CARE HOME ADULTS 18-65
Forge House Forge House 60 Higher Street Cullompton Devon EX15 1AJ Lead Inspector
Belinda Heginworth Unannounced Inspection 6th March 2007 09:00 Forge House DS0000067786.V325237.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 Forge House DS0000067786.V325237.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. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Forge House Address Forge House 60 Higher Street Cullompton Devon EX15 1AJ 01884 32818 01884 38777 forgehouse@ukhcg.com 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) FORGE HOUSE SERVICES LIMITED Anna Jane Leinster Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection New service Brief Description of the Service: Forge House is a large detached property in the town of Cullompton. The house is spacious and homely. Some adaptations on the ground floor have been made to meet the needs of physically disabled service users. There are eleven single bedrooms with washhand basins in each. The home has a large lounge and dining room, kitchen, a smaller lounge, an office and a number of communal bathrooms and toilets. There are gardens to the front and rear of the property. Fees range from £666 to £1018 per week. An extra cost of £13.50 a week is charged towards the cost of transport for those service users who use it. This will be the first report since the new orginasiation took over Forge House. They intend to send a copy to all relatives and care managers and discuss with those service users who will be interested and would understand. They also intend to have a copy available in the office and will add it to the Service User Guide. Forge House DS0000067786.V325237.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 the home has received since the new organisation took over 5 months ago. The inspection was unannounced and took place during a weekday over 6 hours. The manager and a representative from the company were present throughout the day. Prior to the inspection the manager completed a pre inspection questionnaire. This provided information about service users, staffing and fees. It also explained how the home is maintained and what checks, policies and procedures are in place to ensure that the health and safety of service users and staff is not compromised. This information helps the inspector to prepare for the inspection and form a judgement on how well the home is running. The majority of service users currently living at the home have extremely limited verbal communication skills. Time was spent throughout the inspection observing the care and practices delivered by staff and wherever possible talking to those service users who were able to verbally communicate. Surveys were sent, prior to the inspection, to the nine service users currently living at the home, one was returned. Comment cards were sent to four professionals and two GP’s. Three professionals and one GP responded with very positive comments about the home. Telephone contact was made with three relatives. Surveys were also sent to eight members of staff, only one was returned. However, when the surveys were sent out, many of the staff that received them no longer work at the home. During the inspection four members of staff were spoken with and their views on the home and services were discussed. All comments from professionals, service users, relatives and staff have been included throughout this report. During the inspection three service users were case tracked, meaning they were either spoken to about their experiences of living in the home, or were observed . Staff on duty were asked about those service users’ individual needs and preferences. In addition the records kept for these individuals were also looked at. These included care plans, medication records and records in relation to financial transactions made on behalf of them. This process helps to identify how well the home is meeting the key standards that have been inspected. These are identified at the beginning of each section of the main body of the report. The inspector looked around parts of the building and read other records, these included, quality assurance policies and fire safety records. Time was also spent talking with the management. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 7 This is the first inspection since the new organisation took over, however it was clear throughout the inspection that service users’ lives have become more enriched, relaxed and active. Staff are able to provide a more consistent service through the excellent training and guidance from the management. The records have been audited and good progress has being made towards changing and improving them. This will ensure staff are provided with the information they require to deliver consistent, safe and service user focused care. Comments from one care manager said “there have been considerable improvements for my client”. A comment from another care manager said, “since the new management, changes seem to be lifting the standards of care provided at Forge House”. Relatives spoke very highly of the improved services, one relative said “this is the first time we have ever been able to go on holiday without having to worry”, another relative said “ they are so good at involving us in the changes and keeping us up to date with information”, a further comment from another relative said “ the changes in my son have been incredible, he is so much happier, is going out more and doing more in the house”. What they could do better:
Some of the records need to ensure service users’ confidentiality is maintained, for example, the new handover record and communication book. Staff use these to record information that needs to be passed on to other staff. However, some of the information included personal details about service users. This would mean that any professional wishing to read information about a service user under their care would also be able to read information about other service users. This was discussed with the management who said they would change this. It was agreed that the shift pattern would be reviewed to look at improving opportunities to provide more add hoc evening activities. Currently planned evening activities take place but due to the current shift system, day staff’s shift end at 8.30pm therefore reducing the opportunities for activities to take place out of the home beyond this time. Some improved practices are needed to medication procedures to ensure the safety and welfare of service users are fully protected. Handwritten entries on the medication administration records should be checked and signed by two people. Medication is re-dispensed in medi-wallets when service users go home to relatives. This is checked by two staff and relatives sign to say they have received it. However, the medi-wallet in one case did not have clear instructions on what should be given and when and the medication was not listed on the wallets. This could put service users at risk of receiving the wrong medication and medical professionals would not know what the medication was should an emergency happen while away from the home.
