CARE HOMES FOR OLDER PEOPLE
Leopold Muller Unit RNID Poolemead Centre Watery Lane Twerton Bath Bath & N E Somerset BA2 1RN Lead Inspector
David Smith Key Unannounced Inspection 1st February 2007 09:30 X10015.doc Version 1.40 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 Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Leopold Muller Unit Address RNID Poolemead Centre Watery Lane Twerton Bath Bath & N E Somerset BA2 1RN 01225 332818 01225 480825 gill.harris@rnid.org.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) RNID Mrs Gill Harris Care Home 22 Category(ies) of Sensory impairment (22), Sensory Impairment registration, with number over 65 years of age (22) of places Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 22 Patients aged 30 years and over with Sensory Deprivation, suffering from sickness, injury and infirmity Can include up to 5 Young Physically Disabled Persons Staffing Notice dated 03/04/2001 applies Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 18th January 2006 Brief Description of the Service: Leopold Muller is registered to accommodate 22 residents with sensory loss, who have personal care and/or nursing care needs. There is a special provision, included within this number, for 5 residents who require nursing care to be aged 50 or under. The home is located on the main Poolemead site, together with other units, which provide support for a wide range of adults with sensory loss and other disabilities. Day services are provided for residents, which focus on occupational, educational and therapeutic activities. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a Key Inspection of this service. The home was visited by myself and one colleague, who supported the inspection process. We gathered information during this visit through discussions with residents, the Manager, Activity Co-ordinator, Nurses and Support Workers. Interaction and communication between staff and residents was also observed during the course of our visit. Care plans and associated records were examined together with Risk Assessments, accident/incident reports, medication, staffing and health and safety records. We were also provided with a tour of the home. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI inspection and notifications of significant events which have occurred within the home. The Commission also provided the home with a range of Survey Forms for residents and Comment Cards for other stakeholders prior to this visit. Three resident’s surveys were completed and returned, together with ten comment cards from other stakeholders. What the service does well:
Each resident spoken with, and those who responded by Survey, said they liked living in the home and were well supported by staff. Each relative who replied by comment card said they were satisfied with the overall care provided by the home. The health care professional who responded by comment card said they were satisfied with the overall care provided by the home and described the service as “excellent”. The manager heads a professional team of workers who are committed to delivering a high quality of care and support in line with each resident’s needs.
Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 6 Professional external advice is sought whenever necessary, and good multidisciplinary contacts have been established through this process. This supports the specialist service provided to the residents. Staff are provided with specialist training to enable them to provide appropriate care and support to residents. What has improved since the last inspection? What they could do better:
Care plans and risk assessments must be reviewed/updated following reports of falls or accidents. This will promote the welfare and safety of residents and staff. Strategies and risk assessments to support residents who present behaviours which challenge the service being provided must be improved. This will promote the welfare and safety of residents and staff. Staffing levels during the night must be increased to promote choice and the welfare and safety of residents. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 7 The home should continue to review the progress in providing residents with information in a format which is accessible to them. This would support each person to be involved in their care planning in a meaningful way. The home should continue to consider plans to increase the size of resident’s bedrooms where the use of a hoist is required, provide a private garden and private entrance to the home. This would provide an improved environment for residents. Clear organisational guidance should continue to be sought to help assess suitability of staff members where a conviction is disclosed or is recorded on the Criminal Record Bureau Enhanced Disclosure. This will help to ensure the safety and welfare of residents. 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. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with the information they need to enable them to decide if they wish to live in the home. Each resident has their needs assessed prior to moving to the home, to enable them to feel assured their needs will be met. EVIDENCE: The home has a Statement of Purpose and Resident’s Guide which sets out its aims and objectives, including the range of available facilities. This enables prospective residents, their relatives and funding authorities to make fully
Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 10 informed choices about whether or not the unit is suitable to meet each persons’ specific needs. The care records for one resident who has recently moved into the home were examined. These showed that there were comprehensive assessments carried out to determine whether the home could meet their needs. These included medical details, preferred communication methods, their hobbies and interests and family involvement. Any potential risks to this person were also identified. Each resident who responded by survey said they did have enough information before they moved in to decide if it was the right place for them to live. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care is delivered but not always in accordance with each resident’s care plan. Care records must be updated to reflect increased risks in relation to reports of accidents or falls. Residents are protected by the home’s medication policies and procedures. Each resident is treated with respect and his or her right to privacy promoted. The home should continue to review the accessibility of information for each resident. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three care plans were examined, and each one was adequate in content for meeting health needs. Files contained health care risk assessments such as Waterlow assessments (for the likelihood of a pressure sore developing), Risk Assessment for the prevention of falls, how to move and transfer safely, nutritional assessments and methods of approach staff should use. However, these plans were not all holistic and the reviews did not contain some information read in other documents such as the accident book. One plan for a new resident had not reviewed the effectiveness of the strategies recorded for dealing with inappropriate behaviour. In fact staff spoken with were using different techniques from those planned. Daily notes showed that there had been a lot of incidents of aggression, which was not clear from the plan. We discussed this with the Manager who agreed that it would be useful if this resident also had a Mental Health assessment, however the home’s GP has advised to initially focus on this individual’s physical health issues and then request a Mental Health assessment at a later date. Care plans are developed with the residents’ involvement where possible, but this very much depends on the level of the person’s skills, ability and awareness. Each care plan is written in plain English, but is not yet available in any other format. Discussions with the Activity Co-ordinator showed that the development of other appropriate accessible formats for residents continue to be reviewed and a record of this process will form part of each care plan, when this process is completed. It is hoped some care plans can be adapted using the symbolbased approach, known as ‘Widget’. Each resident who responded by survey said they ‘always’ received the medical support they needed. Each relative who responded by comment card said they were satisfied with the care provided by the home. One relative said “We believe our relative is given the care and attention to the high standard set” and another “We are satisfied that our relative is well cared for and is happy”. Each care plan includes of a number of Risk Assessments for each area of residents’ care and support. Whilst this is good practice, the home should ensure there is an identified risk to assess. This should avoid risk assessments being completed unnecessarily. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 13 There was clear evidence of review meetings being held and the outcomes reflected in the reviewing of care plans. Each time a meeting is held the minutes are forwarded to the relevant Funding Authority. The manager ensures a structured approach for the care planning and review process. Each Nurse has responsibility for a number of residents, care plans, review meetings and will also supervise the relevant Keyworkers. This system ensures consistency and accountability. Each care pan is supplemented by the daily records for each resident. These are divided between the care and support provided by the home’s staff and a separate record of other health care professionals, such as GPs, District Nurses and Chiropody. We did note that the home does maintain comprehensive records of all residents’ accidents and falls. However, one resident who has had a number of falls had not had their care plan or risk assessments amended to reflect this increased risk. These records must be used to ensure care plans remain up to date and the risks to each resident and the staff team are reduced as far as possible. The home’s GP, who responded by comment card, said the home worked in partnership with them, had a clear understanding of residents’ care needs and always incorporated their advice into individual care plans. They described the service as an “excellent home”. The afternoon medication round was observed. This was carried out to a very high standard, allowing sufficient time for staff to clearly communicate with each person and ensure all medication was safely dispensed. The home’s policy in relation to medication administration was viewed and found to be comprehensive. The home’s GP said medication is appropriately managed in the home. We observed staff supporting residents by explaining information to them either by using British Sign Language, Deaf Blind Manual Alphabet and Hands On Signing. The staff observed appeared confident in the use of these communication methods. Their interactions also demonstrated a clear understanding of the needs and abilities of the residents. Through these observations it was apparent that each resident was treated with respect. Staff members were seen to address each person individually and knock on bedroom, bathroom and toilet doors or use doorbells (which make the light in each room flash), prior to entering rooms. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff to ensure that activities and other pursuits match their expectations, and satisfy their social, cultural and recreational interests. Residents are supported by staff to use community facilities, enjoy holidays and visit family and friends. Staff support each resident to make informed choices. Specialist methods of communication are used to support this process. A healthy and well balanced diet is promoted within the home and is served in pleasant surroundings. EVIDENCE: Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 15 Residents have access to a wide range of activities and recreational pursuits, organised by staff and the activity coordinator. We spoke with the activity co-ordinator who explained her role within the home and how she links with the Manager, Nurses and keyworkers to ensure a varied programme of activities for each resident both within the home, accessing facilities on the Poolemead site and in the wider community. Residents regularly attend theatre trips, church services, lunches out of the home and days out. There are a number of planned events which are displayed on the home’s notice board and in a separate folder, which can be used to communicate with residents on a 1:1 basis, if this helps them to decide