Inspection on 29/03/04 for Principle House

Care Homes For Adults (18 ­ 65)Principle House95 Ringwood Road Walkford Christchurch Dorset BH23 5RAUnannounced Inspection29th March 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Principle House Address 95 Ringwood Road, Walkford, Christchurch, Dorset, BH23 5RA Email Address principlecare@aol.com Name of registered provider(s)/Company (if applicable) Principle Care Ltd Name of registered manager (if applicable) Mark Richard Hulme Type of registration Care Home No. of places registered (if applicable) 6 Tel No: 01425 277707 Fax No: 01425 277707Category(ies) of registration, with (number of places) Learning disability (6) Registration number D080000443 Date First registered 29th August 2002 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 29th August 2002 NO NO 09/10/03 If Yes Refer to Part CPrinciple HousePage 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 329th March 2004 10:00 am Sophie BartonID Code096672Name of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different perspective to the inspection process Name of Specialist (e.g. Interpreter/Signer) (if applicable) Name of Establishment Representative at the time of inspectionPrinciple HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection visits Description of service Part A: Summary of Inspection Findings Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods Used & Findings The Standards. National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration ( if applicable) Lay Assessors summary (where applicable) Providers Response Providers comments Action Plan Providers agreementPrinciple HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the NCSC in respect of Principle House. The inspection findings relate to the National Minimum Standards (NMS) for Care Home published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Report of the Lay Assessor (where relevant) · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000 and the Children Act 1989 as amended. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Principle HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Principle House opened in August 2002. Its purpose is to provide accommodation and support for 6 adults who have a learning disability. The home is situated in Walkford, Christchurch and it is a family style home. All bedrooms are single with en suite facilities. There is a lounge / diner, separate kitchen, and gardens to the front and back. The accommodation is on two floors, with 3 bedrooms downstairs and 3 bedrooms upstairs. There is an office and sleeping in room for staff. Local shops are within walking distance of the home, and there are regular buses into the town of Christchurch. The home is staffed 24 hours a day, including one waking night staff. The home also arranges structured day care for residents if this is assessed as a need, and incurs an extra cost.Principle HousePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection took place without prior warning on 29th March 2004. The Registered Manager was not available initially but returned to the home shortly after the Inspection started. This inspection and the previous three inspections have highlighted that this is a well run home, with the needs of service users being clearly met. The home is able to meet the needs of service users who have a learning disability and present with challenging behaviour. The management and staff group are dedicated to the service users. The staff and service user group are close and interact well. It is a friendly and welcoming home. The manager has considerable knowledge of disabilities, relevant good practice guidance and legislation. The home is commended in a number of their practices. Staffing is high, the home funds numerous activities and a holiday for service users, transport is provided, and care planning and risk assessments are detailed and informative. The majority of Standards that they havent met has only been due to minor shortfalls/issues, which do not impact on the welfare of service users. Only one requirement has been made. The number of recommendations made at this inspection is higher than previously made. The reasons given are due to other commitments that have needed to be undertaken by the Registered Manager. However, the Inspector is confident that the good practice recommendations will be met by the Registered Manager, as there is a commitment by all of the Directors to provide a home that exceeds the National Minimum Standards. To gather evidence for how the home is complying with the regulations and meeting the standards, the Inspector spent time talking to the Registered Manager, interviewed two care staff privately, spoke to a relative and spent time over lunch and during a house meeting with the service users. The Inspector also spoke to one of the other Directors, Janet Korrie, the cook and observed staff and service users interacting. Service users were not spoken with individually and/or privately at this inspection, but were instead spoken with informally in a group setting. At the last inspection in October 2003, the inspector spoke privately with three of the service users. Choice of Home (Standards 1-5) 0 of the 4 standards assessed were met. There are clear systems in place to ensure that all service users have detailed and through assessments of their needs prior to admittance and care files evidenced that this has happened. The home has developed contracts for service users, and there is a clear admissions policy. The minor shortfalls relate to the need to ensure that the assessor and the service user sign assessments. Contracts should also be agreed by the service user prior to moving into the home. The Principle House Page 6 home is also providing a service to service users who have some mental health difficulties as well as a learning disability. Staff should therefore have specific training in this. Individual Needs and Choices (Standards 6 ­ 10) 3 of the 4 standards assessed were met. The current service users each have a full care plan, detailing how the home is to meet their assessed needs. Risk assessments have been completed and are extensive. Service users are encouraged to make their own decisions, with many procedures in place to enable service users to be as independent as possible. The manager needs to ensure that all behavioural plans are available to staff. Lifestyle (Standards 11-17) 1 out of 3 standards assessed were met The home has open and frequent contact with relatives. The daily routines promote independence. Service users are provided with varied and nutritious meals and help to plan, prepare and cook their meals. Due to highlighted issues, staff need further