CARE HOME ADULTS 18-65
Pennings View Porton Road Amesbury Wiltshire SP4 7LL Lead Inspector
Tim Goadby Unannounced Inspection 2nd December 2005 10:20 – Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 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 Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 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. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Pennings View Address Porton Road Amesbury Wiltshire SP4 7LL 01980 624370 01672 569477 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) Cornerstones (UK) Ltd Teresa Guthrie Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Any placement for short-term care or for emergency placement must be agreed with the Commission before the placement commences. For the purpose of this condition, short-term is defined as a placement that is expected to last not longer than 3 months. An emergency admission is defined as an admission whereby someone is likely to be placed at short notice without an up-to-date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. 25th May 2005 Date of last inspection Brief Description of the Service: Pennings View is a privately operated home. It provides care and accommodation for 7 young adults with a learning disability. The owners, Cornerstones UK Ltd., have a number of similar establishments across the county. Pennings View is on the outskirts of Amesbury. Residents are able to access a range of local amenities. The property is a two storey domestic dwelling. There are bedrooms on both floors. All residents have single rooms. One of these has an en-suite bathroom. There is a large garden at the rear of the house. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in December 2005. A total of 5.5 hours were spent in the home. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records, with case tracking; discussions with service users, staff and management; survey of service users, relatives and professionals. As no senior staff were present on the day of the inspection visit, the main concerns arising were discussed with them on the telephone, and confirmed in a letter, in advance of this inspection report. What the service does well:
Pennings View is a service which provides care to an established service user group, offering them stability in their lives. Despite some issues that can arise amongst service users, they generally appear to be compatible. The atmosphere at visits to the home is always relaxed and welcoming. Residents are observed to be confident in interacting with staff, and in exercising choices. Service users’ social and recreational needs are met. The home has consistently demonstrated strengths in the range of activities and opportunities that are offered to service users. Access to community participation is a regular feature. People are also supported to maintain key relationships with their family and friends. Service users have their needs met by the accommodation provided. The property itself is a pleasant and homely environment. All service users have their own rooms, and there is also a good amount of communal space. Feedback from service users and relatives is positive about the home. 5 service users returned comment cards before this inspection. All responses indicate satisfaction with the service provided by Pennings View. People feel safe and well cared for, and report that staff treat them well. There were 3 comment cards from relatives. All of these were satisfied with the care given. Families feel they are made welcome in the home at any time, and that they are kept appropriately informed and consulted about important matters. One person commented that Pennings View provides their relative with a “secure and happy lifestyle”, and that the individual has “grown socially and academically” as a result. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
4 requirements remain unmet from previous inspections. A further 6 requirements are identified in addition, as a result of this visit. 11 good practice recommendations have also been made. The majority of the requirements made in this report are set for compliance by 31st January 2006. The CSCI will undertake additional regulatory activity around that time, to ensure that all necessary steps have been taken to ensure the welfare and safety of service users. Any failure by the registered persons to do so will lead to further enforcement action. A range of service user records need improvements, to enhance the provision of an effective service to them. Care plans must address all areas of need effectively, and be kept reviewed and updated. The input of individuals to their own care must be shown wherever possible, especially where any restrictions or control measures have been assessed as being necessary. Goal setting needs to ensure that overall aims have been broken down into a series of measurable actions, to aid meaningful review. For those service users who have a more restricted weekly programme, because of their preferences, records need to show clearly why this is, and what is being done to try and address it. Strategies for the management of complex and challenging behavioural needs must be clearly defined, to ensure the protection of service users and staff. Guidelines have to be kept under regular review; and must ensure that the input of other relevant agencies is incorporated appropriately. Use of physical interventions is applied within a suitable framework, but needs further attention, to show that they are properly tailored to individual service users. Recruitment records must provide evidence that all required checks are completed, at the appropriate times. These records need to be available for
Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 7 inspection, to enable the Commission to verify that the company’s practices ensure the protection of service users. Service users’ best interests are not being safeguarded by the home’s practices in record keeping. Not all required records are being kept up to date and accurate. As well as the deficits in service user and staff records already mentioned, an example was seen of repeat errors in one person’s medication administration record. There are also various failings of good practice. Key documents are not always dated and signed when they are drawn up. Spaces for relevant people to indicate their awareness of policies and guidelines are often left blank. Linked information is held in more than one place, without effective cross referencing between these. It is not possible to conclude that staff rotas are ensuring safe levels of support for all the assessed needs of service users, which places people at risk. Some service users are assessed as potentially needing 2 staff for some interventions. But this is not reflected in staffing numbers or deployment. Staff often have periods of lone working. At night, only one person sleeps in. During the days, it is common for one staff member to support service users outside the home; and for one to be at Pennings View with any others. Suitable risk assessments and management strategies are not in place. Emergency procedures are not clearly defined. Despite some improvements in fire safety practice, as set out above, there are still deficits which place service users and staff at risk. Not all required checks and staff instruction are being carried out and recorded at the prescribed intervals. A fire containing door has been noted as not closing properly, but there is no information about what is being done about this. The effectiveness of updated procedures may be compromised by having previous guidance still in the same file, some of which gives contradictory information. The risk assessment could go into greater detail about all areas of the property. Another area in need of repair is in a downstairs bathroom. A strip light has been removed from above a cabinet over a sink. This has left some electrical wiring exposed. The area needs to be repaired and made safe, to ensure the protection of service users and staff. 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. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standards relating to admissions to the home were not applicable at this inspection. Service users have their needs met by the care provided. EVIDENCE: The home has not had any new admissions since the previous inspection. One service user place has just become vacant, so it is likely that prospective replacements will be considered over the coming months. The company has admissions procedures in place. There is also a condition of registration relating to any short-term or emergency admissions. Pennings View supports people with a variety of needs. The majority have lived at the home for a number of years. In addition to their learning disability, service users may have a range of health issues. The home has access to input from other relevant professionals. Systems are in place for ongoing monitoring and review of individual placements. The managers of teams with continuing input to Pennings View had no concerns about the service at the time of this inspection. The care manager for one service user had concluded, through assessment, that this individual’s Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 10 needs would be better met in an alternative placement. This person had therefore moved on from Pennings View. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Service users’ needs may go unmet, as they are not fully reflected in their individual care plans, which are not kept reviewed and updated. Goal setting and review systems need some attention, to ensure that they are clearly measurable. This will assist service users in making progress on their identified aims. The home fails to show the input of service users to decisions about their own care. Suitable risk assessment and management systems are in place. But the home fails to define some of the control measures used, leading to concern about whether service users’ welfare is properly upheld. EVIDENCE: Cornerstones is working on the implementation of a new care plan format for all its registered homes. In the meantime, existing plans and associated guidance at Pennings View have not been kept properly reviewed and updated.
Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 12 Sampled records show little change from the previous inspection, in May and June 2005. There is no clear evidence that service users or other people have contributed to significant decisions about care. There is space to show the input of various people, including the service user, or their representative, to care plans and other documents. But in most examples seen, it is only staff of the home who have signed these. Goals are set, but in some cases they need to be broken down into sets of actions, so that progress can be measured when they are reviewed. This is particularly true when the overall goal is a long term one, or covers a number of issues. Examples of goals, such as “to be more motivated in the mornings”, or “to be aware when other service users do not want interaction”, are not measurable. Risk assessments and management guidelines are in place. These have been completed for a range of topics. A scoring system is in use. There is information about how this operates. Staff are expected to sign completed documents to indicate that they are aware of the set approach, and will work in accordance with it. But this has not been done in all cases. In some cases, control measures are imposed. In the sampled files, these are not always fully defined. For instance, where two service users are known to have the potential to clash, the documented advice is to “try to keep them apart if either is in an aggravating/agitated mood”. No definition is given on what mood state is meant by this. Nor is there any clarification about what steps staff may take to intervene between the service users. Some control measures have been suggested in the home’s risk assessments, with no further information about whether or not they are being pursued. In another instance, reference is made to guidelines from a consultant. But there is no further information about what these are, or where they may be found. The home must show exactly what steps are being taken, and how these interventions are devised, monitored, and reviewed. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. They were met at the previous inspection. One recommendation is restated, for checking at future visits. EVIDENCE: Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Service users are protected by the home’s policies and procedures for dealing with medicines, but errors in record keeping indicate the need to ensure good practice is applied consistently. EVIDENCE: The current service users do not keep their own medication, or take it independently. So staff have to assume the responsibility for all aspects of this task. Arrangements for storage, recording and administration of medication are mostly satisfactory. To address a requirement of the previous inspection, arrangements for the recording of medication have been clarified. It is now possible to see, via individual care plans, at what time a service user has been administered any drugs. The usual time is made clear in the plans, and if there is any change on a particular day, this is noted in the daily record. Entries on one service user’s medication administration record were unclear. One element of the daily prescription had been signed for at the wrong time, and then crossed out, on 6 consecutive occasions. Checks of actual medication indicated that these were recording errors, rather than mistakes in
Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 15 administration. A general requirement relating to accurate record keeping has been set under the appropriate standard. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users with complex and challenging needs are placed at risk by the home’s failure to sufficiently define the steps being taken to manage these. EVIDENCE: Pennings View supports service users with a range of behavioural needs. Behaviours have been defined for individuals, and strategies put in place to manage them. There are gaps in the available information, which make the overall approach unclear. For instance, one service user has a list of defined behaviours that may present difficulties. Not all of these have a recorded strategy in place. Presentation of information also needs addressing. Definitions of behaviours, and the strategies to respond to them, are not recorded together. Crossreferencing between different pages in one file, or between a number of different files, proves difficult. In some cases, one document mentions the need to also read another. Staff are not always clear where the other piece of information can be found. When it is noted as important to read the two in conjunction, there need to be much clearer systems for combining them. Sampled records also fail to show up to date information on the input received from other agencies. Relevant professionals have previously expressed concern to the CSCI that their advice is not always applied effectively. There is a failure to transfer such guidance into the home’s own service user records. This contributes to the deficits in implementing agreed strategies. Physical interventions are practised on occasions for some service users. Recording is in place for whenever this occurs, and is generally of good quality,
Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 17 with clear and informative detail. Incidents are reported to the CSCI, as required by the Care Homes Regulations 2001. There is evidence that staff have received relevant training on the techniques used. This was most recently updated in March 2005. The general framework for use of physical interventions sets out appropriate boundaries, with a focus on trying other approaches whenever possible. There is clear guidance that physical interventions must not be used with one service user, as they would be likely to elevate the situation. General policy information includes a description of the interventions that might be used within the home. The organisation has eight approved techniques for holding people. Some information in individual files is unclear, but it appears that three of them have been noted as applicable to various service users at Pennings View. Of these, two require two people to carry them out. The implications of this for staff cover are not explicitly addressed. Guidance on the use of physical interventions with individual service users is again difficult to follow, because of the need to refer to different documents in different files. Some of the information in different places appears contradictory. For instance, one service user’s file implies that all 8 approved holds might be used with them, whereas the general procedure includes a note that only 2 holds are to be used with this person. Greater definition of when to use physical interventions is also needed. Guidelines set out which behaviours might lead to this. But the actual triggers for use are not made clear. There are detailed written descriptions of the holds used by Cornerstones staff. But no pictorial representations were seen. These can be helpful in providing a clear visual aid about correct technique. They can act as a reminder for staff, and assist with consistent application. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 27 & 28 Individual and communal space meets the needs of service users. EVIDENCE: Information on room sizes is contained within the home’s Statement of Purpose. This gives dimensions in feet. The measurements have not been verified. Calculations converted from them indicate that all rooms exceed 10 square meters. Each resident has a single room. They are decorated and furnished to reflect the individual personalities of their occupants. Many of the items are people’s own possessions. All are lockable. Bedrooms vary considerably in size and layout. 2 are on the first floor. These have areas of sloping ceiling, and dormer windows. Some ground floor bedrooms have French doors. One bedroom has an en-suite bathroom. The rest of the household has 2 other baths, both with showers. There are also 3 toilets. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 19 Communal space consists of a large lounge; an entrance hall with some seating; and the kitchen. The latter also has a small seating area around a table. Staff sleep-in facilities are situated in a first floor room, which also serves as an office. The garden provides another useful amenity. It is well maintained. Various sports equipment has been provided. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 34 The ability of the staff team to support all service users safely and effectively at all times is limited, placing people at risk. Evidence is not available that service users are protected by recruitment and selection practices. EVIDENCE: Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 21 There has been one staff change since the previous inspection. An employee aged under 18 has left the home. A requirement relating to this individual’s job description has therefore become immaterial. Pennings View has a manager; deputy manager; and, at the time of this inspection, five other care staff, working a variety of hours. Other cover can be provided on a relief basis by employees who are usually based in any of the company’s other services. The home runs on a minimum of two staff per shift, during daytime hours. The aim is to increase this to three or more people, whenever possible. The number actually on site varies, as it is common for staff to be away from the home, escorting people on various activities. When they do this, they are contactable via mobile phone. The company also operates another care home which is next door to Pennings View, so assistance may be summoned from this establishment in an emergency. Overnight cover is provided by a person sleeping on site. They can respond to any situations that need support. They also have access to an on-call manager, if necessary. Arrangements for staff cover are not clearly linked to the assessed needs of service users. For instance, two people living at Pennings View are recorded as maybe needing a physical intervention that will require two staff. But guidance for the support of these individuals does not state that there must always be two staff available. The home’s rotas, and the deployment of staff whilst on shift, means that this is not the case. There have been no new staff appointments since the previous inspection, but one person is just about to start. The majority of staff recruitment records were not available for inspection. So it could not be verified that all the required checks have been carried out. General information about the company’s recruitment procedures shows that there is an awareness of the statutorily required checks. Job offers are made conditional on these being completed satisfactorily. New starters are then employed on an initial 13 week probationary period, which may be extended up to a further 13 weeks, if necessary. Some records were seen in relation to the recently advertised post. Application forms are completed, and shortlisted candidates attend for interview. A set list of questions is used, and records are kept of responses. Records are also kept about visits that candidates undertake to the home, and which service users they meet. The company has devised a checklist to track the various stages of the recruitment process. This needs amending, as it does not cover some relevant
Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 22 elements, including a statement about the person’s health, documentary evidence of any qualifications and training, and work permit status, where applicable. Two references had been taken up for the selected person, including one from a previous employer in the care sector. But there was no recorded information about criminal record checks. After checking with a senior manager, staff reported that these were not yet complete. The company’s responsible individual was instructed, during a telephone call on the day of the inspection visit, that a satisfactory result from a check of the national list of people deemed unsuitable to work with vulnerable adults must be received before this person begins working. Evidence of appropriate work permit status is also required for the particular individual. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41 & 42 Deficits in areas of record keeping mean that the service is failing to safeguard the best interests of service users. Service users are placed at risk by failures in fire safety practices; and by a lack of prompt attention to areas of the property in need of repair. Service users and staff are placed at risk by an absence of clear risk assessments and management strategies governing situations where there is lone working. EVIDENCE: There are spaces on documents such as care plans and risk assessments for staff to sign. But sampled records show that this is not happening in all cases. This means there is no evidence of staff awareness of key policies and guidelines they need to follow to work effectively. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 24 Similarly, the failure to date and sign all service user records detracts from the quality of these. It is not possible to judge how current some guidance is. There is also a lack of accountability when it is not clear who has completed an important document. The home has a fire risk assessment, fire procedure, and evacuation procedure. A requirement of the previous inspection, for these to be reviewed, has been met. The documents now address relevant factors, such as premises issues, and the likely levels of awareness and co-operation of individual service users. Different approaches for day and night time are also set out. Some further improvements could be made. Firstly, the risk assessment does not address all areas of the premises separately. Apart from the kitchen and laundry room, documents simply consider ‘upstairs’ and ‘downstairs’. Secondly, although the most recent documentation, from July and August 2005, is clear about evacuation procedures, there is still some earlier less detailed guidance on file, which could lead to confusion. For instance, two different assembly points are stated. The fire log book shows that not all required safety checks are being carried out and recorded at the required intervals. Alarm systems should be tested once a week. But this was last done 18 days before this visit. A monthly test of the emergency light system is not recorded for November 2005. Other checks are up to date. But a failure of one bedroom door, which is a fire containing door, to close properly is recorded 18 days before the inspection, with no further information about any action to address the deficit. The door, when checked on the day, was still not closing properly. This means it would not afford the necessary protection in the event of a fire. Fire drills have been carried out at the necessary intervals throughout 2005, but staff instruction has not been kept up to date in the second half of the year. Only one person is recorded as receiving this during the period July to September; and no-one has yet been recorded as receiving it during the final quarter of the year. In one ground floor bathroom, there is a hole in the wall above a cabinet over a sink, where a strip light has been removed. The remaining electrical wiring is exposed. Staff have frequent periods of lone working, either when they are outside the home supporting service users; or being the person left on site with others whilst their colleague is doing this. This is despite the fact that some service users are assessed as potentially needing two staff to intervene in certain circumstances. There are insufficient risk assessments or management strategies in place for these situations. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 25 A ‘Safety of staff’ policy, dated August 2003, sets out the company’s general duty of care to its employees, and states that they will be provided with necessary information and training to promote their safety and welfare. A risk assessment about lone working at night instructs staff to have the cordless phone with them, and to contact the on-call manager. But the triggers for doing so are not defined. Nor is it made clear what response there may be. There are no lone working risk assessments for other times or situations. Staff report that, when outside the home, they always carry a mobile phone. If necessary, they will contact an on-call manager for assistance. In an emergency situation, they are advised to call the Police. At home, the most likely source of immediate assistance is the other Cornerstones service which is next door. Staff also state that they have been told not to attempt any intervention if it is unsafe to do so. Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X N/A 3 N/A X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score X 3 X 3 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pennings View Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X X X 2 2 X DS0000060337.V269648.R01.S.doc Version 5.0 Page 27 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 YA6 Regulation 12-1,2,3;15 Requirement All service users must have individual plans for all assessed needs, drawn up with their involvement and that of relevant other persons. The plan must be reviewed and updated to reflect changing needs, and in any case at least every 6 months. COMMENT: The timescale for all requirements on service user records relates to review and updating of all current guidance. Failure to address these requirements within this timescale will lead to further enforcement action. This part of Regulations also applies to the above Requirement. Where needed within individual plans, there must be clear and objective definition of behavioural needs, to Timescale for action 31/01/06 1 2 YA6 YA23 17-1a,Sch3-1b 15;17-1a,Sch3-1a 31/01/06 31/01/06 Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 28 3 YA23 12-1;13-6,7,8 3 4 YA23 YA33 17-1a,Sch3-3p,q 12-1;18-1a 5 YA34 17-2;Sch46;19,Sch2 enable effective monitoring and intervention. (Timescale from 12/01/05 not met) The homes use of physical interventions must be supported by clearly defined individual guidelines for any service user affected, including descriptions of techniques applied. (Timescale of 30/09/05 not met) This part of Regulations also applies to the above Requirement. The persons registered must ensure that staff are provided in sufficient numbers to support service users’ assessed needs at all times. The persons registered must maintain all required records relating to staff employment checks. (Timescale from 03/06/04 not met) COMMENT: Evidence of compliance was not fully available. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. Staff records required by regulation to be kept in the care home must be available for inspection at all times. (Timescale from 12/01/05 not met) COMMENT: Some records were available at this inspection, but not all required documents could 31/01/06 31/01/06 31/01/06 31/01/06 6 YA41 17-2,3;Sch4-6 31/01/06 Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 29 7 YA41 8 YA42 8 9 YA42 YA42 10 11 YA42 YA42 be produced. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. 7;9;17;19;Sch2,3,4 The persons registered must maintain all records required by regulation, and ensure that these are up to date and accurate. 12-1;13-4b,c Suitable risk assessments and control measures must be in place to ensure the safety and welfare of staff and service users, in situations where there is lone working. 17-1a,Sch3-3q This part of Regulations also applies to the above Requirement. 23-4c,d All checks and instruction relating to fire safety must be carried out and recorded at the prescribed intervals. 13-4a;23-2b,4c(i) The faulty bedroom door must be repaired and made safe. 13-4a The area of exposed wiring in one bathroom must be repaired and made safe. 31/01/06 31/01/06 31/01/06 31/01/06 31/12/05 31/12/05 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 YA6 YA9 Good Practice Recommendations Service user plans should define the actions to be taken towards achieving longer term goals. When risk assessments identify the need for control
DS0000060337.V269648.R01.S.doc Version 5.0 Page 30 Pennings View 3 YA12 measures to be in place, those measures should be defined as clearly as possible. There should be more detailed information in individual records about support to service users who have limited access to formal education or occupation. COMMENT: This recommendation from the previous inspection was not checked on this occasion. Pictorial representations of any physical interventions used in the home should be available, to aid consistent application of these. More care staff should commence studying for NVQ awards as soon as possible. COMMENT: This recommendation from the previous inspection was not checked on this occasion. The home’s recruitment checklist should be amended to better reflect the requirements of Regulations. Steps should be taken to ensure that systems for demonstrating staff awareness of key policies and guidelines work effectively. COMMENT: It is expected that staff sign to demonstrate that they have read and understood guidelines. But this is not happening in all cases. All records should be clearly signed and dated when they are compiled. There should be more effective cross-referencing where linked information is held in separate folders, to aid ease of use. Fire safety records should show the actions being taken once defects are identified. The fire procedure and risk assessment should be reviewed further, to address all areas of the premises in detail; and to remove any duplicated or contradictory guidance. 4 5 YA23 YA32 6 7 YA34 YA41 8 9 10 11 YA41 YA41 YA42 YA42 Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pennings View DS0000060337.V269648.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
