Inspection on 28/09/06 for Inglenook House

This inspection was carried out on 28th September 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Inglenook House 04/09/07

Inglenook House 07/03/06

Inglenook House 19/09/05

Inglenook House 19/10/04

Inglenook House 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Inglenook House 46 Lipson Road Lipson Plymouth Devon PL4 8RG Lead Inspector Helen Tworkowski Unannounced Inspection 28th September 2006 9:45 Inglenook House DS0000003533.V302627.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 Inglenook House DS0000003533.V302627.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 Older People and 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. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Inglenook House Address 46 Lipson Road Lipson Plymouth Devon PL4 8RG 01752 229448 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) Jan Limited Dawn Florence Bartlett Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (10), Physical disability (10) of places Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Learning disabled adults some of whom may have a physical disability Age 18yrs Date of last inspection 7th March 2006 Brief Description of the Service: Inglenook House is a care home Registered to accommodate 10 Adults with a Learning Disability, some of whom may also have a Physical Disability. The range of needs catered for includes, adults with medium to high levels of dependency. The house is a large, mid-terraced property situated in the Lipson area of Plymouth and is close to the city centre and local shops and parks. Service users are accommodated in six single, and two double bedrooms. There is a large lounge, separate dining area, kitchen, laundry, and garden/patio area. There is level access to the rear of the property and a ramp that can be fitted to the front access to support service users requiring the use of a wheelchair. The fees charged are currently between £393.59 and £932.43. Additional charges are made for Hair dressing (£6), Chiropody (£7.50), toiletries (varies), Luxury items (varies), and holiday spending money (varies). Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this inspection two visits were made to Inglenook: 28th September 06, 9.45am to 3.20 pm and on the 4th October 9.54 am to 3.00 pm. As part of these visits the Inspector toured the home, looking at the environmental standards. The Inspector spoke with the manager and two of the staff about aspects of the service. Various records were inspected; these included those for Service Users, staff and in relation to Health and Safety. The Inspector spoke with two service users and spent time with other service users, including sharing a meal. In addition to these visits nine service user surveys were sent out, of which four were returned. Ten staff surveys were also given to staff, and three were returned. Surveys were also sent to the local GP, a physiotherapist, and the Team Manager of the Learning Disability Team. Only the local GP responded. The Inspector spoke to Speech Therapist, Care Manager and Day Centre worker in relation to an individual Service User. What the service does well: What has improved since the last inspection? Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 6 The process of improving Service User Plans has started though has not been completed. These plans should help ensure that an individual’s needs are known and consistently met in an agreed way that suits that individual. Bank Accounts for individual Service Users have been opened, though improvement work was identified in relation to the payment of benefits. 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. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, (1), 2 (3). Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users can not be confident that all their needs will known prior to a move to Inglenook and that these needs will be properly recorded. This could mean that needs are not consistently met. EVIDENCE: One person was due to move into Inglenook a few days after the first site visit to Inglenook House. Information had been received from the specialists working with the person. This information did not cover all of the persons needs. The Inspector was told that staff had received training from behavioural specialists so that they were familiar with aspects of the individuals needs. The Inspector was also told that staff had visited the individual and got to know Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 9 about the person’s needs. However all of this information had not been written down. It is important not only for individual staff to know about a person who is to live at Inglenook, but that this information is recorded. It provides a “base line” for comparison for the future, it is part of the process of ensuring no needs are missed and is the basis for the drawing up a Service User Plan, which documents how needs will be met. The Inspector was told that following discussions with professionals providing care and support to the individual it had been agreed no introductory visits would take place, however the person was given a Service User Guide with photographs, and had met staff. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) 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, and 9 (7, 14, and 33) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service User needs are known to staff however documents that should help ensure there is consistency lack detail. EVIDENCE: The Inspector looked in detail at Service User Plans for three people, at the plan for the person who was about to move, and briefly at a further plan. Service User Plans are documents that are drawn up from assessments of needs. The Service User Plan must contain clear information about how needs will be met and reflect the person’s history, culture and preferences. The Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 11 Inspector was told that Service User Plans were in the process of being revamped so that they contained more detailed information, however this process had not been completed. One of the Service User Plans, which had been revamped, contained clear information about how needs were to be met. Two others contained less detailed information, and had not yet been revised. One