Inspection on 20/09/07 for Nottingham Neurodisability Service Hucknall - Millwood

This inspection was carried out on 20th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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... 01/04/08

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 Steve Keeling Unannounced Inspection 20th September 2007 09:00 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.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.V347263.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.V347263.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.V347263.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 6th November 2006 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 £544 to £1905 per week. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents 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. One regulation inspector and one regulation manager conducted the unannounced visit. The main method of inspection used was ‘case tracking’ which involved selecting two 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. The acting manager and one member of staff were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of resident’s bedrooms, to make sure that the environment is safe, clean and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, which included information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA) although the content of the AQAA was limited. As part of the inspection process, the conditions of registration were reviewed with acting manager and were correct. What the service does well: Residents are encouraged to make independent decisions about their lives and their independence is encouraged. Residents can participate in a range of activities and they can maintain contact with their family and friends as they wish. Residents receive personal support according to their wishes and their physical and emotional needs are met. Medication management is safe and now adheres to codes of safe practice. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 6 Residents feel that staff listen to and act on any concerns they might have and staff have received training in relation to the Safeguarding Adults Resident’s benefit from a safe, well-maintained environment, which is comfortable and clean throughout. What has improved since the last inspection? What they could do better: The Service User Guide could be updated to include the current fees charged at the home. The Pre admission in house assessments could be signed and dated by the assessor and all areas within the assessment documentation could be fully completed. OUTSTANDING FROM 06/11/06 Residents care plans could be reviewed and updated as residents needs change and care plans could contain sufficient information to protect the residents and staff should the need for restraint be required. OUTSTANDING FROM 06/11/06 Care plans and risk assessments for each resident could be re-organised and indexed to make them accessible and user friendly to ensure they are live/working’ documents. Barriers to resident’s perspective being included in the care planning process could be noted and other avenues, such as family and significant others be explored. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 7 The practice of care staff maintaining separate records from the nursing notes could lead to important information not being reported and documented in the nursing care plans. The reliance on processed food especially for vegetarians could cease to ensure that dietary options are well balanced and include a good source of protein. Residents could be provided with the opportunity to access gay/lesbian groups as they wish. The recording of complaints could be improved to ensure they reflect any areas of concern thus protecting residents from possible abuse. The process for recording money, which is taken out of the home for spending with or on behalf of residents, could be improved. Documentation relating to routine maintenance could be maintained more efficiently. Policies and procedures in relation to the recruitment of staff could be followed and any outstanding allegations of criminal offences could be identified and discussed. Staff could specify a full history of past convictions on their application forms. The service could achieve the target of 50 of staff trained to National Vocational Qualification level two and above. All staff could undergo an effective staff induction process, which is fully documented and adheres to the “Skills For Care” principles. OUTSTANDING FROM 06/11/06 All staff could receive a formal structured staff supervision programme. The acting manager could enrol on a recognised, degree level, Registered Mangers Award. An effective resident’s consultation process could be established which seeks the views of residents at the home. OUTSTANDING FROM 06/11/06 Health and Safety records could be streamlined and unnecessary repartition of information could cease. Records in the Health and Safety folders could be maintained to show which staff are involved in fire drills and advice could be sought from the Fire office in this regard to the maintenance of appropriate records of testing. A tool could be utilised by the acting manager to ensure an overview of Health and Safety auditing is carried out, all appropriate checks are completed and Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 8 that all staff are clear about their roles and responsibilities in relation to Health and Safety procedures. The outcome of Regulation 26 visits could be forwarded to CSCI on a monthly basis to demonstrate that the quality of service provision is effectively monitored. OUTSTANDING FROM 06/11/06 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.V347263.R01.S.doc Version 5.2 Page 9 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.V347263.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is adequate. We looked at outcomes for the following standards. 