Inspection on 05/12/06 for Pfera Hall

This inspection was carried out on 5th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is 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

Pfera Hall 16/12/08

Pfera Hall 27/11/07

Pfera Hall 22/06/06

Pfera Hall 10/03/06

Pfera Hall 22/08/05

Pfera Hall 23/03/05

Pfera Hall 02/09/04

Pfera Hall 16/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Pfera Hall Old Ledbury Road Redmarley Gloucestershire GL19 3JU Lead Inspector Mr Richard Leech Unannounced Inspection 08:45 & 5 & 6 December 2006 10:30 th th Pfera Hall DS0000016539.V317800.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 Pfera Hall DS0000016539.V317800.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. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pfera Hall Address Old Ledbury Road Redmarley Gloucestershire GL19 3JU 01531 650880 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) Stones Holdings Limited To be appointed Care Home 19 Category(ies) of Learning disability (19), Mental disorder, registration, with number excluding learning disability or dementia (19) of places Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2006 Brief Description of the Service: Pfera Hall is registered to provide care with nursing for up to 19 service users with learning disabilities and mental health difficulties. It is near the village of Redmarley, between Ledbury and Gloucester. The home is set in substantial grounds and is surrounded by countryside. The home is divided into three units named Nimrod, Dorabella and Winston, though at the time of writing ‘Dorabella’ was empty and plans were being made to turn this into a specialist service. Each unit has a lounge, kitchen, dining area and laundry as well as bathroom and toilet facilities. A separate wing houses the managers office, reception and day care facilities. The home has several vehicles in order that service users can access the wider community. The manager said that the standard fee for the service is £2773.80, but that there is negotiation with funding authorities depending on the assessed needs of each service user. The Service Users Guide includes information about what is included in the fees. Prospective service users and their representatives are provided with information about the home including copies of the Statement of Purpose and Service Users Guide. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Tuesday morning, lasting until about 21:45 in order to meet some members of the night staff. A second inspector was present on this day between 10:00 and 17:00. The inspection continued on the following day between 10:30 and 16:30. Before the inspection surveys were sent out to service users’ families in order to seek their feedback. About half of the staff team were also sent survey forms to complete. In addition feedback was sought from health and social care professionals involved in service users’ care, either on the telephone or through written surveys. During the visits to the home many service users were spoken with and observation of life in the home took place. There was discussion with many members of the staff team throughout both days. Much of the second day was spent with the manager, gathering information and providing feedback. A range of records were checked including samples of care plans, risk assessments, medication charts, daily notes, complaint records and certain policies and procedures. What the service does well: People living in the home are supported to access a range of activities in the home and community, promoting their quality of life. Support is also offered for people to stay in touch with family and friends. A balanced and varied diet is offered, with fresh food being used regularly in cooking. Appropriate recruitment and selection procedures are in place, helping to protect service users. Positive feedback was obtained from many sources including service users, staff, relatives and from health & social care professionals. Examples of this feedback are given in the report. Systems are in place to check the quality of the service and to make improvements. Appropriate support is offered to meet service users’ personal care needs. The units offer a generally homely and comfortable environment. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Significant work needs to be done to improve care planning in the home, along with risk assessment and management plans. There also needs to be greater consideration of the way that restrictions and limitations on service users are assessed and documented. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 7 Although there had been good progress with providing appropriate training for staff, further input is needed in this area. Some progress had also been made with providing staff with regular supervision meetings, but this had not yet been consistently implemented for all staff. Some protocols still need to written for certain ‘as required’ medications. As part of looking after service users’ money properly there need to be more frequent balance checks on people’s finances. A work surface in one kitchen needs replacing. A radiator in one person’s bedroom was not working at the time of the inspection and the service user complained of their room being very cold. Some areas of the home had an offensive odour which must be tackled as far as possible. Some mops and buckets were being stored in a linen cupboard, which is unhygienic. Recommendations are made which should be given consideration. In summary, there had been a considerable improvement in many areas of the home’s operation. However, significant shortfalls remained. Whilst it is accepted that there were plans for addressing these, non-compliance may result in enforcement action being taken. 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. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory framework exists for referral and assessment which should help to ensure that future admissions to the service will be appropriately handled. EVIDENCE: There had been no new admissions since the last inspection. The manager talked through the steps that would be taken in respect of a new referral and potential admission. There is a referral form, as well as other templates for assessing and recording the person’s needs. Following receipt of a referral and discussion with the referrer, the manager said that he would assess whether the referral seemed appropriate. If so he would visit the person in their current setting, talk to care staff and family and obtain background information and documentation. This would be usually done with a psychology assistant from Pfera Hall. The manager said that compatibility is given consideration, including through the use of a tool devised with psychology services. Having arrived at a picture of the person’s needs the manager said that there would be further meetings to discuss how the service might meet these. Staged visits to the home would be offered, providing the person and others involved in their care with the opportunity to see the accommodation and to meet the service users and staff. The manager said that there is a 13-week Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 10 trial period after which a meeting takes place to decide whether to confirm (or end) the placement or to extend the trial period. The Service Users Guide outlines the referral and admission process, including introductory visits to Pfera Hall and meetings to discuss care needs. In the past there has been some difficulty around transfer of responsibility between care teams in the person’s area of origin and local services. The manager described how he would ensure that there was clarity in this area, and described arrangements for emergency psychiatric cover if necessary. In view of there being no new admissions to check this standard is assessed as being met. As with all services, checking of the assessment and admissions arrangements will form part of future inspections to ensure that actual practice accords with the National Minimum Standards. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning in the home is inadequate, increasing the risk of inconsistent practice and of service users’ needs not being met. Whilst choices are offered in many areas of day-to-day life, there are also significant restrictions on service users’ freedom which are not appropriately documented and justified. Risk assessment in the home is poor and does not promote effective and consistent risk management. EVIDENCE: Care plans for four service users were looked at. Files seen showed little improvement since the last inspection, though the manager and staff said that some people’s care plans had been fully reviewed and updated. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 12 One person’s plans had been written in May 2005. There was little evidence of review and update on file, besides the writing of a monthly report by the person’s keyworker. Some were clearly out of date, such as one plan saying that the person needed to be escorted by staff when out in the community (the person now spends considerable periods of time on their own in the community). Many plans did not clearly define the need/issue, examples being where the ‘problem’ was described simply as ’money management’ and ‘personal hygiene’. Interventions were vague and incomplete, such as ‘assess hazards and guide [service user] in making safe choices, both for himself and others’ and ‘needs to be encouraged to have a more adult relationship with peers’. In some cases it was not made clear whether staff needed to prompt and encourage or provide more direct assistance. Some plans included restrictions which were not fully documented/justified, with no evidence of consultation with and agreement from the person such as, ‘only give sufficient funds for his needs’ (in terms of going out in the community). Staff spoken with said that the latter would not be the case, agreeing that this could represent an infringement of the person’s rights to access their own money. The plans above were headed ‘problem no.’. It has been pointed out in previous reports that this terminology is inconsistent with modern approaches to care planning. There was little evidence of the person’s involvement in the care planning process besides opportunities for comment during the monthly keyworker review and some signatures on care plans. The plans were handwritten, making them harder to read than a printed copy. One daily record for the person in December included reference to a relative being informed that the service user was ‘risk assessed’ before being allowed out and that if there were any problem they would not be allowed to go. Staff spoken with about this said that the person could not be prevented from going out but that transport would not be provided under certain circumstances. No reference could be found in care plans and risk management plans about how the person’s safety in the community on a particular day might be risk assessed and where this would be recorded. The above indicates a lack of clarity and consistency about practice, which in this case was also being conveyed to relatives. Similar issues were found with other people’s care plans that were checked. Another person’s plans were seen to be headed ‘problem no’, and also included unclear guidance such as a plan stating that 2:1 support was needed in the community, another saying that the ratio was 3:1 and a third stating that staff should assess whether 2:1 or 3:1 was required (though not indicating how to assess this). Unclear statements were made such as ‘This [agitation] can be caused by any number of reasons including a change to his routine’, followed by notes and interventions which did not clarify possible triggers. The guidance did not constitute a robust management plan, consisting instead of a series of suggestions/possible approaches, such as using a low arousal approach, going for a drive and offering a cigarette. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 13 Other care plans were noted to have unclear interventions such as ‘to use low arousal approach with minimal supervision’ (in respect of promoting independence with personal hygiene). Staff spoken with described some of the interventions they actually made around personal care in this case, such as running the bath for the person, many of which were not recorded in the plans. Some plans viewed were seen to be regularly reviewed, with evidence of changes being made where necessary. Feedback was obtained from some health and social care professionals involved in service users’ care, some of whom had recently conducted reviews at the home. One person described the care plans viewed as ‘basic’, with some identification of the issues but lacking clear guidance about the interventions to be followed. They added that in their view the review process was not sufficiently thorough/evidenced. Consequently interventions in some areas had changed but the care plan did not reflect this. However, they expressed satisfaction about completion of a new assessment around promoting independent living skills and about the overall standard of care provided. In the last report a requirement was made for all staff involved in writing care plans to have appropriate training in care planning, given the shortfalls that had been identified. Discussion and records indicated that that this had been partly achieved, with some team leaders talking very positively about this input. Some team leaders had not yet had this training. Some admissions forms seen would benefit from being rewritten as they included handwritten additions such as new telephone numbers to the extent that the clarity of the information was compromised. Some person centred assessments had been undertaken, considering issues such as activities but also people’s wider goals and interests. This is a positive development, though now needs to be built upon, for example with people’s goals incorporated into care planning and review processes. Service users spoken with described being offered choices in day-to-day life, such as about which activities to attend. Staff spoken with also gave examples of how they aimed to offer and respect people’s choices as far as possible, and this was observed during the inspection. However, there were still restrictions and limitations in place for which there appeared to be no documentation. For example, the bathroom in Winston was noted to be locked. Staff spoken with gave very different reasons as to why this was the case, and the team leader said that it should not be locked. No documentation could be found by the staff or manager about this restriction. Whilst there may be valid reasons for such