Inspection on 14/12/05 for International Eating Disorders Centre

This inspection was carried out on 14th December 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

International Eating Disorders... 02/10/08

International Eating Disorders... 26/10/07

International Eating Disorders... 20/09/06

International Eating Disorders... 02/03/06

International Eating Disorders... 05/10/04

International Eating Disorders... 24/02/04

International Eating Disorders... 31/03/03

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

CARE HOME ADULTS 18-65 International Eating Disorders Centre 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW Lead Inspector Mike Murphy Announced Inspection 14th December 2005 09:30 International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service International Eating Disorders Centre Address 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW 01296330557 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) Dr Clarke Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons aged 16 years and above with Eating Disorders Date of last inspection 21st January 2005 Brief Description of the Service: The International Eating Disorders Centre (IEDC) is a registered care home providing care, a programme of treatment and accommodation for 9 service users with an eating disorder. It is located about a half mile from Aylesbury town centre. The home has been converted to form one large house. There is parking to the side and rear of the home. The home is conveniently situated for the amenities of Aylesbury. The home describes its treatment programme as having four phases: preadmission assessment, in-patient care, partial care and aftercare. On admission service users enter a highly structured five-stage treatment and rehabilitation programme to which they and their families consent before admission. The home is staffed by a multidisciplinary team which includes medical staff (including a consultant psychiatrist), nursing staff, a consultant psychologist, counsellors, a dietician, cook, and healthcare assistants. Because of the specialist nature of this service it is not possible to assess it against all of the standards in ‘Care Homes for Adults (18-65)’. This applies in particular to those standards in which service user autonomy and independence feature. However, because the home admits young people of 16 and 17 years of age it is subject to the supplementary standards for care homes accommodating young people of those ages. Service users on the IEDC programme agree to give up a degree of autonomy and independence for a time in exchange for an opportunity to gain greater control over their lives. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by two inspectors on Wednesday 14 December 2005. The methodology consisted of individual discussions with the two service users resident at the time, discussion with the proprietor, manager and other staff, and reading care plans and other documents. The inspection took place at a time of change for the home. The manager was moving on from her post and a new programme director and deputy manager had been appointed. The home was considering its response to changes in the external environment. The therapeutic programme is structured and there is a high level of staff supervision of service users in the early stages of the programme. Needs and objectives were recorded in care plans and the level of observation required. Some care plans had gaps in information which appear to reflect inconsistencies in practice with regard to assessment, and to service user participation in the development, review and evaluation of care plans. Variations were also noted in the standard of risk assessments in care plans. The home has procedures governing complaints and the protection of vulnerable adults (POVA). These, and associated documents and procedures, require updating and review by managers in the light of changes in recent years. Staff recruitment and induction procedures are generally in order but important points of detail need attention by managers. The home’s induction pack is comprehensive and the induction of new staff seems satisfactory. The staff training programme needs review to ensure that it meets mandatory training and that required of staff working in such a specialist unit. The staff supervision policy is thorough but appears to apply only to nursing and care staff and some aspects have yet to be implemented. The remaining standards to which the home is required to conform to will be assessed in the unannounced inspection which will take place before the end of March 2006. The inspectors would like to thank the services users, managers and staff for their time and hospitality during the course of this inspection. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Changes at management level present the home with an opportunity to clarify managerial responsibilities – in particular those of the registered manager. There is currently a blurring of managerial responsibility at senior level and clarification of the role, particularly in relation to that of the unit co-ordinator, is essential. At present, the title ‘manager’ is synonymous with ‘nurse manager’. By definition this limits the responsibilities of that post to nursing matters. This not consistent with those of a registered manager who is normally responsible for all aspects of the the day to day running of a registered service. Involve nurses in assessments. This would provide continuity of care from assessment to all phases of in-patient care and develop the assessment skills of less experienced nurses. Service user plans must be further developed and show evidence of the involvement of service users in their development and review. Risk assessments must be completed to indicate the nature and degree of risk and to include a management plan to address identified risks. Risk assessments must be periodically reviewed and updated. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 7 It is essential in a unit with such a structured care programme that there are effective supervision arrangements in place for all professional and care staff. These should be outlined in the organisation’s supervision policy and its implementation monitored by managers. The programme of activities on offer should take place planned in accord with the Centre’s contract with service users. Improvements must be made to medication practice. These may require additional training and periodic supervision of staff responsible for the administration of medicines. All complaints must be recorded by managers and managed in accordance with the home’s own procedures and the National minimum Standards. The outcome of all complaints, including those dealt with by therapists, must be recorded by managers. 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. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Some of the assessment and admission documentation was incomplete which may indicate that service users are not been fully assessed prior to admission. EVIDENCE: The clinical team carry out assessments. Service user plans include an admission questionnaire regarding the service users commitment, an admission document which outlines the date of admission, makes reference to previous medical history, medication, past risks and next of kin details. Service users plans included an admission protocol, a family structure questionnaire and an in-patient declaration. Some of this information was found to be incomplete in some of the service users plans examined on this inspection. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Care plans did not indicate evidence of service user involvement in their development and review. This may prevent service users from taking an active role in their own well-being and progress. The risk assessment documentation was incomplete and risk assessments are not kept under review, which potentially put service users and staff at risk. EVIDENCE: Three service user plans were reviewed at this inspection. Service user plans covers identified needs and objectives by service users and staff to support service users meet the identified needs. The plan identified the level of observation that the service user required but was not specific as to what each level was. Two of the service user plans seen did not show evidence of service user involvement in review of their care plan and some plans did not include written evidence of review to make it clear that the previous care plan had been discontinued. Some service users said that they were not involved in the evaluation of their care plans and felt they should be as it was key to their progress. None of the service user plans examined included a photograph. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 11 Two of the service user plans included a risk assessment tick list and one included a summary of the risk with guidance for staff on how to manage the identified risk. The other service user plan did not include page two of the risk assessment document, which was the summary of the risk and guidance on its management. The third service user plan had no risk assessments in place. The risk assessments in place included a date for review but there was no evidence to show that a review had taken place. Risk assessments showed no evidence of the involvement of the service user involvement in their formulation. The home has a missing person procedure in place, which does not make reference to informing the Commission if a service user goes missing. The review date of this policy is September 2005. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not fully assessed on this inspection. They will be assessed at the unannounced inspection before the end of March 2006. EVIDENCE: Standard 12 was not fully assessed on this inspection. In discussion service users reported that recently the activities programme had not always taken place as planned and that they were not informed of changes until the day they occurred. One service user commented that “(service users) were expected to comply and commit to the programme as part of their treatment plan but the home was not sticking to its commitment to provide a programme of activities”. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Improvements are required to medication practices to safeguard service users. EVIDENCE: Standard 18 was not assessed. However service users confirmed that they have a key worker and co-worker. The key worker is the nurse manager, who, due to other commitments, is said not to get to spend enough key time with individuals. Service users report that she attempts to make time for them, which frequently results in her working late to achieve this and her other duties. This arrangement needs to be reviewed. Service users are involved in the administration of their medication. The level of involvement is dependant on the level of observation the service user is on at the time. Service users on levels 1 and level 2 require staff to administer their medication. On levels 3 and 4 the service user is supported in administering their own medication from the office under staff supervision. The home has a medication policy which was last reviewed in September 2005. The policy does not include guidance on the administration of medication in line with the level of observation. It does not include the procedure for disposal International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 14 of medicines. Medication received into the home and disposed of is recorded on an A4 hardback book. Service user medication administration records examined were found to be confusing. Discontinued medication had not been taken off the medication administration records and changes to medication were handwritten, some of which did not include the full instructions on its administration. For example one service user was prescribed ‘Zopiclone’ with instructions to take one every day. This is a hypnotic (sleeping tablet) which should be prescribed to be administered at night. One service user was prescribed ‘Senna’ tablets one to two daily. However it was being administered as an ‘as required’ medication as outlined on medical records. The medication administration records did not reflect this. The medication administration records indicate changes to medication, which were not always signed for by the precriber and the medical notes did not always indicate why medication was changed. Some service users were on ‘as required’ medication but there were no guidelines in place on the indications for the administration of such medication. The previous medication administration records were found to be disorganised. Some medication administration records indicated that on occasions medication was not administered but the codes used were not explained to indicate the reason why. The staff nurse on duty stated that the home does not use any ‘homely remedies’ and that all medication administered is prescribed by doctors The staff nurse confirmed that new staff and agency staff are inducted in the administration of the home’s medication procedure prior to administering medication. A tick list for induction of agency staff was seen which confirms that agency staff are made aware of the medication times and the policy and procedure on administration of medication. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 and 23 The home has a policy and procedure governing staff practice with regard to complaints and protection. Managers need to ensure that records are maintained at all stages of the complaints procedure. The POVA and POCA policy requires updating and must include reference to local procedures and guidance documents held in the service. Overall, inconsistencies within the present arrangements potentially exposes service users to risk. EVIDENCE: The complaints policy is outlined on pages 13 and 14 of the Service User’s Guide and Handbook. Responsibility for ‘following through’ (the term used in the policy) complaints lies with the nurse manager. The final paragraphs of the policy state ‘The home believes that wherever possible complaints are best dealt with on a local level between the complainant and the home. If either party is not satisfied by a local process the case should be referred to the Commission for Social Care Inspection’. This is not in keeping with the standard which says that procedures should include information on referring a complaint to the (then) NCSC (now CSCI) at any stage should the complainant wish to do so. The administrative tracking and recording of complaints could be improved. While there is no evidence that would lead one to think the home does not respond promptly to complaints, complaints records appeared incomplete. On this inspection for example, this was evident where a complaint had been dealt with by a therapist. While the therapist may have responded to the complainant’s satisfaction, records of the progress of the complaint were not fully maintained. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 16 In another service user’s file the service user had written a letter of complaint which did not appear to have been responded to. The staff nurse on duty confirmed the issue had been resolved but there was no record on file to confirm this. In such circumstances it is essential that the complaints records are kept up to date as the complaint is progressed, records of meetings and correspondence are maintained, and that the final outcome is recorded in the complaints record. Service users confirmed that they have weekly community meetings. They said they feel that issues are addressed in those meetings and they get feedback on the outcome. Minutes of community meetings were not seen at this inspection. The home has policy statements on POVA (Protection of Vulnerable Adults) and POCA (Protection of Children Act). Although both are stamped as having been checked in 2005, both require updating. POVA came into force on 26 July 2004. POCA has been operational since October 2000. The home’s POCA guidance includes reference to a register maintained by Buckinghamshire Social Services. This has now been superseded by the POCA list. The home should confer with local child protection services and revise and update its policy. The POVA policy refers to the Department of Health intending to implement POVA and goes on to describe in brief but general terms what the legislation covers. This should be updated now that the POVA list is place and be revised in line with local POVA procedures. A folder in the staff office on the ground floor contains a number of documents relevant to POVA and POCA and it would appear that there is already reference material on POVA and POCA available to staff. It is essential that the home’s policy governing this is up to date, and that it includes an operational procedure outlining the application of the policy in practice and a list of key reference documents (to include those in the folder in the staff office). According to the training programme one member of staff attended abuse awareness training in 2005. The home should obtain dates for 2006 training in Bucks (including those which will enable a member of staff to act as a trainer to others if available) and ensure that all staff receive training in POVA. The home’s recruitment procedures require all staff to have an enhanced CRB check including both a POVA and POCA check. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not fully assessed on this inspection. They will be assessed at the next inspection which is scheduled to take place before the end of March 2006. EVIDENCE: Although standards in this section were not assessed it was noted that a number of improvements to the environment have been made. A new shower room has been fitted on the ground floor. A wc has been replaced. New flooring has been fitted in the staff office. Some areas have been repainted. In early 2006 it is planned to replace the carpet in the conservatory with melamine flooring. All areas visited during the inspection were clean and tidy. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 The home has a multidisciplinary team providing a range of skills to support service users. Procedures for the recruitment and supervision of staff are generally sound but weaknesses identified on this inspection must be effectively addressed by managers if service users are to be fully protected. EVIDENCE: All staff have job descriptions and all new staff are provided with copies of the GSCC codes of conduct on induction. There is a wide range of skill and experience within the service and the staff structure aims to ensure that staff have access to more experienced staff where necessary. The service has a mix of full-time, part-time and voluntary staff including psychologists, registered nurses, psychotherapists, psychiatrists, healthcare assistants (HCAs), an administrator, a cook and domestic staff. The recruitment and supervision processes aims to ensure that staff have the right qualities for the work. Three HCAs were pursuing NVQs at the time of this inspection. The home runs its own in-house training sessions on eating disorders. The home does not offer training on aggression. Its practice to date was explained as, “to lead by example” and to facilitate individual and group discussion after a challenging event and to then follow up the subject in supervision. