Inspection on 26/10/07 for International Eating Disorders Centre

This inspection was carried out on 26th October 2007.

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... 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 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 26 October 2007 09:40 International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V344453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service International Eating Disorders Centre Address 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW 01296 330557 01296 339209 enquiries@eatingdisorderscentre.co.uk 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 Douglas Muzondo Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons aged 16 years and above with Eating Disorders Date of last inspection 20th September 2006 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. 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-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. Because of the specialist nature of this service it is not possible to fully 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 period of time in exchange for an opportunity to gain greater control over their lives. Information regarding the services offered is available through its website and on request. Care fees are £375 to £420 per day. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in October 2007. The inspection included a visit to the home, discussion with the nurse in charge that day and other staff, examination of documents (including the care plans and medication charts of four residents identified for care tracking), perusal of the service’s website, a tour of the home and grounds, a meeting with five service users, consideration of information provided by the registered manager in advance of the inspection and consideration of the results of completed survey forms returned to CSCI in connection with this inspection. The IEDC is a specialist centre which provides care and treatment for up to nine service users with an eating disorder. It has good systems in place for assessing the needs of prospective service users. The centre has a multidisciplinary team of staff who offer a range of therapeutic approaches within the context of a structured five level treatment programme. The Centre is a two-storey building. At the time of this inspection only the ground floor was accessible to a wheelchair user. The registered manager intends to address this over the next 12 months and see whether a disused lift can be brought in to service again. It is an older style building but the overall quality of the accommodation is good and all areas were clean, tidy and in good order at the time of this inspection. Service users gave very positive accounts of their experience of the service. Staff were reported to provide good support. The mix of therapeutic approaches: individual and group therapies, cognitive behavioural and family therapies, were seen as complementary and to provide the right mix for a person with an eating disorder. The mix of disciplines: including psychologists, nurses, psychiatrists, counsellors, and a dietician were valued and again seen to complement each other. The home has policies which aim to promote equality and diversity. Although the ethos of the service has a Christian basis service users can opt out of sessions which may have a religious element. This inspection finds some areas which require management attention. The Centre’s arrangements for the control and administration of medicines fail to fully meet some aspects of the standards. The complaints policy and some of the literature on the subject of safeguarding vulnerable adults require review. However, despite some weaknesses in its paperwork the Centre responds promptly and effectively to any concerns. Its procedures for the recruitment of staff are generally sound but some weaknesses were noted on this inspection. Overall, on the basis of the evidence of this inspection, the Centre is considered to be providing a service which is highly valued by its service users, many of whom have had experience of other such services elsewhere in the country. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that its arrangements for the control and administration of medicines are rigorous and minimise risk to service users. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 7 Staff files must demonstrate evidence of conformance to the Regulations in the recruitment of all staff to protect vulnerable service users. The complaints procedure needs to be reviewed and should accurately reflect the role of CSCI in the complaints process. This will provide service users with correct information. Pre-printed sections of care plans – such as those relating to selfadministration of medicines - should be adapted to the circumstances of individual service users. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 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.V344453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are thoroughly assessed before admission to ensure that the home can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: The service accepts referrals from medical staff, psychologists and care managers. Places in the Centre may be funded by the service user’s own primary care trust (PCT) or privately (by the service user or their family). The primary diagnosis must be an eating disorder. The prospective service user and their family are provided with a copy of the brochure. The brochure outlines the approach of the service, summarises the ‘levels system’ (of treatment), outlines the relationship between the Centre and the Royal Buckinghamshire Hospital and includes an insert which provides information relevant to the eating disorder experienced by the prospective service user. This may be followed up by a telephone call from the unit coordinator in order to deal with any enquiries the person or their family may have. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 10 In the normal course of events the prospective service user is invited to the Centre for a consultation with a psychologist, a medical assessment, to view its facilities and to meet staff and current service users. The process includes gathering relevant information from health professionals already involved with the person, such as the person’s consultant psychiatrist and general practitioner (GP). Where the referral is progressed the person is offered a trial admission of around four weeks duration. During this time the new service user is treated on Level 1 of the programme. According to the brochure this ‘…allows for assessment of the general physical condition, cognitive functioning, emotional expression and any pastoral needs, in preparing the individualised treatment plan’. A review is held at the end of this time. Where the service user and they or thier family and the Centre agree to continue with the admission then the service user continues with the programme. For some service users resident at the time of this inspection the process did not take such a measured course. Some, particularly those being treated in NHS services, felt that matters moved faster than expected once a place at the Centre was confirmed. It seemed as if they were not given sufficient time to fully consider the matter. While none regretted accepting a place at the Centre some felt that they had not been given a choice. This is not a criticism of the Centre - to a large extent it is out of its control. It is important however, that prospective service users feel that they can make an informed choice about admission. Service users found the pre-admission information useful but 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. Perhaps brief examples written from the service user’s perspective, based on their experience, might be included in future editions. Although the statement of purpose and service user guide were not assessed in detail during the course of this inspection a copy of the ‘Service User’s Guide and Handbook’ was provided for the inspection. It is an informative and well written document providing information on a range of topics. Service users had received a copy. Some felt that, while it was useful there was a lot of information to take in, particularly during the early period of admission. The guide includes a few extracts from the Bible and the programme includes a ‘Group (Spirituality)’ meeting on three mornings a week. These reflect the ‘biopsycho-social-spiritual model of health and illness’ which underlines the approach of the service. Service users were asked how they felt about these extracts and whether they influenced life in the home. Service users said that International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 11 they didn’t mind them and indicated that religion did not have an undue influence on the treatment programme or others aspects of home life. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each service user. Care plans include risk assessments, a multidisciplinary programme of care and evidence of liaison with healthcare agencies in the community. These aim to ensure that service users’ needs are met and that they are supported in regaining their independence. EVIDENCE: There is a care plan in place for each service user. Care plans are comprehensive and detailed and include sections for each professional discipline: general medical, psychiatry, psychology, family therapy, dietician and nursing. Each care plan examined included a photograph and autobiography of the service user. Risk assessments cover the risk of harm to self, suicide, selfneglect, aggression and violence, risk of exploitation and of harassment and risks related to eating disorders such as ‘purging’, compulsive exercise and International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 13 ‘addiction’ to pro-anorexic websites. Risk assessments may also include a Waterlow pressure sore risk assessment. The treatment approach of the Centre involves voluntary acceptance of some restrictions – particularly at Level 1 of the programme and to a lesser extent at Level 2. These require careful and sensitive implementation by staff, particularly where this is a significant risk of self-harm. In some files, contingency plans were noted should the service user refuse to co-operate with the programme while still remaining vulnerable. Care plans include a one page therapeutic ‘contract’ in which the expectation of both parties – the service user and the Centre – are listed. It is noted that some of those examined had not been completed. Where relevant care plans include a copy of the care programme approach (CPA) care plan drawn up by mental health services in the service user’s home area. Some documents headed ‘Care Plan’ were based on a typed proforma and did not appear to have been adapted to the needs of individuals. In the care plans examined these covered ‘Self Medication’ and ‘Treatment of Anorexia Nervosa’. The process of self medication outlined in these documents was not dissimilar to the process of administration by staff. In some files there was a separate self-administration of medicines risk assessment. These documents would benefit from review by the manager. Care plans included details of correspondence with NHS services, periodic reviews by different disciplines and records by nurses made during the course of each shift. Service users are involved in a community meeting on three mornings a week and group meetings at other times. A poster giving contact details for a local advocacy service, Aylesbury Vale Advocates, was on the notice board. Service users expressed positive views on the benefits of the therapeutic programme, had a high level of confidence in the staff and all those spoken to during the course of this inspection felt that they were gaining real benefit from their stay at the Centre. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported in maintaining links with family and friends and in making use of the amenities in the local community. Each service user’s diet is carefully planned and monitored and aims to promote the recovery of the person’s physical and psychological health. EVIDENCE: At the time of this inspection none of the service users were attending college. In the past the Centre has had service users attend courses at Aylesbury College. The Centre is not too far from Aylesbury town centre. Depending on the level they are on in the treatment programme, service users can go into the town and make use of the shops, cinema, library and other amenities of the town. According to the service user’s guide ‘Our treatment programme offers the service user the chance of attaining increasing independence and autonomy, International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 15 with a great deal of underlying support and encouragement. The levels system is merely a structure to help you to plan your recovery within the treatment programme’ (page 25). Such visits are considered privileges and are linked to the progress the service user is making and their compliance with the treatment programme. Service users accept this as a condition of admission. Such trips are negotiated with staff and variable levels of support and supervision may be required. Requests are in writing and records were seen during the course of this inspection. For some service users this will mean being accompanied by a member of staff. Others may go with their family or friends or with other service users. Service user comments in the CSCI survey on this aspect of the Centre included: ‘During the day we have several groups and 1 to1’s, so it is fairly packed. During the evening we can watch TV, DVDs, do homework, puzzles, play games. During weekends, depends whether you have visitors, depends whether you go out or not. Sometimes if there are enough staff on they will take us into town or somewhere, but its determined by number of staff on at the time’ – ‘With the whole programme there are elements where we can amuse ourselves. I think that this is important as we can take these strategies and use them in real life. I do wish we had a bit more freedom at weekends however, especially when we have visitors….’. The strict dietary programme may require a service user to interrupt a visit out and make a brief return to the Centre for a snack. The outing can then be resumed. Close links are maintained with families and family therapy may form part of the programme. Relationships with friends are maintained although for many service users the distance between their home area and Aylesbury may make regular contact difficult. Structure is an inherent part of the programme. A typical weekday will involve breakfast at 8.30 am, a meeting at 9.15, a snack and drink at 10.30, group and individual therapy sessions during the course of the morning, lunch at 1.00 pm, group and further individual sessions in the afternoon, a snack and drink at 3.30 pm, this is followed by further sessions or free time, the evening meal is at 6.00 pm. Some therapy sessions or ‘homework’ may take place in the early evening. Late afternoon or evening activities include ‘home work – selfdirected study’, outdoor activities, Pilates, weekly journal writing and ‘CBT Home work’. Given the specialist nature of the service meals are highly structured. Diets are drawn up on an individual basis by a dietician. Each service user is allowed three ‘pet hates’. Portion control is carefully calculated. Service users are supervised by staff while eating and for a time after each meal. Nutritional status is carefully monitored. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff provide good support to service users and arrangements for liaising with healthcare services in the community are good. This aims to ensure that service users healthcare needs are met. Weaknesses in the home arrangements for the control and administration of medicines are noted and if not corrected pose a significant risk to service users. EVIDENCE: The qualities and skills of staff were acknowledged by service users, both at the meeting on the day of the inspection visit and in responses to the CSCI survey. Comments included: ‘I have a key worker who is very approachable if I have any issues. If it cannot wait and they are not on duty, other members of staff are very happy to help’, - ‘Yes, they are very helpful and put our needs first’ – ‘From my initial contact with staff on the phone, I felt comfortable, well informed and important. My problems were listened to and useful advice given….– ‘(In response to the question ‘Do the staff treat you well?) ‘.. always with respect, they work so hard as well and are caring always’. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 17 Because of the specialist nature of the service, at levels 1 and 2 service users do not have much choice with regard to times for getting up and going to bed, meals and activities. They are required to conform to their plan of care. Restrictions are eased and service users have increasing choice at level 3 and level 4. All service users are registered with a local GP practice. Additional medical services are provided from the Royal Buckinghamshire Hospital. Service users healthcare needs are also met through the multidisciplinary staff group working at the Centre and the physiotherapy department at the Royal Buckinghamshire hospital (including the facilities of the gymnasium and hydrotherapy pool if required). The home states that it is ‘NICE compliant’ i.e. compliant with the guidelines on eating disorders issued by the National Institute for Health and Clinical Excellence in 2004. Dentistry is provided from a local NHS practice when required. A number of opticians are available in Aylesbury town centre. Wheelchairs can be provided from the Royal Buckinghamshire hospital when required. Medicines are generally prescribed by the service user’s GP or psychiatrist and are dispensed and delivered by a local chemist. Medicines are supplied in their original containers and the home does not use monitored dosage systems. Only nurses administer medicines. Medicines are recorded on receipt in to the home and there is a contract with a pharmaceutical disposal company for the disposal of unused medicines. Reference texts available to nurses, service users and other staff include a British National Formulary (September 2007), the 2003 guidelines on medicines in care homes published by the Royal Pharmaceutical Society of Great Britain and a general textbook on medicines published in 1995. It was suggested that the registered manager either download or obtain