Inspection on 01/04/08 for Nottingham Neurodisability Service Hucknall - Millwood

This inspection was carried out on 1st April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 18/03/09

Nottingham Neurodisability... 20/09/07

Nottingham Neurodisability... 06/11/06

Nottingham Neurodisability... 08/12/05

Nottingham Neurodisability... 14/07/05

Nottingham Neurodisability... 31/01/05

Nottingham Neurodisability... 02/08/04

Nottingham Neurodisability... 03/03/04

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

CARE HOME ADULTS 18-65 Nottingham Neurodisability Service Hucknall Millwood Hankin Street Hucknall Nottingham NG15 7RR Lead Inspector Karmon Hawley Unannounced Inspection 1st April 2008 10:00 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nottingham Neurodisability Service Hucknall Millwood Hankin Street Hucknall Nottingham NG15 7RR 0115 968 0202 0115 964 2747 sandra.horton@fshc.co.uk Address 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) Four Seasons Homes (Ilkeston) Ltd ** Post Vacant *** Care Home 22 Category(ies) of Physical disability (22) registration, with number of places Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nottingham Neurodisability Service Hucknall - Millwood is registered to provide personal care with nursing to male and female service users who fall within the following categories :Physical Disability (PD) 22 The maximum number of persons to be accommodated at the Nottingham Neurodisability Service Hucknall - Millwood is 22 20th September 2007 2. Date of last inspection Brief Description of the Service: Millwood care home provides personal care and accommodation for 20 younger adults who have an acquired a traumatic brain injury. The home is owned by Four Seasons, which is run as a small business. The home is one of 3 registered homes on the same campus located in a residential area of Hucknall close to shops, pubs, the post office and other amenities. The home was opened in 1995 and consists of a purpose built 2-storey building. All of the homes bedrooms are single occupancy, and 11 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift to access the first floor. The home has a small patio area and there is ample car parking space available. The fees currently charged at the home range from £1470 to £1905 per week. Special care and 1-1 care is at the cost of £20 per hour. These costs do not include the costs of hairdressing, toiletries and chiropody. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the acting manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We did this inspection with one inspectors; it was unannounced and took place over one day. The main method of inspection we use is called ‘case tracking’ which involves us choosing four residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the service users living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke to three members of staff and four people who use the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. What the service does well: A warm and welcoming atmosphere was evident on entering the home and staff were seen to interact well with both people using the service and their relatives. They remained professional at all times whilst offering care and support in a dignified manner. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 6 People using the service spoken with all stated that they were happy living at the home and that the staff were very good. They also spoke positively about the activites and food on offer. Health care needs are generally well recorded and monitored so that the staff know how to help each individual and can keep them safe. We saw many examples of the care staff being kind, caring and reassuring towards people and they help people to meet their needs. There is a good programme of internal and external activities and outings available and these are well publicised. Relatives are welcomed into the home by staff and are kept well informed about their loved ones. The people who use the service can make their own decisions about their dayto-day life and the staff respect their decisions. People using the service know they can complain and will do this when they need to. Complaints are well recorded and investigated. Staff spoken with were knowledgeable and were able to discuss the individual needs of people using the service and how they support them in meeting their needs. What has improved since the last inspection? The service user guide and the statement and terms of conditions have been updated to ensure that prospective service users have the necessary information they may need to make an informed decision as to whether they move into the home. The preadmission assessments are now all completed and the information is utilised within the plan of care to ensue that people’s needs are met. Although further improvement is still required a marked improvement has been noted in regard to updating plans of care to develop consistency of care for people using the service. The menu has improved offering a well balanced diet and further choices for people using the service. Staff have undertaken further training in regard to the protection of vulnerable adults to ensure that people using the service remain safe. The recruitment policies and procedures have improved to ensure that people are protected from unsuitable people being employed. New staff now undertake an induction ensuring that they are aware of their roles and responsibilities, thus ensuring that they are able to support people using the service effectively. