Inspection on 01/12/05 for Matson House

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Matson House 23/01/07

Matson House 23/05/06

Matson House 25/08/05

Matson House 07/03/05

Matson House 30/07/04

Matson House 11/03/04

Matson House 24/11/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Matson House Matson Lane Matson Gloucester Glos GL4 6ED Lead Inspector Ms Tanya Harding Unannounced Inspection 1st December 2005 09.10 Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Matson House Address Matson Lane Matson Gloucester Glos GL4 6ED 01452 307069 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) Selwyn Care Limited Mrs Jennifer Hands Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Manager must access additional training & development opportunities & receive regular formal support from the Group Care Manager in order to further develop the skills in managing the care home. Details of the necessary training & timescales for completion have been agreed with the Registered Provider. 25th August 2005 Date of last inspection Brief Description of the Service: Matson House is part of the care provision offered by Selwyn Care Limited. The home is situated on the outskirts of Gloucester in the Matson area. The organisation provides residential and day care services to adults with Autistic Spectrum disorders and associated behaviours. The home shares the site with the Organisations office, another home and the day care facility. There are spacious grounds around the home, with a lake, garden, fields and a large car park. Matson House has been split into two, Charles House and George House, each occupying a separate floor of the building and each with its own staff team. A new registered manager has been appointed in June 2005. There are spacious bedrooms and communal areas for use by service users, including separate kitchen, dining and lounge areas for Charles House and George House. There are also separate staff facilities for each of the houses. The home provides transport to enable the residents to access activities outside the home. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted over ten hours with two separate visits made to the home on 1st December and on the 8th December 2005. The registered manager and the deputy manager supported the inspection. A number of records were examined including care files and staff records. Several staff were spoken with and a number of service users were greeted and observed in their home environment. At the request of the CSCI Regulation Inspector for this home a CSCI pharmacist inspector carried out a follow up to the specialist inspection on 15th March 2005 of the arrangements for handling medication (Standard 20 National Minimum Standards Care Homes for Adults 18 – 65). The inspection took place over three hours during the morning of Thursday 1st December 2005 and examined stocks and storage of medicines, a sample of Medication Administration Record (MAR) charts, other medication records, the medicine policy and procedures. There were discussions with three members of staff. The main purpose of this visit was to assess progress made with meeting the large number of requirements made in the last inspection report. This report presents an overview of areas of service where satisfactory progress has been made. The findings of this report show that the Organisation has taken a number of steps towards improving the service provision which mainly consist of rectifying staffing shortages and implementing a better quality assurance system. However, there is also evidence that some requirements which have been repeated in a number of reports, have not been addressed to a satisfactory standard. The Commission is considering taking further action to ensure compliance is achieved in respect of these requirements. There is an agreed condition of registration by which the registered manager of the home is required to undertake additional training and development. The timescale for this to be achieved is July 2006. What the service does well: Many of the rooms provided for service users’ private and social use are very spacious. There are large accessible grounds around the home, which are used for the benefit of the service users. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Practices and written guidance around risk assessments and adult protection issues need to improve to ensure there is a robust system for protecting the service users from any harm and abuse. Some of the practices in the home are still restrictive and steps need to be taken to remove any unnecessary restrictions and to promote awareness amongst the staff of more empowering approaches. A large number of requirements have not been addressed and the Organisation needs to take further steps towards meeting the Standards and Regulations in order to improve the quality of the service it offers. A number of judgements made in this report are based on anticipated improvements which may become evident if the proposed actions are implemented and followed through by the registered manager with support from the Registered Providers. In future inspections the Commission will look for evidence of sustained improvement in areas where shortfalls have been identified as well as for a more proactive approach from the manager and the providers in addressing any problems and quality issues. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 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. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 The updated admission procedure should ensure that people’s needs and aspirations are assessed prior to prospective residents moving into the home. EVIDENCE: At the time of the visit there was one prospective service user taking an opportunity to ‘test drive’ the home. The person was already known to the management of the home and staff spoken with confirmed they have been issued with guidance about the person’s needs and behaviours. The registered manager explained her understanding of the admissions process and the need to gather comprehensive information about any prospective resident in order to determine whether their needs can be met in the home. The manager has carried out a pre-admission assessment in conjunction with the sponsoring authority assessment. These were not examined in detail on this occasion. The Organisation has updated its admission procedure in line with the relevant standards. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Better detail and presentation of care guidance should give staff increased understanding of service users’ needs and promote consistency of approach in meeting those needs. Shortfalls in the risk assessment approach in the home could potentially put service users at risk of harm. EVIDENCE: Significant improvements have been made to how the care information is presented. A number of care files were examined. The information about people’s needs and wishes has been made easier to access and understand. There are now different sections for guidance on how service users should be supported with activities of daily living, what interests they have and any other relevant guidance. The new format is more user friendly than the previous one and has a greater focus on the service users. Once all of the care files have been changed this should provide a good baseline for further developing the information and guidance in a person centred way, to ensure the views of the service users about how they want to be supported to live their life are reflected. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 11 A record of behaviour for one service user described the person being asked to clear up the floor after they had urinated on it. There was no information on whether this request was appropriate and how it was received by the service user. The person’s care plan must clarify the expectation staff can have about the person clearing up after themselves, with consideration being given to the person cognitive abilities and infection control practices. A number of requirements were made in the last inspection report around the improvements necessary to the way risk assessments are carried out and recorded in the home. There are risk assessments in place for service users. These are brief and do not demonstrate a comprehensive overview of identifying risks, hazards and steps which staff must take to reduce or eliminate these. These are long-standing requirements and lack of progress in this area is concerning. A requirement to implement a risk assessment for a specific service user who chooses to sit on the floor in communal areas has been responded to and a copy of the assessment has been provided to the Commission. This lacks important detail and may not offer the necessary protection to the service user. A risk assessment for a new service user with regards to travelling in vehicles was more detailed although could be further improved. Missing person’s forms need to include service users’ photos and additional information about the person’s vulnerability (where this is appropriate, such as whether the person is able to communicate or has significant medical issues). Systems for managing service users’ finances were not inspected on this occasion. Personal moneys are made available to service users and receipts of any expenditure are kept. Information in care plans should provide detail of how each individual wants to be supported to keep and use their money. Further assessment of this standard will be made at future visits. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Service users have opportunities for regular structured activities and are supported to maintain family relationships, although information about how this is done is not yet evident in records. Restrictive practices in the home may potentially compromise people’s autonomy. EVIDENCE: Service users have access to a number of timetabled activities including rambling, skiing and trips to the pub. Some people access the day centre on the same site and have regular sessions with the music therapist, aromatherapist and / or art therapist. Discussions with staff and service users provided evidence that relatives visit the home and service users are supported to go on home trips. Contact with relatives is also maintained by telephone and key-workers have the responsibility for keeping parents/ relatives updated on individuals’ progress. A formal agreement has been made with some families about notifying them of significant events. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 13 Care files were examined for several service users. Much of the information about what support service users need with accessing activities, maintaining relationships and with being more independent in their lives was not present. This is still being collated and developed. A requirement was made in the last report about ensuring that a consistent approach is established to support the service users when they are accessing the kitchen and may want to get a snack or a drink. There was evidence that this has not been addressed to a satisfactory standard. From discussions with staff and from observation it was evident that one particular service user is discouraged from taking food from the kitchen. This is done differently by different staff and consideration must be given to implementing some very clear boundaries around what actions staff are expected to take if the person comes into the kitchen and decides to help themselves to food or drink. Staff advised that another service user is sometimes discouraged to have a drink when they ask for one. This is because the service user tends to request a drink after a short period of time. In terms of good practice, all service users should be supported to have snacks and drinks when they want these. Some restrictions may be seen to be in the best interest of an individual for health reasons for example. If this is the case, clear information about any such restrictions must be documented in care plans after an agreement has been reached on the best approach with other significant people, such as the sponsoring authority, family members, and other professionals. One member of staff suggested that instead of confronting the service user about taking the food, the behaviour can be anticipated and a suitable snack / snacks can be left ready for the person to take, when they decide. The dining room door in Charles House was noted to be locked. Reasons for this must be established. Any unnecessary restrictions must be removed. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Improved guidance in care plans should enable staff to provide support in line with service users’ individual preferences. Service users receive support with managing their health needs. Medicines were found to be generally well organised and most issues from the last inspection have been addressed. Staff spoken with are motivated to ensure there is good practice in the handling of medicines. Formal training for all staff in the care and safe handling of medicines is yet to be completed. EVIDENCE: Care information for individuals is being revised to provide greater focus on how service users want and like to be assisted with their needs including personal care needs. The improved guidance should direct staff on how to provide the necessary support in a respectful and dignified way. There was evidence that home has provided support to service users with health needs. This included supporting one service user in hospital and continuing to monitor a person’s progress once back at home. Records of health related appointments are kept but were not assessed in detail on this occasion. General health care plans again lack some important detail and this needs to be included, for example information about how each person indicates whether they are in pain or feeling unwell. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 15 One person has been supported to lose weight sensibly with input from a dietician. Standard 20. Some new medicine cupboards have been provided. In George House it needs fitting flush to a solid wall. In both houses medicines for internal use need to be segregated from those for external use. Inspection of some Medication Administration Record (MAR) charts found these to be generally complete. A few gaps in records were noted. Where medicines are not currently used (because they are seasonal for example) the chart needs to be marked to explain this. On George House there was one anomaly between tablets remaining in the monitored dose system (MDS) pack but signed as administered. Handwritten entries must be signed by the authorised staff making this with a signed check for correct transcription by a second authorised staff member. Some handwritten charts are not fully dated. Protocols are in place describing the use of medicines prescribed ‘as required’. One was identified to be updated. Some ‘as required’ medicines must be returned as they are not used now or have been in use beyond the stipulated 6-month shelf life. On George House a protocol for one resident must be prepared and agreed with the doctor covering the use of four tablets of one medicine during a particular procedure. For one resident on Charles House use of olive oil and homeopathic eardrops must be reviewed, as the latter also appeared to contain olive oil. If needed small bottles of olive oil of medicinal quality must be used and regularly replaced rather than the large bottle seen. Some medicine containers other than MDS packs are dated but it was not clear if this was the receipt date or opening date thus audits were not possible. The MAR chart could be marked when a new pack is opened. Regular audits should be conducted to demonstrate medicines are being given correctly as prescribed. This is particularly relevant for medicines only occasionally used. Since the last inspection procedures have changed for medicines during leave periods and new forms have recently been introduced. Information about quantities taken out and subsequently returned must always be recorded. There is an in-house medication training and assessment programme before staff are authorised to administer medicines and some staff have studied a formal course from a local college about the ‘Safe Handling of Medicines’. One staff member spoken to had not received formal training even though in post for over four years. She is booked to attend a Care of Medicines course tutored by a pharmacist. All staff must receive training of this nature as well as the in-house programme before being authorised to handle medicines. Competence in handling medicines can also usefully be included during the staff supervision process at least each year. Staff signature forms must include initials used when signing medicine records so that staff can be identified. Dates of joining and leaving are relevant. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 16 There is a September 2004 British National Formulary but this should be replaced with the September 2005 edition. The medicine policy and some procedures were reviewed. There is some good information in parts but in others the information is not relevant to this home (mention of nurses in several places and trolleys). More specific information needs inclusion (issues such as use of ‘as required’ medicines and handwritten entries on MAR charts for example are not mentioned). The Homely Medicines list dated September 2000 must be reviewed as some items need more information and others must not be used. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Shortfalls in approach and guidance for protecting service users may be putting people at risk of harm and abuse. EVIDENCE: Since the last inspection the Organisation has responded to concerns raised about staff conduct. The Commission has concerns about the delay in suspending staff who were implicated. The Organisation has procedures for responding to allegations of abuse and poor practice which direct the registered manager to take action in order to prevent the alleged perpetrators having contact with service users until a full investigation is carried out. These procedures must be followed at all times to ensure that immediate and unconditional protection is offered to the service users. A copy of the policy on protection of service users has been provided to the Commission for reference. This gives step-by-step guidance on how to respond to an allegation of abuse and looks at the decision making process during the potential investigation. It is not clear why in the above case the required action was not taken immediately. The Organisation has a personnel officer who is responsible for carrying out investigatory interviews and co-ordinating the disciplinary process. Support is also sought from the registered manager of Matson House or from the manager of the sister home on the same site. In terms of good practice all personnel involved in internal investigations should be independent of both homes. This would ensure a more objective approach and will help to protect the Organisation from criticism. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 18 Staff spoken with confirmed that there is a requirement to complete bruise charts and complete incident records in the event of a service user being hurt. Staff have been instructed to revisit the bruise charts after the incident to ensure that any sign of injury or bruising which may not have been obvious straight after the incident, is also recorded. This is good practice. Staff were not aware of any specific guidance about protecting service users from violence within the home (from other residents). There have been previous requirements for the home to implement detailed protocols on how to ensure the protection of service users from violence in their own home. In the absence of evidence that this has been done, the requirement is repeated and must be addressed urgently. Information seen for one service user stated that if the person is displaying challenging behaviours staff ask the person to stop. It was not clear whether this approach was effective. This should be established and more guidance must be provided for staff if necessary on how to deal with such incidents. Previously the home has been asked to ensure that the placing authorities and relatives (where appropriate) are informed of incidents which may adversely affect the well being of an individual. This is to give other significant people the opportunity to question approaches used in the home. This is being done in some instances, but not consistently. The requirement is repeated and the inspector will be writing to the relatives and the placing authorities to seek their views about the care provided. Feedback from this consultation will be included in the next inspection report. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: A detailed assessment of the environment was not carried out on this occasion. The manager advised that key areas such as kitchens and bathrooms in the home are cleaned everyday. She intends to review the cleaning programme in order to incorporate a schedule for deep cleaning into this. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 34. Appropriate staffing levels should improve the support provided and increase opportunities for service users. Dedicated management support and careful monitoring of staff skills and competency should mean that service users’ needs are met by an effective staff team. EVIDENCE: A number of new staff have been employed since the last inspection and some staff have left to pursue other employment. The management team is also quite new and it is felt that there is still much work to be done by the Organisation to develop the team. The registered manager advised this has been recognised and staff meetings and supervisions are used look at the strengths and learning needs of individual staff. She has started to look at cohesiveness of teams and their approach. Staffing levels have improved as required in the last report and the home is no longer asked to provide monthly rotas to the Commission. Information about staffing levels will continue to be monitored and the Care Director has agreed to include details of this in Regulation 26 reports. A requirement is repeated in this report for the home to provide a written confirmation of how many staff are required to be on duty at each Charles and George Houses on each shift. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 21 Pre-employment checks and other information relevant to staff is collated and kept centrally. There was evidence that progress has been made in obtaining the missing information although there are still gaps and this must be addressed. A number of staff were spoken with. New staff confirmed that they received a period of induction, during which they were asked to shadow a designated shift leader who acted as a mentor. There was evidence of some management support being given for new staff in way of discussions about the roles and responsibilities. Staff were given opportunities to read service users’ files and were introduced to the system of record keeping. New staff are expected to access a Studio III course which teaches them de-escalation, breakaway techniques and physical intervention techniques. Staff attend induction and foundation courses, NVQ related courses as well as a number of mandatory courses related to health and safety. A record of these is kept in the main office and has not been examined on this occasion. The Organisation should collate information about how many staff have achieved NVQ2 or above in order to assess whether the Government set standard is being achieved (as detailed in Standard 32.6). Staff should also be attending Ldaf training (see Standard 35.8) and specialist training in Autism in order to gain better understanding of service users they support. Staff in the home receive formal supervision. This standard was not assessed fully during this visit; however, it is recommended that formal supervision for new staff is carried out more regularly for the first few months to ensure that their practice develops as it should. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 Increased management presence in the home and improved quality assurance systems should provide a better overview of the shortfalls in the quality of the service and result in more proactive remedial action being taken for the benefit of the service users. EVIDENCE: Discussions with the registered manager and the deputy manager provided evidence of how they have been identifying and prioritising the areas for improvement. The registered manager felt that greater presence in the home during shifts would enable her to observe staff practice and become more aware of how service users’ needs are being met. The manager advised that much work has been done with the staff team on challenging outdated approaches and presenting different ways of working which are more respectful towards the service users. Progress in this area will be further assessed at future inspections. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 23 The registered manager is required to access additional training in a number of areas in order to further her skills and knowledge in key aspects of her role. At the time of the inspection there has been no progress with this. This is a condition of registration and has a timescale of end of July 2006. The manager has been reminded of this. The Care Director now has the responsibility for carrying out Regulation 26 visits. The format for recording outcomes of such visits has improved and assessment will be made at future visits of whether this is effective. Regulation 26 visits must unannounced and be carried out at least once a month and resulting reports must be forwarded to the Commission. It has been agreed that Regulation 26 reports will include reference to how staffing levels are being maintained. Management meetings now include reference to the National Minimum Standards in order to monitor compliance and address shortfalls. This is seen as a more proactive way of monitoring the quality of the service. Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X X X Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 25 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 YA6 Regulation 14&15 Requirement Care plans for all service users must provide guidance which is clear and reflects the needs and wishes of the service users. (Progress is ongoing) Clarify the expectation staff can have about the person clearing up after themselves (as described in the text), with consideration being given to the person cognitive abilities and infection control practices. Ensure this information is recorded in care plans. Ensure that the necessary risk assessments are carried out and recorded for all service users. Not met within timescales of 31st October 2004, 30th June 2005. Risk assessments must be Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 26 Timescale for action 31/03/06 2. YA6 12 28/02/06 3. YA9 13(4&6) 31/12/05 4. YA9 13(4&6) 5. YA9 13(6) sufficiently detailed to demonstrate that risks and hazards have been comprehensively considered. Risk management 31/03/06 protocols must be implemented to ensure all service users in the home are protected from violence. (Timescale of 31/10/05 not met) Missing person’s forms 31/03/06 need to include service users’ photos and additional information about the person’s vulnerability (where this is appropriate, such as whether the person is able to communicate or has significant medical issues). Practices and approaches which restrict service users’ choices and freedom of movement must be identified and recorded in individual care plans with clear detail as to the reasons for these and evidence of multidisciplinary agreement. Restriction where no such agreement is evident must be reviewed and removed where appropriate. Ensure all staff have clear guidance on supporting service users to have access to drinks and snacks in line with the standard. Guidance must 31/03/06 6. YA16 12 and Sch 3 7. YA17 16(2) 13(6) 12(5) 31/03/06 Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 27 8. YA20 18(1) be issued to staff to ensure that their approach is consistent, respectful and promotes understanding as to the nature of behaviours displayed by the service users. Previous timescales of 31/10/04, 30th June 2005 and 31/10/05 not met. All staff administering medication to complete a formal training course encompassing the details in this Standard. (Previous timescale 31/7/05 not met). The new medicine cupboard on George House to be bolted flush to a solid wall. Handwritten entries on MAR charts must be complete and be signed by authorised staff with a second staff signature as an accuracy check. The medicine policy and procedures (including the homely medicines list) must be reviewed to ensure all aspects of managing medicines are included and that it is specific for Matson House Regular audits must be completed to demonstrate medicines are being given correctly as prescribed. A protocol for one resident must be prepared and agreed with the doctor covering the use of four tablets of one medicine during a particular procedure. DS0000016500.V281282.R01.S.doc 31/03/06 9. YA20 13(2) 28/02/06 10. YA20 13(2) 17(1) 28/02/06 11. YA20 13(2) 31/03/06 12. YA20 13(2) 28/02/06 13. YA20 13(2) 17(1) 31/03/06 Matson House Version 5.1 Page 28 14. YA23 13(6) 15. YA23 13(6) 16. YA23 12 and 13(6) 17. YA33 18(1) 18. YA34 17(1)Sch4, 19&Sch2 19. YA23 13(6&8) 20. YA39 26 The home must establish and adhere to procedures for notifying the placing authorities and significant others such as relatives or advocates when an adverse event occurs in the home. The manager must take prompt and decisive measures to protect service users from physical and any other form of abuse by others. Provide better guidance for staff on managing incidents appropriately (refer to text). Provide a written confirmation of the current staffing arrangements for Charles and George Houses for day and night cover for both homes. Ensure that all recruitment checks are carried out as necessary and all required information is collated and kept for all staff. (Previous timescale of 30/09/05 not met). Review physical intervention protocols in line with the Department of Health Guidance. Original timescales 31/10/04 and 30/06/05. To be assessed at the next visit. Visits under Regulation 26 must be unannounced and carried out at least monthly and resulting reports must be forwarded to the Commission. DS0000016500.V281282.R01.S.doc 28/02/06 28/02/06 31/03/06 28/02/06 31/03/06 31/03/06 28/02/06 Matson House Version 5.1 Page 29 Reference to staffing levels must be included in these reports. 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. Refer to Standard YA20 YA20 Good Practice Recommendations A September 2005 edition of the British National Formulary to be obtained. Handwritten entries on MAR charts to be signed by the authorised staff member making the entry with a signed check for correct transcription by second authorised staff member. Information about options open to staff in the event of a violent attack should be clarified to the team. Formal supervision for new staff should be carried out more regularly than for established staff for the first few months to ensure that their practice develops, as it should. The telephone number for the Commission in the policy for protection of service users should be amended to 01452 632750. Procedures for carrying out investigations should be reviewed to ensure personnel involved in internal investigations are independent of both homes. The Organisation should collate information about how many staff have achieved NVQ2, Ldaf training and specialist training in Autism. This information should be included in staff files and centrally for reference at future inspections. 3. 4. YA23 YA36 5. 6. YA23 YA23 7. YA35 Matson House DS0000016500.V281282.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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