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 8 Much of the home is in need of decoration and replacement of carpets, furniture, fittings and so on. Although the management have identified these areas, a time scale for completing has not been produced yet. Also areas where a risk has been identified until the work has been completed, assessments of hazards with clear action on how to minimise the risk in the interim period have not been completed. This potentially puts service users and staff at risk of harm. The management said they would complete this immediately. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 9 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 Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assured their needs can be met with good assessment and admission practices. EVIDENCE: Service users have been living at the home for many years. Full assessments of needs were completed prior to admission. Relatives confirmed their involvement in this process. Service users were unable to confirm their involvement due to limited verbal communication skills. The new management are in the process of re-assessing service users’ needs using a detailed process. For those that are completed a graph is produced that highlights areas where extra support is required and areas where there is more independence. This information then helps to produce a more detailed and accurate plan of care. The management can then arrange appropriate staff training which will ensure service users receive consistent, appropriate and safe care. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is provided to staff to help meet and monitor service users’ needs safely and consistently. Decisions made on behalf of service users are done so in consultation with service users, their representatives, other professionals and therefore in their best interests. EVIDENCE: Service users have detailed records that provide a background history, assessments of need and individual plans of care. The new management are in the process of producing more useable and effective information to staff. Two care plans had excellent information and guidance, ranging from health, emotional, social, physical and care needs. These records confirmed that service users’ needs are assessed, monitored and well met. A recent assessment highlighted that a wheelchair user required more equipment to help maintain independence and help staff provide care in a safe way. A new
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 12 hoist and an electric wheelchair was purchased and transport suited to their physical needs has been arranged. The service user seemed to enjoy the independence the new wheel chair provided. Staff have received training for the use of the new equipment, therefore ensuring the service user and staff’s safety is not compromised. Staff spoken with on the day of the inspection had a good understanding of individual service users’ needs and said that as far as possible they try to honour individuals preferred routines. Staff felt they are provided with clearer guidance and verbal communication has improved between staff through good handover meetings. Throughout the inspection staff were observed offering service users choices, speaking in a caring and respectful manner and using various methods to communicate effectively. One service user and staff showed the inspector a communication board they used. Photographs of various places the service user likes to visit are chosen by the service user each day and placed on the board. As each activity is finished, the service user puts the photograph away. Staff said this has helped the service user have a better choice on where to go and the board sets out clearly when it will happen. Any hazards to service users are assessed with clear actions recorded on how to reduce any risks to service users or staff. Currently, daily diaries are kept for each service user to record daily events, the new management intend to change this system to ensure staff record information in the appropriate sections of care plans. This will make the monitoring of care more effective. Relatives are invited to attend reviews of care plans, some relatives said they found them useful and are pleased to be involved. Care managers reported improved standards of care and better support for the staff team. Any decisions made of behalf of service users are discussed with care managers, staff, relatives and service users, wherever possible. This ensures that such decisions are always made in the best interests of service users. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from accessing the local community and taking part in appropriate activities. Service users’ rights are respected at all times and relationships with families are maintained. Service users benefit from a varied and healthy diet which they help to choose and prepare as much as possible. EVIDENCE: It was clear through observations made that service users have a good relationship with staff. Service users were treated kindly and with respect. Photographs of what staff are on duty are put on a board each day to inform service users of which staff will be supporting them. Due to limited verbal communication skills most service users were unable to talk about leisure, social or educational pursuits. However, staff have a good
