Inspection on 02/10/08 for International Eating Disorders Centre

This inspection was carried out on 2nd October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

International Eating Disorders... 26/10/07

International Eating Disorders... 20/09/06

International Eating Disorders... 02/03/06

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: International Eating Disorders Centre 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 0 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: International Eating Disorders Centre 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW 01296330557 01296339209 enquiries@eatingdisorderscentre.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Douglas Muzondo Type of registration: Number of places registered: Dr Clarke care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Persons aged 16 years and above with Eating Disorders Date of last inspection Brief description of the care home 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. 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: pre-admission assessment, in-patient care, partial care and aftercare. On admission service users enter a highly structured five-level 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. The home can also admit young people from Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 9 Brief description of the care home aged 16 years of age and is subject to the supplementaty standards for care home accommodating young people of those ages. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of one day and covered all of the key National Minimum Standards for younger adults. Prior to the inspection, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgments about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager, staff and service users, examination of some of the homes required records, observation of practice and a tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 36 Feedback on the inspection findings and areas needing improvement was given to the manager and chief executive at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Requirements made at the previous inspection of the 26th October 2007 have been complied and this inspection has resulted in further requirements to improve practice. Care fees are 395 pounds to 425 pounds per day. What the care home does well: What has improved since the last inspection? The service user guide has been developed to clearly outline all aspects of admission and the treatment programme for individuals. Improvements have been made to medication practices and recruitment records. The complaints procedure has been revised to clearly outline the homes /providers role in relation to dealing with complaints. Areas of the home have been decorated which makes it bright and welcoming. Care Homes for Adults (18-65 years) Page 8 of 36 The manager is proactive in seeking service users views and in changing practices to offer a more person centred approach. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are assessed and provided with the key information prior to admission to enable them to make an informed choice on whether the centre can meet their needs. Evidence: At the previous inspection it was assessed that the statement of purpose and service user guide was an informative and a well written document providing information on a range of topics but service users felt that it would have been helpful if it identified more clearly the facilities provided at the Centre and those provided at the Royal Buckinghamshire Hospital. Service users would also have liked more information on what the application of the levels system means in practice - in particular on the restrictions that apply at levels 1 and 2. A recommendation was made that the service users guide should be updated to ensure an appropriate reflection of day-to-day life in the home. A copy of the service users guide and handbook was viewed at this inspection. This was updated to outline the different levels of the treatment Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: programme and access to other professionals on and during admission but not specifically at the Centre and the Royal Buckinghamshire hospital. Service users spoken with confirmed that they had received a copy of the handbook and found it informative in relation to their admission to the centre. The service user guide outlines the admission criteria and an admission policy, which includes the aims and objectives of admission. Prospective service users are referred by their General Practitioner, Consultant Psychiatrist or Psychologist. Service users who self refer must contact their General Practitioner or Consultant for a written letter of referral. Prospective service users are invited to the Centre for an assessment and consultation with a Psychologist and or Physician. The service user is given the opportunity to view its facilities and to meet staff and current service users. Service users are admitted on a four week trial period and are placed on level 1 of the treatment programme during the assessment / trial period. Service user plans viewed included an admission form, which outlined personal and contact details for individuals. It outlined their medical, family and social history with medical reports from referring professionals. One of the admission forms viewed was not fully completed and indicated to refer to the medical report. This should be completed to give a brief outline of the reasons for admission. The Annual Quality Assurance document outlines that the centre provides opportunity for potential clients on informal visits to have informal interviews with current service users so that they can hear/know more about the service provision from the experiential perspective of incumbent service users. The Annual Quality Assurance document outlines that plans for improvement are to improve the current web-site and introduce some video links and video conferencing with a view to conducting assessments through video-conferencing and including a video link to our website that will show more physical aspects of our unit and the local environment.The progress with this will be followed up at the next key inspection. Service users spoken with confirmed that the admission to the centre had happened quicker than they had anticipated and they did not have much time to think about. For some service users they felt this was a good thing, as they didnt have sufficient time to change their minds. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans are not user friendly, specific and detailed to enable staff to meet service users in a safe and consistent way. Service users are given the opportunity to make decisions, which promotes their well being. Risk assessments do not include clear management plans with some risk assessments not being reviewed, which potentially could compromise service users safety. Evidence: Four service user support plans were viewed at this inspection. This sample included service users from each of the four levels of the treatment programme. The support plans viewed were well organised with the information accessible. The daily records contained within the support plans were informative and well written. The support plan proforma outlines the short and long term need and the action required to meet those Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: needs. One of the support plans viewed did not include the action required to meet short/long term need. None of the support plans viewed were clear and specific as to what the short /long term need and action was to meet the identified needs. Some of the support plans viewed did not indicate the current level of treatment that the service user was at. Some support plans showed evidence of assessment for advancement to level 2 but this assessment was not completed for advancement to level 3 and 4. Some support plans showed evidence of review and updating as the service user progressed. One of the support plans viewed included two support plans but it was not clear which one was the current one that the staff and the service user were working from and to. Service user plans showed evidence of service users involvement in that support plans were signed and dated by service users and key workers. Service users confirmed that they had signed their support plans but some commented that they didnt really understand them and it was not clear what the plan of care was. Some service users indicated that staff were not consistent in the way they worked with them. The registered manager felt this was because he as the registered manager was able to allow some flexibility in relation to service users requests where as other staff would not. A recommendation was made at the previous inspection that all sections of care plans should be specific to the needs of individual service users. Care plans based on proformas should be adapted to take account of this. The care plans viewed would indicate that care plans are not specific and a requirement will be made to address this to provide continuity of care for service users. Service users are supported to make choices and decisions within the restrictions imposed on them dependent on the level of the programme that they are on. Service users on level 1 and 2 of the programme have limited choices with imposed restrictions. Service users are made aware of those on admission and contracts are in place to evidence this. The Annual Quality Assurance document confirms that service user therapeutic contracts are in place which provide evidence to the effect that service users rights to make informed decisions are upheld and that they give consent to entry into the treatment programme with the awareness that certain privileges and rights will be suspended in the interest of recovering from their eating disorders. The home has a policy on decision making which outlines how service users are enabled to make choices and decisions. House meetings take place four times a week with service users given the opportunity to address issues in the home and share their views, choices and opinion on what they would like to change. The service users have access to advocacy services if they choose to with information on how to access advocates displayed on notice boards. The home has a policy on the use of advocates with the contact details for advocacy services is included within this policy. At the time of the inspection none of the service users had advocacy involvement. Service users confirmed that they feel their views are listened to and acted on where possible. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: Service user plans included a completed risk indicators assessment form and management plan. These were dated and signed. The risk management plan was not specific as to the action to take to reduce each identified risk from the risk indicators assessment form. Generally the management plan indicated that the service users were to be closely observed.Some risk assessments did not indicate they were reviewed and updated as service users progressed through the levels and the identified risks reduced.These need to be further developed to ensure that all risks and clearly defined,managed and reviewed. Service user plans included a pressure sore assessment with a body chart to indicate any marks on individuals on admission.These were all dated and signed. The home has a missing person policy in place to support how staff manage a situation where a service user is absent without prior agreement. Feedback from professionals indicated that privacy and dignity is respected and that the centre are very accommodating of individual needs with regards to visitors and the need fro personal and private space. Feedback from one service users confirm that staff always treat them well with comments that they are supportive and easy to talk to. One service user commented that some staff respect service users but others dont because they want to be in control.This was not expanded on and the service user did not give their name to enable it to be followed up at the inspection. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for leisure activities, family and community contact are made available with service users being provided with nourishing meals to promote the recovery of the persons physical and psychological well being. Evidence: Service users on level 1 and 2 do not participate in work placements or further education. Service users on level 3 and 4 become involved in aspects of community life to prepare them for discharge. The Annual Quality Assurance document outlines that the centre has links with local schools, charity shops and coffee shops where service users do voluntary work as well as participating in work placements, training and education prior to discharge. This is integrated into the whole treatment curriculum as community reintegration . The centre also has links with local career development Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: advisory teams and they support individuals who choose to attend their workshops. The Annual Quality Assurance document outlines that plans for improvement are to increase the options for voluntary work and work