CARE HOME ADULTS 18-65
Lindisfarne Greenvale Court Frizington Cumbria CA26 3SZ Lead Inspector
Liz Kelley Unannounced Inspection 16 and 30 November 2007 10:00
th th Lindisfarne DS0000022679.V352938.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 Lindisfarne DS0000022679.V352938.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. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Address Greenvale Court Frizington Cumbria CA26 3SZ 01946 813402 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) griffinclse@walsingham.com www.walsingham.com Walsingham Miss Pamela Brannon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD (Learning disabilities) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2nd June 2006 Date of last inspection Brief Description of the Service: Walsingham are the Registered Company for Lindisfarne. They have similarly registered homes in Cumbria and throughout the Country. Lindisfarne is located in the village of Frizington on the West Coast of Cumbria. There is a large enclosed garden and patio area. Car parking is available and there is level access into the home. Lindisfarne is on a lower level to the nearby residential court of flats and houses and the incline to the home is graduated. Accommodation is on one level and the corridor and door entrances are designed for people who may use wheelchairs. There is a kitchen, dining room, lounge, office and utility room, with private bedrooms situated off the two corridors leading from the entrance hall. Toilets and bathrooms are specially equipped and designed. The current scale for charging is £563.32 per week. A Handbook is available for prospective residents, and the latest Commission for Social Care Inspection report is made available on request. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection where all the key areas of the National Minimum Standards were assessed. Residents, and their families, and members of staff had given their opinions regarding the home to Commission for Social Care Inspection (CSCI). These comments, and the observations made by the inspector, have informed the judgements made in this report. We also: • Received questionnaires from professionals and other people working with the home • Interviewed the manager and spoke with staff • Visited the home, which included examining files and paperwork • Received a self-assessment report/questionnaire from the manager. This year the staff team and residents have experienced some difficult times. Two residents had passed away after having been nursed and cared for at the home. Staff have been struggling to meet the needs of new people and there have been difficulties with them settling in with other people living at the home. This has all been compounded by severe staffing shortages that have been filled with agency staff. Three relatives replied to our surveys and all were complementary on the care their relative received, only one referred to the problems of staff shortages. What the service does well: What has improved since the last inspection?
The home has had physical areas of the home upgraded for example new carpets and redecoration of the lounge and some bedrooms. Staff have been on training in readiness for introducing care plans that are in a style termed “person centred”, which when introduced makes care and support more tailored to individuals specific needs. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 6 What they could do better:
Permanent staffing levels must be increased so that residents needs can be better met and a more person centred approach can be introduced. Currently staff are struggling to meet basic needs and opportunities for individual activities are particularly suffering. The high use of agency staff needs to be reviewed and the organisations policy on recruitment needs to be speeded up so that residents are not adversely affected by staff shortages created by these recruitment procedures. Before accepting new people into the home the manager needs to ensure that the staff team have the skills, training and capacity to safely and effectively meet their needs. The compatibility with other people in the home must also be given due regard. Both care planning and risk assessment should be made more individual and be up-dated to make sure that staff have clear and current information on how to care for people and keep them safe. This is particularly important with the high use of agency staff who may not be as familiar with peoples’ needs. Care plans must be more detailed to give staff clearer guidance on how to care for individuals. And they must contain all the important issues from assessments, with strategies of how to manage challenging behaviours. Any advice from professionals must be recorded and a system for ensuring all staff have read and are following these should be developed. The CSCI Pharmacy Inspector carried out an inspection visit on 2.11.07, and reported that staff were carrying out unsafe practices. Improvements that must be made following this visit included: ensuring that the administration of medicines in food or fluids is done appropriately, safely and in residents’ best interests; the service must ensure that all staff who administer medicines are trained and assessed as competent; and staff understand and adhere to the service’s medication policy. The manager and staff need to have a better understanding of how to safeguard people from harm or abuse, and must undergo training in this area. This should also include how to respond to allegations made via staff using the whistle-blowing procedure. The manager needs to use quality checking measures to keep on top of important areas in the home such as reviewing care plans to ensure they are meeting changing needs. Also many key policies relating to keeping people safe need to be reviewed and updated. And generally both files relating to residents and administration files need to be better ordered and be cleansed of old and out-dated material to make it easier for staff to find important information that they need on a day-to-day basis. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 7 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. Lindisfarne DS0000022679.V352938.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 Lindisfarne DS0000022679.V352938.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 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. New people referred to the home have not been properly assessed and the home has had difficulty meeting their needs as a consequence. EVIDENCE: New people referred to the home did not have a full assessment that was carried out and recorded by the manager or home’s staff. At the time one person was referred the home was seriously understaffed, and the need for a high level of supervision had been stressed by a number of professionals in reports sent through to the home in order to keep this person safe. Staff also reported that they did not have the training to be able to meet the needs of the new people needs and consequently the staff team are struggling to do so. They have also failed to properly consider the compatibility issues with other people already living at the home. The home previously had a group of people who were middle to old age who had lived together for over 10 years. They had been judged by CSCI on previous inspections to be meeting their needs well. The age range now is from very young adult to old age and the ability of staff to meet the range of needs is severely compromised.
Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 10 The current practice for admitting a new person to the home is putting people at risk. The manager should develop an assessment process and forms for their own use so that all the information and observations made prior to a person being accepted are properly analysised to determine if the home can meet the persons needs, and if the home has the capacity to do so. The manager must also ensure that any staff undertaking assessments are suitably qualified to carry out this task. In future the manager must carry out a full needs assessment which takes into account the specialist care the person requires and the skills, knowledge and training of the staff team in order to ensure the well-being of all people living in the home. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. People’s care plans are basic and need to be developed in a more person centred way if people’s individual needs are to be better met. EVIDENCE: Care plans and residents’ files would benefit from a review, and clearer instruction for staff on daily routines, personal care for each person and how to keep people safe. This is particularly the case for the new people to the home who had important pieces of information missing from care plans that were in assessments from previous placements. Both care plans and health care plans require up-dating and need to be stored in a more orderly manner with important instructions for staff such as risk assessments being given a higher profile and more readily accessible. Files at the moment are very large and heavy and the amount of information is over whelming, so much so it is difficult to tell which is the latest piece of advice, or most current plan. This problem is illustrated by the fact that an agency worker
Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 12 had felt the need to quickly and very roughly scribble out her own care plan when taking a person out of the home to ensure they were safe. The care needs of the more established residents are being met by acquired knowledge of a relatively stable staff team, rather than by clear plans. All plans need to be developed in a more person-centred way. One professional reported that they felt the quality of life for residents could be greatly improved “through a more enabling, more structured and individual day programme”. There was no evidence to suggest that the manager was carrying out any type of quality audit check to measure quality or frequency of review or adapting plans to changing needs of residents. In light of the Mental Capacity Act the home needs to review the people living in the home with regard to their capacity to make decisions and set up support for those requiring an advocate to represent their best interests. The manager has recently conducted a very good piece of work following a recommendation from a CSCI Pharmacy Inspection which involved multidisciplinary decision-making with regards to the administration of medication. This now needs to be carried out for other areas of decision-making and detailed in each person’s care plan. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. People’s lifestyle choices are being adversely affected by staffing shortages. EVIDENCE: Staff are working hard to cover shifts and to care for people living at the home as best they can but they are being severely hampered by long-term staffing shortages. People each have a different weekly programme of activities; most of these are based around attending a day service. Staff are doing their best to be flexible and make the most of the few opportunities they have to take people out on their own. This is summed up by a relative who said “I feel that under the circumstances the care home do a great job in making their lives as comfortable and varied and enjoyable as possible”. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 14 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, 20 and 21 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The monitoring and recording of healthcare is poor and requires co-ordination to ensure that residents are getting the support they need to maximise their health and well-being. EVIDENCE: The Pharmacy Inspector, Angela Branch, carried out an inspection on the 2nd November, 2007 - four requirements and three recommendations were made. A separate letter was sent out, the requirements and recommendations can be found later in this report. She judged that quality in this area was poor. Improvements that must be made following this visit included: ensuring that the administration of medicines in food or fluids is done appropriately, safely and in residents’ best interests; the service must ensure that all staff who administer medicines are trained and assessed as competent; and staff understand and adhere to the service’s medication policy. The full Pharmacist report is available on request from CSCI.
Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 15 Each person has a Health care plan, however it was difficult to find the latest guidance from health care professionals. For example staff reported that they had worked closely with the Learning Disability Team on strategies for one person but the written records of these meetings, and the outcomes were difficult to find. Staff hold a lot of information on people but this needs to be better coordinated so that staff can readily access important instruction to enable them to safely support and care for people. For example information regarding one persons’ severe food allergy was buried in the middle of an old report but was not found elsewhere in their file. This person had also lost a drastic amount of weight just prior to being admitted to the home and there was no evidence of monitoring weight or seeking specialist advice from a dietician about nutritional needs or from other specialist on the behaviours which led to the weight loss. The care plan stated that staff were to prevent these behaviours but no instruction on how to carry this out. Some people in the home are now showing signs of getting older and the home needs to give careful consideration to how they will meet these people’s needs. This includes the training staff will need and reflecting this in care plans so that staff can be sympathetic to these changing needs. The manager has identified that staff require training on dementia but further consideration is required on training needs and the general approach of the staff team to the needs of older people. These issues on training and properly recording changing needs are particularly important when the home uses such a high number of agency staff. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. The handling of Safe-guarding issues is poor and needs to improve to ensure that residents are protected and their well being promoted. EVIDENCE: Evidence indicates that referrals are not being made to social services of alleged incidents involving residents. The home’s safe guarding and disciplinary procedures should have been invoked and were not. The Adult Protection policy available in the home is dated 2004 and there was no evidence that it had been reviewed since. Consequently it is out of date with local and national protocols. An incident of whistle blowing was poorly handled by the senior staff and manager leading to severe criticisms from the multi-disciplinary safe guarding group, who included the police and social services. This results in residents being placed at risk and not being protected by the systems of the home. The organisation, Walsingham have responded to criticisms of mismanagement in safe guarding people with an action plan to address these failings. On the inspection of this home there was no evidence to demonstrate these improvements had filtered through yet. A large part of this action plan is to ensure staff have training in safe guarding vulnerable adults. They also need to ensure that this is sufficiently covered in a new member of staff’s induction programme, as well as receiving more inLindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 17 depth training in this area. Walsingham also need to ensure that the whistleblowing policy is up-to-date and staff are familiar with its content. Staff in the home are having to deal with more challenging behaviours and have been put under stress in having to protect other more vulnerable people in the home. Consequently, it is recommended that the current level of training in physical intervention is reviewed to assess what level of training staff now require in order to protect people in the home. Currently staff are trained only to level 1 which is a “hands-off” approach which involves diversion, recognising triggers and de-escalation. This assessment needs to be carried out by a qualified person in these techniques accredited through the British Institute of Learning Disabilities. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 18 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. People live in a comfortable, safely maintained home that meets their individual needs. EVIDENCE: The home has a good location in the heart of the community which leads to ready access to local amenities such as health centre, shops and pubs all within walking distance. The home is a purpose built bungalow and is well equipped for peoples needs, having specialist bathing aids and hoisting equipment. People’s individual rooms are well furnished and decorated to their own preferences. On the day of inspection the home was orderly and clean, and a cleaner was busy attending to individuals rooms and one resident was helping to put laundry away. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 19 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): 32,33,34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is severely short staffed which is putting a dedicated staff team under strain and is affecting the care being delivered to people in the home. EVIDENCE: The home has a core group of experienced staff, and health care and social services staff report that they listen to advice and provide good care to residents. This staff team has provided care to all but 2 new residents, for over ten years and a strong bond and relationships have been formed. This was recently highlighted by the death of two long-standing residents and this was reported as an upsetting time for staff. Although the staff team were judged to be hardworking and did their best to provide a good level of care to people this was seriously affected by severe staffing shortages and the high use of agency staff. A number of professionals reported that they recognised that the home was under staffed. “Given the available resources I think the staff do a tremendous job under difficult conditions” “poor staffing levels mean that, unfortunately they cannot fully meet clients needs” and another said “ I believe a higher
Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 20 staff/client ratio would make a vast difference to the clients quality of life by possible enabling a more structured individual day programme for service users”. The home has been running for the past year with 3.5 members of the staff team down, and the use of agency staff was now up to 80-100 hours per week. The organisation uses two agencies and there was confusion in the home as to who directed these staff and who was responsible for their supervision and training. A barrier for recruiting new staff was identified as the processes employed by the central Walsingham HR office based in London and co-ordination between the regional office and the home. This has led to staff being offered a position and not having a start date for 3 to 4 months after the interview. Consequently some people gain employment elsewhere or pull out due to the being frustrated with the delay. This must be resolved as it is compromising the care being delivered to people in the home and putting the staff team under considerable strain. While staff report that they feel supported by the manager formal staff supervision sessions are not consistent or regular, and do not always focus on practice and development issues for each staff member. The manager needs to ensure these take place regularly, focus on quality and care issues and are stored in a more orderly fashion. The same applies to individual training plans, which need to be more orderly and the home needs an overall training profile and plan for the home. This will assist in identifying gaps in training and when courses need renewing. Staff reported that they had been provided with a range of training courses to assist them in working with people with learning disabilities. However training in meeting more specialised care needs is not currently being provided and the staff team all reported a need for training in dementia care and autism. The manager should be given support and resources to provide this training to the staff team. The staff team have received training in person-centred planning and are trying their best to put his into practice. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home needs to improve with more checks and audits to ensure that a quality service is being offered to people living at the home. EVIDENCE: Quality assurance monitoring is not effectively implemented as a core management tool. Resident’s interests are not safeguarded as evidenced by poor recording and not fully following set procedures. This has lead in some circumstances to putting residents at risk, for example by not following medication and safeguarding procedures. There is little or no evidence that spot checks and quality monitoring systems are in place for care planning, with care plans and risk assessments that have dates of 03/04.
Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 22 Many of the home’s policies and procedures also require up-dating, and certain key policies should be kept under constant review depending on the changing needs of people living at the home. For example three of these key policy’s Physical Intervention, Dealing with Violence and aggression and Safeguarding Adults were last reviewed on the 8.2.04. Health and safety aspects of the home are satisfactorily managed and the home is well maintained. For example all fulltime staff have gained an appointed First aider certificate and the home has a qualified moving and handling assessor who attends regular up-dates. Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 23 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 1 3 2 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 1 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 2 33 1 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 2 1 x 1 x x 3 x Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 24 Yes 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 YA2 Regulation 14 Requirement People must not be admitted to the home without full assessments, and due regard given to whether the home has the resources to meet their needs Peoples care plans must be reviewed and up-dated to reflect changing needs The manager and staff must report allegations of abuse to the appropriate authorities and review their own procedures to ensure they are robust and protect service users The registered person must ensure that at all times suitably qualified, competent and experienced staff are working in the home in sufficient numbers to meet the needs of residents Staff that handle medication must be suitably trained in the services medication policy and must receive training in safe handling of medication with assessment of competence in order to protect residents’ health. Timescale for action 30/11/07 2. 3 YA6 YA23 15 13 (6) 15/12/07 10/12/07 4. YA33 18 31/12/07 5. YA20 18(1)(2) 01/04/08 Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 25 6. YA20 13(2) Medication for residents identified during the inspection must be reviewed with their doctors to ensure they receive the correct treatment. 16/11/07 7. YA20 13(2) Where medicines are given in 16/11/07 food or fluids arrangements must be in place to ensure that this is compatible to ensure residents receive safe and effective treatment. 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 YA2 Good Practice Recommendations The manager should use a needs assessment tool to record and analyse if they can meet the needs of new service users, in addition to any other assessment received from other sources. Each person should be assessed by a multi-disciplinary team to determine capacity to make decisions under guidance from Mental Capacity Act 2005, and if appropriate an advocate found to represent people. Specialist professional advice for healthcare or behaviour management should be document and clearly laid out in care plans and risk assessments for each individual. All medication received into the service should be recorded. The decision to administer medicines in food and fluids should be reached through multidisciplinary discussion for each medication, clearly documented in care plans and reviewed regularly. This should include assessment of residents’ preferences, mental capacity, consent, best interests, alternative ways of giving medication and the necessity of medication. Medicines that are no longer required should be returned
DS0000022679.V352938.R01.S.doc Version 5.2 Page 26 2 YA7 3. 4. 5. YA19 YA20 YA20 6. YA20 Lindisfarne to the pharmacy for disposal. 7. YA23 Staff should receive training on safeguarding vulnerable adults from abuse and this should include how to handle allegations made by staff using the whistle blowing procedure. An assessment should be carried out by a qualified trainer to determine the level of physical intervention training required to keep people living at the home safe The homes high reliance on agency staff should be reviewed in order to give people living at the home a better service The registered person should review its recruitment procedures to make them more effective in supplying staff to care homes without unnecessary delays Staff require specific training on autism and dementia to meet the needs of residents 8. 9. 10 11 YA23 YA33 YA34 YA35 Lindisfarne DS0000022679.V352938.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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