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 14 knowledge of service users’ needs, likes and dislikes and try to arrange activities to suit these needs and preferences. These range from walks, swimming, shopping, horse riding, clubs, pubs, cafes and many more. Art & craft sessions are held in the home as well as therapeutic activities such as massage sessions. Relatives said opportunities for activities in and out of the home had improved. One relative spoke about how their relative in the home had never wanted to go out before and was now out a lot more and was also occupied when they were in the house. Service users’ daily records provided information about activities that took place regularly. One service user spoke about going to the shops, enjoying swimming and pub outings. On the day of the inspection, two service users went out for a walk in the morning, one planned to do some shopping in the afternoon and many had massage sessions in the home in the afternoon. Some service users were involved in helping prepare lunch and the evening meal of lasagne. Other staff were observed spending time with service users doing puzzles or just sitting chatting on a one to one basis. Discussion took place with the management about evening activities; although this has improved in terms of planned evening activities, the opportunity for add hoc evening activities are limited by the home’s shift system. The day shift ends at 8.30pm when two night staff come on duty, because of the needs of the service users, more staff are required for activities. The management said they would review the shift system to find a way to introduce more staff to be on duty after 8.30pm to enable more unplanned activities to take place. Relatives said the new management have held regular meetings and provided newsletters to inform them of any changes. They said the staff team are very supportive in how they help their relatives to maintain contact through telephone calls and visits home. Menus are provided on a three weekly rota and are compiled with the staffs’ knowledge of service users’ likes and dislikes. On the day of the inspection, a photographic board described all meals for the day. For lunch, pizza and salad was provided. One service user did not want tomatoes and this was respected. Service users helped themselves to drinks and fruit afterwards. Throughout the day some service users helped themselves to biscuits from the kitchen and fruit from the fruit bowl in the dining room. Drinks were also freely available. The kitchen has a stable door, the bottom half is locked to prevent service users from harm when there are no staff in the kitchen to supervise. This “restriction” has been agreed within care plans and risk assessments and discussed with care managers and relatives. However, the majority of the time there are staff present so that access is not restricted. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in a way they prefer and their health needs are well met. On the whole medication practices protect service users health and welfare. However, some minor improvements in administration records and some practices will further protect service users. EVIDENCE: Staff were seen to help, support and guide service users in a way that was respectful but also kept them safe. Care plans and risk assessments provide staff with good information on service users’ likes, dislikes and preferences. Staff had a good knowledge of the service users’ needs. This will improve further when all assessments and care plans are completed and re-organised. Health care needs are regularly assessed and clearly recorded. Staff write a daily record of all events for each service user. Any health issues are also recorded and monitored. The new care plans will make it easier to monitor health appointments through having a separate health section.
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 16 Medication is supplied in a monitored dosage system and boxes and bottles. It is stored in a trolley, which is secured to the wall and kept in a locked room. Only staff that have received training administer medication. The new management are in the process of arranging up dates in medication training for all staff and intend to assess staffs’ competencies on a regular basis to ensure they remain competent to give out medicines. Medication records were accurate, however, some handwritten entries were not signed or evidenced they had been checked by two staff. This would ensure that handwritten entries are accurate, therefore protecting service users’ welfare and safety. When service users go home for visits to relatives, medication is re-dispensed from the monitored dosage system, into medi-wallets. Two staff check this process and relatives sign to say they have received it. However, on one wallet, the instructions for giving the medication was not clear and the wallet did not describe what medication was in it. This is unsafe, particularly in case of emergencies. Medical professionals would be unable to identify what the medication was and what the dosage was. The manager said this would be rectified immediately. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and service users are assured they are listened to and complaints are dealt with appropriately. Residents are protected from potential abuse through staff’s knowledge of policies and good practices. EVIDENCE: The home has a detailed complaint’s procedure and all relatives and care managers have received a copy. The new management is looking into an appropriate complaint’s procedure for service users with limited verbal communication skills. They hope to seek advice from a speech and language therapist to ensure they use a method that will be useful to service users. Staff have a good knowledge of service users and are able to recognise when service users are unhappy and will work on finding out what the problem is and try to resolve it. Some service users can indicate when they are unhappy. One service user who has complex needs was observed expressing unhappiness. Staff were gentle and patient in trying to resolve the issues. Relatives said, “the new management are so approachable they would have no problem raising concerns and said they know it would be dealt with immediately”. The home and the Commission have received no complaints since the new organisation took over 5 months ago.