training and resources in supporting service users with personal relationships and sexuality. Service users should be encouraged to become more involved in the preparing and cooking of meals. Personal and Healthcare Support (Standards 18-21) 2 out of 4 standards assessed were met. There is clear evidence that service users health care needs are met and staff proactively liaise with specialist workers. Minor changes are needed to the medication recording system. The manager is commended on his recording and collating of the information on service users seizures and associated behaviours and making these available to other professionals. Concerns, Complaints and Protection (Standards 22-23) 1 out of 2 standards assessed were met There have been no concerns or complaints reported to the Commission about the home. The manager clearly encourages and enables service users to voice any concerns they may have. The homes adult protection. Physical intervention and financial procedures are all extensive and aim to minimise risk or harm to service users. Although all existing staff have received training in adult protection and physical intervention it has not been provided to the relatively new staff. Environment (Standards 24-30) 2 out of the 2 standards assessed were met It is a comfortable and safe home. Bedroom sizes exceed the Minimum Standards and all service users have a single room with en suite. Kitchen and laundry facilities are domestic in style. There is a detailed maintenance programme, and repairs to the home are carried out regularly.Staffing (Standards 31-36) 2 out of the 6 standards assessed were met The home exceeds the Minimum Standards in relation to staffing levels. This is a well staffed Principle House Page 7 home, allowing service users to partake in many activities and opportunities. There continues to be the need for staff to have an annual appraisal and also there has been a recent failure to ensure that staff receive regular supervision. The Directors have arranged for staff to attend numerous training courses and they aim to have the majority of the staff qualified to NVQ 3 level rather than just NVQ 2. Learning Disability Award Framework foundation training remains an outstanding recommendation. Conduct and management of the home (Standards 37-43) 4 out of 6 standards assessed were met The manager has provided a safe environment and staff have access to policies and procedures in order to ensure the smooth running of the home. It is again recommended that service users are encouraged to maintain their personal records. Staff commended the management on then positive and open atmosphere maintained in the home and the support available to them by the management team. The home is financially viable and there are clear systems for financial planning and monitoring.Principle HousePage 8 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard The manager should record the visits to the home by prospective service users. There have been no new service users admitted; therefore this recommendation will be carried forward to the next inspection. Service users should be enabled to agree and sign a contract prior to them being admitted to the home. There have been no new service users admitted; therefore this recommendation will be carried forward to the next inspection. The manager should develop behaviour plans detailing the agreed approach for all service users who present with challenging behaviour. This has been partly met. 10 11 12 YA34 YA35 YA36 The manager needs to evidence that new staff have had a three-month probationary review and that service users have been involved in this review. Staff should undertake Learning Disability Award Framework Training. Staff should receive an annual appraisal.1YA42YA53YA6Principle HousePage 9 14YA41Service users should be more involved in the maintaining of their personal records.CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Principle HousePage 10 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, the National Minimum Standards and the relevant sections of the Childrens Act. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action 1 18 YA36 Staff must receive regular one-to-one formal supervision with their line manager. These supervision sessions must be recorded. 30.06.04RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s) No. Refer to Good Practice Recommendations Standard * There should be evidence that service users have agreed the assessment of their needs. 1 YA2 Any limitations on a service users rights should be recorded in the service users file and evidence provided that these have been agreed with the service user and/or other professionals/representatives. Staff should undertake training in mental health, to ensure that the staff have the skills to meet the needs of service users living in the home. The manager should ensure that service users introductory visits to the home, and observations about their needs and compatibility with the other service users, are formally recorded. This recommendation is brought forward from the inspection report dated October 2003.2YA33YA4Principle HousePage 11 4YA5Service users should be enabled to agree and sign a contract prior to them being admitted to the home. This recommendation is brought forward from the inspection report dated October 2003. The assessments, care plans and review documents should be signed by the member of staff completed them, and where possible signed and agreed by the service user. The Manager should continue developing the behaviour guidelines for each service user and make these available to the staff and service user. Staff should receive training and information on personal relationships and sexuality in relation to supporting adults who have a learning disability. Service users should be given the opportunity to help plan, prepare and cook their meals. There should be guidelines in place (agreed with a specialist epilepsy health professional) detailing what action and when to take the action when a service user has a seizure. There should be clears guidelines for staff (again agreed by health professionals) for when prescribed prn medication should be given to service users. The administration of homely medication should be recorded accurately.5YA66YA157YA178YA199YA2010 11YA23 YA31There should be training provided for new staff on adult protection and physical intervention to ensure they are competent in these areas. Staff should be made familiar with the General Social Care Council code of conduct. There should be evidence on personnel files that a member of staff has successfully completed their probationary period. Service users should be involved in reviewing the performance of staff during this period. Staff should only commence working in the home once the Manager has received satisfactory references and Criminal Record Bureau check. The Registered Manager should continue to arrange for staff to receive Learning Disability Award Framework training. This recommendation is brought forward from the inspection report dated October 2003.12YA3413YA35Principle HousePage 12 Staff should receive an annual appraisal. 