CARE HOME ADULTS 18-65
Regis House 29 Causeway Rowley Regis West Midlands B65 8AA Lead Inspector
Lesley Webb Key Unannounced Inspection 27th February 2007 08:50 Regis House DS0000056464.V326552.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 Regis House DS0000056464.V326552.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. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Regis House Address 29 Causeway Rowley Regis West Midlands B65 8AA 0121 559 6667 0121 559 6512 regishouse@highfield-care.com 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) Southern Cross Healthcare Centres Limited Angela Bennett Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One service user identified in the variation report of 17.9.03 may be accommodated at the home in the category of MD. This will remain until such time that the service users placement is terminated. One service user accommodated at the home may be in the category LD(E). This will remain until such time that the identified service users placement is terminated. 17th January 2006. 2. Date of last inspection Brief Description of the Service: Regis House is a 2 storey Victorian property situated in a residential street in Blackheath, close to shops and local community facilities. Southern Cross has recently acquired Regis House and there is a sense of optimism for the future amongst the management and staff. The home is registered to provide care and accommodation for 6 residents with a learning disability, 1 person with a learning disability who is over 65 and 1 person with a mental disorder. The lounge and dining room are on the first floor with bedrooms and bathroom on the ground floor. There is a toilet available on both floors. The home does not have a lift and would therefore not be suitable for people with physical disabilities. The home has a minibus to enable residents to access community facilities. The aim of the home is to enable residents to maximise their life opportunities and choices within a risk management framework. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day. The process included analysis of pre-inspection documentation supplied by the home and examination of records required to be held under The Care Home Regulations 2001. Information supplied by the home states that fees range from £545.00 to £1333.00. In addition to this time was spent talking to service users, indirectly observing interactions between staff and service users, interviewing staff and looking at records. At the end of the inspection the registered manager was given feedback on the findings of the visit. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking two individuals care provided at the home. For example the people chosen consist of both male and female and have differing communication and care needs. No relatives of service users were present during the inspection. However four relatives comment cards were received by the Commission for Social Care Inspection prior to the visit, all of which state they are happy with the overall care provided to their relatives. The inspector would like to thank service users, management and staff for their co-operation and assistance. The discussions and atmosphere through out the inspection was constructive and those involved interacted positively as part of the process. What the service does well:
All staff that were interviewed demonstrated understanding of the importance of care plans and what they should contain. As one person explained, “They are important because everyone has individual needs, so can minimise risks. There should be a plan for every need telling us how to meet each need”. Also all staff that were interviewed demonstrated understanding of their responsibilities to support people to make decisions. For example one person explained, “its all about communication, offering choices. For example we do a come dancing session on Thursdays and one person wont go, we would prefer if she did but cant make her. Can put ideas in mind and offer new experiences. We also have residents meetings with an agenda, we also communicate on a one to one basis on a daily basis”. The home should be congratulated for its efforts to involve those with specific communication difficulties to make decisions. A professional from the local speech and language department is currently involved with home to implement communication books to ‘promote client participation and understanding during residents meetings’.
