Inspection on 02/03/06 for International Eating Disorders Centre

This inspection was carried out on 2nd March 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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... 14/12/05

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 Unannounced Inspection 2nd March 2006 09:30 International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 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.V285953.R01.S.doc Version 5.1 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.V285953.R01.S.doc Version 5.1 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.V285953.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons aged 16 years and above with Eating Disorders Date of last inspection 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 nine 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 while in exchange for an opportunity to gain greater control over their lives. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 2nd March 2006 over a period of four and a half hours. Two inspectors, Mike Murphy and Maureen Richards, carried out the inspection. The focus of the inspection was to assess the remaining key standards. The inspection methodology consisted of discussions with the manager, the staff on duty, a private discussion with one service user, a tour of the building and examination of records. Progress made on the requirements of the previous announced inspection was not assessed, as the timescale for meeting some of those requirements was not yet due. In accepting admission to the home, service users accept a voluntary limitation on freedom and decision making and agree to conform to a highly structured therapeutic programme. The restrictions associated with this are eased as service user’s progress through the programme and attain more independence. To a certain extent this also impinges on the assessment of the standards on this inspection since many aspects will not apply. The staff and residents to whom inspectors spoke had a clear understanding of the nature and potential benefits of the programme and seemed comfortable with it. The service provides a high level of support to service users where required. The home employs a multi-professional staff team and additional healthcare services can be accessed through the GP or direct contact where appropriate. The arrangements for the administration of medicines were not assessed on this inspection (they were fully assessed at the last announced inspection) but points of detail were discussed with staff. The home’s environment meets the two key standards. Some rooms were out of use due to a damp problem in some parts of the building being treated. Some improvements were noted, in particular the installation of a new shower room on the ground floor. The amount of personal care materials on shelves in the bathroom caused some concern and the manager is asked to look at alternative ways of storing these. All areas inspected were clean and generally tidy. The kitchen was clean and well organised although some staff had not labelled food stored in containers in the fridge. Overall the home provides a comfortable and safe environment for service users at all stages of the programme. In conclusion, therefore, this inspection finds that this home is providing a valued service to residents and that, in the context of the limitations referred to above, it meets the standards assessed on this inspection. What the service does well: International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 6 Service users are made aware of the restrictions imposed on them as part of the programme prior to admission and make the decision to commit to this. The latter stages of the programme give service users opportunities for personal development, privacy and to engage in a wider range of community activities. Family involvement is encouraged. Service users have regular psychology input and have given very positive accounts of the value of that part of the programme which is experienced as highly supportive. The home provides nutritionally balanced meals. Service user personal care needs are met and supported. Service users have access to a range of healthcare professionals. What has improved since the last inspection? What they could do better: The manager must ensure that the revised medication policy is in line with the guidelines of the Nursing and Midwifery Council and of the Royal Pharmaceutical Society of Great Britain. The manager must ensure that all handwritten entries on medication records are clear and legible. The organisation should review the arrangements for meal preparation in the evenings and at weekends. The manager should set up a separate record of healthcare appointments in residents files. The arrangement for the storage of service users toiletries should be reviewed. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 7 All staff need to ensure that containers of food stored in the fridge are labelled when opened. 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.V285953.R01.S.doc Version 5.1 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.V285953.R01.S.doc Version 5.1 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): Standards in this section were not assessed on this unannounced inspection. They were assessed at the announced inspection carried out in December 2005. EVIDENCE: International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 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): 7 The programme of care limits service users decision making in aspects of their care, which service users commit to and are made aware of prior to admission. EVIDENCE: Standard 6 was not assessed at this inspection. Standard 6 was assessed at the previous announced inspection. Requirements were made at that inspection to improve service user plans. One service user plan examined on this inspection was not updated to reflect the actual level of the programme the service user was on. The service user plan showed evidence of the service users involvement in its evaluation. Requirements relating to the development of service user plans is still within the timescale to be actioned. Progress on this will be assessed at the next inspection. Service users make the decision to be admitted to the home and agree to a programme, which limits their decision-making. The level of observation determines the service users freedom and decision making within the home and service users are able to make choices within the framework of the programme. The home has no specific advocacy involvement. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 11 The staff nurse on duty reported that service users tend to look after their own money. The home does not act as an appointee for any service user. The staff nurse on duty confirmed that limitations on the use of facilities, on choice, or other matters are based on the clinical risk presented and on the level of the programme that the individual service user is on at any given time. On levels one and two of the programme service users are observed closely with all aspects of care while at the home. On levels three and four service users are discreetly observed and are given more responsibility in relation to their programme. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 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): 11,12,13,14,15, 16 & 17 The latter stages of the level of observation and programme give service users some opportunities for personal development. Service users are expected to take part in the planned programme of activities, which provides opportunities for users to address their eating disorder and promote their well-being. Service users can engage in community activities as dictated by the level of observation. Visits and family involvement is encouraged which supports service users in their progress and future care. Service users rights are limited by the level of observation required to promote their progress and well-being. Nutritionally balanced meals are provided which meet service users individual needs. EVIDENCE: International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 13 On level 3 and 4 of the programme service users have opportunities to maintain and develop social and independent living skills. Service users on level 4 are encouraged to live in the flat attached to the home to enable them to develop those skills in preparation for discharge. All service users have individual key sessions with the psychologist and with their key worker. Service users are also required to attend group sessions. Each of these should support service users to communicate their feelings, to explore their problems and positive ways of dealing with them. Service users were extremely positive about the contribution of the psychologist in their progress. The staff nurse on duty confirmed that individuals spiritual needs are met and that a spiritual growth meeting is held daily – attendance is optional. All service users are expected to participate in the weekly planned programme of activities. At the previous inspection service users commented that the programme of activities on offer did not always take place. The service users in the home at this inspection felt that this had improved and that the planned programme took place the majority of the time. On level one of the programme service users are unable to take part in work placement, training or education. As service users progress through the levels they would be supported to return to further education, training, or a work placement if they wish. The staff nurse commented that the programme director will liaise with employers in support of service users returning to work where required. On level four of the programme service users are able to access community resources independently. On level two and three of the programme service users can access community resources with staff support. The home has a folder with information on local activities. The home is on a bus route to the town centre and has its own transport, which is used to take service users for appointments or for trips out. Activities out of the home have to be planned in advance to ensure that there is a sufficient mix of staff on duty to cover both the outing and the home. The manager was unable to confirm if service users are on the electoral roll. All service users are expected to participate in the planned programme as part of their treatment plan. This includes a mix of group and individual sessions involving a range of professionals. Service users on level three and four of the programme can pursue their own interests and hobbies in the evenings and at weekends. The home does not provide long term care and therefore a holiday is not included as part of the contract price. Service users confirmed that they are expected to choose and agree a group activity, however there were no issues with this as at the time of the inspection as only two service users were living at the home. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 14 The staff nurse on duty confirmed that service users can see visitors on any level of the programme if they wish. However, visitors are expected to come outside of programme times unless prior arrangements have been made. Service users on level one and two of the programme would be unable to see visitors in private and would be expected to leave their bedroom door open during a visit. Visitors are not allowed to stay overnight. As part of the programme the home offers a family week, where members of the family are invited to participate in the individual programme and in family sessions. The manager confirmed that visitor’s guidelines were in place and are outlined in the service user guide. This was not seen at this inspection. The level of observation restricts service users freedom of movement, choice and promotion of independence. On level one and two service users are observed whilst using the bathroom and in their bedrooms. Service users do not have a key to their bedroom and there is no lockable facility in their bedroom. Service users are given their own post to deal with. Service users are called by their preferred name and this is recorded in the service users plan and made known to staff during handovers. Staff work one to one with service users and are expected to engage directly with them. Male staff are chaperoned by female staff when providing one to one support to female service users. Service users are expected to participate in the weekly activity programme and do not have a choice on whether to join in specific activities. Service users access to areas of the home is restricted in line with the level of observation. Service users on level one and two are not expected to clean their bedrooms, do their laundry or participate in household tasks. Service users on level four move to the flat attached to the home and are expected to take responsibility for household tasks. They are supported in developing those skills as