restrictions, where they are in place they must be fully documented, kept under review and, as far as possible, agreed with service users. The home’s Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 14 charter of rights has a section about freedom of movement. This clearly states that a risk assessment will be in place in such circumstances. In previous reports comments were made about an apparent expectation that service users would be in bed by 23:00 when one of the two teams of night staff were on duty. During this inspection service users repeated this concern, in one case saying that night staff had turned off a programme that they were watching at 11pm, saying that it was time to go to bed. There was also reference to this from service users in the person centred assessments that had been conducted in-house. There was no evidence of any action having been taken to investigate this issue since the last inspection. Where there is an assessed need to promote a structured day (which may include encouragement to keep to a particular routine in the evening) this should form part of individuals’ agreed care plans and should always be balanced with people’s rights to choose when they go to bed in their own home. In their surveys some staff indicated that there was further work needed to promote genuine client choice and to remove restrictions that were not related to assessed needs and risks. One service user said that he had an advocate. The manager gave examples of other people who had accessed advocacy. Risk assessments and risk management plans for five service users were checked. The following observations were made: • There was reference to practices which may represent infringements of service users’ rights. One risk assessment stated ‘staff to search [service user’s] room when he is out’ in respect of an identified risk of the person being in possession of particular items, with no evidence found of discussion with the person and the rationale for this intervention. A team leader spoken with said that this should not be done, indicating that there were ways of engaging the person to cooperate with staff for manage this risk in less invasive and covert ways. There was some confusion about headings. For example, the above assessment included that a person had access to their toolbox under supervision in the section headed ‘description of risk’ rather than ‘management plan’. Assessment material and daily notes described some key risks which did not appear to be referred to in risk management plans generated by the service, such as vulnerability in the community or risk of committing theft for one person. Whilst staff described a range of practices that they employed to manage such risks many of these were not reflected in documentation. One person’s file had a tick list assessment for the risk of violence dated 2003 with no evidence of subsequent review, along with an undated risk profile. Another person’s file included detailed management guidelines DS0000016539.V317800.R01.S.doc Version 5.2 Page 15 • • • Pfera Hall • • from 2002 with no evidence of review, and a single risk assessment dated April 2004, also with no evidence of review. One risk management plan stated that a person needed to be weighed monthly. The most recent weight recording found by staff on the file was from June 2005. Risk assessments seen provided little or no evidence of consultation with service users. Given the nature and complexity of issues around risk that present in the service, it is essential that there is a robust system for assessing and managing risks which promotes clarity and consistency. The manager agreed that it should not be assumed that team leaders would know how to assess risks and devise a management plan. He described some input that staff were receiving from a specialist in the organisation, although not all team leaders had yet received this support. Some staff also expressed concerns about significant risks not always been appropriately assessed, documented and managed. Some risk assessment and management plans did show signs of having been updated and improved since the last inspection, but as described above the overall picture remains patchy. Some feedback was obtained from a placing authority expressing concerns about the overall risk management plan for one person, describing the plan as ineffective since it did not accurately portray all the risks. There were also comments about it being unclear how staff were to address and monitor the risks. Representatives of this and another placing authority also reported that they had not been made aware of significant events. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to access a range of activities in the home and community, promoting social inclusion and general wellbeing. People living in the home are supported to maintain and develop important relationships. Service users’ rights are not always fully respected, impacting on their independence and autonomy. Where there are limitations there is inconsistent assessment, consultation and recording. A balanced diet is provided which responds to service users’ needs, preferences and lifestyles, promoting their health and quality of life. EVIDENCE: Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 17 Activity plans for four people were looked at; both in terms of daycare planners and in care plans and daily records. These provided evidence of service users being supported to access a range of activities in the home and community. Examples included swimming, golf, art, music sessions, literacy & numeracy, computing, textiles and cooking. There was also evidence of facilities being accessed such as shops, pubs and the cinema. In the home there are facilities such as a pool table, televisions, music centres and DVD/video players. Many service users described having entertainment systems in their rooms. A letter from a consultant on one person’s file said, ‘I am…pleased that the staff are enabling [service user] to have both individual and group activities’. Other positive feedback was obtained from some representatives of placing authorities, commenting on the range of activities available. During the inspection one person was seen being supported to apply for jobs. This reflected one of the person’s goals as stated in their person-centred assessment and in discussion during the visit. As noted earlier, the positive work started towards adopting a more person-centred approach will need to continue and to underpin all care planning in the home. Service users spoken with expressed general satisfaction with the support they received to take part in different activities. Some felt that there was not always enough to do during evenings and weekends. Several staff echoed this. Some felt that consideration should be given to achieving more flexibility in the evenings by adjusting the rota, saying that currently there was a need to return from trips by about 21:00 for handover and shift change. However, many staff also said that there had been a marked improvement in activity provision in the previous few months, with people going out into the community more. A representative of the daycare section described the arrangements for assessing people’s needs and wishes around activities, giving examples of how the timetables were flexible and individualised. Recording of activities undertaken in daycare