14 YA36 This recommendation is brought forward from the inspection report dated October 2003. Service users should be encouraged to help maintain their personal records. This recommendation is brought forward from the inspection report dated October 2003. There should be an accurate record kept of all meals provided for the individual service users. The two-sided registration certificate should be displayed in the home. 16 YA42 There should be a clearer record made of when staff have received fire training. Day staff should receive fire training every 6 months. Night staff should receive this fire instruction every 3 months.15YA41* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.Principle HousePage 13 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: Number of Service Users spoken to at time of inspection Number of Relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs) YES YES NO YES YES YES NO NO YES YES NO YES YES YES NO YES NO NO NO YES 6 1 0 NO NO YES YES 21 0 29/03/04 10:00 8Principle HousePage 14 The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Principle HousePage 15 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives, philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. X X Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Key findings/Evidence This standard was not assessed at this inspection.Standard met?0Principle HousePage 16 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user using an appropriate communication method, and with an independent advocate as appropriate. 2 Key findings/Evidence Standard met? The Inspector examined two care files. They both contained a Care Management care plan and assessment. An initial assessment form had also been completed for each service user prior to them being admitted to the home and this included information on the areas of needs detailed in Standard 2.3. The manager clearly stated his expectations on what information would be provided for each new service user, and that he requires a full and detailed care plan, and multi-agency assessments. At the last inspection it was noted that there was no evidence seen to confirm that service users had been involved and agree with their assessment. There have been no new service users admitted therefore it is not possible to review this recommendation. However, the manager is currently completing new risk assessments and behaviour plans for service users and stated that these will be fully discussed with the service users. The proformas seen for these assessments allow for a service user to comment and sign them. There continues to not be a record made of the limitations placed on the most recent service users rights, choice and freedom, (or evidence that they have been agreed by the service user) although there have been a number of restrictions initiated.Principle HousePage 17 Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 2 Key findings/Evidence Standard met? Through discussions with the Manager it was evidenced that he has a clear understanding of the needs of the service users. The daily recording by staff further indicated that they can meet the needs of service users who have a learning disability and challenging needs. Two care staff were spoken with privately. They had no previous experience of working within the caring sector, but had received guidance and training from the Providers. Training had been given on autism and epilepsy, as these are specific needs relating to some of the service users. The Manager and staff are aware of advocacy schemes and one service user had been referred for advocacy. The Manager proactively seeks good practice guidance and relevant clinical guidance in relation to caring for adults who have a learning disability. Of concern is that the assessment and care plan for one of the service users stated that he needed to be in a home which has the experience of meeting the needs of someone who has a learning disability and mental health difficulties. Although the manager has experience in this, he has not, and none of the care staff, have received training in mental health. The home is not registered to provide care to adults who have mental health difficulties. However, in discussion with the manager and with staff it was clear that this service users needs were being met, and the relevant specialist support from outside agencies is being proactively utilised. Previous inspections noted concern that there was limited support given to a service user in relation to his communication needs. The Manager confirmed that a referral has now been made to the speech and language therapist. Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis, before making a decision to move there, and unplanned admissions are avoided wherever possible. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection. An outstanding recommendation from the previous report stated that the home should ensure that service users introductory visits to the home, and observations about his needs and compatibility with the other service users, is formally recorded. As no new service users have been admitted since this recommendation was made, it will be carried forward to the next inspection. The manager did confirm that he will meet this standard.Principle HousePage 18 Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 2 Key findings/Evidence Standard met? The Manager has a contract proforma used for service users. Five of the service users have a contract. These service users have (or their representative has) signed the contract and the service user keeps a copy of this contract themselves. The Manager informed the Inspector that the most recent service user did not yet have a contract. The reason given for this was that the contract also specifies the restrictions and limitations placed on the service users rights and these had not yet been fully assessed. The contracts are individualised and specify the areas detailed in Standard 5.2.Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home and how these services will meet current and changing needs and aspirations and achieve goals. 