Inspection on 28/11/07 for Salisbury Court

This inspection was carried out on 28th November 2007.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Salisbury Court 05/11/08

Salisbury Court 13/02/07

Salisbury Court 07/03/06

Salisbury Court 28/09/05

Salisbury Court 08/02/05

Salisbury Court 02/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Salisbury Court Off Barnoldby Road Waltham Grimsby North East Lincs DN37 0BS Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 28th November 2007 08:30 DS0000002910.V356046.R02.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 DS0000002910.V356046.R02.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. DS0000002910.V356046.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Salisbury Court Address Off Barnoldby Road Waltham Grimsby North East Lincs DN37 0BS 01472 821634 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) www.mencap.org.uk Royal Mencap Society Position Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000002910.V356046.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 Brief Description of the Service: Salisbury Court is care home providing personal care and accommodation for 6 adults with learning disabilities some also have associated physical disabilities. New Era Housing Association owns the building. Mencap provides staffing and support. The home is located in the village of Old Waltham. It is close to local shops and amenities and there is a regular bus service from the village to the nearby towns of Grimsby and Cleethorpes. The home is a detached dormer bungalow in a quiet residential area. All accommodation for people is provided on the ground floor with the staff sleepin room/office and shower/toilet on the first floor. There are six single bedrooms and each has a wash hand basin fitted. The home has a bathroom with an Aqua Nova assisted bath and toilet, a shower room with wheelchair access and toilet and a separate toilet. There is a combined lounge/dining room and adjacent kitchen and a separate laundry room. The gardens are easily accessible to residents and there is a car parking area. As at 28th July 2006 the weekly fee per week was £725.03. People who use the service will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these and more up to date information on weekly charges can be obtained from the manager. Information on the service is made available to prospective and current residents via the homes statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. DS0000002910.V356046.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over three days in November 2007. Surveys were posted out prior to inspection; three were returned from relatives, ten returned from staff and two from health professionals. In addition to this one relative and a health professional were talked to over the telephone. Some of their comments have been included in this report. Mrs Jane Lyons carried out the visit. During the site visit we spoke to the manager, the area manager, four support workers and two relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We also looked around the home and looked at lots of records, for example; individual’s care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. Six people live at the home, two people were at home during the visit, the remaining individuals were out at day services. All the people who live at the home had communication difficulties, which meant they were unable to complete a written questionnaire or tell the inspector about their care needs or give their views on the home. During the visit we issued an immediate requirement notice to review staffing levels to ensure there were enough staff in the home to meet the needs of people and carry out all of their duties safely. Following the visit we received confirmation that satisfactory action had been taken in respect of this, however the management must ensure that the staffing levels are regularly reviewed. What the service does well: The bungalow is located in the local community and is on a bus route making all leisure facilities and shops easy to get to. The people who use the service were provided with a homely, tidy and well-decorated environment. All people are provided with a single room that is nicely personalised to their own taste, in a house for no more than 6 persons thereby providing them with a more homely environment. DS0000002910.V356046.R02.S.doc Version 5.2 Page 6 People who live at the home have good access to professional medical staff and are able to access external services such as dentists and opticians as needed. Relatives and parents are kept in contact with and people who use the service are helped to go and visit their relatives. When new staff are employed they are checked to make sure they are safe to work with the people who live in the home. The staff were friendly and knew a lot about the people who lived in the home. New staff have done basic training (induction) in how to work with people with a learning disability, this means they have more understanding in how to care for people who live at the home. What has improved since the last inspection? A new manager is in place at the home, she has lots of experience of working with people with learning disabilities and is very enthusiastic about making improvements to the quality of life for the people who live at the home and all the management systems. New flooring has been provided in the bathroom which has improved those facilities. The manager has better organised the layout of her office space and provided more storage for the paperwork which provides an improved working space for the manager/ staff and for people to visit. Questionnaires and face-to-face discussion with relatives indicate that some relatives remain dissatisfied with some aspects of care provided to their sons or daughters. This has resulted in long-standing unresolved issues between some