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 18 Some of the staff have received training on abuse awareness but many staff are fairly new. The management have carried out an audit on all training for staff and have identified abuse awareness as one area that is needed for all staff, even those who have already received it. The management feel it would be good practice for all staff to receive the same training. Staff spoken with, even new staff, had an excellent understanding of various types of abuse, how to recognise it and what to do if they suspected any. Some staff were aware of policies relating to abuse and the local “alertor’s” guide. Staff said all policies have been reviewed and it was taking time to read through them and to ensure they understood them. The management intend to go through important policies at team meetings and have identified the “alertor’s” guide as one. All service users have individual bank accounts operated by the manager who acts as appointee, apart from one service user, who has a relative acting as appointee. Benefits are paid in directly to these accounts and standing orders are set up to pay fees. Good records are kept of all financial transactions with good auditing processes. This ensures service users are protected from financial abuse. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with clean and comfortable surroundings. The standard of décor, furnishings and fittings within the house needs to improve to provide a more homely atmosphere. To protect service users from harm better risk assessment of the building need to be completed. EVIDENCE: Since the new organisation has taken over the running of the home, the management have completed an audit of the environment. Many areas were identified for improvement. In some cases immediate work had to be completed to ensure the home was safe for service users, for example, a new fire panel had to be fitted and repairs made to the roof. Some bedrooms have also been re-decorated and some carpets have been made safe. However, many areas of the home are looking very “tired and tatty”, the kitchen in a particular is in a “run down” state, the hall carpet needs replacing and the upstairs corridors need re-decoration. The management have compiled an improvement plan and prioritised work. However, there are no time scales
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 20 given for the work that is lower in priority. This would re-assure service users, relatives and care managers. Also, areas that require replacement and are slightly unsafe have not been assessed for potentially causing harm to service users and staff. For example, hot water from taps in wash hand basins, a bath panel in a bath downstairs, which has a large crack. Assessments of hazards need to be completed to ensure staff are aware of how to keep risks of harm to service users to a minimum. All staff spoken with said it would be nice to see improvements to the home and felt it would be completed over time. The management already had plans drawn up for a new kitchen and arranged quotes for the replacement of carpets. A maintenance man has now been employed and was observed decorating an area of the home. Service users’ bedrooms are bright and cheerful and decorated and furnished to their own tastes and preferences. One service user has a key to their room but all others are unable to use a key. The management are looking into more suitable locking systems. On the day of the inspection the home was bright, cheerful and clean, service users were observed enjoying the space provided, including the gardens. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by caring staff that meet their needs. This will be further enhanced when all training has been completed. Service users are protected by robust recruitment procedures. EVIDENCE: The manager provides 4 staff on duty until 8.30pm and two staff awake at night. The manager said this is flexible and some day staff will stay on longer to enable planned evening activities to take place later than 8.30pm. During the inspection service users’ needs were observed being met effectively with the numbers of staff on duty. Relatives spoke highly of the staff team and one said “the atmosphere is so cheerful and relaxed now”, another said “the staff seem so much more positive since the new company took over”. A staff member who responded to a survey said “The new management are good at getting things done when you ask, they consider it and act on it as soon as they can”. They also said “ the changes that have happened in such a short space of time has been great, it’s all going so well and the home is starting to
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 22 feel more stable and working well”. The staff spoken with during the inspection made similar comments. One service user said they “did more” and said the staff were “good”. The management have completed an audit of staff training and have identified new training and updates necessary to ensure service users’ needs are met consistently and safely. All staff have been registered to complete units 1 & 2 of the Learning Disability Award Framework (LDAF), these are normally induction units for new staff and provide basic knowledge of the care necessary in learning disabilities services. The management felt it would be useful for all staff to receive this training and qualifications, even those who have already achieved National Vocational Qualifications (NVQ). 