was seen to have improved. Some concerns were expressed by staff and service users about no longer accessing college. The manager and staff in daycare outlined the reasons for this along with hopes that provision in this area would restart. This should be pursued, since there was evidence that service users had benefited from the social and vocations aspects of college life in the past and that some were keen to access these opportunities again. Some staff expressed concern about the age appropriateness of some daycare activities. In the last report a recommendation was made about staff in daycare accessing appropriate training. Records and discussion indicated that some Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 18 relevant training was being accessed, including LDAF and NVQ training. As also noted in the last report, given the specialist nature of the role there should be ongoing consideration of training needs for staff working in daycare. Service users spoken with described having regular contact with family members by phone or through visits. Staff spoken with described how they promoted this contact. One person said that they would like to go home more often. The manager said that the current arrangement reflected the contract from the funding authority. There was a suggestion that, where appropriate, consideration could be given towards supporting people to use public transport in order to promote their independence and freedom of movement. During the inspection one person returned from a visit home. Other service users were seen to have telephone contact with family. People were observed getting up and having breakfast at different times, and choosing where they spent time over the course of the day. Staff described providing encouragement for people to attend scheduled or spontaneous activities, and there was evidence of this approach in daily notes viewed. Service users’ files checked did not consistently record people’s preferred form of address. This should be noted and respected. Staff were observed using terms such as ‘sweetheart’ and ‘luvvie’. Whilst some service users may be comfortable with this, each person’s preferred form of address should be ascertained, recorded and used. As noted, there are restrictions on people’s movement which, although they may be justified in terms of risk, are not consistently documented and recorded. As also noted, some service users complained about the imposition of a set time for bed on certain nights. Some training is provided by the organisation about service users’ rights/empowerment and about attitudes and values. It would be appropriate for all staff to receive this training in view of ongoing issues identified about people’s rights. Some staff also expressed concerns about people’s rights not always being appropriately respected at times, though said that there had been a marked improvement recently. Service users spoken with indicated that they were happy with the food that was served in the home. One person felt that there should be more ‘healthy food’ available and another person felt that the choices were too limited. Every person spoken with said that they could ask for an alternative if they did not like what was on the menu. People were seen having drinks and snacks during the day in a flexible, individual way. Several meals were observed, with people eating at different times according to their activities and preferences. Food was attractively presented and people indicated that they had enjoyed their meal. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 19 Records of clients’ meetings indicated that food and menus was discussed. Some people went food shopping with staff during the inspection. Records were seen of what people had eaten, though it was suggested that this could be expanded. For example, one entry just said ‘pasta’, giving no indication of what the meal was, whether there were accompaniments and dessert or of how much was eaten. Fluid charts were seen to be completed for one person in accordance with specialist recommendations. The manager described plans to change menus in consultation with a nutritionist. Staff reported that fresh meat and vegetables were regularly used in cooking. Fresh fruit was seen to be available. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there was evidence of personal care being provided appropriately, improved care planning in this area would promote the consistency of practice in accordance with people’s needs and preferences. There is scope to improve systems for monitoring and recording people’s access to healthcare services as part of ensuring that people receive the care that they need to remain well. The management of medicines has improved but further work is needed to promote best practice in this area. EVIDENCE: Staff described how they provided personal care, demonstrating respect for people’s preferences and awareness of privacy and dignity issues. Care plans described how people’s personal care needs were met to some extent. However, as noted in Standard six, some goals and interventions were unclear. Improving care planning in this area would help to promote service Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 21 users consistently receiving personal care support in the ways they prefer and require. A protocol has been written around the use of the monitor in use in one unit. Practice in this area will be considered in future inspections. In previous reports it has been suggested that the team look into adopting health action planning. Although a format has been made available in the home this had not yet been implemented. This was put down to ongoing staffing difficulties, which had begun to ease at the time of the inspection. This should now be taken forward for people with a learning disability, with consideration being given to whether it may also be a useful tool for people without a learning disability. Comments have also been made in reports about healthcare appointments being included as part of daily notes (as well as being recorded in the diary), rather than having a separate recording format. This system remained in place, making it difficult to quickly establish when service users had most recently had routine healthcare appointments. Such a system increases the potential for some routine healthcare interventions to ‘slip through the net’, although direct evidence of this happening was not found during this or the last inspection. Many homes have a separate recording format for different healthcare appointments so that this information can be easily accessed. A template supplied as part of the improvement plan for the last inspection indicated that such forms are already available in the service. In some files these subsections were present but no entries were seen. As noted, there was evidence that people’s weights were not being taken as often as care plans indicated they needed to be. Correspondence indicated that people living in the home were receiving specialist healthcare services such as psychiatric reviews. Some nursing reports were seen which included summaries of the person’s mental and physical health. Arrangements for handling medication in both units were checked. Work on establishing and agreeing lists of homely remedies was continuing. In the last report a requirement had been made to review the medication