relatives and the home. The management have held regular meetings and had regular conversations with these relatives since the last inspection which have improved levels of communication and started the process of collaborative working. Staff have done a lot more specialist training around looking after people with problems associated with learning disability. The manager needs to make sure that the training is directly related to the needs of the people that live in the home so their care needs are met appropriately. The manager has ensured that the staff and people who use the service have had lots of specialist support from health professionals, it is important that the staff all follow their recommendations consistently to improve the health and welfare of the individuals. DS0000002910.V356046.R02.S.doc Version 5.2 Page 7 The manager has fully investigated all complaints received and maintained more detailed records of investigations and the action taken. People who have made complaints have been informed of the outcomes. What they could do better: Two requirements remain from previous inspections and nine from the last inspection in February. The management need to look at all requirements made at this report and put in place an effective improvement plan to address all deficiencies within the timescales given. Staffing levels need to be reviewed regularly to make sure there are enough staff in the home to meet the needs of people and carry out all of their duties safely. People need to have a better plan of activities/interests and records kept to show that they are happening. Records of people’s personal care support, bowel monitoring, exercises and weights need to be kept to ensure that they are receiving the care they need. When people have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help people to take it. They must ensure that to protect the individual’s rights to refuse medication, medication is only given covertly when it has been agreed in a multi agency forum that this is in the best interest of the service user and a signed agreement has been obtained from health professionals. Staff must have clear guidance on when to administer the medication in this way. They must make sure that the risk of assisting people with mobility problems are reduced by ensuring all staff use the appropriate equipment to move and handle people safely. They must make sure that people’s health and safety is protected when using bedrails by competing full risk assessments and ensuring that the equipment is checked regularly. They must ensure that all staff have received training in safeguarding adults and that this is regularly updated to offer full protection to service users. All the staff are receiving one to one supervision from their manager but this is not happening as often as it needs to. Staff must be provided with more regular, formal support, to ensure they are provided with all the guidance; leadership and support they need to ensure they receive management feedback on their performance. Some people who use the service display behaviours, which can be difficult to manage from time to time. A lot of the staff reported through surveys and DS0000002910.V356046.R02.S.doc Version 5.2 Page 8 discussions that they had not had sufficient training to equip them for the challenges they faced. This must now be provided to ensure the rights and interests of individuals are promoted and to ensure staff to have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way. Carpets that are stained must be cleaned more regularly to ensure that the individuals live in a home which is pleasant and comfortable. They must provide appropriate toilet facilities which will better ensure the individual’s comfort and dignity. They must make sure that the individual and the staff are not exposed to risks from the moving/handling equipment stored in the individual’s room and efforts are made to ensure the room is homely and comfortable. They must make sure that all staff know the procedure to be followed if there was a fire at the home, this will better protect everyone’s safety in the home. 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. DS0000002910.V356046.R02.S.doc Version 5.2 Page 9 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 DS0000002910.V356046.R02.S.doc Version 5.2 Page 10 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 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the homes information documents, such as the statement of purpose, were up to date to provide the information that people thinking of using the service or their carers need to enable them to make informed decisions about the homes capacity to meet their needs. Systems are in place to ensure individuals have their needs assessed prior to admission to the home. EVIDENCE: There had been no new admissions to the home in the last year and the home was fully occupied. Six people reside at the home and two were present during the visit. Assessment of this outcome group was based on examination of records and information given by people in face-to-face discussions and questionnaires. The acting manager was unable to locate a copy of the homes statement of purpose, but an assurance was provided that one was in place and had recently been reviewed and updated. This was later provided and appropriate. A copy of the service user guide, which gives information about the home, was in place. The guide was out of date and must now be updated to show the recent change in manager, current staffing, outcomes of quality monitoring arrangements and to include more information about fees and charges. DS0000002910.V356046.R02.S.doc Version 5.2 Page 11 The admission procedure was sufficient to guide staff on the actions to be taken to ensure prospective individuals needs are properly assessed and planned for. All the files looked at contained a copy of the local authority