Inspection on 22/11/07 for Morecambe Re-enabling Unit

This inspection was carried out on 22nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Morecambe Re-enabling Unit 30/05/07

Morecambe Re-enabling Unit 23/02/06

Morecambe Re-enabling Unit 13/10/05

Morecambe Re-enabling Unit 26/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Morecambe Re-enabling Unit 29 Morecambe Road Morecambe Lancashire LA3 3AA Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 09:30 22 November 2007 nd 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 Morecambe Re-enabling Unit DS0000059653.V350571.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. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morecambe Re-enabling Unit Address 29 Morecambe Road Morecambe Lancashire LA3 3AA 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) 01254 420303 Calderdean Ltd Mrs Margaret Smith Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home shall at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission The home is registered to accommodate a maximum of 11 clients to include: Up to 11 clients in the category OP (older persons). Up to 2 clients in the category PD (physical disability) aged 45 years or over. 30th May 2007 Date of last inspection Brief Description of the Service: The purpose of Morecambe Re-Enabling Unit is to work with older clients discharged from hospital and, with support, return to their own units. A fulltime Manager and a team of staff manage the Unit. Ordinary living facilities are available within the Unit to enable clients to regain their daily living skills. To enable clients to develop the skills and confidence to return unit, the staff at the unit work alongside a variety of professionals, including occupational therapists, physiotherapists, rehabilitation social workers and health visitors. The re-enabling programme normally lasts for a period of one to six weeks but this can be extended to meet the clients’s needs, if required. The Unit is situated in a residential area of Morecambe and is close to the shops and amenities in Torrisholme. It is situated on the main bus route into Morecambe town centre. Clients are encouraged to maintain their links in the community by attending Day Centres and Over 60’s Clubs and recommence their hobbies and interests. Opportunities are normally provided for them to engage in social activities both insides and outside the Unit. Visitors are made welcome at anytime. The current range of fees are from £399.00 to £399.00 per week. Further details over fees can be obtained from the general manager or manager of the unit. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second site visit to this service and was unannounced so the registered providers, general manager, staff and people who use the service were not aware of the visit. We carried out a site visit to the service which took one day. This visit forms part of the overall inspection for the unit so that we can be sure the clients are being cared for properly and to make sure the unit is a safe place for clients to live in. As well as the site visit, judgements have been made about the service based on information supplied by the current registered manager/general manager. Comment cards were made available. A number of comment cards were received from external professionals and people who have used the reenabling service in the past. The site visit included taking time to sit and speak with clients in the unit, speaking with staff and speaking with the registered manager/general manager of the unit. As well as this, a selection of documents were examined. The unit’s registered manager/general manager made herself available during the inspection to answer questions and provide additional information. We looked around parts of the unit, including communal rooms, a small number of personal rooms, bathrooms and toilets to see first hand if the unit was a comfortable, clean and safe for clients to live in. Additional information was also supplied from a pre-inspection questionnaire completed by the general manager. People who use this service are referred to in this inspection report as ‘clients’. What the service does well: The unit’s ethos is that clients are supported to re-learn their skills and confidence to enable them to return home. The service is described as being “dynamic” as all clients have their own individual presenting needs, wishes and circumstances from the point of referral. There are a range of multi-disciplinary professionals (occupational therapists, speech therapist, dietician, G.P.’s, amongst others) who are available to work alongside staff. The environment is generally well maintained and provides a pleasant environment for the clients to live in. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 7 Throughout this inspection record various issues have been raised, some from the inspection itself, some from clients and some from occupational therapists, physiotherapists, social workers, care managers and commissioners of services (who are part of the multi-disciplinary team who work alongside the unit to ensure client’s needs are met. Areas where the unit could look at whether they could improve include – When a client is admitted, the unit should ensure it gets to know and records Needs, wishes, routines and hopes for the individual concerned so that the service can be confident it is providing a needs-led and responsive service. The unit should develop and provide opportunities for the clients to take part in social and re-enabling programmes to further develop their skills and confidence. Concerns were raised over the unit’s lack of consistency in providing and supporting the clients to undertake their re-enabling programmes and in providing personal care. This also includes ensuring clients are provided with day to day activities (e.g. shopping, meal preparation) so that they regain basic skills for their return home. There is also the need to look at the night staffing