2 Key findings/Evidence Standard met? The manager has completed an information record sheet and profile for each service user (although a profile sheet has yet to be completed for the most recent service user admitted). This includes details on the service users health needs, behavioural issues, medical needs and likes and dislikes. The Care Management Care Plan obtained for each service user includes further information on personal care, social, communication, education and employment needs.Principle HousePage 19 The home has developed a review format which indicates how the home is meeting the service users needs identified in their care plan. It outlines the services and facilities being provided by the home and whether the service users goals and aspirations have been met. The home initiates a formal review at least six monthly for each service user. This includes having a multi-disciplinary meeting and reviewing the service users needs and the suitability of the placement. The manager states that the service users keep a copy of the homes care plan review. Pictures are used throughout this document to aid their understanding of its contents. The review form has not been signed by the service user or by the member of staff completing it. The Manager is in the process of developing behaviour guidelines and full risk assessments for each service user. These have been completed for three of the service users but not yet been shared with staff or the service users themselves. These are however comprehensive and focus on increasing positive behaviour and reducing challenging behaviour. The Manager has also sought support with these plans from other professionals. Each service user has a named key worker. The manager has agreed with the majority of service users the restrictions posed on them. The restrictions for each service user vary, and are a result of identified risks, and accompany a risk assessment. Service users have signed to confirm that they accept the restrictions. Examples of restrictions include limiting the availability of matches / lighter, going out with staff supervision only, and staff administering medication. Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions and that right is limited only through the assessment process, involving the service user and as recorded in the individual Service User Plan. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 20 Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day-to-day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? The inspector spent time over lunch with service users, and was present during their house meeting. There was clear evidence that they are consulted on and participate in all aspects of life within the home. Service users are informed about any changes to staff and house appointments during the house meetings. Service users are also asked whether they have any concerns about how the home is being run. Service users were encouraged to complete questionnaires about the care provided in the home last year, and a report was written and made available to them as feedback. Service users are not formally involved in staff recruitment. However, the recruitment procedures include prospective staff spending time with the service users during the day. The service users are then questioned on the appropriateness of the staff.Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 3 Key findings/Evidence Standard met? The manager has completed a preliminary risk assessment for each service user. The proforma used includes the potential risks (sexual, physical, financial, emotional, verbal) to the service user from others, the risks from the service user to others, and environmental risks within the home and outside the home. Where a specific risk has been identified a more thorough risk assessment has been completed to run alongside the behavioural guidelines for each service user. Some of these however are still in their infancy, as are not yet fully completed by the manager. The manager stated that once all the risk assessments are completed they will be kept in a specific file in the staff room, and are therefore accessible to staff. As confirmed in the last report the manager must be commended on the risk assessments completed for each service user. It clearly sets out a variety and full list of potential hazards, an assessment of the service user in relation to the potential risk/hazard, the level of risk identified and the action to be taken by staff to minimise the risk. This is very good practice. The care plans also identify that staff time is spent giving service users training in personal safety to avoid limiting their preferred activity. Service users have been given support and training in personal safety and to access the community independently. The home has a procedure to follow for unexplained absences by service users. Risk assessments have been sought for service users prior to admission.Principle HousePage 21 Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998 and in the best interests of the service user. 3 Key findings/Evidence Standard met? Both staff spoken with had a clear understanding of confidentiality. They respected that information told to them in private would remain so, unless there were clear adult protection issues identified. The Statement of Purpose and Service User Guide informs service users and their representatives of the homes statement on confidentiality. The Manager has information on the Data protection act 1998, and service users individual records are accurate and kept securely in a locked office.Principle HousePage 22 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection. The home exceeded this standard at the last inspection.Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 23 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in the local community in accordance with assessed needs and the individual Plans. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection. The home exceeded this standard at the last inspection.Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to and choose from a range of appropriate leisure activities. 