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 7 Staff now receive formal supervision sessions which enable them to further develop their skills, thus enabling them to care for people using the service effectively. The registered person now ensures that a monthly monitoring report is sent to the Commission for Social Care Inspection to ensure that effective monitoring of the outcomes of the service can take place. Improvements have started to take place in regard to the quality monitoring systems within the home to work towards seeking views of the people living at the home. 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. The summary of this inspection report can be made available in other formats on request. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Now that the terms and conditions have been updated people using the service can see how much the cost of their care will be before they may a decision to move into the home. The individual needs and aspirations of people using the service are assessed and a plan of care devised according to this to ensure that their needs are met. EVIDENCE: To ensure that all people using the service are aware of the current fees of the home this has now been included in the terms and conditions of residence. The terms and conditions, which had been signed, were available within those files observed. Case files observed demonstrated that people had undergone an assessment of their needs before they entered the home. This enabled a plan of care to be devised considering these highlighted needs. Assessments had been signed and dated and were fully complete to ensure consistency of care. One member of staff spoken with was able to discuss the preadmission procedure and stated that they were informed of people’s needs before they entered the home. The nurse in charge on the day of the visit stated that people can come and visit the home and spend a period of time there before they made a decision to move in. One case file was observed where the person was ‘testing’ out the service on a respite visit. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 10 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As a number of plans of care had not been updated in regard to the use of restraint the use of the positive response training is consequently underutilised. People using the service are enabled to make their own decisions about their lives as able and take risks as part of an independent lifestyle. EVIDENCE: The case files of people living in the home are now indexed making it easier to access and use these, thus enabling staff to be more aware of people’s need. Plans of care addressed people’s highlighted needs and reflected their personal choices and preferences, they were based upon supporting people to maintain their remaining skills and assist them in others where needed. Records observed showed that where necessary blood pressure monitoring had taken place as required and the plan of care reflected the individual’s need in regards to this. Plans had been updated in regard to changes in their care and condition, with the exception of the use of restraint. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 12 Risk assessments were in place for highlighted risks and there was evidence that these and the plans of care had been negotiated with the people living at the home or their relative if they were unable to partake in this discussion. Staff have attended training in dealing with challenging behaviour and were able to discuss how they deal with any concerns, they confirmed that talk down techniques are now used instead of restraint wherever possible. However plans of care had not been updated and these still referred solely to the use of restraint. Staff stated that they had to wait until plans were completed before they could fully implement their training; which compromises what techniques may be used. Staff spoken with were able to discuss the individual needs of those people case tracked and the support that they may require. Staff were observed to successfully use talk down techniques throughout the day and treat people with respect at all times. They were also seen to assist people as needed to meet their needs. People using the service that was spoken with stated that they were happy living in the home and staff helped them when needed. One person said that they liked to remain as independent as possible but staff were there to support them if they wanted. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are enabled to live a full and interesting life as they wish with a variety of activites to stimulate them on offer. People using the service are supported to maintain relationships that are important to them and their diverse needs are fully considered. EVIDENCE: There is a dedicated activities coordinator responsible for organising, recording and evaluating the social activities. Evidence of consultation, where possible, was seen on individuals care files via the initial assessment within the interests/likes section. Each person is individually assessed, his or her needs, behaviour, interests and cognitive functions to ensure that a specific programme is developed for each person. A specific therapeutic programme of weekly activites which develop and maintain skills for each person was displayed on a board for people to see and a large poster of the day’s events were also on display. Easy read methods are used so that people can look at pictures associated with that activity so that they may easily understand what Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 14 events are on offer. Some of the activites on offer were reminiscence, exercise, communication skills, cooking, films, basketball, current affairs and field trips. Throughout the visit their were a number of varied activites available, chess, puzzles, and various indoor games, also a number of people went out after lunch to go bowling. The method of recording social activities that people are involved remains very clear, as do records of whether residents