further Service User Plan did not contain comprehensive information, particularly in relation to health care needs. The Inspector was told at the first site visit that there was no Service User Plan for a person who was to move to the home three days later, as staff did not know enough about the person to write a plan. All Service Users must have a Service User Plan at the point they moved to the home, unless the admission is in an emergency. If a care home has insufficient information to draw up a Service User Plan, then it has insufficient information to admit that individual and to provide a service. The Inspector spoke with staff about the needs of the people in the care home, and staff did have a good understanding of needs. The Inspector also spoke with one Social Services Care Manager who confirmed that they were satisfied with the Care Provided and a Day Service Worker who confirmed that Service users were well presented. There were risk assessments on file, however these documents were not clear and did not identify what the actual risks were and how these risks might be eliminated or managed. One person had had a series of falls, the risk assessment in relation to these was not well recorded: accident reports were not always filled out, some information was recorded in the daily notes. There was no overview of this individual’s falls, which would be useful in understanding what was happening and in preventing future falls. In spite of the lack of proper records there was evidence that action had been taken to avoid future falls, advice had been sought and additional rails fitted. Service Users were observed making choices about how they spend their time, about the sort of food they are to eat and about trips out. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) 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, 16, and 17 (10, 12, 13 and 15) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 13 Service Users are given support to participate in a range of activities, both in the home and in the community. EVIDENCE: Staff told the Inspector that food is cooked from fresh ingredients each day. Service Users are involved in choosing meals from a number of recipe books. Individual dietary needs are taken into account. On the first visit to Inglenook, one service user was involved in helping to prepare the evening meal. The Inspector ate one meal with Service Users, they clearly enjoyed the meal and were given appropriate support to eat, and were encouraged to be as independent as possible. There is limited space in the lounge, and whilst staff are able to sit and eat with Service Users for some meals, if every one is home then this is not possible. It is important for staff to eat with Service Users so that they can provide support, but so that they can also provide a good model at meal times. Each of the Service Users has a plan of the week with activities they are to take part in. The loss of Social Services Day Centre’s has meant that staff have had to find alternative activities for service users; this process is on going. During the second visit to Inglenook, many of the service users went out shopping or for a drive. Service Users who stayed at home spent time in their rooms, watching TV, talking with staff, or doing puzzles or games. In the afternoon of the second visit a number of service uses went out for a drive in the minibus for an ice-cream. There was clearly a positive rapport between some of the Service User and staff. It is recognised that finding interesting and suitable activities for Service Uses can be very challenging. It is recommended that the process Inglenook has started is continued; an emphasis needs to be placed on activities so that they are suited to the individuals and their interests and reflects the fact they are adults. For example rather than doing children’s’ jigsaws- it might be possible to sort out materials for recycling. Where Service Users have families, contact is supported and maintained, this includes visits and via phone calls. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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 and 21 (8, 9, and 10) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users are treated with respect and dignity by staff. There is a commitment to supporting service users with their changing health care needs. Aspects of the medication system were not thorough, with out of date medication and inappropriate procedures that that could have put Service Users and staff at risk. EVIDENCE: Care staff manage all of the medication at Inglenook. The home uses a monitored dose system, which is provided by a pharmacist. One of the Senior Care Staff showed the inspector the system. The system was generally well Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 15 managed and drugs were being administered as prescribed. There were however some areas of concern. One lot of medication in use had passed it’s expiry date. Some medication that was in “blister packs” and to be used “as required”, was again old and had started to visibly deteriorate. Controlled drugs were not being stored as such, being recorded in a controlled drugs book with double signatures. Insulin was being administered by staff who have not received training from a medical professional authorised to do so- e.g. a diabetic nurse. But were being trained by another member of staff. This “cascade” training is not acceptable in relation to administration of insulin. It was also noted that staff were placing themselves at unnecessary risk of needle stick injuries, advice must be sought to ensure that this avoided. The staff spoken with had knowledge of medication and were aware of how to obtain information if they did not know something. Some medication is offered “as required” or “p.r.n”, no guidance is available to staff as to when this must be offered. Guidance, agreed with relevant professionals should be available to staff to specify when and under what circumstances such medication should be given. Four Service User Surveys were returned to the Commission, all four people responded that they felt that staff treated them well and that carers listened and acted upon what was said. The Inspector spoke with one Service User about the care and support he received and he felt that