3 Key findings/Evidence Standard met? The service users living at Principle Care receive structured day care from the Providers. This however is at an extra cost and is funded by Local Authorities responsible for the individual service user. To evidence this standard for how the home promotes the service users leisure activities the Inspector examined the daily records for two service users paying particular attention to evening and weekend activities. The records for February confirmed that staff had supported one of the service users at the weekend and evenings to go for walks, to the pub, watching football, cinema, café, and to the local shops. It was noted however that one service user took particular enjoyment in music, but this was not being offered to him at present. There was a recommendation by another professional for this service user to take part in more valued activities. The Inspector is aware however, that this is difficult due to the particular needs of this service user, and in discussion with the Manager he confirmed that further activities were being sought. Holidays are arranged for the service users. The Manager confirmed that the majority of the holiday cost is funded by the home.Principle HousePage 24 Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 2 Key findings/Evidence Standard met? The Inspector spent time talking to the father of one of the service users. He confirmed that communication is open and the he is made to feel welcome in the home. Daily records also confirmed that service users are encouraged to keep in regular contact with their family, through phone calls and home visits. Two service users have been supported to attend a local college where they have the opportunity to meet new friends. The Manager also confirmed that he had supported a service user in arranging for a friend to come and visit. He also stated that he had spoken to all service users during a house meeting about their right to have people to come and visit them in the home. The manager has a clear understanding on supporting adults who have a learning disability in developing appropriate relationships. However staff have not received specific training in this and there are not any resources or information kept in the home to assist staff and service users in understanding sexuality or maintaining intimate personal relationships. Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 25 Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 2 Key findings/Evidence Standard met? The Inspector spent time talking to the homes cook, reviewing the menus and had lunch with the service users on the day of the Inspection. Meal times were observed as being social events, and were unhurried and relaxed. The staff eat with the service users. Menus evidenced that the meals provided were nutritious and varied. Individual tastes were catered for. During the house meeting, service users were asked whether they wanted alternatives to the forthcoming weeks menu. Service users are not involved in the preparing, cooking or serving of the main meals. This is disappointing as the service users are able to do this with support. However, it was confirmed that they can make their own snacks. Service users are also not involved in planning the shopping list or going food shopping. However they are able to go to the local shops for snacks. There was not a clear record made of the food provided for each service user.Principle HousePage 26 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes policies and procedure for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? An initial assessment is completed for each service user. This details their needs in relation to personal care, and informs staff of how to meet their needs. Daily records again evidence that staff provide individualised personal support. Times for getting up and going to bed are flexible. Observations made by the Inspector showed that personal support is provided in private. The service users also have a choice of male or female staff members to help support them. One service user has particular needs in relation to communication and a referral has now been made to a speech and language therapist. The home has made links with community nurses and liases closely with psychiatric services where necessary. Services users are taken shopping and given the opportunity to choose their own clothes with guidance. Care plans clearly evidence that service users are encouraged to be as independent as possible with their personal care needs.Principle HousePage 27 Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No of service users with pressure sores at the time of inspection (from information taken from care notes) 102 Key findings/Evidence Standard met? Two care files examined showed that service users have been supported to attend the dentist, GP, Psychiatry and Psychology appointments, and contact maintained on behalf of the service users with community nurses and the epilepsy nurse where appropriate. The Manager collates the necessary records to ensure that the specialist health workers have the necessary information to help the service user. The records made of seizures (and any associated behaviours) are accurate and detailed. However, there are no clear epilepsy guidelines agreed with the health professionals for one service user, whereas the Inspector would expect to see clear guidelines for staff on what action to take and when in relation to the service users seizures. The Manager confirmed that he had requested these from the neurological consultant, but as yet they have not been received. The dates of health appointments are all clearly recorded on service users files and the outcomes of the appointments are also recorded effectively. The home has currently supported the new service user to be registered with a local GP and dentist.Principle HousePage 28 Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 2 Key findings/Evidence Standard met? Each key worker has completed an assessment with the service users in relation to their understanding of the medication they are on and whether they are able to self medicate. The service users have been fully involved in this assessment, and have been asked their wishes and feelings in relation to whether they self medicate. The manager is currently working in supporting a service user to see whether he can self medicate, but this is a slow process to ensure safety. There is a risk assessment with respect to each service user and their ability to self medicate. Each file seen contained a signed consent to medication form from service users (and/or their representative). There is also a list for each service user on the homely medication that they can take. One of the Directors has the responsibility of recording all medication received into the home. The recording is accurate, and the previous recommendation made in relation to signing the computer printed record sheets has been implemented. Photos of service users have been attached to the administration record. However, there is not a clear record on the administration record of whether the service user has any known allergies. The home has a detailed and thorough policy on the administration of medication. Staff induction also includes training in the homes medication administration procedures. Staff who administer medication have not all completed an accredited course in medicines. The