placements by negotiating with more local organisations. At the time of the inspection none of the service users were involved in education with one individual involved in a voluntary work placement. Service users have a structured weekly programme of individual and group therapies with two evening leisure activities scheduled in.Service users are expected to take an active role in the individual and group therapies and non participation is viewed as non compliance. Service users are able to request in advance leave from the centre in the evening or at weekends to go out with family or to undertake a social activity.This maybe escorted by staff or unescorted depending on the level of the treatment programme the individual is on and their compliance with the programme during the week.Records of requests for leave were viewed which were signed off to indicate the decision on the request for leave with a rationale for the decision. Service users on level 4 of the programme live in the flat within the centre and they are encouraged to develop their social and independent living skills with them being responsible for planning their meals and their free time in the evenings and at weekends. Service user support plans included a spiritual self assessment which outlined if the service user had a specific religious need. If they choose not to this was respected. The Annual Quality Assurance document outlines that 3 spirituality matters groups are held weekly and that attendance to these is optional depending upon the individual personal philosophies. Service users spoken with during the inspection confirmed this. Visitors are welcome at the centre but are discouraged for the first two weeks of admission and assessment. Visiting is encouraged to take place at the weekends so as not to interfere with the weekly programme of activities. Evening visiting may be permitted on request depending on individual circumstances. Part of the treatment programme involves family therapy and family days prior to discharge where issues involving the family unit in relation to the eating disorder is discussed and explored. The arrangements for visitors are outlined within the service user guide. Service users are made aware on admission of the restrictions imposed on them during each level of the programme. The treatment plan is individualised to suit individuals needs. Service users on level 1 of the programme have the most restrictions imposed on them with the possibility of them being monitored and supervised at all times day and night and whilst meeting their personal care needs. As service users progress through the levels the restrictions are lifted with service users given more responsibility to start to take control of their lives. Service users are called by their preferred name. Service users post is delivered to the office and given to them unopened. Parcels and packets maybe requested to be opened under staff supervision and any unsuitable/unsafe items will be kept by staff. Service users are expected to Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: take part in the daily programme of therapies and groups and non-attendance is seen as non-compliance unless under medical advice. The rules on smoking and alcohol and outlined within the service user guide. The Annual Quality Assurance document outlines that service users have 3 main meals and 3 snacks per day and all these are served in accordance with assessed individual nutritional needs as recommended by the chartered dietician who reviews these weekly. Service users actively participate in these weekly reviews and their food hates, preferences and choices are taken into account in the formulation of individualised meal plans. Individual meal plans were viewed and found to be varied with evidence of service users choices and hates being taken into consideration. Staff eat with service users and service users on level 1 and 2 are expected to take supplements and be monitored after each meal. Service users on level 3 of the programme become involved in assisting with their meal preparation with service users on level 4 of the treatment programme and preparing for discharge being able to choose alternative food selections and suggested menus. The home has a food safety and hygiene and mealtime policy to support practice. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are well met, promoting their health and well-being and ensuring that they receive medication in a safe and consistent manner. Evidence: Service users on level 1 and 2 of the programme have limited choice in relation to times for getting up and going to bed. There is more flexibility as the service user progresses to level 3 and 4. However service users on all levels are expected to attend the daily programme of activities that commence at 9.30 am until 5pm Monday to Friday. In response to feedback from service users there is more flexibility with getting up and going to bed times at the weekend. Service users have a designated keyworker and co-worker. Service users spoken with were clear who their keyworker was and advised that they got some planned time with their keyworker. Service users confirmed that they were aware they could talk to any staff member on duty if they wished to, although found some staff more approachable than others. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Service users have access to a wide range of health professionals. Service users have a full medical check up as soon as possible after admission. A local General Practitioner visit the centre weekly with service users being able to go to the surgery in between if required. Service users have regular weekly input from a Consultant Psychiatrist, Chartered Psychologists, Family Therapist, and Dietician with the opportunity to access physiotherapy facilities at the Royal Buckinghamshire hospital if assessed as being required. Service user support plans include written records to evidence professionals input with individuals. Service users also have access to qualified psychiatric and general nurses and health care assistants on a 24 hour basis. Service users can access local dentistry and opticians if required and service user files include a record and outcome of healthcare appointments outside of the centre. At the time of the inspection the majority of service users were self medicating with a competency form in place to confirm that the individuals were assessed as being competent to self administer their medication.The competency form is completed daily until such time as the service user is signed off to self administer.Individual self medication