38 of care staff have obtained NVQ qualifications at level 2 or above. Many new staff have started working at the home, the management hope once staff have completed their LDAF qualifications more will be registered to complete NVQ, taking the percentage to over 50 , which is the standard that needs to be obtained. A new staff member was spoken with on the day of the inspection. She described the induction process she went through before working with service users and the continuing training she receives. The training is very detailed and includes all aspects of health & safety and practice issues, therefore ensuring service users’ safety and welfare is protected. All staff spoken with said the training has improved so much, which they found reassuring and useful. Training was arranged for the next day on Total Communication. This will help staff understand various ways of communicating with service users who have limited verbal communication skills. Three staff files were read. Recruitment practices were found to be robust and protect service users from potential abuse. This includes ensuring new staff do not work in the home until satisfactory police checks are completed and appropriate references are obtained. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is excellently managed with systems that review, develop and improve the home, which ensures the home is run in service users’ best interests. Improvements are needed to protect service users’ confidentiality through record keeping. Service users safety and welfare are well protected. EVIDENCE: The manager has many years of experience in the care sector and in managing staff. She has obtained a level 3 in NVQ, completed the Registered Manager’s Award and intends to complete NVQ 4 in care. Staff spoke very highly of the manager’s leadership style and said she provided an excellent and clear sense of direction and was extremely supportive. One
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 24 service user said they “liked the manager”. Feedback from a relative said, “The staff and management are so approachable, they keep us informed and consult about my relative’s care”. Throughout the inspection the manager was observed being kind and respectful to service users and providing good direction to staff. The Responsible Individual, representing the organisation was well respected by staff and relatives and was observed working well with staff and service users throughout the day. Regular meetings are held with staff, relatives and care managers, news letters are produced for relatives and care manager to keep them up to date with any changes in the home. The management have worked hard to audit all policies, procedures, training and service users’ records in the short time they have taken over the running of the home. They have involved relatives and care managers in these reviews and have achieved a lot of progress towards improving all aspects of the service. The management have produced a development plan for the continuing improvement. Once this work is completed, the organisation has an excellent quality assurance system that includes seeking the views of service users, relatives, staff and outside professionals to ensure the home continues to be run in service users’ best interests. Some records relating to service users’ care was not recorded and kept in line with the Data Protection Act. This means that personal details of service users were recorded on the same page as personal details of another service user. If professionals wanted to look at information relating to their service user, they would also be able to read confidential information about another service user. This was discussed with the management who said they find and new system of recording to ensure confidentialities are protected. The Responsible Individual carries out monthly visits to the home, where inspections of records, including financial records, observations, and environmental checks and talking with staff and service users takes place. Reports are produced and copies are sent to the Commission. The fire logbook was found to be up to date and accurate. Fire risk assessments and staff training were completed, therefore protecting service users safety and welfare. The CSCI obtains information prior to inspections. The information includes conformation that all necessary policies and procedures are in place and are up to date. These are not inspected on the day but the information is used to help form a judgement as to whether the home has the correct policies to keep service users and staff safe. In this instance policies and procedures were in place. These along with risk assessments are reviewed regularly and are up dated where necessary, to ensure they are appropriate and reduce risks to staff and service users.
Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 4 X 3 X 2 3 X Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 26 N/A 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. Standard Regulation Requirement Timescale for action 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 YA14 YA20 Good Practice Recommendations Service users should be given the opportunity for add hoc evening activities beyond 8.30pm and a review of the home’s shift system will be necessary. Handwritten entries on medication administration sheets should be checked and signed by two staff to ensure service users’ health and welfare is fully protected. Any containers used for re-dispensing medication should be clearly labelled with clear instructions and what the medication is. Time scales for identified improvements to the environment would reassure service users, relatives and care managers of when work will be completed to improve the physical environment. Where there are areas that the physical environment may cause a risk to service users, clear risk assessment should be completed to minimise the risk of harm to service users or staff. Records should be maintained in accordance with the Data
DS0000067786.V325237.R01.S.doc Version 5.2 Page 27 3. YA24 4. YA41 Forge House Protection Act to ensure service users’ confidentiality is protected at all times. Forge House DS0000067786.V325237.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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