have participated in social activities, which include an evaluation of each activities success, and if the activity was interrupted by the challenging behaviour. People spoken with said that they enjoyed the activites on offer and several people were looking forward to the bowling trip that afternoon. Staff were seen to spend individual time with people ensuring that they were supported as needed in their chosen activity and people were seen to enjoy the activites that they were engaged in. One person spoken with said that the routine of the home was flexible and they could choose how they spent their time, they said that they were happy at the home and had made friends there. People living in the home are enabled to access the local community and interests groups such as ‘Headway,’ a group where people with head injuries can meet. One person spoken with explained that they often went shopping with staff and brought their own things, they were pleased to do this and had a fridge in their room where they could store their purchases. Although there is no one who wishes to attend the local churches at present the nurse in charge stated that people would be supported to attend if they wished. To ensure that important relationships are maintained, there are no restrictions on visiting and visitors were seen to come and go throughout the day. One person using the service also was seen to go out with their visitor into the local community. Due to the diverse needs of people living in the home people are supported as needed to maintain personal relationships. There was evidence within the plan of care to show that these were discussed with people using the service to ensure that people’s rights, choices and boundaries are maintained. The Annual Quality Assurance information received byt the Commission for Social Care Inspection prior to the visit stated that the service takes into account individual lifestyle choices and beliefs when creating a service user care plan. Staff spoken with were clear about their role in supporting people and demonstrated a good level of knowledge about individuals needs and how to support people to achieve them. The menu on offer has been updated and choices and variety is available for individual needs. The reliance on process foods for the vegetarian option has now ceased and meals such as roasted vegetables in a sweet chilli sauce, vegetable curry and meat alternatives such as Quorn are offered. The Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 15 mealtime was observed briefly and the food presented appeared appetising and plentiful and was being consumed positively by those people present. People spoken with stated that the food was at a good standard and they enjoyed their meals, one stated that their had been improvements in the menu and more choices were now available and that they could help themselves to drinks at anytime. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service receive personal support in the way they prefer which respects their dignity. People using the service are enabled to access services that meet their physical and emotional needs. EVIDENCE: Plans of care reflected the level of personal support people needed and their preferences in receiving this. People using the service spoken with stated that staff respected their wishes and assisted them in their preferred manner. Staff were observed to assist people in a professional, supportive and caring manner at all times. There was evidence within those case files seen to reflect that people are enabled to access services such as the general practitioner, chiropodist, hairdresser and hospital services as needed. One person using the service was seen to be assisted by a member of staff to go to the local doctors surgery. One person spoken with said that they could see the doctor at any time if they were unwell. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 17 Medication policies and procedures were observed and demonstrated that these protect people who use the service. Accurate records were maintained and the medication reflected the prescription. There were no gaps in signing for medication administered. Mediation records showed the assistance a person may need in taking their medication and if they had any allergies. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service feel confident that they can voice any concerns and that these will be listened to and resolved. Although people are further protected from abuse, additional work in regard to the accounting methods of people’s personal allowances is recommended to ensure that these are fully protected. EVIDENCE: The service has received one complaint, which was referred from the Commission for Social Care Inspection since the last visit. This was in regard to standards of care and the management of the service. There was evidence to show that this had been fully investigated and an action plan put into place to address any issues of concern. The complaints policy is available for service users to access within the terms and conditions of residence, however this was out of date as it stated to contact the National Care Standards Commission not the Commission for Social Care Inspection, which may cause confusion for those who may wish to make a complaint via this route. People using the service spoken with stated that staff were very kind and they felt that they could approach them with any concerns that they may have. All staff members spoken with were able to discuss how they would deal with any concerns received. To ensure that people using the service are protected, staff have received additional training in regards the steps they should follow in the event of a safeguarding allegation. Since the previous visit two safeguarding alerts have been made to the protection