risk assessments were in place to support this. Records are maintained of the amount of medication given with audit checks in place to ensure that the medication is being taken as prescribed. Service users have a lockable facility in their bedrooms to store their medication. Staff at the home do not administer homely remedies or as required medication unless agreed and prescribed by the doctor. The manager confirmed that written guidelines would be put in place for the use of as required medication The home has a medication policy in place to outline the procedure in relation to ordering, receipt, administration and disposal of medication. Records are maintained of medication ordered, received and disposed.It was noted for one medication that the records of medication received did not correspond with the actual amount that was received. This must be addressed with the individual staff member concerned to ensure that correct audits of medication are being maintained. The medication was found to be stored appropriately with some overstocking of one medication and one strip of medication was removed from its original packaging. This is unacceptable practice and must be addressed with all staff responsible for medication administration. The home has a drugs fridge to store medication when required and a locked cupboard within a locked cupboard to store controlled drugs. There was none in use at the time of the inspection. The training records indicate that all of the permanent nursing staff have undertaken drug administration training in 2007. Service users spoken with confirmed that they feel they have good access to professionals and spoke very positively of the treatment they receive. Feedback from one professional involved with the centre indicated that they felt health care needs were always met and that service users are usually supported to manage their medication correctly. They indicated that what the service does well is to offer Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: individualised care with excellent psychological input. Another professional commented that the centre provide flexible, person centred care with a high level of psychological therapeutic support and it promotes respectful and valuing relationships with service users and external professionals. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure service users views are listened to and acted on and to safeguard service users. Evidence: The home has a complaints procedure in place, which is included in the service users handbook and is displayed on the notice board at the home. The Annual Quality Assurance Assessment document outlines that the home has not received any complaints in the last twelve months. A log has been set up to record complaints and their outcomes. The home has received a number of compliments from ex service users and their families. A recommendation was made at the previous inspection that the complaints procedure should be revised to conform fully to all aspects of this standard. This has been addressed and outlines the organisations and the Commissions role in relation to complaints. The Commission has received one complaint in respect of this service, which will be forwarded to the Provider to investigate and respond to. Service users confirmed that they know how to make a complaint and that concerns raised are dealt with. Service users have the opportunity to raise concerns at the morning meeting held four days a week and there is a suggestion box where service users can raise a concern anonymously if they wish to. The home has safeguarding and whistle blowing policies in place as well as child Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: protection policies and procedures as they can admit service users aged 16. The Annual Quality Assurance document indicates that there has been no safeguarding of vulnerable adults referrals in the previous 12 months. The Commission has received one complaint as outlined above with elements of this complaint resulting in a safeguarding referral being made. The home has a policy on physical intervention by staff and on dealing with service users finances to include gifts. Service users are encouraged to take responsibility for their own finances and guidance on money is included within the service user guide to reinforce this. The training records indicate that staff have up to date safeguarding of vulnerable adult and child protection training. Staff spoken with had a good understanding of what was abuse and of their responsibility to report bad practice. The manager confirmed he was clear when an incident needs to be reported to the Local Authority as part of the local safeguarding procedures. Staff are properly checked prior to commencing work at the home with the need for clarification to be obtained for agency staff to support this practice. Feedback from a professional involved with the centre confirmed that the centre has responded to their feedback in relation to a client. Feedback from one professional involved with the centre felt that the centre always responded appropriately if the person using the service raised concerns. Two out of the three service users who completed surveys confirmed that they know how to make a complaint and complaints are acted on. One service user did not feel this was the case and that nothing gets done after a complaint is raised. This person did not give their name to enable this to be followed up on. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Evidence: The home is located close to Aylesbury town centre. There is limited car parking space in the grounds to the side and rear of the home and unrestricted parking in nearby side streets. The home is on a main bus route. The nearest rail station is Aylesbury. It is a two-storey older style building, which has been converted for its present use. Entry is controlled through a coded lock. The home is conveniently located for the amenities of Aylesbury which include shops, a multiplex cinema, a college and other places for recreation. The Centre makes use of some of the facilities at the Royal Buckinghamshire Hospital, just over a mile away, including its gymnasium and hydrotherapy pool. The ground floor accommodation comprises the entrance hall, staff office, and nine single bedrooms. living room, conservatory, a bathroom, a shower room and two toilets. Upstairs there are administration offices, consulting rooms, dining room, Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: kitchen, meeting room, three toilets and a self-contained flat. All bedrooms are single, pleasantly decorated and comfortably