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 6 People living at this home are supported to make choices about their life style and supported to develop their life skills. During the inspection service users were observed sitting in the lounge doing crocheting, helping tidy bedrooms, sitting in the dining room doing puzzles with staff and going out to various centres. The atmosphere at the home was very relaxed, with lots of interaction and laughter. One service user was particularly proud of oil paintings that she had done, which were displayed in hallways of the home. Another service user also talked about activities, explaining, “I have lots of family, staff take me to see them in the mini bus. We go out lots, I like the cinema to see films about dogs”. Discussions with service users and staff, and observations during the inspection confirm that the principles of respect, dignity and privacy are put into practice. For example a service user was observed spending time in his bedroom (his choice), with staff knocking on his bedroom door and waiting for a response before entering and staff were heard asking service users their wishes in relation to assistance required. Medication systems were examined and found to be appropriate. The home uses a monitored dosage system for the administration of medication, with records of medication entering the home, being administered and disposed of in place. People living at the home feel their concerns are listened to. For example one person stated, “If unhappy I go straight to Angela (the registered manager), she listens to you, sorts things out”. Staff demonstrated excellent understanding of the responsibilities to protect service users from abuse. Responses include, “Being alert, looking for changes in character, investigating any mood swings, talking to try to find out what’s wrong, being aware, watching. If strangers come in to the house make sure they are not left alone. Looking for things, reporting to the manager. Listening to them is important. If you don’t report concerns you shouldn’t be doing the job”. As at the previous inspection observation of staff interaction with service users assured the inspector that staff are approachable, accessible to and comfortable with service users. This was confirmed by a service user who said, “staff are good, help look after us, check on us when we sleep, they are nice” and another who said, “they are all happy, smile”. Good quality monitoring systems were found to be in place that includes monthly, bi monthly and annual audits. An annual business plan is also in place, however it is recommended that further work be undertaken with this so that it evidences issues identified from service user, family and professional surveys are acted upon. A summary of service user questionnaires was viewed that states overall service users are happy with care provided at the home. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Regis House DS0000056464.V326552.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 Regis House DS0000056464.V326552.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): 1,2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective people considering if this home can meet their needs have information on which to base a decision. Once policies and procedures are introduced specific to the service setting the home can be confident practices are in line with legislation. EVIDENCE: Information supplied to the Commission for Social Care Inspection prior to the visit states that the statement of purpose and service user guide have been updated to include current core fees and costs of additional 1 to 1 staffing for a named service user. There were no outstanding requirements from the previous inspection. There have been no new admissions since the last inspection. The preadmissions policy and documentation were examined in order to ascertain of the homes policies and practices would ensure prospective service users needs will be appropriately assessed and managed. The admissions policy is based on the needs of older persons and not the current registered status of the home. The registered manager explained that the organisation that owns the home is in the process of devising new policies and procedures appropriate to the service with the aim that these will come into affect April 2007. Despite
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 10 the failings in the current admission policies the registered manager demonstrated knowledge and understanding of her role and responsibilities in relation to assessing the needs of prospective service users. All of the current service users have resided at the home for a number of years. Recently for some, the home has identified changes in needs, taking appropriate action to meet these. It is recommended that the home introduce a formalised system for periodically reassessing needs to enhance systems already in place. Through observations of care practices, interviews with staff and a review of documentation it can be confirmed that as in previous inspections, the home is meeting the assessed needs of service users accommodated there. Conditions of registration are being adhered to and services offered reflect current good practice and legislation. Regis House DS0000056464.V326552.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): 6,7,8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Attempts are made to involve people in decisions about their lives and to encourage them to play an active role in planning the care and support they receive. EVIDENCE: All previous requirements are now met in full. The registered manager explained that advice has been sought, from the continence nurse in respect of a named service user, key workers and the manager take responsibility for reading care plans to service users and all risk assessments continue to be audited annually and are now individualised, based on each persons needs. All staff that were interviewed demonstrated understanding of the importance of care plans and what they should contain. As one person explained, “They are important because everyone has individual needs, so can minimise risks. Plans for food, falls, bathing, hygiene, environment. Plans for everything, moving and handling, there should be a plan for every need telling us how to meet each need”. Both service user files sampled by the inspector contained