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 19 Staff meetings are held weekly. These tend to have a clinical focus where the progress of service users and other clinical issues are discussed. Other meetings are held where required. The recruitment process involves the completion of an application form, provision of two references, interview and an enhanced CRB certificate. The induction pack is very comprehensive although the GSCC codes of practice are in A4 format rather than the booklet issued by the GSCC. These are available at no charge from the GSCC. Four staff records were examined. Files were generally in good order but some papers were loose filed and could become misplaced. The content of files varied. Some files did not have a photograph of the person. A photocopy of a passport or driving licence is not sufficient because the quality of the copy can vary. It was not always clear why a person left their previous post. This is now a requirement where staff have been employed in a care position with their last employer for over three months. One person appeared to have been employed one week before the enhanced CRB was received – a ‘POVA first’ check was not on file. One open reference did not have evidence of verification by the home. One record had an excellent IPR (individual performance review) on file. A copy of the staff training record for nurses and HCAs was provided for the inspection. The record did not include details of training on eating disorders, supervision or equal opportunities, but it is noted on the pre-inspection questionnaire that a session on the subject ‘Motivation in the Treatment of Eating Disorders’ took place in November 2005, and that another on the same topic is scheduled for February 2006. Three permanent HCAs were pursuing NVQs – two at level 2 and one at level three. Bank HCAs were not pursuing NVQs. Mandatory training is organised by the unit co-ordinator and the administrator. Training on eating disorders is given by the nurse manager and a psychologist. The home’s development plan for quality assurance includes support for NVQ training for healthcare assistants (at levels 2 and 3) and for ongoing mandatory training. All nurses and HCAs are recorded as having completed an induction. The majority have had training on manual handling and food hygiene. Attendance on other mandatory training is less consistent and needs to be addressed by the home. The home’s policy on staff supervision was issued in September 2004 and reviewed in September 2005. The policy appears to apply to nursing and care staff only and it is unclear what arrangements are required of other staff (psychology, psychotherapist, group therapists, counsellors and medical staff) International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 20 – whether directly employed, engaged on contract or working in a voluntary capacity. The policy, as it applies to nurses and care staff, is a useful one. It defines practice, sets out the basic principles and outlines a framework for conducting supervision. It states that ‘Any notes made should be strictly confidential and kept securely’. To avoid misunderstanding it would be prudent to mention that supervision notes may be disclosed in some circumstances e.g. when questions of professional practice are raised or when an investigation of an adverse occurrence or serious incident occurs. The policy says that supervisors will be trained through ‘…an accredited supervision course’. No staff have attended such a course to date. Supervision does take place but it was reported that, for care staff, it can be displaced on occasions by events and other pressures on the timetable. This is not satisfactory. It is especially important in a service such as this that staff have regular access to supervision. The failure to establish this on a regular basis potentially devalues the work of care staff working closely with service users. Appraisals are held annually. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home was reviewing its management arrangements. This presents an opportunity to address potential weaknesses and devise a structure which both meets current responsibilities, delivers improvements for the benefit of service users and supports developments in the service. The development plan for quality assurance provides a very good framework for improving the quality of the service. This now needs to be effectively implemented and indicators of the benefits for service users under each subject heading be identified. EVIDENCE: The home does not have a registered manager. The present manager will be leaving her post early in 2006. A successor is likely to be appointed from the present staff team. The Centre has decided to review its management arrangements in 2006 and some options were discussed at inspection. CSCI does not prescribe any particular management structure. That is a matter for an organisation. CSCI does however need to be able to identify the International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 22 registered persons i.e. the registered provider and the registered manager. Each has a separate accountability to the Commission. The registered manager normally has day-to-day control of the home and should have the authority commensurate with the responsibilities associated with this. To date the term ‘manager’ in this service has been synonymous with ‘nurse manager’. This limits the position to responsibility for nursing and care staff only. This is reinforced by the manager being rostered to work shifts, not being supernumerary, acting as a key worker, and not having sufficient protected time to attend to management work. In September 2005 the home issued its ‘Annual Development Plan for Quality Assurance’. A copy was provided for the inspection. This includes a ‘Quality Statement’ which says that service users should