Inspection on 06/11/06 for Nottingham Neurodisability Service Hucknall - Millwood

This inspection was carried out on 6th November 2006.

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 no outstanding requirements from the previous inspection report, but made 13 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... 20/09/07

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 Key Unannounced Inspection 6th November 2006 09:00 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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.V317723.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.V317723.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 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 Vacant Care Home 22 Category(ies) of Physical disability (22) registration, with number of places Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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 8th December 2005 2. Date of last inspection Brief Description of the Service: Millwood is a care home providing personal care and accommodation for 20 younger adults who have an acquired or 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, and 11 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has a small patio area and there is ample car parking space available. The fees currently charged at the home range from Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 7.5 hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. On this occasion the inspector was unable to fully ascertain the views of the service users as service users did not wish to speck to the inspector for any significant length of time. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the home setting and that their safety and well being is being maintained. On this occasion two service users notes were case tracked. The home does not have a registered manager in post. In the absence of a registered a manager the managerial input was being supplied by a deputy manager who was on holiday at the time of the inspection. The person in charge at the time of the inspection was a manager from a sister home within the campus and had only been supplying managerial input for four days on a part time basis. What the service does well: What has improved since the last inspection? The service users information board located in the manager’s office has been amended and does not identify the physical conditions of the service users thus protecting their confidentiality. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 6 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.V317723.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 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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. 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. 2 This judgement has been made using available evidence including a visit to this service. The pre-admittance assessments examined on the day of the inspection did not ensure that the service users holistic needs were being met. EVIDENCE: The pre-admission assessment documentation of the two case tracked service users was examined. The assessment documentation utilised a recognised assessment tool in an attempt to identify the holistic needs of the service users. The assessment documentation did not fully evidence that service users are fully involved in the decisions about their lives and do not play an active role in the care and support they receive as the assessment process did not identify individual goals and aspirations. On the day of the inspection the senior member of staff confirmed that this element within the assessment process requires further development. The registered person is required to ensure that the assessment processes utilised within the home is effective in identifying the service users goals and aspirations and the service users are actively involved in the assessment process whenever possible. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 9 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, 9. This judgement has been made using available evidence including a visit to this service. The care planning procedures within the home were ineffective and the safety of the service users is compromised. Service users are not encouraged to make in dependent decisions about their own life The service users ability to take risks as part of an independent lifestyle is promoted. EVIDENCE: The case tracked service users had care plans in place but the practice of involving people who use the service in the development and review of the care planning process is ineffective. As mentioned earlier in the report the service users aspirations and gaols were not addressed effectively as no care plans were evident in relation to this element of care. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 10 A case tracked service user care plan appertaining to diabetes lacked specific instructions for staff should the service user experience hyperglycaemic or hypoglycaemic episodes. An examination of the blood glucose monitoring documentation for the same service users also evidenced that the service users blood glucose levels were erratic ranging from 26.6mmols on 1.3.06 to 4.9mmols on 21.04.06. Further examination of the service users Medication Administration Records (MAR) evidenced that the service user had been placed on a sliding scale insulin administration regime by her General Practitioner. The purpose of the sliding scale is to ensure that the service user is administered different doses of insulin depending on her level of blood glucose, with the intention to “fine tune” the insulin administration and normalise blood glucose levels. The service users care plan did not mention the sliding scale insulin administration regime. It was also evident that the sliding scale had been ignored on many occasions by the nursing staff at the home, which would place the service user at significant risk of harm. The senior member of staff confirmed the shortfalls and responded immediately by contacted the service users General Practitioner and a Pharmacist for advice. She also stated that an investigation will be commenced on 7th November 2006 to identify the nursing staff involved in the incorrect administration of insulin, once identified appropriate actions will be taken to ensure the safety of the service user. The service user did not have a care plan which specifically addressed her diet in relation to diabetes management. The service user had experienced a significant weight gain, which according to documentation examined at the time of the inspection, had caused “exhaustion” on mobilisation, but the service user had not been referred to a dietician for weight management. The “Waterlow score” (a tool to measure the service users susceptibility to pressure ulcer formation) was performed sporadically with the last evaluation being performed on 29.07.06. The service user had been identified as “at risk” of pressure ulcer formation but no care plan was evident to address the identified complication. An examination of the care plans further evidenced that the care plans had not been updating and evaluated effectively to ensure that any changing needs of the service users are effectively addressed. The person in charge on the day of the inspection stated that the evaluation of care planning documentation is currently ineffective as some care plans had not been re-evaluated for approximately one year. An examination of the care plans that had been re-evaluated simply stated, “continue with care plan” which is not an effective evaluation of the care plans. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 11 An examination of the care planning documentation did not evidence that service users are involved in developing the plan of care as the care plans did not evidence any service users or their representatives signatures, indeed many care plans did not evidence the signature of the staff member who initially produced the care plan. The registered person will ensure that the care planning and evaluation processes utilised in the home are effective in meeting the holistic needs of the service users and that service users are involved in the care planning process whenever practically possible. The home does not offer an effective consultation process to ascertain the service users satisfaction with the service. The person in charge confirmed that the service users are not fully involved in decision-making processes at the home. The person in charge stated that a consultation process will be initiated, such as service user meetings and will commence in the near future. In ensuring that the home is run in the best interests of the service users and service users can make decisions about their lives, the registered person should ensure that an effective systems are established, based on seeking the views of service users, to measure success in achieving the aims and objectives of the Statement of Purpose of the home. The promote independence; service users are encouraged to perform domestic tasks within the Independent Living Skills (ILS) room once a risk assessment has been performed. Service users can make themselves drinks and small meals and the ILS rooms are utilised to assess the service users ability to perform domestic tasks safely. Service users are also encouraged to do their own laundry and ironing under supervision to further promote the service users living skills. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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 12, 13, 15, 16, 17. This judgement has been made using available evidence including a visit to this service. Service users benefit from the provision of a varied social activities programme. Service users are encouraged to interact within the local community. Service users can maintain appropriate relationships within family and friends. Service users rights and responsibilities are respected at the home Service users are offered a healthy diet but the inappropriate storage of service users meals will place the service users at risk. EVIDENCE: The person in charge and a member of the nursing staff confirmed that service users are encouraged to participate in a varied social activities programme within the home and within the local community. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 13 An examination of the case tracked service users notes evidenced that social activities are recorded within the care planning documentation. An activities coordinator is employed over five days per week and promotes activities such as arts and crafts, board games and film nights. The service users can also utilise the homes mini bus and can access trips to the local parks, swimming pool and attend day centres and trips to the coast. A record of the service users planned social activities schedule is on display on the service users bedroom door to aid the communication process for the service users. The person in charge and a member of staff stated that the home operates an open door policy in relation to visitations so as to facilitate and maintain appropriate relationships within family and friends, although it was established through conversations with staff members that visitations are somewhat infrequent. The person in charge could not evidence any policies or procedures in relation to the safeguarding of service users who develop intimate relationships. The person in charge stated that it would be paramount to protect the service users at the home. To promote the service users safety an assessment would be performed to ensure the service users could give informed consent in relation to intimate relationships. Once informed consent is established the person in charge would discuss issues in relation to as contraception, sexually transmitted diseases and privacy and dignity. The service users guide states that to promote respect and dignity staff members are not allowed to enter the service users rooms without knocking on the service users door and receiving a response from the service user, unless it is considered that the service user is at risk or unless it is identified within the individual care plan. The inspector witnessed several interactions between service users and staff members and it was evident that staff did knock on service users doors before entering and that staff addressed service uses in a respectful manner whilst offering guidance rather that instructions. A service user stated that the meals at the home are very good. A four weekly menu is provided to the service users at the home so as to promote the service users choice. An examination of the menu evidenced that varied and wholesome meals are provided, the daily menus evidenced that a least two meal options are available at lunch time so as to promote the service users choice in relation to meal provision. Whilst performing a partial inspection of the home the inspector observed service users pre plated meals within the ILS room. The meals were covered with cling film but an apple pie was not covered. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 14 The person in charge asked a carer why the meals were in the ILS and not stored appropriately within a refrigerator. The carer stated that the meals were left for the service users to eat later in the day and it was common practice at the home to leave the meals in the ILS room. The carer also stated that when the service users are ready for their meals a microwave is used to reheat the food, the carer also stated that the meals are not temperature monitored prior to consumption, as a temperature probe was not available. The person in charge stated that she was not aware that the practice of storing un-refrigerated meals was commonplace at the home and appreciated the potential dangers in relation to food contamination. To ensure the safety of the service users the registered person will ensure that all meals are appropriately stored within a refrigerated environment, covered appropriately and labelled with the date of production. The registered person will also ensure that all food is temperature monitored prior to consumption to minimise the risk of bacterial contamination to the service users. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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. 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 18, 19, 20. This judgement has been made using available evidence including a visit to this service. Service users do not receive personal support in a way they prefer and require and the physical and emotional needs of the service users are fully not met. The current practices in relation to the administration of medicines at the home are ineffective in maintaining the safety of service users. EVIDENCE: The service users should be afforded access to health care services that meet their assessed needs. An examination of the service users care planning documentation evidenced that a section is made available to record interventions from the Multidisciplinary Team (MDT) which could include interventions from General Practitioners, Podiatry services, Opticians, Physiotherapists, Occupational Therapists, Dentists, Dieticians and Specialist Nurses. Within one case tracked care plan the section appertaining to MDT interventions was blank and another case tracked MDT record only had one referral documented for a psychiatric referral. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 16 As mentioned earlier in the report a service user blood glucose levels were not controlled effectively as the blood glucose levels ranged from 26.6mmols on 1.3.06 to 4.9mmols on 21.04.06. The service user also had a significant weight gain from 16.5 stone to 18 stone causing, as documented in the service users care plan “exhaustion on mobilisation”. Given the aforementioned issues it was apparent that the health needs of service users are not monitored effectively and appropriate actions and intervention had not taken place, such as a referral to the a diabetic specialist nurse or specialist dietician for advice relating to diabetes management and weight control. The registered Person will be required to ensure that service users have access to appropriate health promoting interventions from the MDT to ensure that optimum physical and psychological well being is promoted. The current practices in relation to the administration of medicines at the home are ineffective in maintaining the safety of service users. At the time of the inspection no service users were responsible for the selfadministration of medicines. The person in charge stated that should a service user wish to be independent in the administration of medicines a risk assessment would be performed. If the service user was deemed as being safe, the service user would be supported to be independent in relation to the self-administration of medication. As stated earlier in the report a case tracked service users MAR charts were examined and it was evidenced that the service user had been placed at risk of harm due to the inappropriate administration of insulin by the nursing staff at the home as the sliding scale insulin regime had not been followed. Further examination of MAR charts evidenced that the MAR charts had gaps present with no explanation as to why the service had not received the medication. MAR charts should not have gaps present, if medication cannot be administered an explanation must be documented and appropriate “key” must be used. The temperature within the medication fridge had been monitored on a `daily basis but the temperature within the medication fridge was outside acceptable limits as the temperature was recorded at 0 degrees and 1 degrees centigrade on many occasions throughout October 2006. Further concerns identified in relation to medication management at the home included: The medication cupboards in the medication room were not locked The temperature within the medication room exceeded 25 degree centigrade. The medication trolley was not secured effectively although the facility had been made available in the medication room. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 17 Hand written entries on the MAR charts did not evidence two signatures. All handwritten entries on MAR charts should evidence the person who wrote it and the person who checked the entry as correct so as to ensure the safety of service users at the home. The registered person is required to evidence to the Commission of Social Care Inspection the actions to be taken to ensure that practices in relation the medication management at the home ensure the safety of service users at all times. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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): Quality in this outcome area is good. We looked at outcomes for the following standards 22, 23. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place, which is effectively distributed throughout the home to ensure that concerns and complaints are identified and acted upon. Service users are protected from abuse, neglect and self-harm. EVIDENCE: The person in charge was not investigating any complaints at the time of the inspection and the Commission for Social Care Inspection had not received any complaints appertaining to the service provision at the home. The complaints procedure was evident within the “Statement of Purpose” which all service users are given on admission to the home. The complaints procedure was also on display in the foyer of the home. An examination of the complaints procedure within the statement of purpose evidenced that it is clearly written, and is easy to understand but did not evidence agreed timescales to respond to complaints. The complaints procedure was only produced in one format and it is recommended that a number of formats including large print and pictorial representations are made available to enable service users with impaired cognitive abilities to complain or make suggestions effectively. The inspector was unable to determine the service users understanding of how to make a complaint, as the service users were not willing to discuss the complaints procedure with the inspector. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 19 An examination of the staff-training matrix evidenced that staff receive appropriate training in relation to the protection of vulnerable adults (POVA) with training being provided on 23rd January 2006, 18th August 2006 and 26thSeptember 2006. A member of the nursing staff spoken with on the day of the inspection confirmed that training opportunities in relation to POVA takes place at the home but he had not received the training as he was on holiday at that time. The nurse, who had only been in the country for a short period of time, also stated that he last had POVA training approximately 20 years ago. The staff member was unable to demonstrate an acceptable knowledge of issues relating to POVA but stated that he would liaise with the acting manager of the home if he had any concerns in relation to the safety of service users at the home. An examination of the staff-training matrix evidenced that less than 50 of the workforce had received POVA training in 2006, although the person in charge stated that additional training will be provided in the near future to address the shortfall. The ensure the safety of all service users at the home the registered person will ensure that all staff at the home receive appropriate training in relation POVA to ensure the safety of the vulnerable adult is maintained. Whilst examining the medication room the inspector found a record book appertaining the management of the service users finances. The person in charge was not aware that any service users money was being managed within the home as she believed that all monies were centrally managed from the complexes administration offices. The case tracked service users recorded balances were examined as was the money available within the individual service user envelops. The recorded amount and the actual amount of money available did not correlate and the person in charge could offer no explanation as the discrepancies evidenced. To ensure the service users finances are safeguarded and service users are protected from financial abuse the registered person will ensure that all service users monetary records are maintained accurately and that balance checks are made at each transaction. The registered person will also be required to provide evidence to the Commission for Social Care Inspection of the policies and procedures appertaining to the management of service users finances and undertake an investigation into the monetary discrepancies identified at the inspection. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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): 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. The home provides a comfortable and safe environment, which is well maintained and homely. Service users benefit from a home, which appeared clean and hygienic, but infection control policies was not followed effectively within the laundry room to ensue the safety of the service users. EVIDENCE: A case tracked service user stated they she was satisfied with her bedroom and the overall cleanliness of the home. A case tracked service users bedroom was seen on the day of the inspection and was found to be well-personalised safe and clean. Service users have audio and visual equipment in their rooms together with books, posters and pictures. The inspector performed a partial inspection of the homes environment. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 21 The home had a acceptable standard of cleanliness, well lit and all areas smelt fresh. Communal areas, which included the service users lounge and dining room were maintained to a satisfactory standard as were the service users bathrooms and toilets which were fitted with appropriate aids and adaptations to meet the needs of the service users. The partial inspection of the premises evidenced that appropriate infection control measures are provided at the home but an examination of the home laundry facilities evidenced that the infection control measures were not being followed effectively. The home operates a “red bag system” in which all infected laundry is placed in red alginate bags, the intention of the red bag system is to ensure that any infected laundry is washed separately at a high temperature to ensure that any contaminates are destroyed. Within the laundry area it was evidenced that the red bags had split open and the contaminated laundry was exposed, which represents a significant risk of cross infection to the service users. The registered person will ensure that infection control policies and procedures are strictly adhered to and liaise with local Environmental Health Office (EHO) to ensure the safety of all service users at the home. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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): Quality in this outcome area is good. We looked at outcomes for the following standards 32, 34, 35. This judgement has been made using available evidence including a visit to this service. An appropriate number and skill mix of staff are employed at the home to meets the service users needs. Recruitment process utilised at the home promotes the safety of service users. Staff receive appropriate mandatory training but the staff induction process is ineffective. EVIDENCE: The staff rota evidenced that on the day of the inspection the morning period was staffed by eleven carers, and two qualified nurses, throughout the afternoon period, twelve carers and two qualified members of staff were on duty and five carers and one qualified nurse covered the night period. Two staff files were examined on the day of the inspection. It was evident that policies and procedures in relation to the recruitment of staff had been followed appropriately thus promoting the safety of service users at the home. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 23 Both staff files evidenced that two satisfactory references had been obtained together with the required Criminal Records Bureau checks (CRB) prior to the staff commencing employment. The person in charge stated that all qualified nurses and care staff employed at the home undergo mandatory training to ensure that service users are safe within the home. An examination of the staff training documentation confirmed that the mandatory training opportunities are provided in an attempt to ensure the safety of service users. The training opportunities included Health and Safety, Moving and Handling, Food Hygiene, Fire Awareness and Infection Control. The staff-training matrix also evidenced that additional training had been performed in relation to Nutritional Awareness. The person in charge said that all staff should receive a structured induction programme to the home but two members of staff stated that the induction was not effective, one member of the care staff stated that she had not received any induction whatsoever. To promote the safety of all service users and staff within the home the registered person should ensure that all staff receive a structured induction programme (within six weeks of appointment) and foundation training (within six months of appointment) to include training on the principles of care, safe working practice, the organisation and worker role, the experiences and particular need of the service user group. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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): Quality in this outcome area is adequate. We looked at outcomes for the following standards 37, 38, 42. This judgement has been made using available evidence including a visit to this service. The service users rights to live in a well run home were compromised due to an ineffective management structure. A range of health and safety documentation was examined and demonstrated that the service users safety is protected and promoted EVIDENCE: A full time manager was last employed at the home approximately six months previously to the inspection. Following the resignation of the manager an acting manager was employed. The acting manager resigned from her position approximately three month previously to the inspection. An acting manager is currently employed at the home but she was on holiday at the time of the inspection. Management input was being provided from a Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 25 manager from a sister home within the campus on a part time basis and the manager had been in post for approximately four days. Given the aforementioned issues identified on the day of the inspection it was evident that the current acting manager has not ensured that systems are in place for reviewing and quality auditing care practices at the home to ensure the quality of care afforded to service users is of a acceptable level. The registered person should ensure that a manager is appointed at the earliest opportunity who has the required qualifications and experience to competently run the home and ensure the safety of service users at all times It was evidenced that the home is maintained to a satisfactory standard throughout and it was determined that appropriate precautions are taken in relation to the control of Legionella contamination, the testing of fire equipment and fire alarms, maintenance of equipment designed of aid mobility such as wheelchairs, hoists and baths. The maintenance technician employed at the home also performs hot water outlet checks on a monthly basis so as to minimise the risk of scolds, internal and external environmental checks to ensure the safety of the service users. The maintenance technician maintains excellent records appertaining to the all the aforementioned issues; the documentation was clear, concise and very well maintained. Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.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 2 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000059002.V317723.R01.S.doc 1 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 1 X X X 3 X Version 5.2 Page 27 Nottingham Neurodisability Service Hucknall Millwood Are there any outstanding requirements from the last inspection? No 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 YA2 Regulation 15 Requirement The registered person shall ensure that the assessment processes utilised within the home is effective in identifying the service users goals and aspirations. The Registered Person shall ensure care plans are updated to reflect service users changing needs. The registered person shall liaise with the local environmental health office to ensure that service users safety is maintained in relation to food preparation and delivery. The registered person shall ensure that service users have access to appropriate health promoting interventions from the Multidisciplinary Team to ensure that optimum physical and psychological well being is promoted. The registered person shall maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the administration of insulin by 1700hrs on 6th November 2006. DS0000059002.V317723.R01.S.doc Timescale for action 29/01/07 2 YA6 18 29/01/07 3 YA17 16 (g) 29/01/07 4 YA18 YA19 13 29/01/07 5 YA20 13 06/11/06 Nottingham Neurodisability Service Hucknall Millwood Version 5.2 Page 28 6 YA23 17 Schedule 4 7 YA30 23 (5) 13 8 YA38 18 9 YA38 26 The registered person shall maintain in respect of each service user a record which includes the information, documents and other records appertaining to the management of service users monies and undertake an investigation into the discrepancies identified at the inspection. The registered person shall undertake appropriate consultation with the authority responsible for environmental health for the area in which the care home is situated to ensure that arrangements to prevent infection at the care home are followed at all times and that practices within the laundry room promote the principles of infection control. The registered person shall, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users The registered person shall ensure that the care home is visited by the responsible individual on a monthly basis and interview service users, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home. Inspect the premises of the care home, its record of events and records of any complaints and prepare a written report on the conduct of the care home which will be DS0000059002.V317723.R01.S.doc 29/01/07 29/01/07 04/12/06 04/01/07 Nottingham Neurodisability Service Hucknall Millwood Version 5.2 Page 29 10 YA38 24 11 YA38 24 12 YA38 39 submitted the Commission for Social Care Inspection. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home in relation to the gaps within the medication administration records. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home in relation to the safe monitoring of medication fridge temperatures The registered person shall give notice in writing to the Commission as soon as it is practicable to do so if any of the following events takes place or is proposed to take place (a) A person other than the registered person carries on or manages the care home; (b) A person ceases to carry on or manage the care home; 04/01/07 04/01/07 04/12/06 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA7 YA37 Good Practice Recommendations The registered person should ensure that effective service users consultation process is established which seeks the views of service users at the home. The registered person should ensure that a manager is appointed at the earliest opportunity who has the required qualifications and experience to competently run the home and ensure the safety of service users at all times. The registered person should ensure that the complaints procedure is available in appropriate formats to aid the service users to report concerns and complaints. The registered person should ensure that all staff receive an effective induction to the home to ensure the safety of service users. 4 5 YA23 YA32 Nottingham Neurodisability Service Hucknall Millwood DS0000059002.V317723.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V317723.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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