Inspector noted that there are not individual guidelines for the administration of prn medication. The manager stated that staff are clear that they cannot administer prn medication unless he has been informed. The Inspector also noted that the administration of homely medication had been recorded under the `prn form and not under the `homely medication form. This could cause confusion for staff and allows for an error in over administration of homely medication to be made. The manager stated again that homely medication can again only be administered if he has agreed and this therefore reduces this chance of error.Principle HousePage 29 Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? On each file there is a record made of the service users (and their representatives where appropriate) wishes in relation to death and dying. The home has had to deal with an unexpected death of a service user. This was understandable a very upsetting situation for the home and other service users. The manager and staff dealt with this with sensitivity and respect. Service users and staff were given the appropriate support for their bereavement. Staff and service users attended the funeral, and the Manager helped arrange the funeral, and took into consideration what the service user would have wanted.Principle HousePage 30 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure which includes the stages of and times-scales for the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days 2 2 0 0 0 0 100 3 Key findings/Evidence Standard met? The above two complaints were made by a service user. They were not in relation to the care provided by the home, but related to the behaviour of another service user in the home. The manager responded appropriately and recorded the outcome of the complaint. The Commission has not received any complaints. In discussions with Care Managers, only positive comments have been received about the home. Service users are encouraged to voice any concerns they have about the home. The Inspector was present for a house meeting and complaints/concerns were discussed as part of the agenda.Principle HousePage 31 There is a clear complaints procedure for the home, which is detailed in the Service Users Guide and Statement of Purpose. The Manager is arranging for each service user to have a key ring with the number of the Commission on it, to ensure that service users have access to the Commissions telephone number.Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence, or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YES02 Key findings/Evidence Standard met? The home has a comprehensive, detailed and informative policy on Adult Protection. It ensures that staff have full understanding of what is abuse, the different forms of abuse, and what action to take if they suspect or witness abuse. The manager has also undertaken risk assessments for each service user in relation to the risks they pose from abuse by others and abuse to others. The No Secrets policy is accessible to managers and staff. There is also a clear whistle blowing policy which is again accessible to staff. However, in discussion with staff they were not clear what procedures to follow if the manager was not available or if an allegation was made against the manager. Some of the service users at Principle Care can demonstrate physical and verbal aggression at times. The Directors and some of the staff have attended accredited training courses in physical intervention and restraint. There are however over 50 of staff who have not received training in appropriate physical restraint and intervention. The homes policy is in line with the Department of Health guidance on physical intervention. The home has notified the Commission immediately of the circumstances and incidences when restraint was used in the home. These occasions have been when the service user is harming themselves, others or property. The home has clear procedures and policies to be followed in relation to service users finances and money, which inform staff of how to protect service users, and ensures their money is handled safely.Principle HousePage 32 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 33 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite Key findings/Evidence This standard was not assessed at this inspection. YES NO NO 6 6 0 0 Standard met? 0 6 00 0 0 0Principle HousePage 34 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 3 Key findings/Evidence Standard met? All the bedrooms seen were well furnished and the service user had room for all their personal possessions. Each service user has a key to their bedroom and the lock is fitted with an override facility in case of emergencies. Bedding and floor coverings are of a good quality. The size of the bedrooms exceed the National Minimum Standards. There is ample space for service users possessions. Each room has a bed, chest of drawers, table, comfortable chair, wardrobe and cupboard space and lockable storage. Each room has a window, which provides a view when seated. Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 35 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of inspection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? During inspection the home was clean and free from offensive odours. The manager has indeed gone to extensive trouble to ensure that rooms are cleaned thoroughly, and that procedures are in place to ensure service users rooms are free from offensive odours. The laundry facilities are separate from the kitchen area. The home has a policy / procedure in place for the control of infections and safe handling of waste. This is detailed and thoroughly researched, enabling staff to have clear directions and information in relation to ensuring the home is run safely. It clearly exceeds the standard. There are separate hand washing facilities in the laundry room, kitchen and cloakroom. The laundry floor finish is impermeable. The manager confirmed that the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999.Principle HousePage 36 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 2 Key findings/Evidence Standard met? Each member of staff has a job description, which is linked to meeting service users individual goals. The staff were observed interacting closely with the service users and appropriate relationships have developed between service users and staff. In discussion with staff they were clearly aware of their own knowledge and skill limitations and they commented that the team and management are supportive. The staff have an understanding of the aims of the home and were clear advocates for promoting service users independence and autonomy in a safe environment. Staff