1 and 2. This judgement has been made using available evidence including a visit to this service. The Service Users Guide (SUG) does not provide details of the fees charged at the home, which could compromise potential residents or their representative’s ability to determine the suitability of the service in meeting their needs. People have assessments performed prior to moving into the home but the assessment process was incomplete which could compromise the health and wellbeing of the residents. EVIDENCE: A Statement of Purpose and Service Users Guide is made available to all residents and their representatives, which sets out the aims, objectives, philosophy of care and the services and facilities at the home. The documentation also contains a complaints procedure. The service users guide, under the section “terms and conditions of residence” states that the basic fees charged at the home are provided in an appendix at the end of the document. An examination of the document showed that the information was not available. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 11 Resident’s files contained copies of pre admission in house assessments. These had not been signed or dated by the assessor and some areas had not been fully completed leaving the assessment process incomplete. Resident’s files showed that multidisciplinary involvement was considered for the case tracked residents. One resident expressed concerns at the appropriateness of her placement at the home, but felt that staff were supportive and ‘ they do make an effort to try and meet my needs here’. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate. We looked at outcomes for the following standards 6, 7, and 9. This judgement has been made using available evidence including a visit to this service. The care planning process is ineffective in ensuring the changing needs of residents are identified. In addition the care plans are very bulky and impede access to information. Residents are encouraged to make independent decisions about their lives. EVIDENCE: The care plans seen have been drawn from the information acquired via initial assessments and cover the holistic needs of service users. The care plans adhere to equality and diversity requirements offering support to residents with for example sexuality, emotional needs, hygiene, self-esteem, life skills and independence, as well as health care needs such as hypertension, diabetes, infection control and self-harm. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 13 Residents care plans and risk assessments contained a large amount of information, from which it was difficult to decipher the daily needs and interventions required by staff. It is recommended that the assessments, support plans and risk assessments for each resident are re-organised and indexed to make them accessible and user friendly to ensure they are live/working’ documents. There is a need to ensure that care plans are reviewed and updated as residents needs change and care plans should contain sufficient information to protect the residents and staff should the need for restraint become apparent. A resident was able to describe how staff supported her if she became anxious and presented with challenging behaviour and indicated that she felt supported by staff. The resident indicated that when she exhibited challenging behaviour staff would talk to her and hold a pillow between themselves and the resident. The residents care plan for support with challenging behaviour did not contain these details or when and how staff should initiate restraint and for how long. A residents care plan stated that the resident should have her blood pressure monitored on a daily basis. The care plan did not specify the parameters, which the residents blood pressure should be maintained or the actions to be taken should concerns be identified. Furthermore we were unable to find any evidence that the resident’s blood pressure was recorded as specified within the care planning documentation. A resident was unable to give an account of how he was involved in his care planning process and a document within his care plans regarding the residents input had been left blank. The acting manager indicated that this is because the resident is unable to give his views. It is recommended that a note of the barriers to resident’s perspective being included in the care planning process and other avenues, such as family etc explored. A resident reported feeling consulted with about how her needs can be met by staff at the home and was also able to describe how residents are involved in cooking and doing their own laundry if they wish and said that ‘ this helps me feel more independent, even if I am in a care home’. Staff spoken with were generally able to confirm suitable levels of knowledge relating to the needs of the case tracked residents. The care staff at the unit currently maintain separate documentation and are responsible for reporting any incidents or areas of concern to the qualified nursing staff. The acting manager said that he is considering reviewing the system as it could lead to important information not being reported and documented in the residents nursing documentation. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. We looked at outcomes for the following standards 12, 13, 15, 16, and 17. This judgement has been made using available evidence including a visit to this service. Residents can participate in a range of activities. The resident’s rights and responsibilities are upheld and they can maintain contact with their family and friends as they wish. Residents are provided with a varied menu but an over reliance on processed food was observed. EVIDENCE: The method of recording social activities which residents are involved in has changed since the last inspection. There is now a very clear chart, which indicates morning and afternoon activities for each resident. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 15 Records of whether residents have participated in social activities is also maintained and includes an evaluation of each activities success and if the activity was interrupted by the challenging behaviour. 