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 12 plans that included specific aims and goals for needs including monitoring of heath, falls, risk of harm, personal hygiene, dressing, moving and handling, incontinence, sleep, sight, foot care and shortness of breath. One particular person also had care plans for behaviour and physical interventions. The inspector instructed that these be reviewed and expanded as currently do not reflect all practices within the home and do not contain specific instructions for staff (further details relating to this can be found in the complaints and protection section of this report). Observations made during the inspection indicate that person centred approaches to care are in place. For example service users were assisted to undertake tasks based on their individual needs and choices, individuals views were sought before offering assistance and routines of the day were individualised. It is recommended that documentation be implemented that supports these practices and that staff receive training to compliment this form of care planning. Care plans are reviewed, however it is recommended that staff receive guidance in relation to this as the inspector found that the contents of the review records do not always reflect the contents of daily records. Discussions with service users, observations of care practices and examination of records confirm that service users are supported in decision-making processes. Records confirm that service users meetings take place on a regular basis where topics including the home, activities and staff are discussed. It is recommended that the minutes of meetings be expanded to include agreed actions and timescales in order that effective monitoring can take place. All staff that were interviewed demonstrated understanding of their responsibilities to support people to make decisions. For example one person explained, “its all about communication, offering choices. For example we do a come dancing session on Thursdays and one person wont go, we would prefer if she did but cant make her. Can put ideas in mind and offer new experiences. We also have residents meetings with an agenda, we also communicate on a one to one basis on a daily basis”. The home should be congratulated for its efforts to involve those with specific communication difficulties to make decisions. A professional from the local speech and language department is currently involved with home to implement communication books to ‘promote client participation and understanding during residents meetings’. Risk assessments are in place for identified needs as identified in plans of care. These include assessments for pressure ulcers, dependency, moving and handling, falls, self medication, outings, community, key holding, behaviour, health, mail, gender care, medication, relationships and the environment. It is recommended that moving and handling assessment be reviewed as currently this is based on the needs of older persons and not people with learning disabilities. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are supported to make choices about their life style and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Talking to service users, interviewing of staff, observation of practices and examination of records indicate that people living at this home lead full and active lives. During the inspection service users were observed sitting in the lounge doing crocheting, helping tidy bedrooms, sitting in the dining room doing puzzles with staff and going out to various centres. The atmosphere at the home was very relaxed, with lots of interaction and laughter. One service user was particularly proud of oil paintings that she had done, which were displayed in hallways of the home. Another service user also talked about activities, explaining, “I have lots of family, staff take me to see them in the mini bus. We go out lots, I like the cinema to see films about dogs”.
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 14 Information supplied to CSCI prior to the inspection states that internal activities offered to service users include daily living skills, socialization programmes and fun times. External activities include community events, lighthouse project, craft shop, coffee mornings, fetes and daytrips. When looking at records maintained within the home in the main this information was found to be accurate. For example individual living skills and community access timetables are in place and records of activities undertaken include going for walks, shopping, jumble sales and a party. It is recommended that further work be undertaken to ensure activity requests made by service users in residents meetings are evidenced and if not undertaken an explanation recorded. Staff demonstrated excellent knowledge of the needs of people living at the home in relation to activities and leading fulfilling lives. Responses included, “By keeping busy, externally and internally. For some the more they do the better they are, it motivates them, gives self confidence, outside in the community we try to teach financial skills, offer choices, encourage to do as much as possible” and “we believe in offering a lot of activities and taking then out, encouraging to do as much as for selves, it might be only washing a dish, others moping the floor after tea but it helps promote independence, let them make decisions and give choices”. The home operates a four-week rotating menu. Four service user comment cards were received by CSCI prior to the inspection all of which state they chose what to eat, go shopping for food and are happy with meals provided by the home. Individual service user records relating to meals were examined by the inspector with four indicating that they have specific dietary requirements as detailed in their plans of care and/or nutritional assessments. The home was instructed to obtain professional advice regarding its menus as currently these contain insufficient evidence that the dietary needs of all people living at the home are being met. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people living at this home receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The registered manager stated that all previous requirements have now been addressed. The preferred rising and retiring times of each service user are now recorded in their individual plan of care, all service users are now offered as a minimum annual routine health screening, improvements have been made in respect of care planning for routine health screening and record keeping has been reviewed. Action has also been taken to sensitively seek and record the wishes of residents in respect of terminal care and death including observance of religious and cultural customs. It is recommended that the home seek involvment of the family of one service user in order that wishes are recorded in full. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 16 Discussions with service users and staff, and observations during the inspection confirm that the principles of respect, dignity and privacy are put into practice. For example a service user was observed spending time in his bedroom (his choice), with staff knocking on his bedroom door and waiting for a response before entering and staff were heard asking service users their wishes in relation to assistance required. Initial health assessments are currently being introduced and other documentation indicates appropriate health referrals are being made to occupational therapists and the speech and language department. Care plans and risk assessments are in place for the management of health related needs, including instances where people refuse medical intervention. Medication systems were examined and found to be appropriate. The home uses a monitored dosage system for the administration of medication, with records of medication entering the home, being administered and disposed of in place. Staff that administer medication have been appropriately trained and competency assessments are also undertaken at regular intervals to ensure practices remain safe. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have excellent knowledge of supporting people to raise concerns and protection, with evidence that people living at the home feel their concerns are listened to. Further work must be undertaken to ensure systems for the management of aggression offer protection in full. EVIDENCE: Four service user comment cards were received by CSCI prior to the inspection. All state service users feel safe at the home and know who to talk to if unhappy. Service users confirmed these comments when talking to the inspector, for example one person stated, “if unhappy I go straight to Angela (the registered manager), she listens to you, sorts things out”. In addition to this four relatives cards also confirm they have been made aware of the complaints procedure. As at the previous inspection complaint procedures are in place and are publicly available within the home including pictorial procedures on walls to support service users. There has been one complaint in the last twelve months that was found to be partially substantiated. Complaint records were examined and found generally to be acceptable however it is recommended that records maintained within the home include copies of outcome letters sent to complainants. Staff spoken to demonstrated excellent understanding of supporting people to raise issues or to complain. As one person explained, “we usually do this at residents meetings, go through the complaints procedure. Making sure we put in words they understand, show forms and explain that we are here to help them” and another “If they talk to
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 18 me and say they are upset about something I try and sort, talk about it. If serious I have to explain that I have to report to the manager on their behalf, encourage them to be involved, encourage and support them to feel happy to raise concerns”. Adult Protection Policies including Whistle blowing and multi agency procedures are in place to guide and support management and staff in the event of an allegation of abuse. Examination of these documents found that the homes policy states staff should receive training annually and this is not occurring (the majority of staff have received training but this does not occur as per the policy). Despite this staff demonstrated excellent understanding of the responsibilities to protect service users from abuse. Responses include, “Being alert, looking for changes in character, investigating any mood swings, talking to try to find out what’s wrong, being aware, watching. If strangers come in to the house make sure they are not left alone. Looking for things, reporting to the manager. Listening to them is important. If you don’t report concerns you shouldn’t be doing the job”. As mentioned earlier in this report a service user residing at the home has behaviour care plans, risk assessments and other documentation in place to meet an identified need. Work must be undertaken to improvement systems for the management of behaviours, as currently in some instances these do not comply with the homes own written policies and procedures. For example records of incidents and injuries need to include evidence of investigation and outcomes, records need further detail to include if aggression displayed was verbal or physical, physical intervention forms must be completed when PRN medication is used for controlling behaviour and the home must be able to demonstrate that any agreed interventions are agreed within a multi disciplinary forum. A service user is currently being prescribed PRN medication for behaviours and this appears to contradict the homes medication policy that states ‘ medication should never be used as a form of chemical restraint’ but the homes physical interventions policy states ‘physical intervention forms to be completed when use of medication as form of intervention is used’. It is strongly recommended that the home implement the findings of the Cornwall Enquiry as detailed in the guidance supplied to all registered services by CSCI. Staff are also required to undertake non-violent crisis intervention training, as per the homes written policy. These issues were discussed in detail with the registered manager who demonstrated commitment to ensuring all of the above areas were acted upon as a matter of priority. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home live in a safe, generally well-maintained and comfortable environment. EVIDENCE: Regis House is a 2 storey Victorian property situated in a residential street in Blackheath, close to shops and local community facilities. The lounge and dining room are on the first floor with bedrooms and bathroom on the ground floor. There is a toilet available on both floors. The home does not have a lift and would therefore not be suitable for people with physical disabilities. Since the last inspection a bedroom and the kitchen have been painted. The registered manager stated that the kitchen is due to be refurbished and the stairway leading to the first floor redecorated with particular attention given to meeting the needs of a service user whose sensory perceptions have deteriorated. A tour of the building was undertaken with no major issues identified. The home was clean and no offensive odours were present. The
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 20 inspector was invited to view a number of bedrooms and found all to be individually decorated to a good standard. It is recommended that advice be sought in relation to the building and surrounding grounds in relation to the Disability Discrimination Act. Infection control measures appear appropriate however greater numbers of staff require infection control training as per the homes written policy. A bathroom has been refurbished since the last inspection, meeting a previous requirement. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 21 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): 32,33,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home have understanding of the support needs of people living there. Improvements to some training and induction processes will provide staff with further knowledge and skills, enhancing support people living at the home receive. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 22 EVIDENCE: As at the previous inspection observation of staff interaction with service users assured the inspector that staff are approachable, accessible to and comfortable with service users. This was confirmed by a service user who said, “staff are good, help look after us, check on us when we sleep, they are nice” and another who said, “they are all happy, smile”. Throughout the visit staff were seen talking to service users in a friendly yet respectful manor and offering support discreetly and respectfully. Records indicate that staffing levels are maintained according the assessed needs of individuals living at the home. Currently there are between two and three staff on duty morning and evenings and two waking staff during the night. This is an increase since the last inspection in order to meet the changing needs of a named service user. Information supplied to CSCI by the home prior to the inspection states that there are fifteen staff employed at the home (including the manager and four bank staff). Records and discussions with the registered manager confirm that all but one person either holds a national vocational qualification or is in the process of undertaking this qualification. The registered manager confirmed that no specialist training has been undertaken recently; with priority being given to ensuring staff receive training in other areas. It is strongly recommended that action now be taken to ensure greater numbers of staff undertake dementia care and nutrition training in order that they have the appropriate knowledge to care for people living at the home. A number of staff personnel files were examined and in the main found to contain all documentation as detailed in the Care Home Regulations 2001. Further work must be undertaken to ensure all documents are in place on all files. Further work must be undertaken to ensure induction processes equip new staff with the necessary knowledge to perform their roles. Induction processes currently in place only include a few hours where new staff are shown basic information and policies. There is no evidence that indicates induction processes are based on current good practice guidelines such as ‘Skills for Care’ or that new staff shadow other workers before commencing shifts in their own right. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place enabling the home to measure if it is meeting its aims and objectives. EVIDENCE: Information supplied to CSCI by the home prior to the inspection states ‘the manager oversees overall responsibility for the home, supported by a team leader who organises day-to-day care for service users as well as supervising junior staff. The team leader also takes charge of the home in the absence of the manager. The support workers assist, encourage and empower service users through their individual development and support plans, allowing service users to be independent and have a voice is the main objective of the team. Discussions with the manager and observations of practices throughout the visit confirm this statement to be true. The registered manager has been in
Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 24 position for a number of years and has undertaken training, which includes a national vocation qualification level, four and the registered managers award. In addition to this she has undertaken short courses including mental health, abuse, diabetes, pressure care, nutrition and counselling skills. When talking to the registered manager she recognises the need to up date her own knowledge in some areas, including person centred approaches to care and physical interventions. As at the previous inspection good quality monitoring systems were found to be in place that include monthly, bi monthly and annual audits. An annual business plan is also in place, however it is recommended that further work be undertaken with this so that it evidences issues identified from service user, family and professional surveys are acted upon. A summary of service user questionnaires was viewed that states overall service users are happy with care provided at the home. The only area that service users were unsure about was if they are involved in writing and changing their care plans. In response to this the registered manager has wrote ‘I feel this is because the service users are unsure of the meaning of the question’. This was discussed with the registered manager, with the inspector reinforcing the need for person centred plans to be introduced (as detailed earlier in this report). Generally health and safety is well managed within this home. Pre-inspection information supplied by the home states that fire equipment was checked 24/01/07, the most recent fire dill took place 17/01/07, fire alarms are tested weekly, the environmental health department visited the home 17/10/05, the gas supply was serviced 30/08/06, a legionella assessment was undertaken 03/04/06 and that emergency lighting and emergency call systems are checked monthly. Examination of documentation indicates that the majority of staff working at the home hold up to date certificates in first aid, manual handling, food hygiene first aid and fire. Very good fire drill records are in place that detail start times, responses, the involvement of service users and staff and any identified issues. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 3 3 4 3 X X 3 X Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Comprehensive care plans for behaviour must be introduced based on each person’s needs and capabilities. These must include detailed and specific instructions for staff. The home must obtain professional advice regarding its menus and be able to evidence all specific dietary requirements are being catered for. The home must improve systems for the management of behaviours. This must include: Recording investigations and outcomes for incidents, Recording if aggression is verbal or physical, Completing physical intervention forms when PRN medication is used for controlling behaviour, Agreeing interventions within a multi disciplinary forum. 4 YA23 13(6) All staff must undertake non-violent
DS0000056464.V326552.R01.S.doc Timescale for action 30/04/07 2 YA17 16(2)(i) Sch 4(13) 13(6(7(8 15 Sh3 (p)q 30/06/07 3 YA23 30/04/07 30/04/07
Page 27 Regis House Version 5.2 5 6 YA30 YA34 7 YA35 crisis intervention training, as per the homes written policy. 13(3) All staff must undertake infection control training. Sch 2,4 The home must ensure that staff personnel files contain all documentation as detailed in the Care Home Regulations 2001. 18(1)(i)(2) The home must ensure that any new staff receive structured induction training. 30/06/07 30/04/07 30/06/07 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 2 Refer to Standard YA2 YA6 Good Practice Recommendations That a formalised system for periodically reassessing needs is introduced. That person centred plans be introduced for all service users. That staff receive training in person centred approaches to care. That the registered manager receives training in person centred approaches to care appropriate to her position and responsibilities. That staff received guidance in relation to records of reviews of care plans. That the minutes of residents meetings be expanded to include agreed actions and timescales. That further work be undertaken to ensure activity requests made by service users in residents meetings are evidenced and if not undertaken an explanation recorded. That the moving and handling assessment be reviewed as currently this is based on the needs of older persons and not people with learning disabilities. that the home seek involvment of the family of one service user in order that wishes are recorded in full in relation to funeral arrangements. That records maintained within the home include copies of
DS0000056464.V326552.R01.S.doc Version 5.2 Page 28 3 4 5 6 7 YA7 YA14 YA19 YA21 YA22 Regis House 8 9 10 11 12 13 14 15 YA23 YA23 YA24 YA32 YA35 YA37 YA39 YA40 outcome letters sent to complainants. That staff undertake adult abuse training as per the homes written policy. That the home implement the findings of the Cornwall Enquiry as detailed in the guidance supplied to all registered services by CSCI. That advice be sought in relation to the building and surrounding grounds in relation to the Disability Discrimination Act. That action now be taken to ensure greater numbers of staff undertake dementia care and nutrition training. That induction processes are based on current good practice guidelines such as ‘Skills for Care’ That the registered manager undertakes training in physical interventions appropriate to her position and responsibilities. That further work be undertaken so that the business plan evidences issues identified from service user, family and professional surveys are acted upon. That the home implements the new service specific policies and procedures by the end of April 2007. Regis House DS0000056464.V326552.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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
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