he was well supported. The Inspector observed other Service users over the two days spent at Inglenook- all the Service Users were well dressed, in clothes that suited them. When anyone needed changing this was done quickly and quietly. The Inspector spoke with a Speech Therapist about the support offered at Inglenook in relation to supporting an individual with their communication. The Speech Therapist said that she had discussed concerns with the manager of the home with the regard to staff having a negative attitude towards one person, who presented the service with challenges. As has already been noted earlier in this report not all health care needs have been thoroughly documented in relation to diabetes. However it was clear that staff at Inglenook were not complacent about health care needs. Service users were attending regular appointments regarding their health. Where a Service users needs had changed markedly through an illness then they were supported to continue to be able to live at Inglenook. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) 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,and 23 (16, 18, 35) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service Users and their representatives are able to raise concerns about the service, if they should wish to. There are systems in place for protecting service users from abuse, however those systems in place to manage service users monies are not appropriate. EVIDENCE: No complaints have been received by Inglenook or by the Commission since the last inspection. There is a complaints procedure in the Service User Guide, though many of the Service Users would not be able to access this themselves, they would need support or for someone to act on their behalf. The Inspector was told that Service User Meetings usually follow staff meetings, but there is no record of these. Many of the Service Users might not have the communication skills to actively participate in such a meeting. Inglenook has a system for finding out the views of people who visit or have contact with the service. The Inspector was shown a series of surveys that had been completed by relatives, these expressed very positive views about the home and the quality of the service offered. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 17 All three of the staff completing staff surveys confirmed that were aware of adult protection procedures. They also confirmed that they were never asked to care for people outside their area of expertise. Where staff have difficulties working with individuals this can often lead to staff behaving in an inappropriate or abusive way. It was noted at the last inspection that Service Users money was being paid into a bank account relating to the business. A requirement was made at the last inspection requiring that the home provides the Commission with information about the individual accounts set up to manage each person’s money. The Inspector was advised that the home is in the process of setting up individual accounts for Service Users. The Inspector was advised that the Disability Living Allowance is currently paid to the Care Home not to the individual. The Inspector has discussed with the Registered Provider the issue of Disability Living Allowance- Mobility Allowance. This benefit belongs to the Service User, and is paid to the Service User because of difficulties with their mobility. It does not belong to the Care Home. It is noted that the home provides two minibuses that Service Users use and that the Service Users mobility allowance helps fund these. If Inglenook wishes to make a charge for optional services provided, such as the use of the minibus, then this must be clear in the contract. If the charge for the use of the minibus is not optional, then it is part of the “fee”, and needs to be referred to the contracting organisation (usually social services). Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service Users live in a clean, safe and comfortable home. EVIDENCE: The Inspector toured the whole of the house. It was well decorated, clean and comfortable. Some service users had chosen to decorate or furnish their rooms Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 19 in a manner that reflected their interests and personality. Other rooms had few personal items on view, the inspector was told that this was because service users either had no interest or removed such items. Two of the bedrooms are double rooms; staff confirmed to the Inspector that each person has their own storage space for clothes and personal items. Some of the Service Users use wheelchairs or have difficulties with mobility, there is level access on to a patio at the rear of the house, and there is a small ramp for use at the front. The Inspector observed one service user moving around the house in a wheelchair, and whilst this was possible, doorways did pose some difficulties. As has already been noted handrails have been fitted to aide mobility. It is recommended that consideration is given to fitting self-closing devices to toilet and bathroom doors, so that the privacy of service users is maintained when they fail to shut doors. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) 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 (27, 28, 29, 30) 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 trained and competent staff, though recruitment procedures are not robust and do not ensure that where ever possible service users are protected from abuse. EVIDENCE: The Inspector looked at three staff files to see how staff were recruited. Each file had an application, though not all of these applications gave a clear work history, and there was no record of one being taken at interview. It is an important part of staff recruitment to find out what a person has been doing during their career, and to account for any gaps. This is part of the process of Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 21 checking that staff are competent and suitable to work in a care home. There were two references on file for each individual, however it was not clear how these related to their previous employment. For one person the references indicated that they had started with only one written reference, rather than two. However the file of another individual indicated