of vulnerable adults team. One incident in regard Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 19 to standards of care and the other in regard to sexual abuse, both of these incidents have been investigated and were proved unfounded. Staff have also received training in the protection of vulnerable adults and were able to discuss what they would do if they felt that bad practice was taking place. One person using the service expressed that they felt safe living at the home. Staff have also received Positive Response Training which involves using talk down techniques rather than restraint when dealing with challenging behaviour. They were able to discuss the techniques that were in use and were observed to deal with people living in the home in a calm and sensitive manner when challenged. The personal accounts of four people using the service were checked. The method in use remains complicated as a separate book is kept for transactions of all the people using the service and then a sheet for running totals, this may cause confusion in keeping accurate records, it is good practice to keep a record of transactions on an individual accounting sheet with a running total of money available. One member of staff only signed transactions whereas two signatures would ensure that people’s money is further protected. Accounts are checked on a weekly basis and all receipts are checked against transactions. There is also now a record of when money is taken out of the home for spending with or on behalf of a person using the service rather than just on the return. A staff member was seen to be able to access a persons allowance on their behalf as they were going to town with them. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is further work to be done people live in a relatively comfortable and satisfactory maintained environment. EVIDENCE: The annual quality assurance assessment received by the Commission for Social Care Inspection stated that the service provides a safe clean and comfortable environment, there is work to be done addressing the comfort aspect (décor and furniture) and a plan is in place to do this within the next year’s financial budget. During a brief tour of the home there was evidence that work was taking place as the lounge on the upper floor was in the process of being redecorated and a new carpet had been laid. There were also areas that required attention such as the ground floor bathroom ceiling which had a stained patch that was looked as though it had been caused by a leak and an upstairs bedroom which had an offensive odour. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 21 The rooms of case tracked people were viewed, along with a number of communal areas, all were found to be in a reasonable state of repair and were clean and tidy. One person living in the home stated that it was comfortable and they felt that their room was their own; they looked after it themselves and kept it nice and clean. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are available to support people using the service to meet their needs. People using the service are protected by unsuitable people being employed by the service. EVIDENCE: The staff duty rotas observed showed that sufficient staff are available to meet the needs of people living at the home. The rota demonstrated that eight carers, and two qualified nurses were on duty throughout the day and five carers and one qualified nurse covered the night period. Staff spoken with stated that sufficient staff were available to meet people’s needs. One member of staff felt that although the staff numbers were sufficient it was difficult at times due to the number of agency staff that were used. This was discussed with the nurse in charge who stated that the service continues to advertise for more staff which if successful will alleviate this concern. The duty rota showed that attempts were made to use regular agency staff and that they had been orientated to the home to ensure that they have a basic understanding of the home and the people using the service. People using the service who were spoken with felt that sufficient staff were available to meet their needs. One Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 23 person stated that they were independent, as they liked it that way, however they knew staff would help them if asked. Another person said that they were happy at the home and that the staff were good to them To ensure that people using the service are protected from unsuitable people being employed four staff files were observed to ascertain if they contained all the required documentation. All files contained the documentation required by law such as an application form, references and proof of identity. The requirement set at the previous inspection was examined and evidence was seen within staff files to demonstrate that compliance had been achieved in regards to criminal record bureau checks (a police check to see if an individual has a police caution or criminal record). A new staff member’s file was also observed which showed that good recruitment practices had taken place and they had not been employed until the criminal record check had been returned to the service. Both members of staff spoken with were able to discuss the recruitment practices, which take place within the service that demonstrated that good practice is taking place. To ensure that all new staff are aware of their roles and responsibilities on commencing employment they undergo an induction. There was evidence of new staff undertaking and induction on commencing employment. The new acting manager has now commenced supervision sessions to enable staff to have time to discuss their job role and development needs. There was evidence of supervisions taking place within staff files observed. One member of staff also confirmed that they had undertaken supervisions and that it had been helpful. To ensure that staff have the necessary knowledge and skills to carry out their job role they undertake compulsory training such as fire, manual handling and health and safety. There were noted deficits in a number of subjects however the nurse in charge provided evidence, which demonstrated that, further training courses had been booked to rectify this. Staff spoken with said that training was at a good standard and that they felt supported in their development. One member of staff spoken with felt that additional training for subjects such as epilepsy and diabetes mellitus would be helpful to ensure that they felt fully competent in dealing with these situations. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been changes in the management of the home, people using the service still benefit from an adequately run home. Improvements in regard to the quality auditing systems continue to take place to ensure that the views of people using the service and their relatives are fully considered. EVIDENCE: A new acting manager is now in place. She is a registered mental health nurse and has previous experience in caring for the service user group. Staff spoken with said that the acting manager was approachable and had held a staff meeting and supervision sessions since commencing. To ensure that a quality monitoring system is in place there are records to show that monthly auditing of medication, the environment, equipment and staffing issues take place. Should there be any concerns an action plan is then Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 25 devised to address these. There were also records available to show that maintenance tasks are addressed as required. Due to the client group attempts to hold meetings have so far proved unsuccessful, therefore the nurse in charge and activites coordinator outlined the plans that have taken place to hold support groups and forums for people’s relatives. Notices had been prepared for the first meeting, which were shown to us. Also the nurse in charge stated, which was confirmed by one relative that questionnaires about the service had been sent to relatives to complete. If able people using the service and their relatives are involved in the reviews of their care package to ensure that an opportunity to offer feedback about this is given. The annual quality assurance assessment outlined the future plans that the service has to continue to improve the systems in place. The service sends monthly reports to the Commission for Social Care Inspection to demonstrate that the service has been visited and audited by senior management. The annual quality assurance assessment outlined that all equipment and services are checked as required to ensure that they are safe. To confirm this the most recent gas, lift and hoist certificates were seen and demonstrated that these had been checked as required. There were now records available to show that staff have attended fire drills to ensure that people using the service are protected from the risk of fire, however staff had not signed to confirmed their attendance on these records. Staff spoken with were able to discuss the relevant health and safety issues in regard to their job role and how they refer issues to the management if necessary. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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 3 2 3 3 X 4 X 5 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000059002.V361703.R01.S.doc 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 3 X Version 5.2 Page 27 Nottingham Neurodisability Service Hucknall Millwood No 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 15(1) Requirement Timescale for action 10/05/08 2 YA22 22(7) 2 YA24 2392,b) 3 YA37 8(1) To ensure the health and wellbeing of the people using the service all care plans must be reviewed and updated as peoples needs and the techniques used change to ensure that their people’s needs are met and up to date practices are used. Update the complaints procedure 10/05/08 to reflect the correct details of the commission for social care inspection to avoid confusion should someone wish to use this method to make a complaint. Produce a maintenance 10/06/08 programme that shows how areas, which still require attention are to be dealt with and when this will happen to ensure that people using the service live in a well maintained and comfortable environment. The registered provider shall 20/05/08 inform the CSCI of their intentions to register the current acting manager to ensure that the service is run and managed by a person who is fit to be in charge. DS0000059002.V361703.R01.S.doc Version 5.2 Nottingham Neurodisability Service Hucknall Millwood Page 28 4 YA39 24 The registered person must ensure that continued development takes place and documentary evidence is available in regard to the consultation process to seek the views of people living in the home 22/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA23 Good Practice Recommendations The transactions, balances and audits of peoples personal allowances are kept on one accounting sheet to enable a clear audit to be available, thus protecting people’s from financial abuse. Staff receive further training in specialist subjects such as epilepsy and diabetes mellitus to develop their skills and knowledge in caring for people who have these conditions. It is recommended as good practice to ensure that all staff sign the fire drill register to demonstrate that they have in fact attended these. 2 3 YA35 YA42 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V361703.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. 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