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. A resident confirmed that staff make a positive effort to ensure that she is offered opportunities to make decisions about her lifestyle and become involved in activities and areas of personal interest. This has included jewellery making and keeping pets within the home. The resident also said that she accesses the local community and interest groups, which supports her individual diverse needs. A resident said ‘They do their best, some staff talk more than others, but I know who I can talk to and they help and support me’. Other residents with whom we were less able to communicate were seen to be involved in activities both inside and outside the home on the day of the inspection and were a true reflection of the activities chart. Staff spoken with were clear about their role in supporting residents and demonstrated a good level of knowledge about individuals needs and how to support residents to achieve them. Residents spoken with confirmed they are able to live their chosen lifestyle although a restriction was reported in relation to the opportunities to access a group, which would support residents needs regarding sexual orientation. Staff have made attempts, but have not been successful in specifically organising anything. The menu was examined and showed that a vegetarian option was usually available. However, there is a clear reliance on processed food especially for vegetarians, with burgers, nuggets, fish fingers, spaghetti etc making regular appearances. In addition, a number of the vegetarian options are not well balanced, as they do not include a source of protein. The mealtime was observed briefly and the food presented appeared appetising and plentiful and was being consumed positively by those residents present. Comments from one resident reinforced our findings as the resident said ‘the vegetarian options are a bit bland, if I don’t want veggie burgers and veggie sausages there only seems to be the option of a cheese salad or something else involving cheese’. Residents who required support with mealtimes were observed to be supported by staff in an unhurried and respectful manner. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 16 All food preparation requirements for handling and safety of food were being observed and records seen together with our observations indicated appropriate practice. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. We looked at outcomes for the following standards 18, 19, and 20. This judgement has been made using available evidence including a visit to this service. Residents receive the personal support according to their wishes and their physical and emotional needs are met. Medication management is safe and adheres to codes of safe practice. EVIDENCE: Residents spoken with indicated that staff are respectful and patient when administering medication and records noted, who requires what drink to help with swallowing. Care plans examined showed good levels of Multi-disciplinary involvement, when appropriate. Staff and residents confirmed that access to other healthcare professionals is available as required and as mentioned previously in this report the care planning documentation viewed includes support plans for emotional and physical needs. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 18 Residents spoken with reported that staff are respectful to them, knocking on doors before entering, a resident said ‘They might tell me that it is a bit early to go to bed at 6pm, but they encourage me to stay up, not tell me I can’t go’. Observations of staff and resident interactions were seen to be supportive, humorous and afforded the residents with dignity and choice, whilst offering encouragement and guidance. Medication records were viewed and showed that the recording of medicines has improved and the system in use demonstrates clear and accountable practice. The administration of medication was also observed and found to follow the appropriate practical application of medicine management policies. The storage of medication was examined and processes followed showed a good level of medicine management, although one resident who had moved upstairs still had medication stored downstairs, which seems an unnecessary complication when administering medication. . Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. We looked at outcomes for the following standards 22, 23. This judgement has been made using available evidence including a visit to this service. Residents feel that staff listen to and act on any concerns they might have and staff have received training in relation to the Safeguarding Adults. The recording of complaints is ineffective which could compromise the safety of residents. Residents are protected from financial abuse. EVIDENCE: The local Safeguarding adults policies and procedures were available in the office and staff indicated knowledge of the appropriate application of their roles in reporting any incidents, although they viewed their roles as reporting to the acting manager and completing an incident form, rather then consideration of completing an alert under safeguarding or the complaints procedure. Service users spoken with felt that staff do listen and take any concerns raised seriously. CSCI has received information in relation to four separate complaints being investigated by the centre manager. Records of complaints within the home did not reflect that any areas of concern have been raised since the previous inspection this must be addressed to protect residents from possible abuse. Residents spoken with confirmed that they have access to their money at all times. Financial records for residents small cash needs have been improved, but because of the nature of monies being held and administered via one office Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 20 based staff member, this has led to an overcomplicated method of accessing money having been developed. All records seen were accurate, but it is recommended that when money is taken out of the home for spending with or on behalf of a residents, this is recorded at the time and not completed upon their return, as is current practice. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. We looked at outcomes for the following standards 24, 30. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a safe, well-maintained environment, which is comfortable, clean and fresh throughout. Documentation relating to routine maintenance was not maintained accurately. EVIDENCE: The rooms of case tracked residents were viewed, along with a number of communal areas, all were found to be in a reasonable state of repair. An unoccupied bedroom was viewed. The bedroom had been recorded as having been decorated on the day of the inspection, this was not the case. Residents who gave a view indicated that the accommodation is “ok” and meets their needs. Communal areas were clear and in a reasonable state of repair, although they do not appear very homely because of sparse furniture. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 22 At a previous inspection a requirement was made that the registered person consults with a representative from the Environmental Health department to ensure that arrangement to prevent infection at the care home are followed at all times within the laundry room. The laundry facility was inspected and it was evident that infection control procedures were being followed although there was no evidence that required consultation process had been undertaken. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. We looked at outcomes for the following standards 32, 34, and 35. This judgement has been made using available evidence including a visit to this service. Recruitment policies and procedures not being followed. Newly appointed staff had not received an effective induction programme or were provided with structured supervision, which could compromise the health and wellbeing of residents. EVIDENCE: Staff employed at the home is sufficient to meet the needs of the residents and an appropriate skill mix was evidenced. An examination of the staff rota, on the morning of the inspection showed eight carers, and two qualified nurses were on duty throughout the day and 5 carers and one qualified nurse covered the night period. Staff files were examined which showed that policies and procedures in relation to the recruitment of staff had not been followed appropriately, which could place the residents at risk. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 24 Staff personnel files showed that an outstanding allegation of a criminal offence identified within a newly appointed member of staffs Criminal Record Bureau (CRB) police check had not been acknowledged or discussed with a member of staff on receipt of the CRB or at any later time. In addition the member of staff had not specified a full history of past convictions on an application form. An immediate requirement was made as a result of the aforementioned issues. Records also showed that a member of staff had commenced employment before a satisfactory Protection of Vulnerable Adult (POVA) check or Criminal Record Bureau (CRB) check have been obtained. Although the required checks had been obtained approximately one month after employment had commenced. An induction process is available to all newly appointed members of staff but the Staff records examined on the day of the inspection did not show any evidence that an induction process had been performed. The acting manager said, and records confirmed that some care staff have not received formal supervision sessions to ensure they are effectively supported and developed to perform their roles within the home. The service has almost achieved the target of 50 of staff trained to National Vocational Qualification (NVQ) two and above as records showed that 39 of the care staff are in possession of the required qualifications. A staff-training programme is provided which includes Moving and Handling, Basic Food Hygiene, Safeguarding of the Vulnerable Adult, Health and Safety, Infection Control, Fire awareness, First Aid and Positive Response training. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. We looked at outcomes for the following standards 37, 39, and 42. This judgement has been made using available evidence including a visit to this service. An acting manager has been recently appointed at the unit and is making some progress in developing the service, but further progress is required to ensure that the safety and wellbeing of residents is promoted. EVIDENCE: The acting manager holds a Registered General Nursing (RGN) qualification but does not possess a Registered Mangers Award (RMA). The Acting manager has been on post for six months and has recently applied for registration with CSCI. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 26 Staff and residents spoken with said they had faith in the current acting manager and reported a positive improvement in direction and leadership. Residents and staff said that the acting manager is approachable and fair. Information provided within the AQAA shows that policies and procedures are updated on an annual basis and staff confirmed that they have access to the policies and procedures at all times for reference and guidance. At a previous inspection a requirement was made to ensure that the responsible individual on a monthly basis to determine the quality of service performs Regulation 26 visits provision provided to residents at the home and the outcome of the visit is forwarded to CSCI. Although an action plan submitted on the 06.11.06 states that the visits would be initiated, our records show that only two regulation 26 reports have been forwarded to CSCI on the 24th July 2007 and the 26th April 2007. Residents are not provided with a forum to contribute to any planned developments within the home, as residents meetings are not performed although information within the AQAA states that it is planned to set up a resident’s council to provide an opportunity to residents to establish the views of residents. Health and Safety records were examined and there appears to be a considerable amount of unnecessary repetition of some testing records. For example, there were three copies of the same Fire equipment testing records for home. One in a blue generic Health and Safety folder, one entry of the same in the Fire Log book and a third in the service specific Health and Safety folder. This means that accessing some other records was impeded and it was not clear if tests have in fact been carried out. The same issue was identified with Fire drills. However, records of the testing of fire fighting equipment and the recording of fire drills confirm that they are held at appropriate intervals. There is no record in the Health and Safety folders of the staff involved in fire drills and advice should be sought from the Fire office in this regard and also on maintaining appropriate records of testing. There is an unused, untouched and uncompleted Health and Safety management manual available in the office, which if used offers appropriate recording methodology for Health and Safety audits. It is recommended that this “tool” is utilised and that an overview of Health and Safety auditing is carried out by the acting manager to ensure all appropriate checks are completed and that all staff are clear about their roles and responsibilities. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 27 Staff spoke with were clear about reporting faults to the maintenance staff member, but the audit trail is then hard to follow to ensure actions are taken to correct the faults. Records of Gas Boiler servicing were viewed and showed appropriate compliance, documentation relating to Portable Appliance Testing (PAT) testing was provided after the inspection was performed and was found to be satisfactory. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 28 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 2 2 1 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 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 1 32 2 33 x 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000059002.V347263.R01.S.doc 1 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 2 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 1 x x 2 x Version 5.2 Page 29 Nottingham Neurodisability Service Hucknall Millwood YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 Requirement To ensure that potential residents can make an informed choice about whether they wish to be live at the home the Service User Guide must be updated to include the current fees charged at the home To ensure the health and welfare of residents is promoted the pre admission in house assessments must be signed and dated by the assessor and all areas within the assessment documentation must be fully completed. OUTSTANDING FROM 06/11/06 To ensure the health and wellbeing of the residents care plans must be reviewed and updated as residents needs change and care plans should contain sufficient information to protect the residents and staff should the need for restraint become apparent. OUTSTANDING FROM 06/11/06 To promote the health and wellbeing of residents the DS0000059002.V347263.R01.S.doc Timescale for action 31/01/08 2 YA2 15 31/01/08 3 YA6 18 31/01/08 4 YA17 13 31/01/08 Page 30 Nottingham Neurodisability Service Hucknall Millwood Version 5.2 5 YA23 22 6 YA23 22 7 YA34 SCHEDULE 2 reliance on processed food especially for vegetarians must cease to ensure that dietary options are well balanced and include a source of protein To ensure the health and 31/01/08 wellbeing of residents the recording of complaints must reflect any areas of concern thus protecting residents from possible abuse. To promote the health and 31/01/08 wellbeing of residents staff must receive additional trailing in safeguarding adult procedure to ensure they consider completing an alert under safeguarding or the complaints procedure if required. 20/09/07 To promote the health and wellbeing of residents, policies and procedures in relation to the recruitment of staff must be followed. Outstanding allegations of criminal offences must be identified and discussed and staff must specify a full history of past convictions on their application form. Staff must only commence employment once satisfactory Protection of Vulnerable Adult (POVA) checks and Criminal Record Bureau (CRB) checks have been obtained. To promote the health and wellbeing of residents all staff must undergo an effective staff induction process. OUTSTANDING FROM 06/11/06 To promote the health and wellbeing of residents all staff must receive formal staff supervision DS0000059002.V347263.R01.S.doc 8 YA36 18 31/01/08 9 YA36 18 31/01/08 Nottingham Neurodisability Service Hucknall Millwood Version 5.2 Page 31 10 YA38 26 11 YA39 24 The registered person must ensure that a representative of the organisation home visits the care on a monthly basis to complete the requirements of Regulation 26 and submit to the Commission for Social Care Inspection until further notice. OUTSTANDING FROM 06/11/06 The registered person must ensure that an effective service users consultation process is established which seeks the views of service users at the home. OUTSTANDING FROM 06/11/06 31/12/07 31/01/08 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 YA6 Good Practice Recommendations It is recommended that the assessments, support plans and risk assessments for each resident are re-organised and indexed to make them accessible and user friendly to ensure they are live/working’ documents. It is recommended that a note of the barriers to resident’s perspective being included in the care planning process should be noted and other avenues, such as family etc explored. It is recommended that the practice of care staff maintaining separate notes from the nursing notes is stopped as it could lead to important information not being reported and documented in the residents nursing care plans. It is recommended that residents be provided with access to groups to support residents needs regarding sexual orientation It is recommended that when money is taken out of the home for spending with or on behalf of residents, this is recorded at the time and not completed upon their return, DS0000059002.V347263.R01.S.doc Version 5.2 Page 32 2 YA6 3 YA6 4 5 YA15 YA23 Nottingham Neurodisability Service Hucknall Millwood 6 YA35 7 8 9 YA37 YA42 YA42 10 YA42 as is current practice. It is recommended that to promote the health and wellbeing of residents the service could achieve the target of 50 of staff trained to National Vocational Qualification (NVQ) level two and above. To promote the health and wellbeing of the residents it is recommended that the acting manager enrol on a Registered Mangers Award. It is recommended that unnecessary repartition in relation to the maintenance of Health and Safety records ceases. There is no record in the Health and Safety folders of staff involved in fire drills. It is recommended that advice be sought from the Fire office in this regard and also on maintaining appropriate records of testing. It is recommended that an overview of Health and safety auditing is carried out by the acting manager to ensure all appropriate checks are completed and that all staff are clear about their roles and responsibilities. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V347263.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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