that a there had been a more thorough recruitment process, with a total of three references taken. Each person had a copy of a Criminal Records Bureau check on his or her file, and there was evidence that a Protection of Vulnerable Adults check had been made on two of the people, before they started work. However one of the CRB checks related to previous employment, such CRB checks cannot be transferred between employers. There was evidence on file of an induction and there were individual staff training records on file. Two of the Staff responding to the Staff Survey said that they had had an induction; the third person said that they did not have one. The inspector and manager discussed how a staff training overview would be useful in identifying training needs. Two of the three staff completing the survey felt that they had sufficient training, whilst a third did not respond. The Inspector spoke with a member of staff who said that felt well supported, they received supervision and that that they had had a range of training. The staffing levels at Inglenook vary- most days there are four care staff on duty during the day, with one care staff on duty awake at night and one asleep. One of the staff noted that there was a lack of staff, however the Inspector considered that there was sufficient staff, to meet the needs of the Service Users at Inglenook. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Inglenook is a well managed and safe home. EVIDENCE: Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 23 Mrs Dawn Bartlett is the Registered Manager and was at Inglenook for much of the inspection. Mrs Bartlett demonstrated a good knowledge of the needs of service users, and acted as a positive role model for staff during the visits. Staff completing the surveys commented that they are provided with support from their manager, however one person would have like more communication between staff. During the inspection staff were supportive of each other and appeared to work well as a team. As has already been noted earlier in this report the home has a Quality Assurance system, and questionnaires are completed by visitors to Inglenook. This inspection was unannounced, records were found to be generally in good order. Staff knew were things were kept, and could easily lay their hands on any records requested. These were generally up to date, clear and well laid out. As has already been noted improvements are needed in relation to Service User records. There is a system for completing monthly Health and Safety checks of Inglenook, where issues or repairs are identified these are reported. A general Risk Assessment has been carried out for the premises, though not all identified recommended actions are carried out- for example in relation to checking water temperatures. There is a fire risk assessment, and the majority of recommended actions are being carried out, however it was identified that the training of night staff in relation to fire safety was less frequent than had been recommended. Overall the building was safe well maintained and staff were aware of any repairs or difficulties. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 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 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT Standard No Score 37 3 38 x 39 3 40 x 41 x 42 3 43 x 2 3 x 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Inglenook House Score 3 3 2 X DS0000003533.V302627.R01.S.doc Version 5.2 Page 25 No 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 YA23 YA7 Regulation 20 Requirement The Registered Person must not pay money belonging to a service user into a bank account unless the account is in the name of that service user. Benefits paid to the Service User must not be paid into the Care Home’s own account. The Care home may make charges for services provided. Prospective Service Users must be fully assessed and their needs known and recorded, prior to admission to the care home. Service user plans must be further developed to include sufficient detail relating to all areas of care. This must include health care needs such as diabetes. The Registered provider should give consideration to incorporating Person Centred Planning into the care planning process to ensure a more holistic and long-term outlook. The Registered Provide must ensure that risks are assessed DS0000003533.V302627.R01.S.doc Timescale for action 01/01/07 2 YA3 14 01/01/07 3 YA6 15 01/01/07 4 YA9 13 01/01/07 Page 26 Inglenook House Version 5.2 5 YA20 13 6 YA20 13 7 YA20 13 8 YA34 17, 18 and managed to enable Service Users to benefit from active lives. There must be clear guidance to staff on the administration of as required medication, and the circumstances when it may be administered. Staff who administer medication such as Insulin must be trained by a competent person, and the appropriate medical professional must sign to say that the individual is competent. Medication must be properly audited, so that no out of date medication is administered. A record of controlled drugs must be kept. The Registered Provider must ensure that prior to employment they have completed checks on a prospective employee to ensure that they are suitable. These checks must included two written references and a “POVA First Check”. And until a CRB check has been completed the new employee must be supervised, by a named person, in their work with Service Users. 01/01/07 01/12/06 01/12/06 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard YA12 Good Practice Recommendations The Registered Provider should ensure that a Person Centred approach is used when considering and planning day time opportunities and activities for service users. Consideration should be given to ensuring that these are age appropriate. DS0000003533.V302627.R01.S.doc Version 5.2 Page 27 Inglenook House 2. YA29 The Registered Provider should ensure that access arrangements continue to be appropriate for service users with a physical disability and requiring the use of a wheelchair. Inglenook House DS0000003533.V302627.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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Inglenook House DS0000003533.V302627.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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