if they would like to attend the planned event. The records viewed within the home show a recent ‘Australia Day’ themed party, trips to see pantomimes at the local theatre and to have a Christmas lunch outside of the home. Future events planned are a trip to the Haynes Motor Museum, a holiday to Blackpool and a short break at Centre Parcs. We spoke to several residents who said they liked the home and were happy living here. One resident explained he likes animals and also wanted a fishpond. Staff said this is to be added to the plans to develop a private garden area for the home. Each resident who responded by survey said there are ‘always’ activities planned which they can take part in. Each resident is supported to maintain contact with their families and friends. Each relative who responded by comment card said they are ‘welcome in the home at any time’, can ‘visit their relative in private’ and are ‘always kept informed of important matters affecting their relative’. One relative said “We were made very welcome…we were offered privacy with our relative when we visited” and another “We are always kept informed of important matters and asked if we would like to be updated more often.” We observed interactions between staff and residents who communicated using British Sign Language, Deaf Blind Manual Alphabet or Hands on Signing. The staff informed the residents but allowed them to make decisions, with appropriate levels of support. Each member of staff allowed sufficient time to effectively communicate with each of the residents to support this process. The meals for the home are prepared in the main kitchen on the Poolemead site and served in the large adjacent dining area. This is a very pleasant and clean environment, which looks out over the communal garden. The menu displayed showed a variety of healthy and nutritious meals. Each resident spoken with said they liked the food provided by the home. Each person who responded by survey said the liked the meals, although one said they would like ‘more choice of low fat foods’.
Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 16 It was noted the home’s chef is proficient in using British Sign Language. He told us that this helped him speak directly with residents and helped to build a relationship with them. This helps to ensure they could say what food they like/dislike and address any issues they may have regarding the menu. This is good practice. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The RNID has a robust system for dealing with all complaints. Residents are enabled to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. The home ensures as far as possible that residents are safeguarded from all forms of abuse. However, some residents who exhibit behaviour which challenges the service would benefit form clearer reactive strategies and Risk Assessments. EVIDENCE: There have been no complaints recorded since the last inspection. The home has a complaints policy and procedure in place, which has been supplied to each resident. This has also been produced in a symbol format, known as ‘Widget’, to help each resident understand its content. Each resident who responded by survey said they knew who to speak to if they were not happy and how to make a complaint. Staff ‘always’ listened to them and acted on what they said. Six relatives who responded by comment card
Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 18 said they aware of the home’s complaints procedure, however three said they were not. Each relative who responded did say they had never had cause to complain. Staff said they were aware of the RNID complaints policy, which they are asked to read and sign by the unit manager. They also confirmed that they would approach the manager if they had any concerns regarding a particular resident or an issue within the home. Each member of staff spoken with described clearly their responsibility in providing a safe home for residents to live in. They have been provided with training in the Protection of Vulnerable Adults and described what action they would take if they felt a resident were being abused, they suspected abuse or felt they were not safe. One incident regarding the poor work practice of one member of staff was recently reported by colleagues. This issue was taken seriously by the home and immediately referred under the local Protection of Vulnerable Adults policy and reported to the CSCI. All staff are subject to an enhanced Criminal Record Bureau disclosure, prior to commencing their employment. Clear records are maintained of any accidents or incidents which occur in the home. The Commission is kept informed of significant events which occur. However, the home must remain vigilant in reporting each significant incident, for example if one resident has a number of falls. All residents who can present behaviour, which challenges the service being provided, have strategies within their care plan for staff to follow. These are described as ‘Methods of Approach’. All staff receive Non Abusive Psychological and Physical Intervention (known as ‘NAAPI’) training to enable them to respond effectively to these behaviours in a planned and safe manner. This approach is accredited by the British Institute of Learning Disabilities. Whilst some of the methods of approach provide clear information for staff to follow, others do not. For example one still contained responses to one resident’s inappropriate physical contact, which staff members and the Manager said were no longer being used. Also, the Risk Assessments in place for behaviour such as self-harm did not clearly describe when or how staff should intervene and what the precise risks were. We recommended to the Manager that the home access the Department of Health’s Guidance on Restrictive Physical Interventions to support a review of the home’s care planning in this area. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 19 Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and the residents benefit from the provision of specialist equipment. The residents have sufficient lavatories and washing facilities. The home’s bathrooms have had new baths fitted to meet residents’ needs and promote their independence. Residents who require the use of a ceiling or mobile hoist would benefit from a larger bedroom. The development of the external areas of the home should also be considered. The home was clean and tidy and free from offensive odours. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home is well maintained and there is an ongoing programme of redecoration and renewal, for example one lounge area has been recently redecorated. The home benefits from this process as it does suffer reasonably high levels of wear and tear due to the needs of residents. The home has a disabled shower and new specialist baths installed. These improvements help to better meet all of the residents’ needs and promote their independence. The small kitchen area on the first floor has adjustable height work surfaces and a low level sink unit. This promotes the independence of both wheel chair users and residents who have poor mobility or co-ordination. We viewed seven residents’ bedrooms. These were all very well maintained, decorated in different styles and colours and had wood effect laminate flooring laid. Each resident had many personal items, pictures and photographs which added to the homely feel. Residents spoken with said they liked the home and their own rooms. Those who responded by survey said the home was ‘always’ fresh and clean. There are several features in the home to promote residents’ independence. These include tactile trails to enable residents to move around the home independently, doorbell/flashing light systems mentioned previously in this report and several other tactile objects and picture symbols. We did note that some bedrooms were equipped with ceiling tracking hoists. Mobile hoists were also in use in the home. The manager and staff said that the size of bedrooms does make the use of hoists difficult. We discussed this issue with the home manager. She explained that plans remain to reduce the occupancy of the home and effectively convert the space of two current bedrooms into just one. These plans could not be acted upon this year, due to a lack on funding. However, this together with the development of a private garden area and new private entrance to the home, will be reviewed in the next financial year. There is a large laundry room on the main Poolemead site, which provides a service to the home. However, two washing machines are accessible to residents, if they should wish to wash items of their clothing, or if this is part of their independence programme. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 22 The sluice area is clean and free from any offensive odour. There are handwashing facilities around the unit. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels ensure consistent and responsive support for residents. However, staffing levels at night must be increased. The recruitment process operated by the home is robust, which promotes residents’ safety. However, the home would benefit from clear organisational guidance regarding disclosure of criminal convictions being available. Staff are provided with a comprehensive induction and training programme to enable them to provide appropriate support to each resident. EVIDENCE: There both Registered Nurses and Support Workers working in the home. They are supported by domestic staff, who were seen working in the home during our visit. Each staff member’s role is clearly defined and staff spoken with were keen to provide a caring and responsive service to each resident. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 24 The home ensures its staffing levels during the day are kept under constant review. The rotas examined showed that in addition to the general staffing, there home provides 1:1 staffing support to some residents. This is to ensure their needs are met and provide a consistent approach in supporting them. This is often supplemented by both the Manager and Deputy working in the home during the day. The Activities Co-ordinator also works directly with residents to support trips out of the home or to use community facilities. For example on the day of our visit she was supporting the staff team to take residents swimming in the evening. One resident who responded by survey said staff were ‘always’ available when needed and two said ‘usually’. Seven relatives who responded by comment card said they felt there was sufficient staff on duty, whilst two said there was not. One relative described the staff as “kind, caring and very understanding” There do however appear to be continuing issues regarding staffing levels during the night. Staff spoken with expressed concern that only two members of staff work during the night. Should both night staff be involved in a manual handling task, for example helping a resident into bed, this effectively leaves other residents without any direct staff support. Also, as the residents are accommodated on three separate floors, both members of night staff will at times be on the same floor of the building, again effectively leaving the other floors without direct staff support. It was noted in care records that one resident, who is supported on a 1:1 basis during the day, has become distressed at not being able to immediately access staff support at night. Other records show that some staff who have worked during the evening shift have stayed beyond their shift finishing time to enable some residents to choose what time they would like to go bed. The staffing levels during the night must therefore be increased to promote choice and the welfare and safety of both the residents and the staff team. We viewed six staff personnel files. These contained copies of staff application forms, at least two satisfactory references, interview questions, job description, RNID contract of employment, Criminal Record Bureau enhanced disclosures and a photograph of the staff member. Each new staff member had also been provided with an induction pack, which included RNID induction details, General Social Care Council Code of Conduct, ‘Start to Sign’ Book and the local Protection of Vulnerable Adults Policy. During the last inspection visit, it was recommended that the home obtain written guidance from the RNID in respect of convictions or relevant information contained on Criminal Record Bureau Disclosures. The Manager Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 25 confirmed she is still in discussions with the RNID Human Resources Department regarding this issue and hopes to have this in place shortly. Staff receive both mandatory training and more specialist training to enable them to support residents and communicate with them effectively. There were records of staff attending training in First Aid, Fire Safety, Basic Food Hygiene, Manual Handling, Protection of Vulnerable Adults and NAPPI. In addition to this there was evidence of staff training in NVQs, CACDP British Sign Language Stage 1 and 2, Epilepsy, Diabetes, Loss and Bereavement, CACDP Level 3 in Deaf Blind Communication and Aromatherapy. Most staff have now also received training in Mental Health Awareness. The home now uses a training matrix to record all training undertaken by staff and to help plan future training events. Copies of certificates from training events are also kept in each personnel file. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has ample experience in a senior management capacity, and undertakes relevant training to update her knowledge, skills and competence. The manager ensures the service remains focused on the residents and promotes the review and improvement of the service. All staff are now supervised regularly and a clear record of each meeting maintained. The policies and record keeping in the home promote resident’s welfare and best interests. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 27 The welfare, health and safety of both residents and staff is promoted and protected. EVIDENCE: The manager, Mrs.Harris, is qualified for this post and has significant levels of management experience, which enable her to lead the service and promote good practice within the home. We spoke with several members of staff during the course of our visit. These staff members confirmed they liked working at the home, felt well supported by the manager and said they found her easy to approach. Staff felt she always made time for them and they knew how to contact her if she was not in the home. Through discussions with the manager it was clear that there are plans to develop and improve the service. These include the proposals to increase the size of bedrooms, reduce the number of residents accommodated and develop a private garden area and private entrance to the home. These proposals are being led by the manager and if adopted will improve the care, support and environment offered to the residents. The home conducted a quality review in November and December 2006. Questionnaires were completed by residents, relatives and funding authorities. These covered all aspects of the service including personal care, the environment and staffing. The sample of questionnaires we viewed contained many positive comments regarding the quality of the service provided by the home and also showed that areas for improvement are being acted upon. These developments demonstrate an ongoing commitment to both reviewing and improving the service provided to the residents. This is good practice. The registered provider’s representative makes regular visits to the unit, and produces a comprehensive report of his findings, which is send to the Commission on a monthly basis. The management structure and lines of accountability within the home are clear and straightforward. Staff are aware of this structure and of the senior management hierarchy within the RNID. Registered nurses supervise support workers, and the manager, or her deputy, supervise all Registered Nurses. Records are maintained and supervisees receive a copy of discussions and agreements made during this process. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 28 Each staff member spoken with found supervision useful and supportive. They felt able to talk about any issue with their supervisor. The records examined showed that staff are now being supervised every 6 to 8 weeks as described in their supervision contract and a clear record of each meeting is maintained. The management systems and structures are efficient. The record keeping is of a good standard. Files and documentation are well-organised and easy to access. There are recording systems in place to support Health and Safety within the home, which are being used consistently. Records examined included fire drills, fire alarm system checks, fire fighting equipment checks, water temperature checks, gas safety certificate and risk assessments. The home also conducts weekly health and safety checks, which covers visual checks on the environment, lighting, furniture and other equipment. All of these records were in order and checks were up to date. Leopold Muller Unit DS0000020297.V329437.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 3 X 3 3 2 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 4 4 3 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X 3 3 3 Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 OP38 Regulation 13(4)(c) Requirement Ensure all relevant Risk Assessments and Care Plans are reviewed/improved following reports of falls or accidents. (This was the subject of an immediate requirement notice on the day of the inspection visit). 15(1)(2)( b) The registered person should ensure that care plans are holistic, reflect the care that is being delivered and are reviewed appropriately. No later than 31/04/07 2. OP18 13(6) 13(7) Ensure Behavioural Management Strategies and associated Risk Assessments are improved to promote the safety and welfare of residents and staff. Staffing levels during the night must be increased to promote the welfare and safety of residents and staff members.
DS0000020297.V329437.R01.S.doc Timescale for action 01/02/07 01/05/07 3. OP27 18(1)(a) 01/02/07
Page 31 Leopold Muller Unit Version 5.2 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP29 OP23 Good Practice Recommendations The home should continue to review its progress in providing information to residents in accessible formats. The home should obtain clear written guidance form the RNID to support an informed response to any conviction disclosed by staff members. The home should continue the development plan to increase the size of bedrooms to assist in the hoisting of residents and increase private outdoor communal space. Leopold Muller Unit DS0000020297.V329437.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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
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