levels so that clients can be confident that they are fully supported in their re-enabling programmes The current registered manager/general manager has already recognised the need to look at team working within the unit. This is something that has also been raised in survey forms. Other professionals have said they have seen the benefit in supporting staff to develop skills (via specialist training), be involved in review meetings so that they can better work alongside and support individual clients in their programmes. This may involve providing staff with some additional training so that they are clear about re-enabling work. As part of the management team, the manager of the unit needs to ensure that there are systems in place that regularly audit and check on the practices so that any issues or concerns can be picked up and addressed promptly. For example, medication systems, particularly as the varied needs of clients put different demands on the skills of the staff team in this area. Feedback gained from external professionals should be used to review the service so that it remains responsive and meets the different needs of the clients that it supports. Please contact the provider for advice of actions taken in response to this Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 8 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. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 9 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 Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Assessment information is not sufficient because it does not detail an individuals wishes and needs of the person meaning that staff are unable to tailor a service to meet individual needs. EVIDENCE: Three clients were spoken with about their admission to the home and all confirmed they were seen in hospital by the general manager who provided information about the service, along with a photograph brochure/service user guide so that they were able to see first hand what the unit was about, see photos of staff and the facilities and have any questions answered. Clients confirmed they were made to feel welcome on their arrival and were given time to settle in. Individual comments in survey forms also confirmed Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 11 clients felt they received enough information about the service. One commented – “I was visited in hospital and assessed for suitability to move to the re-enabling unit.” External professionals confirmed that due to their involvement with the prospective client, they are able to provide a good range of assessment information to the service, including a plan for individual clients’ rehabilitation whilst at the unit. Individual files were seen to contain these assessments. Service user guide information is contained in a separate folder kept in each individual room. These guides provide information about the unit, its facilities, staffing and who to speak with if they were not happy about any aspect of their care. Within the folder there are also blank documents provided by the home so that the key member of staff (key worker) is able to talk to the client, ask them about their individual daily routines, activities, likes, dislikes, etc. so that the service can be better tailored to meet the individual needs of the client concerned. The previous key inspection raised concerns that the service was not involving clients by asking for this information. During this inspection, it was not possible to evidence any improvement in this area. The rehabilitation unit is a dedicated unit, in a detached dwelling close to Morecambe. There is individual accommodation, with each person having their own personal room for the duration of their stay, facilities and equipment is provided via the other professionals in the multi-disciplinary team. Staff spoken with confirmed that good information is provided about the rehabilitation needs of the clients, although not fully familiar with the needs and wishes of individual clients. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 12 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): Standards 7, 9, 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 planning arrangements do not contain enough detail to ensure that clients personal care need are met fully EVIDENCE: Care files continue to be split into different sections – one admission, one mobility (yellow), one daily living skills (green), one personal care (red) one medication and health (blue) and a final section on discharge (pink). These files are well organised and information can be found fairly easily. Discussion with the registered manager over “overview of needs” information which are contained in a separate folder for staff to use on a daily basis. Three care files were examined and whilst some improvements were found in the information provided, files did not evidence the day to day personal and social care input and whether their individual rehabilitation had been followed or, if not, a reason why. It is important that this is done so that at review Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 13 meetings the multi-disciplinary team can reassess the client and whether further or different support is needed. There was good evidence that clients healthcare needs are met, clients themselves confirmed this. Comments received from clients about the service are generally positive about the care they have received. Comments include – “I was supported and helped by the staff, as were the other residents, and encouraged along with help from the physiotherapist. Feeling relaxed and comfortable I gradually gained strength”. One resident spoken with said the staff were “excellent – can’t do enough for you”. External professionals (who form part of the multi-disciplinary re-habilitation team) also raised concerns over the unit’s ability to work consistently with clients and one stated the following of individual rehabilitation programmes is “hit and miss”. Concerns