policies and procedures as per the pharmacist inspector’s report of February 2006. A revised policy covering the handling of medication has been produced. Comments from the pharmacist inspector about this have been forwarded to the service and should be taken forward. Medication storage and records checked appeared to be in order. A system of audits was seen to be in place. A recommendation is made for temperature checks to take place in medication cabinets to ensure that medication is being Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 22 stored at correct temperatures. This had started in response to a previous inspection but there was no evidence of ongoing checks being made. A BNF book from 2004 was in use on one of the units. One staff member had brought in their own more up to date version. If there is no copy of the most up to date BNF on site then this should be obtained. On Winston two creams and one preparation had not been marked with the date of opening. There was a discussion on one unit about PRN protocols. These were seen to not yet be in place for all ‘as required’ medications. This needs to be done. Guidance has been forward from the Royal College of Psychiatrists which may be helpful. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place for handling concerns and complaints, helping service users to feel listened to. There have been improvements in the arrangements which help to protect service users from the risk of harm and abuse, although further work is needed to provide additional safeguards. EVIDENCE: A copy of the complaints procedure was on display in the corridor between the site offices and daycare. The manager said that copies of the revised procedure had been given to all service users in July of this year and that this had been talked through with them. Service users spoken with could not recall getting a copy of the procedure but did express confidence about being able to raise concerns and complaints and felt that they would be listened to. As noted, some people receive advocacy services, and the manager is hoping to extend this input. The recommendation from the last report about considering ways of making the complaints procedure more accessible is repeated. Many services produce different versions to make the overall procedure easier to understand. The complaints log was checked. Reasonable records of complaints, investigations and outcomes were seen to be in place. The following observations were made: Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 24 • • All reports/documents should be signed. One write-up seen had not been and was not marked with the author (the manager). Copies of certain records held in Human Resources could be obtained and kept on the file in order to give a complete picture of all stages of the investigation, as discussed on the day. One complaint by a service user made an allegation about being ‘put outside’ when they are ‘naughty’. The manager said that this had been investigated and that the service user would sometimes follow staff outside when in an agitated state. He said that, at times, this helped calm them down, particularly if they ‘burnt off energy’. The manager was unable to find full reference to this practice in the person’s care plans and risk management plans. If this technique is assessed as being beneficial and appropriate on occasions then it should be documented in the person’s care planning file, including safeguards such as when it may or may not be appropriate (e.g. related to weather) and that it must never be a case of the person being ‘put’ outside. As with any care plan/risk management plan all staff would need to be made aware of this and practice monitored to ensure that the person’s rights are not transgressed. Some further information has been requested from the service about the investigation undertaken into this issue. Acute incident sheets seen were satisfactory, and included information about whether restrictive physical intervention had been used and in what way. As noted earlier, significant risks were not consistently assessed and recorded in management plans, although some improvements in this area were noted. Records of service users’ finances appeared to be in order apart from balance checks not being sufficiently frequently. For example, one person’s cash sums had been checked against the records just five times since 10/11/06. Whilst all of those checked were correct, a recent Regulation 26 report highlighted shortfalls in this area and underlined the need for more frequent balance checks. There has been a major improvement in the system for the service notifying CSCI of significant events under Regulation 37. Service users spoken with indicated that they felt safe in the home. Discussion with staff provided evidence that there is much greater confidence about reporting concerns than had been found in June 2006. Nonetheless this discussion also indicated that there is further work to be done with the staff team about creating a culture where, as far as possible, all staff consistently feel able to report any concerns about practice and have confidence that this will be fully investigated and appropriately handled. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 25 Records and discussion with staff provided evidence that the majority of the staff team had accessed training about adult protection and the prevention of abuse in line with a requirement in the last report. This area also forms part of the LDAF induction and NVQ work. Ongoing progress towards all staff accessing this training will be considered in future inspections, particularly since in their surveys a small number of staff reported not being aware of adult protection procedures. A policy was seen about management of staff who are related to each other. As well as being signed and dated, this should also include reference to issues that may arise if a line manager is related to an employee, such as about not conducting their supervision meetings. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been significant improvements to the physical environment, though further work is needed in order to make the home as clean, comfortable and pleasant as possible for the people living there. EVIDENCE: As noted, Dorabella was closed at the time of the inspection. It was reported that the unit had been refurbished and that some new furniture was on order. All communal areas and some service users’ rooms in Nimrod and Winston were checked. As noted, some environmental restrictions were in place without there being supporting documentation. In general the two units were seen to be comfortably furnished, clean and homely. The following points were noted: Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 27 • • • • • • • There were gaps in recording of fridge and freezer temperatures, such as for 23/11/06 and 03/12/06 in Winston. The work surface in Winston’s kitchen was pitted in some areas, compromising hygiene. It requires replacing. One service user said that their room was very cold as their radiator was not working. Staff said that this had been reported five weeks before but had still not been sorted. This was passed to the manager for urgent action. In the ground floor toilet in Nimrod the top of the door scraped the light shade each time it was opened and closed, suggesting that a different shade should be