather than being individual. The assessment did not describe the basis for taking on the new staff without a full CRB check in place. This would include the reason for them being required sooner rather than later and reference to the documentation already in place (such as verified references, a full employment history and a self-declaration about convictions). CSCI was not notified of these staff being recruited on the basis of a PoVA-First check only. • Files for three new staff were checked. The following issues were identified: • One person had only one reference from an employer, the others being from a friends and relative. It may have been that they only had one previous employer due to their age in which case a second reference should ideally come from a more vocational/professional source such as an education and training setting. Their file also had no start date or job description. The person had been included on the rota from October 1st but had not started their position. Staff explained the reason for this. Nonetheless it was agreed that this was confusing. • Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 21 • • A second staffing file did not appear to include the person’s start date. There was no job description in their file. They had one reference from an employer but the second reference was from a friend. The manager agreed to forward evidence (confirmed by the company) that two people recruited for night shifts had been supported at night by an experienced member of staff for the first two weeks of induction. The manager confirmed that food hygiene training is now being conducted for all staff by an external provider rather than being in-house. Training in mental health issues took place in June 2005. The manager indicated that whilst this had been a start some more training in this area would be useful, perhaps focussing more specifically on the issues encountered at Forest House. Some literature was available in files about particular mental health conditions. The company’s supervision format was viewed. The manager said that she found this helpful and that it incorporates an annual appraisal. Staff spoken with indicated that they found supervision meetings supportive and productive. Some supervision dates were checked. In one case there was evidence of meetings every two months, though another person had a gap of almost four months between supervision sessions. The manager should continue to aim to make supervision meetings more frequent (at least every two months). The application forms viewed continued to ask for the most recent employer and should be updated to reflect the change in the Care Homes Regulations relating to previous employment in social care. A requirement about providing guidance for staff on maintaining clear professional boundaries with one person has been met. However, the inspectors felt that more work was needed on monitoring this aspect of care planning to determine how this was working and whether there were any learning points/care plan amendments to be made. Service users spoken with praised the staff, for example, saying that they were ‘nice people’, ‘friendly, helpful and understanding’ and ‘really good’. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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): 42 Whilst many areas of health and safety have shown significant improvement some ongoing shortfalls place service users at risk. EVIDENCE: At the time of writing CSCI had not yet received an application from the acting manager to register. This application was understood to be at the company’s area office for processing before being forwarded to the Commission. In the last report a recommendation was made for the acting manager to receive intensive support and supervision from senior workers in the organisation to ensure that the home is well run and that improvement continues. Whilst there was evidence of some support, the manager agreed that it had not been enough. Shortfalls such as those identified in recruitment indicate that the degree of support and supervision needs to be increased, as would be the case with any manager relatively new to the role. This is particularly important in a home where there have been ongoing and serious shortfalls identified. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 23 Staff spoken with felt that the manager was approachable and very supportive. The manager plans to conduct an individual survey of service users’ views using either a company format or devising her own. A survey of people’s families has already been undertaken as part of quality assurance. The fire log provided evidence of testing of alarms and emergency lighting at suitable intervals. Five fire drills had taken place within the previous few weeks. The manager said that this had been in order to ensure that all staff and service users were involved at some point, and added that they had gone well. The fire alarm went off during the inspection and the response from staff and service users was very quick, calm and well organised. In the last report a requirement was made to ensure that hot water temperatures were at an appropriate level for each outlet. Records indicated that temperatures for the previous few months had ranged from 21°C to over 50°C in bedrooms and toilets. This is unacceptable and must be urgently attended to. There was no record for shower temperatures. These must also be checked to ensure that they are within safe limits. In a telephone conversation on 04/11/05 the acting manager described having called engineers to resolve the problems around hot water temperatures but reported that they had not yet been able to solve this. The Commission will consider what action to take in response to the failure to implement this requirement. Forest House DS0000016440.V260729.R01.S.doc Version 5.0 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 “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x x 1 Standard No 24 25 26 27 28 29 30 STAFFING Score x x x 1 x x 1 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 1 1 x 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Forest House Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x DS0000016440.V260729.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? YES 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 YA10 Regulation 17 (1) b Requirement Timescale for action 30/11/05 2 YA23 3 YA27 4 YA27 5 YA30 6 YA33 Confidential information must be securely stored (Timescales of 11/11/04 & 15/06/05 not met). 