were also raised about how the unit supports people in their personal care - “at times I have felt some of the service users should have been offered support with some aspects of personal care when they have been struggling”, “sadly lacking in terms of bathing and showering”, “sometimes care staff are not proactive in meeting needs e.g. in encouraging residents to bathe” and “it is not dignified to allow a service user to have only 2 showers in the course of 6 weeks”. One positive comment was received – “Can do well for certain individuals – have known them to go ‘extra mile’ for some”. The registered manager/general manager confirmed she was very concerned over the findings of the two pharmacist inspection reports. As a result, she has set in place systems so that medications in, returns and stocks held can be accurately maintained and regular audits undertaken. Consideration needs to be given to ensure that medications taken from stocks for use by clients are easily identified in the drugs stocks book as it is difficult to identify which medications have been returned to the chemist or used by clients. Medication records and stocks, along with controlled drugs, were examined and found to be accurate. External professionals noted that self-medication is not always considered by the unit unless it is specified by the social worker or other professional. The clients spoken with could not remember being involved in their care plan/goal plan or being asked about what they want to achieve whilst at the unit. Clients spoken with were unable to remember whether they had been Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 14 consulted about what they wanted to achieve at the unit and the care plans do not evidence client involvement in this area. As raised in the previous inspection report, the night staffing arrangements remain of concern from the view that no rehab work is carried out during the night-time. Comments from external professionals raised concerns that rehabilitation programmes are not followed through during the night time (between 10 p.m. and 7 a.m.) by staff in the unit – “no rehab done between 10 and 7 as far as I’m aware” and “night-time cover – although carer is available at the unit at night it is never felt we can push rehab during the night to return home”. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Insufficient social or re-enabling activities are provided, which means clients may not be gaining confidence in key skills. The food provided has improved which means that clients are provided with sufficient nutritious food to help in the re-enabling process. EVIDENCE: There was no evidence from any of the clients’ individual files held in their own rooms that they have been asked about their own routines, wishes, social interests, etc. All were left blank, although one resident had said she had “just today been given a form to fill in”. However, one client spoke of her delight as the staff helped her to get ready to attend her daughter’s wedding, making sure her hair, outfit and appearance matched the occasion. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 16 During the inspection, only one activity was seen in place which seemed ad hoc and did not seem to be thought out for the client who was left to it. Clients spoken with felt there was little activity in place, although they were able to confirm that they are able to have visitors at any time - family contact is clearly very positive and important to the clients spoken with. A number of other survey forms confirmed that activities in the unit are “very basic” and the unit needs to improve activities on offer. Other surveys felt that there is a lack of day to day activities that could improve skills of the clients – for example, involvement in clients in shopping and meal preparation. One comment stated that the unit – “will facilitate home visits. Good communication with relatives usually”. Clients who responded via the survey forms and clients spoken with were all very satisfied with the food provided. One resident is a vegetarian. This was clearly stated on their care plan and staff were aware of this. Food records examined evidenced that this was respected by the unit, with vegetarian food being provided. 50 of staff have now received training in food hygiene. Morecambe Re-enabling Unit DS0000059653.V350571.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): Standard 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The services complaint’s procedures works in that people know how to complain and that if they do it will be acted upon. This mean that the people live in a safe environment EVIDENCE: Clients spoken with and those who returned survey forms all confirmed they know who to speak with if they are not happy and know how to make a complaint. Information (Statement of Purpose, facilities within the home, complaints procedure) are in each of the rooms for clients to read at their leisure and in private. Neither the commission nor the service have received any complaints, concerns or allegations regarding this service, although an improvement plan is still ongoing. Information from the home states that no safeguarding referrals or referrals to the “Protection of Vulnerable Adults” (POVA) register has been made. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 18 Staff spoken with confirmed that if a client was not happy they would try to sort out the problem and, if needed, they would involve the manager of the service. Staff have previously confirmed that they have covered safeguarding adults within their NVQ training – staff spoken with were able to confirm appropriate action if any concerns regarding abuse were raised. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 19 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): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The unit is clean, warm and tidy and provides a comfortable and appropriate environment for clients to undertake their rehabilitation programmes. EVIDENCE: Not all individual rooms were seen but a good selection were seen and were found to be clean and tidy and presenting a homely environment for the clients to use. A number of door wedges were seen – registered manager/general manager advised regarding use of these and to look to replacing with automatic door wedges. Concern was raised in the last inspection report over the fire doors being too heavy for some clients to open. As a result, these are being wedged Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 20 open. At that time, the general manager was advised to consult with the fire department over the provision of door release mechanisms, so that fire doors can be open but close when needed so that clients are safe in the event of a fire. The registered manager/general manager is also looking to purchase a better alarm system so that clients can be confident of calling for assistance wherever they are in the unit. Overall the unit is much cleaner and fresher than last inspection. Rooms have been refreshed/redecorated as needed and there is an ongoing redecoration programme in place. All bathrooms/toilets clean and tidy. Kitchen – new units and cupboards – all clean and tidy External professionals comment - “provides a good environment in the fabric of the building”, “presents a ‘comfortable homely environment’, “homely friendly place. Welcoming., Good access to Morecambe for the visitors. Easy access to home as usually in Morecambe.” 50 of staff have had infection control training and previous discussions with staff confirmed that there are a supply of plastic aprons and plastic gloves for use. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 21 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): Standards 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. Staff do not always have the necessary skills and training to meet the rehabilitation needs of the people and this means that some client’s rehabilitation programmes are not consistently carried out properly EVIDENCE: Clients spoken with indicated they were well cared for. Individual comments include - “all the staff were very sympathetic”, “staff very attentive” and confirmed that staff are always” available when needed and listened and acted on what they said. Feedback raised concerns that the management team do not seem to facilitate or support staff by passing on full information, having good communication or by enabling care staff to be fully involved, e.g. by attending review meetings. Night staffing was again raised as a concern and it was felt that the service could be improved if the night staffing arrangements were to be increased to a waking watch so that individual rehabilitation programmes could be continued during the night. Comments include “improve night-time service – no rehab done between 10 and 7 as far as I’m aware”, “night-time cover – although Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 22 carer is available at the unit at night it is never felt we can push rehab during the night to return home” The number of staff who have left the unit since the last inspection was discussed – the registered manager/general manager confirmed the need to have some consistency and indicated staff have left for genuine reasons. Information provided by the unit confirms that 3 care staff have National Vocational Qualification (NVQ) Level 2 or above with 3 members of staff working towards this award. This means that staff are trained to provide a good level of care. Staff files examined evidenced that all the required checks are being carried out prior to a new member of staff commencing work at the unit. Training files evidence that training is now ongoing, with further training planned via an accredited training agency. Future training planned – in January all staff to have safe handling of medications training. From feedback received, there is a need to ensure staff understand their role in enabling clients to follow their rehabilitation programmes and some specialist training may be useful in addressing this. Staff spoken with confirmed the training they have undertaken. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management of this service does not fully promote the best interests of clients in a range of ways that means some clients programmes and rehabilitation is not properly effected EVIDENCE: Discussions with the registered manager/general manager confirmed that a new manager has been appointed and took up her employment on 19.11.07. Once the induction programme and a trial period has finished, all being well, the new manager will be put forward for registration with us. Discussions with registered manager/general manager confirmed that the new Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 24 manager has a range of experience, knowledge and skills to bring consistency and good management to the unit. Some positive comments have been made in respect of this service – “they do a good job in helping their patients get back to their homes”; “I have known them go the extra mile” and “I was supported and helped by the staff, as were the other residents, and encouraged along with help from the physiotherapists – feeling relaxed and comfortable and gradually gained strength”. However, throughout this inspection record various issues have been raised, some from the inspection itself, clients and others from external professionals (who are part of the multi-disciplinary team who work with this re-enabling service. These include : • Obtaining full information about clients needs, wishes, routines, etc. so that the current service can be improved to ensure that it is a needs-led, holistic and responsive service which meets the needs of the clients. Skills of staff to ensure re-enabling programmes are fully undertaken, to ensure consistency in following re-enabling programmes and to ensure that all planned programmes meet identified needs – e.g. meal preparation Opportunities