required. None of the service users take an active role in meal preparation. On level three and four service users have supervised access to the kitchen. The manager confirmed that the home has a no pet’s policy and that the rules on smoking, alcohol and drugs are outlined in the service user guide. Service users have three meals a day with drinks available as required. Snacks are supplemented for individuals as outlined by the dietician. The staff nurse on duty reported that the dietician visits weekly, sees service users individually and agrees a menu plan. Service users are allowed to have three dislikes of food, which can be changed in agreement with the dietician. Service users are expected to eat all meals provided. Service users are expected to eat their meals in the dining room. A staff member eats with the service users and service users are observed following meals. Service users are expected to go to the toilet before meals and the toilets are then locked and can be only accessed with staff permission. A minority of service users may require feeding by naso-gastric tube on admission. This can only be done with their permission. If such feeding is required and permission withheld then the unit is unable to continue with the International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 15 placement. Service users felt that the food provided was of good quality and that the cook had a good understanding of their needs and likes. The cook works five days a week. She prepares the food in advance for the evening meal and weekend meals. Care staff on duty are responsible for reheating and serving those meals. One service user reported that on one occasion an agency staff member was responsible for the meals and did not understand the values of the food she was serving. This had caused distress to the service user. One service user felt that when the home had full occupancy, and there were only two staff on duty, with one being responsible for meal preparation, then there would not be not been sufficient staff to assist with other needs. This needs to be addressed by the manager. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 16 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): 18 & 19 Service users are supported with their personal care needs as required and with the level of observation dictated by the level of the therapeutic programme. Service users have access to a range of healthcare professionals to ensure their healthcare needs are met and monitored. EVIDENCE: Service users on levels one and two observation are assisted with their personal care. Personal care is provided in bedrooms or bathrooms with the staff member present to allow for the door to be kept shut to ensure privacy. Female staff support female service users with their personal care. During the week service users are expected to get up for breakfast and take an active role in the daily programme. Service users are expected to be in bed by 23.30 hours during the week. There is more flexibility with times of getting up and going to bed at weekends. The staff nurse on duty stated that there was no set times for baths and service users were supported in planning this around their programme. Service users are expected to be dressed to go to the dining room. Service users have a choice of staff on shift to work with them. Service users do not choose their own key worker but have a choice of a key worker or link worker to work with. The home has a wheelchair if required for individuals and specialist mattresses to prevent pressure sores for service users on level one of the programmes. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 17 The bathroom has handrails. The home is able to access physiotherapy input as required and service users have regular input from a Psychiatrist, Psychologist and a dietician. District nursing care would be accessed via the GP. All service users are registered at a local GP surgery. Service users have access to a dentist, opticians and chiropodist as required. Service user plans include separate medical notes. The outcome of routine appointments is recorded in the nursing notes but is difficult to track. A separate record should be maintained of other healthcare appointments and the outcome. Service users would be supported with routine screening and contraception advice as required. Service users are supported in attending out-patient appointments as required. Service users medical conditions are overseen by the GP and managed by staff on a day to day basis. Service users are able to see healthcare professionals in private, although male professionals seeing a female service user would be chaperoned. Standard 20 was not assessed at this inspection. This standard was assessed and the previous announced inspection and requirements made to improve medication practices and procedures. A requirement was made to review the medication policy. A revised medication policy was seen which include the procedure for ordering, delivery, storage and disposal of medication. This policy makes reference to medication for home leave. It indicates that in some circumstances the qualified nurse can decant medication into another container. The manager must ensure that those guidelines are in line with the Royal Pharmaceutical guidelines and the Nursing and Midwifery Council guidelines on the administration of medication. The medication administration records seen showed no gaps in administration. An ‘L’ code was used to indicate medication was not given but the code was not explained. One service user’s medication administration records written by a Doctor was illegible. The manager must ensure that all handwritten medication administration records are clear and legible to enable staff to administer the correct prescribed medication. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 18 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): Standards in this section were not assessed on this unannounced inspection. They were assessed at the announced inspection carried out in December 2005. EVIDENCE: International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home provides a warm, comfortable and safe environment for service users. It is reasonably well located for the amenities of Aylesbury and has facilities which enable staff to provide support at each stage of care – from intensive high supervision to independence prior to discharge. There appears to be pressure on storage in some areas. Where this affects personal care items it could potentially compromise standards of care to service users. EVIDENCE: The home is located about a half a mile or so from Aylesbury town centre. It is on the main road and easily accessible by car or bus. The style of the building is in keeping with others in the locality. Only the ground floor is accessible to a wheelchair user. Access to the building is controlled by coded locks. The ground floor comprises entrance hall, the staff office, residents’ accommodation, bathrooms and wc’s, the lounge and conservatory. The first floor comprises the administration office, consulting rooms, a meeting room, kitchen, dining room, wc’s, and a ‘partial care’ flat which may be used by service users on level 4 of the programme. All areas of the home were clean and tidy. Some areas had been redecorated during the course of 2005. A new shower had been installed on the ground floor. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 20 The kitchen was clean and tidy and appropriately equipped. Records are maintained of fridge and freezer temperatures. Fridges were clean but all staff need to ensure that any food opened is labelled. The temperature of the hot water outlet in the kitchen sink was tested at 61.3 degrees Celsius. Residents do not have access to the kitchen without staff supervision. The dining room was bright and clean although some areas of the carpet were worn and should be considered for replacement. The partial care flat consists of a bedroom, bathroom, living room and kitchen. It was not in use at the time of the inspection but is a useful facility. The laundry is always locked when not in use. It includes a washing machine, a separate dryer and sink. Detergents are automatically added to the wash. The light bulb was not shaded. A step ladder had been left in the corridor without explanation. A damp problem was being fundamentally addressed on the ground floor. Some plasterwork had been stripped down and skirting boards were being replaced. A radiator was awaiting re-hanging. Bedrooms vary in size. Three bedrooms were being redecorated at the time of the inspection. A resident gave permission for her room to be viewed. The room was well furnished with bed, desk, chair, armchair and wardrobe. Rooms do not have a sink because of the specialist nature of the service. The colour scheme varied from room to room. A new shower room had been fitted on the ground floor. This contained a walkin shower, wc and sink. The flooring was non-slip. New pipework was due to be boxed in the near future. The extractor fan was dusty and due for cleaning. The temperature in the hot water outlet was tested at 44 degrees Celsius satisfactory. A second bathroom with an over bath shower is located across the corridor. The radiator appeared to have a small leak. Because residents do not have a sink in their rooms soaps, creams, bath foam, shampoo, baby gel, air deodoriser, body scrub, toothbrushes, toothpaste and floss were stored on shelves in the bathroom. Potentially, such items could be shared and this would compromise standards of care. The manager should look at alternative means of storing such items with a view to giving each service user their own storage area. The sluice was partly used as a store room. This did not appear to cause any problems at the time of the inspection but could do so if the sluice was required at any time. The lounge is a good sized room. A new carpet had been laid. The amount of seating is sufficient for the number of residents. A tv, freeview box, dvd and video recorder were available for residents. There were sufficient electrical sockets for the amount of equipment and lighting in the room. The International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 21 conservatory is a reasonable size. Flooring is due to be replaced. Because of work in progress elsewhere on the ground floor the conservatory was, to a certain extent, used as a storage area on the day of the inspection. New lighting and security equipment is to be fitted to the exterior of the home. Overall, the home had quite a pleasant domestic style ambience which appeared to suit the needs of service users resident on the day of the inspection. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 22 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): EVIDENCE: Standard 33 was not assessed. One service user stated that the current staffing levels were sufficient to meet their needs. However, she felt that when five or more service users were resident then two staff on each shift was not always enough - particularly in the evenings and weekends. Staff have to assist with the meal preparation at those times and service users do not get their regular key time with key workers. This should be addressed as service user numbers increase and will be assessed further at the next inspection. International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not assessed on this unannounced inspection. They were assessed at the announced inspection carried out in December 2005. EVIDENCE: International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 x 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 x 23 x ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 3 x x x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x X X X X X X X International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 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 YA20 Regulation 13 Requirement The manager must ensure that the procedure for the management of medication for home leave is in line with the Royal Pharmaceutical guidelines and the Nursing and Midwifery Council guidelines. The manager must ensure that all handwritten medication administration records are clear and legible. Timescale for action 30/04/06 2 YA20 13 30/03/06 International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 26 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 3 Refer to Standard YA17 YA19 YA30 Good Practice Recommendations The organisation should review the arrangements for the preparation of meals in the evenings and at weekends. The manager should set up a separate individual record of all healthcare appointments. It is recommended that the manager provide individual storage facilities for service users personal care materials International Eating Disorders Centre DS0000019232.V285953.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire 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.V285953.R01.S.doc Version 5.1 Page 28 - 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!