expect ‘the highest quality of care and accommodation’, ‘be free to complain about any aspect of the running of the home and to have their complaints welcomed and acted upon promptly’, and, be told about CSCI inspections. The document goes on to outline the organisation’s position on clinical governance and its impact on the service. It says that this will include the following activities: clinical audit, evidence based practice, clinical risk management, performance appraisal and continuing professional development, user involvement, quality assurance and accreditation programmes and quality improvement. It goes on to stress the importance of a ‘risk management strategy’ and ‘…adherence to the (national minimum) standards’. This inspection assumes that the quality assurance plan will apply to all activities, carried out by all disciplines, at all levels, across the service. However, it would appear that the policy has yet to be fully applied in practice, and the document does not include a range of targets and plans commensurate with the range of activity listed above. One aspect of the policy includes ‘Continuing a focussed and effective audit programme’ which includes two tasks: ‘Develop a level 3 progress questionnaire’; and, ‘Provide Feedback’. The questionnaire applies to service users who progress from level 2 to level 3 of its treatment programme and a number of service users have completed a questionnaire over the past year. The numbers to date are small but the questionnaire can provide useful feedback on service users’ experiences. As with all such approaches, the questionnaire will need further development in the light of experience. Policies and procedures are reviewed annually. However, some policies, although reviewed in 2005, were not updated. The service is responsive to CSCI inspection reports. The home has acknowledged the importance of staff training in the ‘Risk Management Action Plan’ of the quality assurance development plan. The staff training record showed good support for training on manual handling and food hygiene but more patchy attendance on first aid and fire safety and no recorded attendance on infection control training. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 23 The service was inspected by the fire authority in February 2005 and no work arising from that visit is now outstanding. Health and safety procedures are well co-ordinated by the maintenance manager based at a partner service – the Royal Buckinghamshire Hospital (also in Aylesbury) – and regular checks are carried out on water and emergency systems. The manager also ensures that GAS, PAT and other electrical checks are carried out as planned. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 1 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 International Eating Disorders Centre Score x x 1 x Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 x DS0000019232.V272929.R01.S.doc Version 5.0 Page 25 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 2 Regulation 14 Timescale for action Service user plans should include 28/02/06 evidence of assessments being carried out prior to admission. All admission paperwork should be fully completed to support this. Service user plans must be 28/02/06 further developed to indicate evidence of being reviewed and of service users involvement in their review. Service user plans must include 28/02/06 risk assessment information and guidelines on the management of risks. Risk assessments must be reviewed and show evidence of service user involvement in the review. The missing persons procedure 28/02/06 must be updated to include notification to the Commission. The medication policy must be 18/03/06 updated to indicate service users role in the administration of their medication and the procedure for disposal of medication. The organisation must ensure 18/03/06 that changes to medication is referred to in service users medical notes and that instructions for administration of DS0000019232.V272929.R01.S.doc Version 5.0 Page 26 Requirement 2 6 15 3 9 13 4 5 9 20 37 13 6 20 13 International Eating Disorders Centre 7 8 9 20 20 20 13 13 13 10 22 22 11 23 13 12 34 Schedule 2 medication are clear and are as outlined in the medical notes. Individual guidelines for the administration of ‘as required’ medication must be put in place. Gaps in the administration of medication must be fully explained. The manager and registered proprietor should consider including training updates on the safe administration of medication for all staff responsible for the administration of medicines in the home annual training programme The complaints policy must be reviewed and include information to complainants that a complaint may be referred to CSCI at any stage of the process. The review should establish a procedure for capturing all complaints and recording progress at every stage, including the outcome. The home’s policy on adult and child protection and its associated procedures, guideline and other documents, must be reviewed and updated in line with current legislation, and local and national reporting arrangements. Staff files must contain the information listed in Schedule 2 (as amended following the introduction of the POVA list in July 2005) 18/03/06 18/03/06 18/03/06 27/03/06 27/03/06 14/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000019232.V272929.R01.S.doc Version 5.0 Page 27 International Eating Disorders Centre 1 2 3 4 Standard 12 37 20 39 The organisation should ensure that service users planned programme of activities take place as part of their commitment to the agreement with service users. The organisation should review the role and responsibilities of the manager’s post and determine whether they are fully consistent with those of a registered manager. Used medication administration records should be reorganised and made more accessible. The home should establish a timed plan for implementing its development plan for quality assurance. This should include indicators of progress and of the benefits for service users under each subject heading. International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 International Eating Disorders Centre DS0000019232.V272929.R01.S.doc Version 5.0 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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