for clients to partake in social and re-enabling activities Training of staff in rehabilitation work so that they are trained and skilled about enabling and supporting the different needs of the clients who may access this service The need to obtain feedback so that the service can be reviewed to ensure that it is a dynamic and responsive service Night staffing – in relation to continuing the re-enabling work Consistency in ensuring personal care needs are met Communication, team working and involvement of key workers in reviews Ensuring good management and auditing systems are followed – e.g. for medication, particularly as the different needs of clients put different demands on the skills of the staff team. Ensuring training is ongoing and updated as needed, with any specialist training accessed to meet identified clients’ needs • • • • • • • • • Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 25 Information provided by the unit confirm that there are a range of quality assurance systems in place, including monthly visit to the unit by the general manager, speaking directly with clients and seeking feedback once the rehabilitation programme has been completed and the client goes home. As well as this, the unit holds the ISO 9001 Quality Assurance Award. A number of letters and cards were seen on display with positive comments from exclients being noted. The unit does not manage any of the client’s money as these clients are independent enough to manage their own finances, although there is a system in place to ensure recording and safe keeping of any valuables. The unit has forwarded copies of the PATT electrical certificates requested at the last key inspection. Information supplied by the unit confirms that all the required policies and procedures are in place and these have been reviewed recently. Staff spoken with also confirmed they have access to these, as needed. Information provided by the home confirms that all the required maintenance and servicing of equipment and facilities has taken place, there are written assessments for the control of substances hazardous to health (COSHH). The home maintains an accident book, although this was not examined during this second key inspection. The unit is now forwarding to the commission notification of incidents – to date, three have been received and appropriate actions noted. The registered manager/general manager has previously confirmed that the home has a fire risk assessment in place. Better risk assessments are now in place. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 26 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 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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 OP6 Regulation 12(1)(b) Requirement The re-enabling programme must be consistently followed, unless the care plan records differently, so that health and welfare needs are met. Activities and opportunities for social and training must be provided according to clients’ preferences, needs and wishes Care records/plans must evidence that personal care is being carried out, unless recorded otherwise Staff who administer medications must be provided with formal training to do so (previous timescale of 31/07/07 not met) Night staffing must be reviewed to ensure that clients needs are met (previous timescale of 30/06/07 not met) Monitoring systems must be followed to ensure that checks on care practices are done. This means that any issues or concerns can be picked up and addressed promptly. Training in food hygiene, moving and handling, infection control DS0000059653.V350571.R01.S.doc Timescale for action 31/12/07 2. OP12 16(2)(n) 31/01/08 3. OP7 12(1)(a) 31/12/07 4. OP9 18(1)(c)(i ) 18 31/01/08 5. OP27 31/12/07 6. OP33 24 31/12/07 7. OP26 18(1)(c)(i ) 31/01/08 Morecambe Re-enabling Unit Version 5.2 Page 28 and first aid must be provided to staff (previous timescale of 31/07/07 not fully met) 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 OP12 OP27 Good Practice Recommendations Care plans should evidence individual routines and preferences to ensure the service is needs-led Activities should be developed within the unit and match the interests, skills and abilities of the current occupants A system so that clients who are not able to get to the remote alarm call box (i.e. if they have fallen) are able to summon assistance should be looked into Staff should receive formal supervision at least 6 times a year and this should be recorded A formal monthly or weekly meeting should take place between the general manager and the unit’s manager to provide support and an opportunity to plan and review the service Consideration should be given to the employment of a cleaner or additional care hours provided to ensure the unit is given thorough cleaning The daily routine of the home should be reviewed as residents should be free to use communal areas at any time, including after 10.00 p.m. if needed. The general manager was advised to consult with the fire department over the provision of door release mechanisms, so that fire doors can be open to allow access but closed when needed so that residents are safe in the event of a fire 4. 5. OP36 OP31 6. OP27 7. OP12 8. OP38 Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 29 9. OP33 10. OP27 The existing quality assurance systems should include feedback from other professionals who are involved in the multi-disciplinary work within the unit so that the service continually reflects and remains a dynamic and responsive service. Staff should be provided with training so that they are clear about re-enabling work and their roles and responsibilities in this area so that they can support clients in an effective and consistent manner, according to individual programmes. Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morecambe Re-enabling Unit DS0000059653.V350571.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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