a bound copy of the most recent guidelines published by the Royal Pharmaceutical Society in October 2007 and that it replace the 1995 book with a more up to date and useful text such as that published by the British Medical Association (a new edition of which may be published in November 2007). Medicines are stored appropriately and there is a medicines refrigerator for substances requiring cool storage. The medicines administration records (‘MAR charts’) of four service users were examined in the presence of the nurse in charge. Two of the four service users were administering their own medicines on the day of the inspection visit. There appeared to be an irregularity with regard to the stock of one medicine which had been prescribed for two service users. The MAR chart had a handwritten copy of the prescription (a copy of the original prescription was International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 18 not available) and included both the dosage and the number of tablets to be administered. The latter is dependant on the strength of the tablets dispensed. In one case it appeared as if a lower dose had been dispensed and therefore the number of tablets to be administered needed to be adjusted accordingly. This however, would put practice at variance with the full instructions on the MAR record. This practice needs to be reviewed. There appeared to be insufficient stock of medicines for another service user. Medicines received in the home are recorded in a book. The member of staff present during this inspection was unable to confirm from the book that a supply had been received. The medicine was next due at 22:00 hours. This part of the inspection was carried out around 18:10 hours on a Friday evening. The matter was discussed with the member of staff on duty and subsequently with the registered manager by telephone on Monday morning. A number of service users administer their own medicines. A risk assessment was on file for some service users. A ‘care plan’ on self-administration in some of the care files examined did not clarify the extent of staff monitoring and it was difficult to differentiate between administration by staff, selfadministration under close staff supervision and self administration with occasional staff monitoring. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding of vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are properly investigated. EVIDENCE: The complaints procedure is outlined in page 14 of the service user’s guide. The policy states that ’The home complies fully to Standard 22’ – this standard. The policy states that as far as possible complaints should be resolved locally i.e. ‘…between the complainant and the home’. It then goes on to say that if there is a failure to resolve the matter then the complaint ‘…will be referred to the Commission for Social Care Inspection and legal advice will be taken as necessary’. This is incorrect. CSCI does not investigate complaints but it does monitor how registered organisations deal with complaints and may form a judgement on an organisation’s performance in respect of this. The procedure does correctly state that a complainant may refer their complaint to CSCI at any stage and it goes on to say that it will facilitate this if necessary. It says that ‘All complaints are responded to in writing by the home’ and that ‘Every written complaint is acknowledged within two days’. The position of the International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 20 CSCI is again innacurately represented in the sentence ‘If either party is not satisfied by a local process the case should be referred to the Commission for Social Care Inspection’. The procedure correctly gives contact details for the Oxford office of CSCI. It is noted that the policy does not refer to an advocacy service although, as mentioned elsewhere in this report, details of a local independent advocacy service are on the notice board. Although not required under this standard it would also be helpful to inform service users of their right to complain to the local authority (usually a PCT) funding a place in the home. CSCI has not received any complaints about this service since the last inspection. The home itself maintains a record of complaints and this was examined. Three complaints have been received since the start of 2007. Two matters were raised by service users during this inspection and these have been referred to the registered manager to look into. While the procedure would benefit from amending to ensure conformance to all aspects of this standard, this inspection has not raised any concerns about the home’s performance on complaints. Service users were positive in their views of staff and expressed confidence in the manager to deal with any concerns they might raise. A relative respondent to the CSCI survey wrote ‘I had an early grievance [details supplied]….I wrote to the proprietor and manager, and by the following Sunday this was sorted out’. The relevant correspondence was seen during the course of this inspection. The home has a policy governing staff action with regard to safeguarding vulnerable adults and on the protection of children at risk. A folder in the staff office includes a copy of the Department of Health Publication ‘No Secrets’ and its policy on the Protection of Vulnerable Adults (POVA). The latter publication is dated 2003, the year before the POVA list became operational. The Department has published subsequent guidance and the home should obtain this from the Department’s website. The file included a summary of the Buckinghamshire joint agency policy dated 2005 but again this appears to be a copy of a document issued just before a final version was circulated. A copy of the current policy should be obtained from the relevant office in Buckinghamshire County Council. Staff have attended training on safeguarding vulnerable adults run by Buckinghamshire County Council. Staff spoken to over the course of this inspection were aware of reporting procedures within the organisation and expressed confidence in managers to investigate accordingly. This inspection would support that view – the registered manager maintains good communications with local statutory organisations in respect of any concerns that arise. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a comfortable, clean and well maintained environment which provides those living there with a comfortable and safe place to live and contributes towards service users well being. EVIDENCE: The home is located on a main road about half a mile from 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. Security lighting has been improved since the last inspection. The home is conveniently located for the amenities of Aylesbury which include shops, a multiplex cinema, a college and other places for recreation. The International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 22 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, nine single bedrooms. living room, conservatory, a bathroom, a shower room and WCs X 2. Stairs lead to administration offices, consulting rooms, dining room, kitchen, meeting room, WCs X 3, 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 suitable for the present number of residents. It is quite well furnished with arm chairs and sofas and has a music centre, TV, DVD player, CDs, DVDs, books and magazines. The DVD player is due to be replaced. The conservatory is a medium sized multi-purpose room. The ground floor is accessible by wheelchair. The home does not have a lift operating at present. The registered manager has stated in pre-inspection information that this is to be addressed over the next 12 months. All areas of the home were clean, tidy and in good order. The kitchen is on the first floor. On the day of the inspection visit it was clean, tidy and in very good order. The self-contained flat was not in use at the time of this inspection visit. The home has a pleasant homely ambience and there is sufficient space for service users to spend time alone or be with others as they wish (subject to their plan of care). The home appears to comfortably accommodate a range of activities. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff skill mix and levels of staffing are good. Procedures for the recruitment of new staff are generally thorough and staff have access to a range of training and development opportunities. This aims to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet people needs. However, weaknesses noted in staff recruitment procedures pose a risk to service users. EVIDENCE: The Centre is staffed by a multidisciplinary team which include: the registered manager, unit co-ordinator, psychologists, consultant psychiatrists, a medical officer (based at the Royal Buckinghamshire Hospital), registered nurses, a family therapist, counsellors, group workers, healthcare assistants, dietician, training and audit officer, chef, administrator, and domestic staff. Where necessary the Centre can utilise some services (such as physiotherapy) at the Royal Buckinghamshire Hospital in Aylesbury. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 24 The staff skill mix aims to meet the needs of service users. Service users thought that this aim was generally being achieved. Service users were complimentary about the qualities and skills of staff and felt that the mix of therapeutic approaches was a strength of the Centre. In terms of nursing and care staff, the present staffing provides for 1 registered nurse and 2 healthcare assistants in the morning and evening and 1 registered nurse and 1 healthcare assistant at night. Where necessary care staff numbers are increased to provide additional support and supervison to service users. The permanent team of staff is supplemented by a pool of bank staff and on occasions agency staff. According to the nurse in charge on the day of the inspection visit the home had one vacancy for a full-time healthcare assistant. Staff recruitment is managed by the home. Applicants are required to complete an application form, attend for interview, provide two references and an Enhanced Criminal Records Bureau (CRB) certificate. Staff may be appointed on a POVA First basis. Four personnel files were examined in the presence of the administrator with regard to conformance to Schedule 1 of the Regulations. Three of four contained a recent photograph of the person – in the case of the fourth an electronic photograph was reported to be on the computer. Application forms, interview dates, references, CRB certificates and start dates were in order in three of four files – although a CRB certificate for one person was not yet on file, a POVA First had been obtained for the person. One application form included sections where only the year of some previous jobs had been entered. This does not facilitate a check on continuity of employment. Where such employment has been in a care position it does not facilitate checks on reasons for leaving such employment, as required since the POVA list became operational in 2004. According to the records one person appeared to have been appointed before either a POVA First or Enhanced CRB certificate had been obtained. New staff undertakes a thorough programme of induction. A training spreadsheet lists the training undertaken by nurses, care staff and the chef. It is assumed that other professional staff ensure that they maintain their continuing professional development as required by their regulatory body. The training record includes the names, job title, contract type and training undertaken between 2005 and 2007. The training includes: induction, manual handling, food hygiene, fire safety, basic life support, infection control (frequency not specified), health and safety, abuse awareness, child protection, drug administration, and NVQ in care at levels 2 and 3. It does not include training on eating disorders. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 25 A training and audit officer has recently been appointed and the registered manager said that the post includes maintaining an overview of staff training. Service users commented on the positive effect of that appointment in achieving greater consistency in food preparation. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed service where a positive approach to care planning and care delivery appears to provide good care outcomes for service users. Arrangements for health and safety are generally thorough and aim to ensure the safety of service users, staff and visitors. EVIDENCE: The registered manager is a registered mental health nurse and has a relevant management qualification. The registered manager has had relevant experience in the NHS prior to taking up post and has been in his present post for over two years. The registered manager has a Post Graduate Diploma is Social Science and around the time of this inspection was close to completing an MSc in Psychology. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 27 The Centre has some systems in place for monitoring the quality of the service but information in a readily accessible form was not available on the day of the inspection visit. In the service user’s guide the Centre sets out the following measures of quality: (1) Promptness of response (‘90 of clients seen within one week of receipt of referral’ and (2)’ a decision on admission or otherwise to be reported to the referring agency within 7 days’ (of assessment)), (3) Psychological and medical reports to be sent to the referring agency on a monthly basis, and , (4) ‘For inpatients we will formally communicate with the referring agency and within 7-14 days of discharge hold a discharge arrangements Care Programme Approach (CPA) meeting’. A community meeting is held three times a week. The Centre has a form for recording basic information on admission and at the point of discharge. A summary of the results was not readily available on the day of the inspection visit. A survey of service users had been carried out. The survey covered a number of areas of interest. Seven completed forms were on file but since the forms had not been dated it was not known the period in which the survey had been undertaken. There was not a record of an analysis of the information, of the results, or of how the outcome of the survey had been used in practice. In information supplied in advance of the inspection visit the registered manager has set out plans for developing quality assurance methods over the next twelve months. Service users resident around the time of this inspection expressed a high level of satisfaction with the service. Comments from service users in written contributions to this inspection included: ‘All comments etc. are normally listened to and actioned if necessary within a 24 hour time limit. There are limitations but I believe it is always there with our best interests at heart’ - ‘I feel on the whole this home is a good place to be. It is run reasonably well and it is more home from home and so friendly. I would recommend it to anyone to come and stay here, they are really nice people’ – ‘If anyone I know in the future is diagnosed with an eating disorder I will definitely recommend the IEDC’ – ‘In conclusion IEDC is a well run, homely and effective unit. My care was of the highest quality, moulded to fit my needs and given with kindness and respect. My aftercare has been planned well and I know it will help me through this big transition’. In answer to the question in the CSCI questionnaire ‘What do you feel the care home or agency does well?’ a relative wrote ‘(1) Really good care is given to all clients by both professional staff and volunteer workers, (2) Care for the International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 28 families are taken into consideration, with family therapy being widely offered, (3) Total, holistic care all round: physical, mental, spiritual and social needs’. A GP wrote ‘…The International eating disorders centre has proved invaluable and undoubtedly saved my patient’s life’ and ‘They communicate extremely well’. On discharge service users are offered telephone support as required and monthly follow up appointments for six months. Health and Safety is governed by the organisation’s Health and Safety policy which was last reviewed in March 2007. A member of staff based at the maintenance department of the Royal Buckinghamshire Hospital is responsible for ensuring conformance to the policy. Systems are in place for providing training in fire safety, food hygiene, infection control, first aid, and moving and handling. Contracts are in place for the maintenance of fire safety equipment. Qualified staff from the maintenance department carry out portable appliance testing (‘PAT’ testing). The maintenance department monitor the temperature of the hot water on a monthly basis – records were seen. The same department is responsible for checking the water system for the prevention of Legionella. The dates of the most recent check of the home’s fixed wiring and of gas appliances were not available at the time of the inspection visit. Systems are in place for recording accidents and incidents. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 29 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 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 4 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The registered manager must ensure that all aspects of the home’s arrangements for the control and administration of medicines maintain the protection of service users. 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. Timescale for action 30/11/07 2 YA34 19 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The service users guide should be updated to ensure an appropriate reflection of day-to-day life in the home. All sections of care plans should be specific to the needs of individual service users. Care plans based on proformas DS0000019232.V344453.R01.S.doc Version 5.2 Page 31 2 YA6 International Eating Disorders Centre 3 YA20 4 YA22 should be adapted to take account of this. Document relating to self-administration of medicines should include a risk assessment in all cases and should specify the extent to which the individual service user is administering their own medicine The complaints procedure should be revised to conform fully to all aspects of this standard. International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI International Eating Disorders Centre DS0000019232.V344453.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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