13(8)17 Staff must adhere to guidance (1)a.S3.3(q) and protocols around the use of restrictive physical intervention, including recording and reporting incidents involving this in full. 12 (1) a. 23 Ensure that necessary work is (2) b. undertaken so that the en-suite shower which is out of use does not cause flooding in the room below. 12-1a/b 13- Bathing facilities must be made 4.23-2a/n accessible in accordance with specialist assessments (timescale of 31/10/05 not met). 13-4. 16-2 Undertake necessary work such f23-2a/k that the laundry is fit for purpose and can be safely accessed by service users independently where appropriate (timescale of 31/10/05 not met). 17 (2). Sch. Ensure that there is a full and 4 (7). accurate record of whether the duty roster was actually DS0000016440.V260729.R01.S.doc 30/11/05 28/02/06 20/02/06 20/02/06 30/11/05 Forest House Version 5.0 Page 26 worked. 7 YA33 17(2)Sch4 6(g)18(2) Keep records in the home of new staff members’ structured induction training. • Document in new staff members’ files or induction material who is ‘the staff member’ as defined in Reg. 18 (2) b, and ensure that this regulation is complied with. Address the bullet points in the text relating to risk assessments for staff starting work on the basis of a PoVAFirst check only, pending the return of a full CRB check. Ensure that staffing files clearly record the person’s start date. Forward evidence (verified by Craegmoor) that two staff members recruited for night duties were supported at night by an experienced staff member for the first two weeks of their induction, as discussed during inspection. References from friends and relatives must only be viewed as supplementary rather than as meeting the statutory requirement for two references. The registered provider must ensure that an application for registration of a manager is submitted (Timescales of 31/08/04 & 31/07/05 not met). Work must be undertaken to ensure that hot water temperatures are at an appropriate level for each outlet (timescale of 31/10/05 not met). Regularly check shower temperatures to ensure that Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 27 • 30/11/05 8 YA34 12(1) a. 13 (4) 19 30/11/05 9 10 YA34 YA34 17(2).Sch. 4. 6(d) 17(2). Sch. 4.6(g) 30/11/05 10/12/05 11 YA34 12 (1) a & b. 19. 30/11/05 12 YA37 8 31/12/05 13 YA42 12 (1) a & 13 (4). 20/12/05 they are within safe limits. 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 Refer to Standard YA6 Good Practice Recommendations • Aim for monthly reviews of care plans to provide more evidence of the service user’s involvement in this process where possible. Ensure that all care planning material is dated. Continue to develop care plans in conjunction with service users, further developing the person-centred material. Ensure that all care plans indicate clearly how a person is to be supported in a particular area and how progress towards an identified objective will be recorded and monitored. Promote service users’ mobility through diet and exercise in accordance with recommendations from the Occupational Therapist. Create individual care plans for this as necessary. • • • • 2 YA9 Incorporate person-centred care planning tools into risk assessment where possible, for example, through completing the ‘Keeping Safe’ section of one format in use. Continue to develop the team’s skills in risk assessment, for example, through training, literature, peer review and reflective practice. Activity plans should be dated. Those no longer applicable should be archived rather than remaining in files. Documentation should always make it clear whether an agreed restriction is in place or whether a person has made a choice, as described in the text. The team should ensure that such ambiguities in documentation are identified and addressed. DS0000016440.V260729.R01.S.doc Version 5.0 Page 28 3 4 YA12 YA16 Forest House 5 6 7 8 9 YA20 YA23 YA24 YA30 YA32 10 11 YA33 YA33 12 YA34 13 14 15 YA35 YA36 YA37 Further improve/clarify supporting documentation relating to medication, such as for the examples given in the text. Ensure that care plans are promptly updated in accordance with assessments and recommendations from external professionals, such as the example cited in the text. Review the system for in-house checks of the environment in order that hazards are more quickly identified, reported and rectified. Review arrangements for ensuring that paper towel dispensers in toilets and bathrooms are regularly refilled. Regarding the guidance about maintaining clear professional boundaries with one person, consider how to monitor/review this care plan more closely to determine whether there were any learning points/care plan amendments to be made. Avoid staff doing excessively long shifts. • All new staff should follow an induction programme which includes LDAF-accredited training. Ideally they should then have access to further LDAF-accredited training at level 2 and/or 3, either as stand-alone units or as part of a full certificate. • In the meantime the manager should access information from ‘Skills for Care’ about the new general induction framework for staff in social care. • Copies of updated job descriptions should be kept in staff files. • If a prospective employee is not in a position to supply the names of two referees who are previous employers (for example, if they have only had one job in the past) then their second reference should ideally come from an education/training source. • Avoid including staff who have not yet started work on the rota. If calculations about staffing levels/requirements need to be made then do this on a separate format. • Review the application form to make it clear that under certain circumstances a reference from the persons last social care employer is needed even if this is not their most recent post. Consider sourcing further training in mental health conditions, particularly training which focuses more on the issues of direct relevance in the home. Aim to make supervision meetings more frequent for all staff (at least every two months). The new acting manager should receive intensive support and supervision from senior workers in the organisation to ensure that the home is well run and that improvement continues. DS0000016440.V260729.R01.S.doc Version 5.0 Page 29 Forest House Forest House DS0000016440.V260729.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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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