fitted. First floor toilets in Nimrod were noted to smell of urine and to have damaged paintwork on the skirting boards (also noted in a Regulation 26 report dated 30/11/06). In Nimrod some mops and buckets were stored in a linen cupboard. This was also pointed out in the above Regulation 26 record, when the manager was reported as saying that he would ask staff to move these. A stir-fry in a fridge in Winston with a best before date of December 4th was seen to still be in the fridge at 19.00 on December 5th. In the last report a recommendation was made to consider whether a cleaner should be employed to clean the communal areas of the units, in order to free up the care staff for direct work with service users. Some staff again said that they thought this would be a good idea. The manager expressed sympathy with this, though said that recruitment of domestic staff was very difficult. A new sink had been fitted in Winston. The daycare kitchen was seen to have been refitted and a new self-closing fire door put in place. Aside from one person saying that their room was cold, service users expressed satisfaction with their rooms. Those seen were pleasantly decorated and personalised. Lockers were seen to have been provided for staff. A basin in Winston which provided ‘hot’ water at too cool a temperature had been repaired, as evidenced by temperature records in the room. Since the last inspection the home has become a non-smoking environment, with smoking shelters being provided. Service users spoken with said that they were happy with this arrangement. Some staff expressed concerns about people going out when it was cold and wet. There were also comments on the much improved air quality in the units. Christmas decorations were being put up during the inspection, with service users and staff both involved, helping to create a homely atmosphere. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are skilled, caring and competent, although there is scope for development in particular areas to help further improve the quality of care. Appropriate systems are in place around recruitment and selection helping to protect service users. Whilst there have been improvements in provision of appropriate training for staff, more progress is needed in this area in order that all members of the team have the knowledge and skills that they require for the job. Improvements in staff supervision need to continue in order to provide all care workers with the support that they require. EVIDENCE: The manager said that six staff were registered on National Vocational Qualification NVQ courses in care at level 2 or 3, and that three staff had achieved a certificate in community mental health. He reported that there were 25 non nursing staff. The home is therefore significantly below the expectations of the National Minimum Standards in terms of staff being Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 29 qualified to NVQ level 2 or equivalent. However, there are plans to support more staff through the NVQ qualifications. Service users were positive about the staff team. Some people commented on them being good listeners and easy to talk to. Throughout the inspection the atmosphere in both units was observed to be calm, with interactions between staff and service users seen to be respectful, warm and supportive. Discussion with staff provided evidence of a good awareness of people’s needs and conditions. Service users made positive comments about the staff, for example saying that they were good and that they treated the people living in the home well. A representative of a placing authority commented on the caring nature of the staff. As noted, consideration should be given to establishing and using people’s preferred form of address. As indicated elsewhere in the report, there is evidence that some staff have development needs in areas such as care planning and risk assessment. Standard 33 was not fully assessed. However, records provided evidence that staff meetings were taking place, as recommended in the last report. There had also been a significant recruitment of new staff in the previous six months, to the point where the manager reported that there were just five vacancies with the process of filling these already underway. Staff spoken with felt that staffing levels were generally sufficient to meet service users’ needs. Some staff thought that the consolidation of three units into two had helped to promote better staffing levels, including having dedicated (rather than floating) team leaders for each unit in the daytime. As noted, some staff felt that changes to shift patterns might improve activity provision at weekends and evenings. Comments in the care workers’ surveys included that there were not always enough staff to take people out into the community as much they would like. Staffing rotas are being supplied to CSCI regularly by the service. These have provided evidence of appropriate staffing levels being maintained. Three staffing files for newer staff were checked. These appeared to be fully in order, according with the National Minimum Standards and the requirements of the Care Homes Regulations. The service has a dedicated Human Resources Section based at another unit. Training records for the staff group and individuals were sampled. These provided evidence of improvements in ‘mandatory’ and other training. However, significant gaps in core training for established staff were still noted including in some cases manual handling, food hygiene, first aid and fire Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 30 safety. The progress made will need to continue in order to provide all staff (including night staff) with the training required for their roles. The requirement about training made in previous reports included that staff must have refresher training in the management of challenging behaviour (currently provided by Studio III) at suitable intervals. Records indicated that this had not been fully implemented. For example, one person’s record continued to indicate that they last received any input in this area in 1999. Given the situations that staff may have to manage it is essential that they receive regular updates in this area. Staff generally reported that they were very satisfied with the training provided by the organisation, with regular time for training being set aside on the rota. Comments are made elsewhere in the report about specific areas where staff may benefit from training. Some handover meetings were observed. It was reported that the handover sheet was being revised to provide more information/detail about each person. In the last report a requirement was made about staff receiving appropriate supervision. The manager reported that he was undertaking all supervisions and that he had begun this process. However, it was acknowledged that not all staff had received a supervision meeting recently. There were mixed responses about supervision in staff surveys and discussion, with some people reporting that they received regular supervision meetings and about the same number saying that they did not. Whilst there has been some progress in this area the requirement is repeated (and includes supervision for night staff). In their survey forms the majority of staff reported that they received enough support to do their job well. The manager provided a copy of the template that he uses to conduct supervision meetings. This was thorough and wide-ranging. As part of general professional development it was suggested that the manager could consider accessing training about staff supervision. Staff surveys indicated that staff who had been working in the service for less than a year were satisfied with the induction that they had received. Newer staff spoken with were also generally satisfied with their induction programmes, though one person commented on a lack of structure and mentoring. Documentary evidence was seen of people working through LDAF* accredited workbooks, which are checked on site, forwarded to the training section and also undergo external marking and moderation. *The ‘Learning Disability Awards Framework’ is a set of qualifications appropriate to people who work in learning disability services. This includes an induction framework, as provided at Pfera Hall. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements to the way the service is run, promoting service users’ safety and wellbeing, although ongoing work is needed to further improve standards in the home. Reasonable quality assurance systems are in place, providing a framework for monitoring and improving the quality of care, though there are plans for development in this area. Progress has been made in addressing health and safety shortfalls, making the home a safer environment to live and work. EVIDENCE: Since the last inspection a new manager has been appointed. At the time of writing he was about to apply for registration with CSCI. The manager is a Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 32 registered nurse. He said that he has also obtained an NVQ level 4 in management. Positive feedback was obtained from staff and service users about the management of the home. This included comments about the manager being very understanding and approachable, trusting and respecting the teams and working hard to improve standards. However, many staff also expressed a desire for greater clarity, leadership and decisiveness from the manager, in some cases expressing a wish for greater support and direction. Whilst delegation of certain tasks to team leaders, such as addressing care planning and risk assessment shortfalls, is entirely appropriate there was evidence of a need for greater monitoring by the manager. For example, as noted some recently produced risk assessment material needed revision. Another example was the manager not being aware that balance checks on service users’ finances were not taking place as frequently as they need to. The manager said that he is, in effect, on-call all the time. This is clearly unsustainable and consideration needs to be given to creating appropriate oncall arrangements. The director of nursing for the organisation, who also has special responsibility for Pfera Hall, is now based on site. Some staff commented on the new team leaders bringing fresh ideas to the service and the positive impact this was having. One newer team leader described how they had reorganised paperwork and filing in one unit, having recognised shortfalls in this area. Although there is still considerable work to be done in areas such as care planning, as indicated in the report there has been a significant improvement in many areas of the running of the home since the last inspection. Quality assurance was considered. Regulation 26 reports are being forwarded for each month. These are have become more detailed and thorough. Records were seen for some recent service users’ meetings. Staff were aware that some people may find a group situation intimidating, preferring instead to give one to one feedback. As noted, monthly keyworker reviews provide an opportunity for service users to express views about their care. The manager said that he had been in touch with a local advocacy service about the possibility of independently facilitating a service users’ forum in the home. This would be a very positive development. As noted, some service users already have their own advocates. The manager also said that the service’s overall quality assurance strategy was being reviewed, with a view to making it more care orientated. He said that Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 33 options being considered included buying in some kind of quality assurance/audit package. The manager said that in the meantime the existing stakeholder surveys would continue periodically. Some surveys had been distributed to service users in October 2006, though the response rate had been poor. The manager said that a full review of policies and procedures was being conducted. During the last inspection it was agreed that many of the home’s policies and procedures were out of date. Progress with quality assurance strategies will be considered in future inspections, including whether findings translate into action, this having been identified as a shortfall of systems in the past. Fire safety records indicated that fire alarms were being tested about weekly and emergency lighting monthly. There was documentary evidence of regular fire drills taking place though no write up of how they went/any issues arising. This should be done. Records of regular tests of hot water temperatures were seen in both units. The manager said that there was a form for daily checking of vehicles. However, the most recent form found on file in ‘Winston’ was for 09/11/06. One vehicle was checked to see of the forms were stored there, but the most recent record was for 11/10/06. The vehicle had been used that day. If the organisation’s policy is for each vehicle to have a documented check each day then this should be carried out consistently. As noted, a new self-closing fire door has been fitted in the daycare kitchen. Doors without self-closing devices linked to the alarm system were seen to be closed during the inspection. As also noted, some gaps were found in fridge and freezer temperatures for some days in the units and mops/buckets were seen in a linen cupboard. Areas of the home where hazardous chemicals were stored were seen to be locked, although in the regulation 26 report dated 30/11/06 a health and safety breach in this area was noted, suggesting that there remains a need for vigilance to promote consistency. Some staff said that service users get to know the keypad code for accessing other units. There was a suggestion that swipe cards help by staff may be more appropriate. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 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 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 1 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 2 x Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (1) & (2) Requirement Prepare written plans as to how service users’ needs in respect of health and welfare are to be met after consultation with the service user. Keep the care plans under review and revise them where appropriate. Timescale of 31/07/06 not met. Ensure that all staff receive training appropriate to the work they are to perform: All staff involved in writing care plans must have appropriate training in care planning. Timescale of 31/07/06 not fully met. Where restrictions are in place they must be fully documented and kept under review and, as far as possible, agreed with DS0000016539.V317800.R01.S.doc Timescale for action 30/04/07 2 YA6 18(1)(c)(i) 31/03/07 3 YA7 12(1) (2) (3) 13(4) 14 15 Sch.3.3 q 31/01/07 Pfera Hall Version 5.2 Page 36 service users. This relates to examples given in the text about restrictions of freedom of movement/access and about bedtimes. Timescale of 31/07/06 not met. Promote and make proper provision for the health and welfare of service users and ensure that unnecessary risks to service users’ health and safety are identified and so far as possible eliminated. As such, ensure that appropriate systems are in place for identifying, assessing, documenting and managing significant risks. Regularly review and update risk assessments as required. Timescale of 30/06/06 not met. Make arrangements for the safe administration of medicines received into the care home: Protocols describing the use of any medicine prescribed ‘as required’ must be written and used. Timescales of 01/03/06 & 15/08/06 not fully met. Promote and make proper provision for service users’ welfare, and make arrangements to prevent DS0000016539.V317800.R01.S.doc 4 YA9 12(1) 13(4)(c) 14(2) 15 (2) 31/03/07 5 YA20 13 (2) 31/01/07 6 YA23 12 (1) a 13 (6) 31/01/07 Pfera Hall Version 5.2 Page 37 service users being placed at risk of abuse: Check service users’ cash balances against running records at suitable intervals as part of ensuring that service users’ money is handled appropriately (ideally after each transaction or at least daily). Timescale of 31/07/06 not met. Clear and comprehensive 30/04/07 care plans/individual protocols must be devised about the management of challenging and high-risk behaviour. Where this involves planned physical intervention in certain circumstances this must form part of the plan/protocol. Timescale of 31/07/06 not fully met. Make suitable 31/03/07 arrangements to prevent the spread of infection, and keep the care home in a good state of repair, clean and reasonably decorated: The work surface in Winston’s kitchen requires replacing. 31/12/06 Provide suitable heating for service users: Repair the radiator in one person’s bedroom which was not working at the time of the inspection. Keep the care home free from offensive odours (this refers to the smell of urine in the toilets in Nimrod). Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 38 7 YA23 12(1) 13(4) & (7) 15 8 YA24 13 (3) 23 (2) b & d 9 YA24 13 (3) 16 (2) k 23 (2) p 10 YA35 12 (1) 13 (3) & (4) 18 (1) c (i) 11 YA36 18(2) Make suitable arrangements to prevent the spread of infection: Remove mops and buckets from a linen cupboard in Nimrod. All staff must receive training appropriate to the work they perform. This must include refresher training in the management of challenging behaviour at suitable intervals. Timescale of 31/07/06 not fully met. All staff must be appropriately supervised. Timescales of 30/04/06 and 30/09/06 not fully met. 31/03/07 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Rewrite front sheets (‘Admissions Forms’) in service users’ files where they are becoming tatty and/or hard to read. Revise the care-planning format to use positive language rather than the heading ‘problem’. Aim for care plans to more directly reflect service users’ own aspirations and goals. Where a structured and staged programme towards a particular aim is in place ensure that the care plan fully reflects how this is to be carried out. Aim to type all care plans. Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 39 2 3 YA9 YA12 Continue to take forward more person-centred approached to care planning. Explore tools available which may facilitate this transition to a more person-centred form of care planning throughout the service. Ensure that placing authorities are consistently made aware of all significant events relating to the service user they place/fund. Consider the comments reflected in the text about activities at evenings and weekends. Continue to consider ways of supporting service users to access college courses if they wish to. Note each service user’s preferred form of address on their files. Consider providing training or other input for all staff in promoting service users’ rights/empowerment. Improve recording of what people eat, as noted in text. Care plans relating to personal care should include more detail about interventions as well as people’s preferences about how this support is delivered. Improve monitoring and recording systems around healthcare as described in the text. Implement the ‘health action planning’ format and framework (or an adapted version as suitable for the needs of each person living in the home). Where there is an identified need for people’s weights to be ascertained at regular intervals ensure as far as possible that this is done. Take forward the recommendation of the pharmacist inspector about arrangements for handling medication in the home as per correspondence forwarded to the service dated 24/10/06. Periodic temperature checks should take place in medication cabinets to ensure that medication is being stored at correct temperatures. If there is no copy of the most up to date BNF on site then this should be obtained. Ensure that creams and liquids are marked with the date of opening. The accessibility of the complaints procedure for some service users should be considered, and any necessary changes to the format made in respect of different people’s DS0000016539.V317800.R01.S.doc Version 5.2 Page 40 4 5 6 7 8 YA16 YA16 YA17 YA18 YA19 9 YA20 10 YA22 Pfera Hall needs. Implement the two bullet points made about complaints in the text. Also address the point made in the text about documentation of practices in relation to one complaint made. Continue to consider and implement ways to create a culture where, as far as possible, all staff consistently feel able to report any concerns about practice and have confidence that this will be fully investigated and appropriately handled. For example, though supervision. As well as being signed and dated, the policy was seen about the management of staff who are related to each other should include reference to issues that may arise if a line manager is related to an employee, such as about not conducting their supervision meetings. • Remind staff to take and record fridge and freezer temperatures consistently. • Consider replacing the light shade in the ground floor toilet in Nimrod so that the top of the door does not scrape it each time the door is opened and closed. • Attend to the damaged paintwork in the first floor toilets in Nimrod. • Review systems for date checking and, if necessary, disposing of food. Continue progress towards getting at least 50 of the care staff qualified to NVQ level 2 in health and social care or a suitable equivalent. Consider comments from staff about wanting a greater sense of direction and leadership from the manager. Consideration needs to be given to creating more appropriate on-call arrangements. When fire drills are conducted keep a record of how they went/any issues arising, as part of the ongoing process of monitoring and improving safety in this area. If the organisation’s policy is for each vehicle to have a documented check each day then this should be carried out consistently. 11 YA23 12 YA23 13 YA24 14 15 YA32 YA37 16 YA42 Pfera Hall DS0000016539.V317800.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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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