were not aware of the standards of conduct and practice set by the General Social Care Council. Volunteers are not employed by the home.Principle HousePage 37 Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme 2 3 1 397 7 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X 462 Nursing X X X003 Key findings/Evidence Standard met? The home is managed by four Directors. Two of the Directors (the Registered Manager and Day Care Manager) have many years experience in caring for service users who have a learning disability. They have undertaken training in challenging behaviour, communicating with services users, including Makaton and British Sign Language, and courses in social care. Some staff have undertaken training in epilepsy, in administering medication and crisis intervention course. In discussion with the two managers they can clearly identify the needs of each service user. Case recording also evidences that the staff have a good understanding of the needs of the service users, and can communicate effectively with them. Care records also evidence that the staff and managers have developed professional relationships with others. Feedback from social and health care professionals confirmed that staff demonstrate a clear understanding of the needs of service users. Three care staff currently hold an NVQ 2, five have an NVQ 3 with a further four staff booked on this course. Two care staff are also booked on the NVQ 4 in care as well. This exceeds the Minimum Standards in relation to NVQ training.Principle HousePage 38 In discussion with staff they are able to articulate how they deal with anticipated behaviours and that they have an understanding of the challenging behaviours displayed by some service users, and in particular how to minimise these. Staff were witnessed being accessible to service users, paying great interest in the things they say and do.Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. 4 Key findings/Evidence Standard met? The staffing hours listed above have been calculated by the Inspector from the rota provided by the manager. A random week was picked in March. This shows that the home exceeds the National Minimum Standards in relation to staffing levels. Due to the increased needs of service users the staffing levels have recently been increased to four staff on each day and evening shift (with one waking and one sleeping staff at night). There were the few occasions when staffing levels dropped to three on a shift, but then other shifts included five staff. The Manager did confirm that when three staff were on a shift a Manager was always available. One of the Directors works full time doing the administration for the home, and another Director is responsible for managing the domestic tasks within the home. As stated above the other two Directors are involved directly in managing the care of the service users, one being the Registered Manager and one the Day Care Manager. Two of the service users require one-to-one support at all times. A further service user requires one-to-one support at specific times only. This allows for two staff to spend uninterrupted time with the other three service users. This staffing level also allows for service users to undertake individual activities. They can choose to go out or stay in, and there choices are not restricted due to staffing. There are regular staff meetings and these are recorded. Specialist services are secured from relevant professions to support the assessed needs of service users.Principle HousePage 39 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? The home follows a thorough recruitment procedure. They have an equal opportunity policy. Although in discussion with the manager he stated that staff are subject to a 3 month probationary period there was no evidence that new staff had received a three-month review which involved service users. A recommendation was made in relation to this following the last inspection and is therefore carried forward. Service users are actively encouraged to be involved in staff selection, and this involves informally meeting the service users and the manager seeking the views of service users. All staff in post have received a satisfactory Criminal Records Bureau check, and two written references. One file checked however showed that the CRB check and references were received after the person started work in the home. All staff have received statements of terms and conditions of employment. Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 2 Key findings/Evidence Standard met? The manager is fully aware of the training needed for staff in order to meet this standard, and has produced a training checklist for staff. Staff have attended training in first aid, food hygiene, fire safety, safe use of medicines, crisis intervention (restraint and physical intervention), equal opportunities, autism, and epilepsy. The home has a comprehensive induction programme, which meets TOPSS specifications. However, the National Minimum Standards recommend that staff working with service users who have a learning disability receive Learning Disability Award Framework induction and foundation training. The Director responsible for training has arranged to be accredited as a LDAF trainer, and therefore plans to assess all staff through the LDAF induction and foundation training units. This however has yet to start. Therefore although progress has been made in meeting this standard it still remains unmet at present.Principle HousePage 40 Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 1 Key findings/Evidence Standard met? The Manager is aware that staff need to have one-t-one formal supervision. However this has not been carried out regularly. A staff file of a member of staff who started in November 2003 showed no evidence that she had received any supervision. The staff interviewed however did confirm that the Registered Manager and Day Care manager 9both Directors) were available each day and were supportive. Informal discussions take place daily. Staff have not yet received an annual appraisal. Staff confirmed that they had been made aware of the grievance and disciplinary procedures and know where to access the procedures and policies.Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care or equivalent. NO3 Key findings/Evidence Standard met? The manager is competent and experienced to run the care home. He has previous supervisory experience in a relevant care setting, and has a relevant qualification in management. He is currently undertaking the NVQ 4 in care, and confirms that he will have finished this course this year.Principle HousePage 41 As can be seen from the findings contained in this report the registered manager has a great deal of knowledge and understanding. He has provided care staff with a considerable amount of information and guidance relevant to caring for adults who have a learning disability. Policies and procedures are informative and thorough. Over the past year the goals and outcomes for service users have been achieved, and there has been noticeable improvement in the behaviour of service users. The staff spoken with had no complaints about the manager. The home is run efficiently and effectively, and complies with the Care Standards Act and Regulations. The registered manager has a clear job description which details the necessary roles and responsibilities of a manager to meet this standard. The registered manager has attended a number of training courses this year including an Instructor in Crisis Intervention course, and Safe Handling of Medicines. Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? The Registered Manager has a clear vision and aims for the home. Staff are aware of these aims and share the managers vision. The staff confirmed that there is an open and positive atmosphere and commented that it is a comfortable and enjoyable home to work in. There is a clear management structure. Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems based on seeking the views of service users are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? This standard was not assessed at this inspection.Principle HousePage 42 Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Younger Adults. 3 Key findings/Evidence Standard met? The home has developed a number of policies and procedures which cover all of the topics set out in Appendix 3 of the national Minimum Standards. The manager must be commended, as these policies are detailed, informative, thoroughly researched and completely applicable to the home and service user group. These policies are accessible for staff, and are easy to read. The Service User Guide contains a summary of the more relevant policies and procedures, including complaints, fire, visitors, admissions, relationships and sexuality, and privacy. Pictures have been used in this document to aid understanding. Following the last inspection it was recommended that a number of relevant policies should be developed in a more suitable format for service users. However following further discussions with the Manager he confirmed that all but one of the service users can understand the information provided in the Service User Guide. For the one service user who would not benefit from the written guide, it was stated that a visual or audio guide would also not be useful to this service user. The manager has recently reviewed all policies and procedures. They are signed and dated. Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained up to date and accurate. 2 Key findings/Evidence Standard met ? Individuals records are kept secure, up to date and used in accordance with the Data Protection Act 1998. Service users can have access to their files. Athough some of the service users have literacy skills they have yet to be invovled in helping to maintian their personal records. There are appropriate records held by the home for each service user and staff member. These are easily accessible and are up to date and accurate. As stated in Standard 17 there is not a clear record made of the food provided to each service user. Individual changes to the meals provided are not accurately recorded. The registration certificate for the home was not dispayed corectly, with only one page of the certificate showing.Principle HousePage 43 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 2 Key findings/Evidence Standard met? Fire safety checks, environmental health and gas appliance checks are all up to date and satisfactory. Water temperatures are regulated and there are risk assessments in place for each service user in relation to the environment and premises. Radiators are covered. There was however no central log kept of fire training, therefore the Inspoector could not establish whether staff have received fire training at approprite intervals. The home has thorough and informative policies on food safety, infection control, health and safety, first aid, and fire precautions. There is a fire risk assessment for the premises. Staff have undertaken training in safe working practices. There is a detailed maintenance plan for the home which details the repairs and redecoration that will be undertaken. Due to the nature of the service users needs the home has carried out a number of repairs and redecoration so that the home is maintained in a clean, and safe way. Accidents and incidences are recorded well and forwarded to the necessary agencies. Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 3 Key findings/Evidence Standard met ? The home displays its insurance certificate, and the insurance cover is appropriate and meets the Standard recommended. There are clear profit and loss accounts for the home and these were made available to the Inspector. These showed that the home is financially viable, and that there are clear systems in place for financial planning and budget monitoring. Lines of accountability are clear. There is no external management.Principle HousePage 44 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateSophie BartonSignature Sophie Barton Signature Signature13.5.04Principle HousePage 45 PART D(where applicable) Not applicable.LAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.Principle HousePage 46 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 29th March 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possible The inspection report is largely accurate and effectively compiled. The inspector was certainly thorough during her visit. I agree with and accept the requirement but feel that there are rather a lot of recommendations. If I may be pedantic page 49 Action taken by the NCSC..... Youre not the NCSC anymore, get over it.Action taken by the NCSC in response to provider comments: Principle House Page 47 Amendments to the report were necessaryYESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. E.2 Please provide the Commission with a written Action Plan by 10th June 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here NOPrinciple HousePage 48 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I ....................... of Principle Care Ltd confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I ....................... of Principle Care Ltd am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Principle HousePage 49 - 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. 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