Inspection on 04/09/07 for Inglenook House

This inspection was carried out on 4th September 2007.

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

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

Other inspections for this house

Inglenook House 28/09/06

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 4th September 2007 9:50 Inglenook House DS0000003533.V344658.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.V344658.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.V344658.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) clearviewpl4@btopenworld.com 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.V344658.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 28th September 2006 Brief Description of the Service: Inglenook House is a care home registered to accommodate ten 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, terraced property 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 between £394and £933. Additional charges are made for Hairdressing, Chiropody, toiletries, Luxury items, transport, and holiday spending money. The Statement of Purpose and Service User Guide are available from the office at Inglenook, and each person at the home has their own copy. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit for this inspection started at 9:50am and finished at 5.50pm. During this visit we spoke to the Manager, to staff and spent time talking to or sitting with Service Users. This inspection included a tour of the house; and the medication and service users finances were both checked. We also specifically looked at the care of three of the people who at Inglenook. We looked at many of the records: care and health plans, daily recording, risk assessments and staff records. We spoke with many of the staff on duty that day, and also sent surveys to staff. In addition surveys were sent to most of the service users and to relatives or advocates of service users. We spoke to one visiting medical professional about the standards of care. What the service does well: What has improved since the last inspection? Service Users money used to be paid via the business account. Individual accounts have now been set up for each person, so that their money can be paid direct to them. A new admission document has been drawn up; this should help ensure that new people’s needs will be well known before they move to Inglenook. The detail in Service User Plans has improved; this should help ensure a better consistency of care. There is now clear information in Service User Plans about when to give some specific “as required” medication, this guidance had been agreed with the G.P. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 6 All necessary checks are now being made in relation to the recruitment of staff. This helps ensure that only the staff who are suited to work with vulnerable people are employed. Improvements are being made to the bathrooms and allocation of bedrooms so that the needs of Service Users can be better met. One relative commented, “They are happy to alter situations to suit individuals to maintain their clients quality of life”. 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. The summary of this inspection report can be made available in other formats on request. Inglenook House DS0000003533.V344658.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.V344658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users can be confident that staff will know their needs before they move, and that they will be given information about the home. EVIDENCE: The last person to move to Inglenook moved at the time of the last inspection, and comments were made in the previous inspection report. Inglenook was asked to ensure that any one moving to the home in the future would be fully assessed. At this inspection we were shown a new form that had been devised to ensure that assessments were more comprehensive. The Inspector discussed with the Manager, the importance of the information that is collected in the document. The Annual Quality Assurance Assessment (AQAA) completed by the Manager says that one of the ways that they have improved Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 9 in the last 12 months is that the “assessment forms now contain a section on Service User aspirations.” The Inspector was told by the Manager, Dawn Bartlett, that the Statement of Purpose and Service Users Guide have been recently updated. These documents provide information about the home to the people who live in it, or who might wish to move. We reminded the Manager of the need to inform the Commission of any changes to these documents. Inglenook House DS0000003533.V344658.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Staff needs are generally known to Service Users. Service Users and their relatives feel that they receive the support they need. EVIDENCE: We also looked at the surveys from five of the service users. Four people said that staff always listened and acted upon what they said, and the fifth person said that they sometimes did. All of the five relatives who responded to the survey said that they felt that Inglenook gives the care that they expect or have agreed. One person said that their relative “always looks well groomed and clean and I have no complaints”. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 11 The Care Plans or Service User Plans relating to three people were looked at during this visit. These documents contain information about how each person’s needs are to be met. The plans looked at during this inspection had been amended since the last visit. They contained more detail, and some contained specific guidance to staff on how each person was to receive help to get up and start the day. Some of the people at Inglenook would not be able to explain this themselves, so it is important that staff know what has been agreed as the best way. Health Action Plans had also been completed. These documents are to help everyone involved with the Service User to understand their health needs, and how they are to be met. They also record particular visits to the see health professionals. See section on Personal and Healthcare Support. There are risk assessments on file for each person. These documents should identify how risks will be managed. Not all of these documents had been signed and dated. One concern raised at the last inspection was regarding the number of falls experienced by one individual. The Inspector was told that the staff had worked with the individual and other professionals on ways that these falls could be better managed, and were adapting the environment to take account of these needs. The Inspector spoke to two staff about whether they were aware of what was in the Care Plans. One said that they were, another person said that they were not, and that they had never been asked to read them. It is recommended that there are systems in place to ensure that all staff have read and understood the plan. We also looked at the surveys from five of the service users. Four people said that staff always listened and acted upon what they said, and the fifth person said that they sometimes did. All of the five relatives who responded to the survey said that they felt that Inglenook gives the care that they expect or have agreed. One person said that their relative “always looks well groomed and clean and I have no complaints”. Information about Service Users needs is kept in the office or in a locked cupboard, so that the information is kept confidential. Inglenook House DS0000003533.V344658.