Inspection on 05/12/06 for Nelson House

This inspection was carried out on 5th December 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nelson House 19/09/07

Nelson House 23/11/05

Nelson House 12/07/05

Nelson House 24/02/05

Nelson House 04/11/04

Nelson House 08/03/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

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

CARE HOME ADULTS 18-65 Nelson House Brimscombe Hill Stroud Glos GL5 2QP Lead Inspector Mr Paul Chapman Key Unannounced Inspection 5th December 2006 09:00 Nelson House DS0000016507.V308056.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 Nelson House DS0000016507.V308056.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. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nelson House Address Brimscombe Hill Stroud Glos GL5 2QP 01453 887721 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) www.nelsontrust.com Nelson House Recovery Trust Mrs Josephine Wickes Care Home 16 Category(ies) of Past or present alcohol dependence (16), Past or registration, with number present drug dependence (16) of places Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Nelson House is an adapted Grade II listed building and is registered to accommodate up to 16 adults who are recovering from drug and/or alcohol addiction. Accommodation is provided over three floors with a range of communal rooms. All bedrooms are doubles as it is considered part of the rehabilitative process that residents must share to avoid isolation. The counselling programme is delivered at a nearby adapted old school building and the Trust also runs a training and education centre close by. Nelson House is part of the Nelson House Recovery Trust which comprises the residential care home and also a number of supported housing projects in Stroud and Gloucester. Residents from these houses may also attend the counselling facilities and the training and education centre. Fees range from £570.00 to £670.00 per week. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and completed over a period of 7 hours on a Tuesday in December. The inspector spent the morning with a member of the counselling team who explained how people are assessed, and how care plans are written and reviewed. Three people’s files were examined in detail and two them met with the inspector to discuss what they thought of the service they were receiving. In the afternoon a tour of the premises was completed with two staff and the inspector spoke at length with the manager about the service. The regulation inspector was supported by a specialist CSCI pharmacist inspector who examined the arrangements for the management of medicines. This part of the inspection was carried out over 4 ¼ hours with the staff member who mainly deals with medication. The pharmacist inspector looked at some of the medicines, various medication records and procedures in the office and visited the night support workers room. Another member of staff was spoken to about some aspects of care plans. Before the inspection was completed surveys were sent to other professionals, staff and clients asking their opinion of the service. All of the feedback received was positive about the service. The principle method used to gather evidence was case tracking. This involves examining the care notes and other related documents for a select number of people living at the home. This is followed up by talking to them. This provides a useful, in-depth insight as to how people’s needs are being met from more than one source of evidence. At this inspection three of the people living at the home were case tracked. What the service does well: One of the clients stated, “I believe in the programme, it’s worked for 21 years. The after care package is second to none, I would recommend it to others” Other clients spoken with agreed with this and the inspector received other comments including “the staff are really good”, “it’s better than the other rehab I was in”, “it was really difficult at the beginning, but it is really good here”. People are thoroughly assessed by appropriately trained and experienced staff. Care plans are detailed, person centred and reviewed regularly. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 6 There is good contact with the local doctors’ surgery and pharmacy, which helps to make sure service users’ health needs and medicine requirements are met. The centre provides people with a good range of activities including regular sport/fitness sessions, life skill sessions and during the summer month’s outward-bound activities. What has improved since the last inspection? What they could do better: 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. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 7 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 Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 8 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, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough assessments completed by appropriately trained staff minimises the risk of people being admitted to the centre whose needs cannot be met. Client contracts identify the responsibilities of both parties making it clear what is acceptable behaviour whilst residing at the centre. With no policy for temporary discharges it makes the process unclear and may make it liable to inconsistency or misuse. EVIDENCE: Each prospective client completes an application form. A counsellor explained that on some occasions this could be completed by the person’s care manager. Each person is assessed by an appropriately qualified person. An example of this would be a team leader completing an assessment. Completed assessments showed that the following areas were assessed for each person: - Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 9 History of previous treatment Drinking/user history Family history – geneogram Relationships Health Mental Health risk assessment – (highlights any history of suicide attempts) Abuse and trauma Forensics and feelings At admission each person is “buddied up” with another client. This person has a special responsibility for supporting the new client. Each person is given a client handbook, this was confirmed by the clients spoken with during the day. On admission a person is assigned a counsellor. They will go through the centre’s contract with the new client and ask them to sign it. The contract covers five main areas: - Instant discharge, rules, therapy, voluntary testing and confidentiality. Clients had signed the examples seen. A good practice identified is that two weeks after admission the counsellor will go through the contract with the client again. This ensures that people are clear about their responsibilities. As part of the admission process counsellors have a checklist to complete which aids a consistent approach. A recommendation would be that this could be redeveloped and made into a tick list. An area that was spoken about at length was the centres use of “temporary discharge”. A counsellor explained that there was no policy for this but various factors were taken into consideration before it was used. For instance, staff would assess the amount of effort the client was putting into sessions and the incident that has instigated the need for a temporary discharge. In the majority of cases people are discharged back to the area from where they were admitted, and care managers would be contacted and informed of the discharge. When people are discharged into the local area they are give contact information for accommodation in the local area. All people are given their benefits before they leave. While people are discharged they are expected to phone daily and be drug tested. A shortfall identified in this process is that there is no policy that defines why a temporary discharge should be implemented and what staff must do during this process. This means that the whole process is not transparent and could be seen as unfair. None of the people spoken with during the site visit had been subject to a temporary discharge and therefore it was impossible to judge an actual experience. One client spoke about their discharge from the home and the “tapered ending” that had been arranged. They were asked how this has worked for them. They stated, “It is tailored to meet my needs, what I need to achieve work, college, etc. The support I am given could be one day a week or five days a week”. The client explained that there is a “leavers group” that meets Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 10 weekly, and as part of these groups they talk or look at transition, relapse prevention, anger management and assertiveness training. Nelson House DS0000016507.V308056.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans identify peoples’ needs and are reviewed regularly to monitor progress towards meeting their chosen goals. Clients are able to make decisions about their lives and staff provide them with support where it is required. Clients are involved in all of the day-to-day activities around the home promoting taking responsibility for their own lives. Potential risks to the clients are assessed and minimised where required to enable the person to complete an activity. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 12 EVIDENCE: Personal files for three of the clients were looked at in detail. After a person has been admitted to the centre care plans are written with them. The first care plans address the needs identified by the initial assessment. Care plans are then reviewed three weekly. The review takes the form of self-assessment by the client, peer review, opinions of the client’s named counsellor and other counsellors that are involved in the clients care. In some cases the care plans remain the same, but most change regularly. The clients’ sign care plans. Speaking with clients during the site visit they confirmed their involvement in their care plans. Clients stated that targets set with the counsellors are agreed with them. All of the clients will see their named counsellor weekly. All clients are asked to complete a daily diary that identifies significant events, this is the clients’ choice as to whether they do or not. All of the care plans examined as part of this site visit had been reviewed in line with the centre’s policy. These documents provided evidence that targets were being achieved. The care plans gave good examples of the clients being supported to make decisions about their lives. Clients’ files contain guidelines for counsellors to follow. Guidelines seen included the centre’s policies/procedures on care planning, risk assessment and guidelines about the format for writing reports. Senior staff check reports written by the counsellors. The inclusion of these policies, etc is good practice as it promotes a consistent approach to these areas. Speaking with clients they explained that as a group they agree the menu every week. The senior peer and two others are then responsible for going to buy the ingredients. A client said that they thought this was really good as it starts to “give back” responsibility. Comments from clients included that “I thought the peer review was amazing” and “I felt support from my peers that I lived with”. Every one takes it in turn cooking but one person said, “Some people cook more often than others because they are better at it”. One client spoke about their experience at the start “At first it was really difficult but I had extra counselling that really helped. The counsellors were excellent and really helped”. When speaking with other clients they made comments that included “the staff are really good” and “it is better than another rehab I was at”. All of the files examined contained risk assessments completed by counselling staff. Nelson House DS0000016507.V308056.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The centre provides people with activities that meet the clients current needs. The food provided at the centre is chosen by the people living there who are responsible for preparing it. EVIDENCE: Standards 12, 13, and 15 are not specifically relevant to this client group. The centre provides clients with a structured timetable of activities that are mainly based within the centre’s properties. As part of the centre there is a day centre, called the Star centre. The centre provides clients with the opportunity to take part in activities such as bicycle maintenance, football, IT (information technology), woodwork, music, art, aromatherapy and pottery. Clients spoken with were really positive about these activities. Staff and clients spoke about Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 14 the Friday afternoon sports sessions that are organised at a local sports centre. This gives all clients the opportunity to take part in games of football, squash and badminton. During the summer months staff organise “outward bound” days when groups going walking, caving, canoeing and complete other activities. The centre uses Alcoholics Anonymous fellowships in the surrounding areas. Staff support clients to attend by providing transport. There is an expectation that clients will attend twice a week. Weekly and monthly meeting are held with the clients where they are given an opportunity to discuss issues about the home. In addition to this they are able to speak individually to their named counsellor. Feedback from all of the clients spoken with was positive about the food at the home. As highlighted earlier in this report the clients choose the menus and they are also responsible for preparing them. The menus seen during the site visit showed a good variation in the meals prepared. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 15 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, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. Some of the arrangements for the management of medicines do not follow accepted safe practice and could pose a risk to the health and well being of service users. EVIDENCE: None of the clients receive any personal care from staff. Records in the clients’ files show that the appropriate professionals meet physical needs whilst emotional needs are addressed by the counselling team. The medication system in place at present has operated for a number of years. In order to reflect current legislation and practices the home needs to address the areas identified by the pharmacist inspector who completed this area of the inspection. Information about how medicines are dealt with is included in the handbook given to all service users but the extent of the service’s involvement with Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 16 managing medicines on behalf of service users should be included more specifically in the therapeutic contract they sign. There is a medicine policy and procedures written in October 2004. Some information needs updating to describe what happens now and also extended to include all aspects about how medicines are managed in the service (for example – ordering and dealing with prescriptions, non-prescription medicines or homely remedies, action in the event of an error involving medicines and any changes resulting from this inspection). A written protocol is needed for any homely remedies that are used - advice from the pharmacist and doctor should be obtained in preparing this. Careful consideration must be given to contra-indications and precautions for using medicines such as ibuprofen. Two staff that mainly deal with medicines have formal training about Safe Handling of medicines and another support worker is currently doing this training. An assessment should be made about what training is needed for any staff who handle medicines according to the extent they deal with medication. Various records used for medicines were seen. The following points are noted for attention • Medicines received records need to include all medicines brought when admitted even if they are not subsequently used, so that there is full accountability for medicines brought into the service. • The profile of prescribed medicines must include all medicines such as inhalers and creams (these may also be self-administered by service users). • The record of medicine administered would be clearer by keeping all the information on one sheet. • Any medicine allergies should be noted here so that the information is to hand when the medicines are administered. • Medicine details need to be an exact copy of what is on the label from the pharmacy and must include the medicine name, dose form and strength – watching that the units are correct (mg or micrograms for example). • Records of medicines given to service users to look after are needed. • Records of non-prescribed medicines (homely remedies) need improving. There is a separate record chart for paracetamol and ibuprofen but it is not clear where other items would be recorded. • Monitoring systems should be in place to demonstrate service users receive medicines correctly and that records are accurate. An audit of a course of antibiotic capsules prescribed for one service user was demonstrated. This showed two missed doses and one capsule not accounted for in the records. The way medicines are prepared in advance is unsafe practice that can potentially cause medicine errors. Certain trained staff place medicines in envelopes in advance for the appropriate dose time for other staff to give. The envelope has the name of the client (generally first name) and dose time (‘lunch’). The accepted safe medicine administration procedure is to only give directly from the container that the pharmacy has provided and labelled with Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 17 the directions from the prescription. This will need more staff training for this particular involvement with medicines. Consideration should be given to supporting clients for independence by them having more involvement with their medicines before discharge. This will need a careful risk assessment. The medicine storage arrangements need reviewing in view of the amount of medicines. Proper medication cabinets designed to the appropriate British Standard should be used. Keys must be kept securely with a responsible member of staff. The cupboard for homely remedies was not properly fixed to the wall and the key was left in the lock. It was not large enough for all the medicines and medicines that are swallowed are not segregated from those applied externally. Some items were out of date and others were items previously prescribed for other service users, including a Prescription Only Medicine. This practice must stop. There were a lot of medicines awaiting return to the pharmacy as none had been sent since August 2006. Although these were kept separately there is more potential for errors or misuse of medicines if unwanted stock is allowed to build up. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clients are able to make a complaint if they are unhappy with the service they are receiving and the complaints procedure ensures that peoples’ concerns are responded to appropriately. Whilst clients are staying at the centre there are supported by staff to manage their monies. It was unclear whether staff had completed training in the protection of vulnerable adults and this may put clients at greater risk. EVIDENCE: When speaking with clients they confirmed that they were able to make a complaint if they were unhappy about something. Clients said that they felt they would be listened to if they did make a complaint. All of the clients spoken with said they were happy with the service they were receiving at present. The centre has a whistle-blowing policy for its staff. From the training records supplied to the CSCI it was impossible to identify whether staff working in the centre had completed training in the protection of vulnerable adults. The manager must ensure that all staff have completed this training and this becomes a requirement of this report. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 19 Clients spoken with during the day were asked about their personal finances and how they were managed whilst they were at the centre. People spoken with explained the process and confirmed they were satisfied with the process. The inspector spoke with the manager about some concerns brought to the attention of the CSCI relating to people’s finances. Firstly that people were receiving bills for their stay at Nelson House after they had left and that this was putting unnecessary pressure on people. The manager explained that this should not be happening and that any outstanding bills for accommodation should be directed to the source funding their time at Nelson house. Secondly, their had been a concern about the recording of peoples finances by staff. The manager said that she had been aware of this and that the problem had now been resolved. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 20 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): 24, 25, 27, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation provides clients with sufficient communal space that is decorated to a good standard and has a homely atmosphere. EVIDENCE: The centre provides clients with sufficient communal areas that include a lounge, dining room and kitchen. Smoking is allowed in the lounge and outside the property. Generally the property is in a good state of repair and recently the lounge has been repainted. There are plans to address a number of issues discussed at this visit, staff on duty explained that: • • All of the halls and landings are due to be painted. Night support worker room to be damp proofed. DS0000016507.V308056.R01.S.doc Version 5.2 Page 21 Nelson House • • TV room, ceiling and wall to be redecorated as water damaged. The main toilet and bathroom will be decorated. Some other shortfalls were identified, and will need to be addressed: • • Plans should be made to redecorate the secondary shower room. The carpet in the TV room was badly stained although staff stated it had been cleaned recently. The provider should look at replacing this carpet in the near future. All of the bedrooms seen were tidy and reflected some of the interests of the people living in them at the time. Bedrooms are not individual and clients share their bedrooms with others. At the time of this inspection the home was generally tidy although the dining room and laundry needed to be cleaned and tidied. Staff explained that this is the responsibility of the clients and it should have been done. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 22 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, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy is thorough and minimises the potential risks to people. It is impossible to categorically confirm that staff are appropriately trained as certificates were not available for examination and the list of training was not comprehensive. EVIDENCE: The home has a thorough recruitment policy and procedure and the files for people recruited since the previous inspection were examined. No shortfalls were identified. Criminal Records Bureau disclosures (CRB) were examined specifically for the centre’s night staff. All of the current night staff were seen to have CRB checks completed. The registered manager provided a list of training completed by the current staff team. The list does not provide evidence of new staff being inducted and Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 23 all staff completing mandatory training to work in a registered care home. It has been agreed that by 28/02/07 the manager will have collated a comprehensive list of training completed by staff with copies of their certificates. The manager must ensure that all staff that work in the home complete all of the mandatory training. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 24 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Training records did not provide sufficient information to confirm whether staff had completed training in health and safety and food hygiene. This may be putting clients at unnecessary risks. EVIDENCE: Since the previous inspection a new manager has been registered with the CSCI. When speaking with a member of staff they explained that they are using a comment sheet to survey the local community about Nelson House. At the next inspection the findings of this will be examined. Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 25 Regulation 26 visits are completed monthly by one of the Trustees. When completing them they will speak with service users or their representatives, speak with staff, inspect the premises inside and out, examine records for medication, fire equipment tests and medication administration. A copy of these documents are then sent to the CSCI. At the time of this site visit the fridges were dirty and food was being stored uncovered. This was brought to the attention of the staff on duty who said that they would ensure this was addressed. Fire equipment testing records showed that they were completed regularly and that all staff had been trained in fire safety. A fire risk assessment had been written for the home in May 2006. From the training records supplied to the CSCI it was impossible to confirm whether staff had completed any health and safety and food hygiene recently. The manager should identify whether this is a training need and if so it should be addressed. Nelson House DS0000016507.V308056.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Nelson House DS0000016507.V308056.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 YA5 Regulation 40, 13(4) c, 13(6) Requirement Timescale for action 02/03/07 2. YA20 3. YA20 4. YA20 5. 6. YA20 YA24 The registered manager must ensure that a policy/procedure for the temporary discharge of clients from the centre is developed. It must make the process transparent. 13(2) Introduce accepted safe practices for the administration of medicines so that they are administered directly to service users from the labelled containers supplied by the pharmacy or surgery. 13(2) Introduce a written protocol for all non-prescription ‘homely remedies’ medicines used and make effective arrangements for secure storage. 13(2) Review and audit the arrangements for recording all medicines received, administered and disposed of to make sure they are always complete and accurate. 18(1)(c)(i) Provide training to all staff who handle medicines, appropriate to their assessed needs. 23(2) d The registered manager must ensure that the carpet in the television lounge is replaced. DS0000016507.V308056.R01.S.doc 01/03/07 01/03/07 01/03/07 01/04/07 04/05/07 Nelson House Version 5.2 Page 28 7. 8. YA27 YA23 23(2) d 13(6) 9. YA35 18 10. YA42 18 The registered manager must ensure that the second shower room is redecorated. The registered manager must ensure that all staff working in the home have completed training in the protection of vulnerable adults. The registered manager must ensure that staff training records are comprehensive, accurate and meet the criteria of these regulations. The registered manager must ensure that staff have completed health and safety and food hygiene training. 01/06/07 01/06/07 28/02/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA2 YA20 YA20 YA20 Good Practice Recommendations The registered provider should redevelop the admission checklist into a tick list. Review recording arrangements for medicines administered to use an individual chart for each service user. Keep all medicines in metal medicine cabinets properly designed to the appropriate British Standard. Include service user’s consent, in the plan of care, of the way in which their medicines are handled Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Nelson House DS0000016507.V308056.R01.S.doc Version 5.2 Page 30 - 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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