furnished. with a bed, desk and wardrobe. None of the bedrooms have en-suite facilities or a hand basin because of the specialist nature of the service. The lounge is comfortably furnished with a conservatory attached. The ground floor is accessible by wheelchair. The home does not have a lift operating at present. The Annual Quality Assurance document indicates that the home intends to provide a lift for accessing upstairs to wheel-chair users, although the presenting history is such that this has never been a need before. The home has a domestic staff member who is responsible for cleaning at the home. The home was clean, tidy and in good order. The kitchen and a separate dining room are on the first floor. The kitchen has been refitted with new cupboards and the cooker has been replaced. On the day of the inspection visit the kitchen was generally tidy although it was noted that there was a build up of food debris by the sides of the fridges. This should be addressed. The furniture in the dining room has been changed and there is sufficient space to accommodate service users and staff at meal times. The home has a self-contained flat, which is used by service users on level 4 in preparation for discharge. Areas of the home have been redecorated with the corridor painted in a light colour, which gives it the impression of being more open and welcoming. The lighting has been changed and made more homely. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited, trained and supported to meet service users needs in a safe and consistent way. Evidence: Staff were observed to be accessible to and comfortable with service users. Service users confirmed that the majority of staff were approachable, that they really care and are supportive and professional. One service user felt from their experience some staff lacked compassion, but didnt give any examples of why they felt that. Completed surveys from service users commented most of the carers are excellent. The people here do really care and you are made to feel part of a family. The home has qualified mental health nurses who have a good understanding of eating disorders. Alongside this all staff attend specialist training in eating disorders, mental capacity act, food issues, exchanges and Tab behaviours. The Annual Quality Assurance document confirms that 11 out of the 15 care staff have achieved a National Vocational Qualification with three staff working towards such a qualification. Feedback from one professional indicated that care staff usually have the right skills and experience but felt the centre could benefit from more experienced nursing staff. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: There is one qualified nurse and two carers on each daytime shift with one qualified nurse and one carer on a waking night shift. The rota indicates a mix of male and female staff. At the weekends some service users go on leave and the staffing levels maybe reduced to one qualified nurse and one carer. The manager works two clinical shift per week and three administration shifts. The home has a team of bank staff that cover vacancies with agency staff only being used as a last resort. The home has separate cleaning and cooking staff. The Annual Quality Assurance document outlines that the Organisation has improved their staff retention strategies and reduced staff turnover, minimising the use of agency staff to fairly sporadic occasions mainly to cover staff on annual leave. The Annual Quality assurance document confirms that two part time staff have left employment in the last twelve months. The home has regular team meetings and weekly update meetings on service users progress. Minutes are maintained to evidence this. Four staff files were viewed to include a sample of qualified and unqualified staff,permanent and relief staff.The staff files viewed included a photograph, application form, curriculum vitae, terms and conditions of employment, two references and POVA first check and a criminal records bureau check.One of the staff files was for a new member of staff. The POVA first check had been received and was on file but the criminal records bureau check had not been received.At the time of the inspection this staff member was working in a supervised capacity and the manager was reminded that this must continue continue until such time as a criminal records bureau check is received. Qualified staff records included evidence of confirmation of Pin number checks. On the day of the inspection there was an agency care staff member on duty. The manager advised that they have an agreement with the agency that all staff employed will be suitably checked. The manager is reminded that he must obtain written confirmation of pre employment checks and training from the agency for each agency staff member supplied. A requirement was made at the previous inspection that the registered manager must ensure that staff files include the information required under Schedule 2 to provide evidence that the home is conforming to the requirements relating to staff recruitment. This has been complied with but must be further developed to include confirmation of checks for individual agency staff members. The manager confirmed that new staff work through common induction standards.The centre has a training and audit staff member who works through the in house induction and common foundation standards with staff. These are completed at the end of the induction.There was no completed induction records available at the inspection and new staff on duty did not have theirs available for reference. The induction records should be completed as staff work through modules and be available Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: at the home to evidence this. New staff work in a supernumerary capacity and this was evidence from the rota on the day of the inspection. The home has a training matrix of training that has taken place which includes mandatory and specific specialist training as outlined under standard 32. The training matrix would indicate that moving and handling, infection control. basic life support and fire training was overdue for some staff. The rota indicated that moving and handling, infection control and child protection training had taken place the week of the inspection and the training matrix was due to be updated to reflect this.The home has a number of first aiders and the manager must ensure that there is a first aider on each shift until such time as all staff have up to date training in basic life support. Staff on duty confirmed that they feel supported in their roles. The records indicate that qualified and unqualified staff have formal supervision.Completed surveys from staff confirm that they have been properly recruited, inducted and trained in their roles. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed with monitoring systems and the required records in place to promote service users health and safety. Evidence: The Annual Quality Assurance document outlines the managers training and experience to date. The registered manager, is a qualified Registered Mental Health Nurse who has completed a relevant management course, a BSc Honours in Psychology, Mentorship and Support for Professional Practice Course, a Post Graduate Diploma in Social Sciences and an Masc in Psychology. He is a recognised affiliate member of the Royal College of Nursing and the British Psychological Society. He has qualified teaching experience which makes him an asset in assessing and supporting the educational needs of the young school and college-going adults who are admitted to the home. He has demonstrated excellent management skills in the management of this service since being in post and has improved the service to benefit service users by adopting a more person centered approach. Requirements made at the previous Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: inspection have been complied with and this inspection has resulted in further requirements to improve the quality of care. A completed Annual Quality Assurance Assessment document was completed by the manager prior to the inspection. The completed Annual Quality Assurance Assessment document was found to be detailed with information supported by evidence and showed an accurate reflection of the progress made with a good insight into the areas that still need to improve. Staff on duty confirmed that they feel the home is well managed with the registered manager being approachable, supportive and proactive in bringing about changes within the home to benefit service users. Written feedback from some staff indicate that they feel the manager is supportive and approachable and the home is well managed but there is interference from some senior Executives on care decisions which can undermine that role. Service users were very positive about the registered manager and feels he is very caring, a good listener, accommodating and flexible. The home completes service user feedback forms with evidence of action being taken to change practices in response to service users feedback.The Annual Quality Assurance document indicates that the service has developed an auditing tool to ensure effective monitoring of key systems in the running of the home. Areas covered by this will include medication administration and disposal procedures, care planning and risk assessments, admission procedures and protocols, report writing, clinical supervision and training, health and welfare of clients, leisure and recreation, post treatment follow-up procedures, relapse prevention and fire safety. This will be followed up further at the next key inspection. The Annual Quality Assurance document indicates that the plans for improvement over the next 12 months is to include service users relatives in the lists of people to whom user satisfaction surveys/questionnaires are given. The provider has weekly meetings with the manager and other professionals for an update on service users, with records maintained to evidence this.The provider do not carry out Regulation 26 visits. This must be addressed with records maintained to support this. A sample of health and safety records were viewed. The fire records indicate the fire equipment was serviced in Sept 2008. Staff carry out weekly fire checks and records are maintained to evidence this. The manager advised that one of those weekly fire checks would be a fire drill but the records did not clearly indicate this. Separate fire drill records should be maintained which outlines the date and time of the fire drill, the staff on duty and the service users in the home at the time of the drill. Records are maintained to evidence that monthly water temperature checks are carried out in different areas of the home each month. Records are maintained to evidence that portable appliance testing is carried out annually, with the next one due October 2008. The records indicate that the fixed lighting was checked in April 2004. The manager was unable to obtain a certificate to confirm a gas safety check. The gas boiler was Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: replaced in 2007 and it should be established when the next service is due. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered manager 30/12/2008 must ensure that support plans are further developed which are user friendly, clear and specific as to the care to be given. To develop user friendly support plans which provide consistency of care for service users. 2 9 13 Individual risk assessments must be further developed to ensure that all risks are clearly defined, managed and reviewed. 30/12/2008 To promote service users safety. 3 20 13 The manager must ensure that staff follow the procedures in relation to ordering, receiving and storage of medication. 28/11/2008 Care Homes for Adults (18-65 years) Page 33 of 36 To promote service users safety. 4 34 19 The manager must ensure 30/11/2008 that he obtains confirmation of pre employment checks for all individual agency staff used at the home. To safeguard service users. 5 39 26 The provider must carry out 30/12/2008 monthly regulation 26 visits with records of the outcome of the visit maintained at the home. To monitor the quality of care & to ensure the home is maintaining standards Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The admission form included in service user plans should be fully completed to outline a summary of the reasons for admission as opposed to saying refer to medical report. Areas of the kitchen should be cleaned and systems put in place to ensure that this is maintained. Induction records should be completed as staff work through modules and be available for inspection to evidence that staff are suitably inducted. The servicing records should be reorganised and made more accessible. The manager should ensure that the gas safety appliance is serviced with records available to evidence this. Separate fire drill records should be maintained which outlines the date and time of the fire drill, the staff on duty and the service users in the home at the time of the drill. Page 34 of 36 2 30 3 35 4 5 6 42 42 42 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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