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. JUDGEMENT – we looked at outcomes for the following standard(s): Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 13 12, 13, 14, 15, 16, and 17. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Service Users have the opportunity to take part in activities on a regular basis, however these are generally as a group. There is a lack of opportunity for Service Users to take part in day-to-day activities on an individual such as going shopping or out to the hairdressers. Service Users enjoy a good standard of meals. EVIDENCE: On the day we visited Inglenook seven of the people went out for the morning to a music and movement workshop. On return some of the people said how much they had enjoyed this. The Manager said that she was looking at trying to arrange a new timetable so that the people what Inglenook had plenty to do. The Inspector looked at the daily notes to see what three of the people had been doing for the last week. These said that people had been out on some of the days trips out, as a group. One the issues raised by some of the staff in surveys was that there was not enough time for one to one sessions with Service Users. One member of staff said “I would like for the service users to be doing more things instead of sitting down doing nothing”, and “the service users never get out a lot apart from a ride around Plymouth in the minibus”. The AQAA completed by the Manager states that one of the things that they will be investigating opportunities in the community for Service Users. One relative commented in a survey “Now the day care centre that my relative attended has been withdrawn it would be nice to see the home acquire more facilities to keep my relative occupied during the day.” As part of this inspection we looked at Service Users finances, it was noticed from the receipts, that Service Users did not always accompany staff to purchase their clothing or shoes. Also that when toiletries were purchased they purchased as three month supply. It is appreciated that at times some individuals might find shopping very disturbing, and that it might not be appropriate for them to always go shopping. However going shopping can is an opportunity for people to develop their skills and can be an interesting way to spend time. Service Users should be involved in their own choice of clothes and should have the opportunity to try on shoes before they are purchased. It was also noted that all of the people in the house had their haircut at Inglenook by a visiting hairdresser. Again whilst this may suit some people, it might not suit everyone. Such practices as everyone having the same hairdresser who comes to the house reflect an institutional approach to meeting people’s needs. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 14 The Inspector was told that Service Users are involved to some extent in choosing meals. The menu book contains information about the meals eaten and sometimes who has chosen the meal. One person told the inspector the food he liked to eat, and on checking there were meals that he had chosen on the menu. The fridge was full of food, and there was fresh fruit and vegetables in the house. The Inspector spent time in the house whilst people were eating, and they clearly enjoyed the food. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users cannot be confident that staff will have the knowledge and skills to meet all of their health needs or of the medications that they need. EVIDENCE: The five service users who responded to the survey all felt that they were treated well, and all of the relatives responding to the survey felt that the care and support was always or usually given as agreed. All of the Service Users were well dressed, and one relative commented in a survey that her relative “always looks well groomed and clean”. It was noted Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 16 during the inspection that Service Users were treated with respect, they were spoken to by staff in an appropriate manner. As has been noted earlier in the report the Inspector was shown Health Action Plans. These Plans contain information about their health and how these needs will be met. The Inspector spoke with a visiting health care professional about how the staff meet the changing needs of one person. She said that she had provided advice about different equipment and furniture, this had been provided. She said that she felt that staff were open to advice, and followed this advice. The medication system was looked at as part of this inspection. A monitored dose system prepared by a pharmacist is used. This was in generally good order, and when the Inspector looked at the records the medication that should have been administered was signed as such. At previous inspections concerns had been raised that there was not enough information for staff to know when to give “ as required medication”, this has now been provided, and was in the Care Plans. There had also been training for staff from the district nurse in relation to administering insulin and checking blood sugar levels. The Inspector spoke with staff about what they knew about dealing with diabetes, and was told that the only information that they had was from previous knowledge and through talking with other staff. One person when asked about how they would manage a hypo/hyperglycaemic attack said that they would be floundering. The Inspector was told that staff administer suppositories to Service Users where prescribed. This is an invasive procedure and should only be done after the staff have received suitable training and been given the delegated authority of the relevant medical professional to administer this medication. The Inspector asked one of the staff about a particular medication that has to be given in a specific way. The staff was not aware of it, nor was the manager. However there was a letter on file from the doctor telling the staff that they needed to look at the leaflet about the medication. This meant that the medication would not be as effective as it should be. The leaflets supplied by the pharmacist did give this information and were in the office. The Inspector also discussed the point that it was not clear, with some medications that are given as required, how much medication was actually in the home at any one time. They was no proper audit of medication. It was also noted that no check had been made on the temperature of the medication fridge since 8/1/07. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users and their representatives have the confidence to raise concerns should they feel the need to do so. There are good records of money held or managed by staff at Inglenook, however money is not always well managed, and Service Users are not well safeguarded from financial abuse. EVIDENCE: No complaints have been received by the Commission about the home, and the “AQAA” completed by the manager also states that they have not received any. All of the Service Users completing the survey said that staff always or usually listened and acted upon what they said, however Service Users generally did not answer the question about how to make a complaint, although three people said they knew who to speak to if they were not happy. All of the relatives who replied to a survey said that the care service responded appropriately if concerns were raised about care. One relative said with regard Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 18 to complaints “This is not a problem we have encountered as we feel free to talk to the management at any time” and another person commented, “Never had the need to make a complaint”. As part of this inspection we were shown a training plan that indicated that training in relation to the protection of vulnerable adults was part of the training staff were expected to complete. The “AQAA” completed by the Manager states that staff complete POVA (Protection of Vulnerable Adults) training. The Inspector was told that where a decision about a change of rooms between two service users was being considered, advocates and relatives were involved so that it was clear that service users were not being pushed into decisions that they did not want or were not in their interests. At the last inspection concerns were raised that a benefit that paid in relation to difficulties with mobility was being paid to the care home, accounts have now been set up so that this money is paid to the individual. The care home is now making charging for transport. From the information supplied to the Inspector the amount each person must pay to use transport depends on how much benefit they receive. As part of this inspection we looked at how the accounts were managed. It was possible to see Service Users money leaving Post Office Accounts and appearing in the cash record in the house. It was noted that in three of the accounts of Service User’s money held in the house, that on occasions large sums of cash £200 or £300 left the account. The receipts for and change from this did not appear back in the record until four to six weeks later. The Inspector was told that this was when clothing, shoes and toiletries were bought for service users. When the receipts were examined it could be seen that the purchases had been made on different days. It was clear that the Service User was not present on many of these occasions; the Manager confirmed that she believed this to be the case. If money is spent on behalf of a Service User, the individual should be present and involved in that expenditure whenever possible. The change and receipts should be returned to the house the same day. It was also noted that on some receipts that “points” had been collected e.g. “Nectar points”. The Inspector asked if the Service User had the relevant card to collect these points, the Manager said that they did not. The points belong to the Service User and have a value. Staff should therefore not be benefiting from these points. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users benefit from clean and comfortable accommodation however the lack of communal space and limited disabled access means that the house is crowded and difficult to move around, particularly for those in wheelchairs. EVIDENCE: The Inspector looked around the house, with the exception of one bedroom where a Service User was asleep. It was well decorated and generally Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 20 comfortable. Some of the Service Users had chosen to decorate or furnish their rooms in a manner that reflected their interests and personality. Two of the bedrooms are double rooms and staff confirmed that each person had their own wardrobe and chest of draws. All of the Service Users responding to the survey said that they house was always or usually fresh and clean. Three of the people living at Inglenook now use wheelchairs. The Inspector was told that the ground floor bathroom is being changed so that it better suits the needs of people in wheelchairs. The Inspector was also told that discussions were being held to see if two service users were happy to change rooms. It was noted at the last inspection that service users had some difficulty moving around the house due to the narrow doorways. It was also noted that the dining room and lounge offer limited space for the ten service users who live in the house (three of whom use wheelchairs) and for the four staff who may be on duty. The Inspector spoke to one of the staff who explained that there is insufficient space for wheelchairs in the lounge, and they are “parked” in front of arm chairs or sofas. This means then means that there the person in the wheelchair would have difficulty communicating with the people sitting beside them. The staff said that the lack of chairs and space meant that sometimes people had to sit behind the person in the wheelchair. The laundry is an external basement area. This room is also used for general storage and for the storage of waste bins and yellow bags containing clinical waste. In addition the room is used to store freezers with food in them. The advice of the Environmental Health Officer must be sought to advise on the appropriateness of such storage. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users are supported by staff who are generally well trained and who have been recruited through a robust recruitment procedure. EVIDENCE: We looked at the recruitment records of four people who had started work in the home since the last inspection. These records were in good order, references had been taken and received prior to the individual starting work. Checks has also been made regarding whether the individual had been referred to a list of people who are not suitable to work with vulnerable people or as to Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 22 whether they had an Criminal Record. One area that could be improved is that it was the employment history for some individuals had gaps. The “AQAA” completed by the Registered Manager shows that 54 (6 out of 11) of staff have NVQ2 or above whilst a further three individuals are working towards this. This document also shows that two staff are working towards a Learning Disability Award Framework (LDAF) award. The Inspector was told that each person received a 4-day in house induction when they started work at Inglenook, and that there were plans to introduce a new more comprehensive induction. There was evidence of training in relation to some aspects of the work such as Fire, medication, food safety, moving and handling. However it has already been raised in other areas of the report staff were unaware of how to deal with some of the situations they came across- for example in relation to diabetes. The AQAA states that there has been improved staffing to compensate for the reduced level of day care provision. There were no indications from the time spent in the home that there were insufficient staff. Staff did comment to the inspector though that there was a lack of planning at handovers. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a safe and well-managed home. EVIDENCE: Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 24 The Manager, Dawn Bartlett, has worked at Inglenook for many years and has significant experience of working with people with a learning disability. Ms Bartlett was present during much of this inspection. Six of the eight staff completing surveys felt that they had enough support to do their job well, and confirmed that they received formal one to one supervision. The staff records looked at during this visit confirmed this. Two staff made comments on the surveys about the lack of staff meetings, and that there was a lack of communication with management. A staff meeting was planned for shortly after this inspection, there had been no meeting for some time. The home had received a visit from a health and safety consultant company on 12/5/06. As a result of this visit various recommendations were made, the Manager told the Inspector that she did not know if these recommendations had been dealt with. There was no information as to whether a Legionella Risk Assessment had been carried out. A Fire Risk Assessment had been carried out and dated 6/8/06, but had not been reviewed since. It is important that these documents are reviewed, at the frequency defined by the assessment. There is a quality assurance system and surveys were sent out May 2007. As has already been noted the survey of relatives shows that all the people who responded to the survey said that the care service always responded appropriately to concerns raised. As a Company runs Inglenook, monthly-unannounced visits must be made by a representative of the company to check upon the running of the home, a report must be made of these visits and copies sent to the Commission. It was apparent that representatives had regularly visited the home, however the Commission had received no reports of these visits. Inglenook House DS0000003533.V344658.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. 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 3 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 2 43 X 3 3 x 3 x LIFESTYLES Standard No Score 11 X 12 3 13 1 14 3 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Inglenook House Score 3 2 1 X DS0000003533.V344658.R01.S.doc Version 5.2 Page 26 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 YA13 Regulation 16 (2) n Requirement Service Users must be given the opportunity and choice, where appropriate, to use local facilities. This means they should be given the opportunity to shop for their own clothes and shoes, and to go out to the hairdressers. All staff should be competent in dealing with any health conditions that they may encounter in their day-to-day work. This means that if people have such problems as hypo/hyperglycaemic attacks staff are aware of what to do. All staff who are administer medication that involves an invasive procedure (such as suppositories) must be certified as competent by the medical person who is delegating this responsibility. Medication must be administered in line with the appropriate medical guidance. This means leaflets that accompany medication should be read and DS0000003533.V344658.R01.S.doc Timescale for action 01/11/07 2 YA19 12 (b) 01/11/07 3 YA20 13 (2) 01/11/07 4 YA20 13(2) 01/11/07 Inglenook House Version 5.2 Page 27 5 YA20 13 (2) 6 YA23 9(a), 12(1)a 7 YA28 23(2)a 8 YA39 26 9 YA42 13(4) where necessary advice from the GP or pharmacist sought. A proper account of records must be kept, so it is possible to establish at any one time how much medication is in the home. Service Users money must be properly managed and audited. This means that money is only removed from the account when it is needed, and any change returned at the first possible opportunity. Any “points” or tokens awarded as part of a purchase belong to the person who makes the purchase. The provision of lounge and dining room space must be reviewed to ensure that there is sufficient space for everyone who lives in the house to live comfortably. Monthly-unannounced visits must be made by a representative of the company running Inglenook to check that it is being properly managed. Copies of these reports must be forwarded to the Commission. All environmental risk assessments including in relation to Legionella must be carried out, implemented and reviewed. 01/11/07 01/11/07 01/12/07 01/12/07 01/12/07 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 YA6 YA16 Good Practice Recommendations There should be a system for ensuring that all staff have read all Service User or Care Plans. Service Users should be given the opportunity to take part DS0000003533.V344658.R01.S.doc Version 5.2 Page 28 Inglenook House 3 YA30 in individual activities both at home and in the community. The advice of the Environmental Health Officer should be sought about the use of the laundry as bin and food storage area. Inglenook House DS0000003533.V344658.R01.S.doc Version 5.2 Page 29 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 © 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.V344658.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!