care plan, updated plans were in place for those persons who had accessed reviews and evidence seen showed information contained in these had been used to develop individual care plans. Records showed individuals had been issued with a licensing agreement in 2003.The resident’s representative had subsequently signed these in 2006. People who use the service had also been issued with a letter from Mencap in April 2005 detailing charges for services. There was nothing to show individuals or their representatives had been advised of charges for 2006/07 as identified at the previous site visit in February. It is important that each individual and or their representative know what he or she is paying for and any terms of residency. Mencap is advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home and should be updated as fees change. There were two people at home during the visit. Neither person could give information about their care needs and the input they required from the staff and outside professionals. At the present time people who use the service are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff. DS0000002910.V356046.R02.S.doc Version 5.2 Page 12 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are not fully supported by the current care records in place, however improvements have been made to some of the records. EVIDENCE: All people that live in the home have a care file, and the inspector is aware that the home is in the process of introducing new planning paperwork; the manager has started to develop plans for people which are more person centred, however it is important that these plans are developed from current assessments to ensure all needs are planned for. With the new paperwork there is a clear shift away from plans that are task focussed and the plans in development seen contained much more evidence about promotion of independence, preferred routines and how residents exercise choice within their individual capabilities. A number of the new plans did detail however that residents required “full support” in many areas which does not give staff clear guidance on how to deliver the care. DS0000002910.V356046.R02.S.doc Version 5.2 Page 13 Three of the existing plans in place were looked at; improvements were seen in how the acting manager has updated the plans where changes in residents needs had occurred although a number of inconsistencies remained, for example a newly devised care plan for an individual who has an ileostomy detailed “report all concerns” however there was no guidance in place to support what constituted a concern. People who use the service have a summarised user friendly formatted plan in place “my plan”, these now need to be updated. There was better evidence to show that formal reviews of care plans involving staff at Salisbury Court, the resident and or their representative, and relevant others were now taking place, although this is not six monthly. One relative detailed however that she was very disappointed that no staff members from the home were present at her son’s review meeting with the local authority held earlier in the year. There was evidence that the home has arranged advocacy support for individuals when this has been needed. Discussion with staff and examination of records evidenced one individual who regularly exhibits challenging behaviours. The home has worked very closely over the last nine months with health and social work staff to provide a more consistent approach in their management of these behaviours. The health staff have provided for this individual a clear behaviour management plan and management flow chart and this has been supported by clear management behaviour strategies which are provided for staff on an easily accessible chart. However a decision has been made with the family and at a multidisciplinary level to provide more appropriate placement for the individual. There was some evidence that staff better understand how challenging behaviour incidents are to be recorded, although much more detail is required in the section of “action taken” as many of the records seen did not describe in full the action staff had taken; many records merely detailed, “left alone” Given the need for staff to be very consistent in their approach and for the actions of staff to be analysed effectively to determine future interventions and management strategies, staff need to more fully describe their actions. The home has not developed any formal systems of reviewing the incident records, the manager confirmed that the social work team are completing this although there are no records of formal review/ evaluation in place. Six of the staff accessed a training course in the management of challenging behaviours and use of diffusion and diversion techniques in March 2007, however since then a number of these staff have left; other existing staff and new staff have not received any training. From staff surveys and discussions during the visit many staff stated that they were concerned at the levels of challenging behaviour displayed and did not feel confident or competent in DS0000002910.V356046.R02.S.doc Version 5.2 Page 14 dealing with incidents. One staff survey detailed “ I was totally unprepared for the level of challenging behaviour when I started work at the home.” There were risk assessment tools for mobility, bed rail provision, medication and general issues; high risk areas had been identified and care plans were in place to support appropriate care provision in most cases. Risk assessments to support the use of bed rails is covered in more detail in the final section of this report. DS0000002910.V356046.R02.S.doc Version 5.2 Page 15 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. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing issues have affected many of the individual’s opportunities to participate in activities or leisure pursuits that meet their needs or access a holiday with the home. Individuals are enabled to keep in contact with family and friends. Improvements have been made to ensure the people who live in the home receive a healthy varied diet according to their assessed needs and choices. EVIDENCE: On the day of the site visit four of the six people who use the service were attending day services, the two remaining individuals stayed at home for the day. All of the people who use the service are reliant on staff and family members recognising and identifying their likes and dislikes and for helping them make decisions and choices. DS0000002910.V356046.R02.S.doc Version 5.2 Page 16 In discussion staff displayed good knowledge of the individual’s needs, likes/dislikes, family support and records contained information on people’s religious observances. None of the people who use the service attended any religious services, other than carol concerts etc at Christmas. The manager confirmed that she had continued to develop positive relations with the neighbours with good results. None of the people who use the service were able to access a holiday this year, the manager is in the process of arranging holidays for all the people who live at the home in 2008.The manager has tried to arrange “special days out” for the people who use the service and one individual visited a local butterfly park which staff said was very successful. One of the relatives commented that all the residents were promised days out as they had not been on holiday this year, but she felt these had not been arranged yet. During the site visit three care files were examined, activity plans were in place however these needed to be updated to reflect the current leisure activities the people who use the service participated in. Daily records of leisure were found to be incomplete, some records were not completed daily and many were found to be very minimal; for example “out for meal” and “socialising with others in lounge”. People who use the service have access to a range of leisure activities in the community including, swimming, walks, pub meals, shopping trips etc. They also have access to more specialist services including, trampolining, hydrotherapy and horse riding. In addition individuals have access to a range of indoor activities such as jigsaws, DVD’s, books, foot spa’s and sensory equipment. Evidence from surveys and discussions with staff revealed that many activities and outings arranged by staff have had to be cancelled over recent months due to the dependency needs of other residents and the impact on the staff support required. A relative survey detailed, “He used to go to the Auditorium, he hasn’t been for a long time. His use of hydrotherapy and swimming sessions seems very infrequent”. One of the health professional surveys detailed “ I am concerned that the people who live at the service have little social life and lives are dictated by house routines”; this was evidenced on the morning of the site visit as the inspector observed two members of staff complete shopping, cooking, housework, paperwork, personal care however meaningful interaction with the two people at the home was seen to be minimal with both staff members talking to them in passing and playing a DVD. The manager however sat down with both individuals and spent time talking and providing sensory support with toys and activities. Staff have not had any particular training in organising and implementing activity programmes for people with complex needs. Consideration needs to be given to providing relevant training in this area. This said, it was positive to see that the manager had arranged for the people who use the service to access numerous outings over the next few weeks DS0000002910.V356046.R02.S.doc Version 5.2 Page 17 including carol concerts, Christmas lights and a trip to see the Pantomime at the Auditorium; she had worked closely with day services to ensure that these outings would not be cancelled due to staffing problems. Birthday parties at the home for two of the people who use the service had also been arranged, the manager told the inspector how she had arranged for an entertainer to visit at a birthday party earlier in the year which had been very successful. Discussion with staff and relatives indicated that people who use the service have contact with their families and they are able to visit the home and see people in private if required. They can use any of the communal facilities and there is no restriction on visiting times. A number of residents also visit their families at home regularly, often staying for the weekend. Key workers helped individuals to maintain family contact by sending cards at significant occasions such as birthdays and Christmas, however staff turnover in recent months has impacted on this; one relative wrote in their survey “ This year was the first time our son did not send birthday cards etc.” The people that live in the home have their own TV, music systems and personal items in their bedrooms. All the people who use the service receive day services provided by the local authority where they have the opportunity for continued personal development for example; through participation in art, craft, cookery, road safety, music classes and communication and life skills training dependant on their individual needs, likes and dislikes. It was identified at the previous inspection that some relatives were dissatisfied with aspects of care provided to their son or daughter. This has resulted in long-standing unresolved issues between some relatives and home; it was clearly affecting staff moral at the time. There was good evidence at this inspection visit that the management have started to address this more robustly; the manager on commencement of her post visited all the relatives of the people who use the service. The Area Manager and manager have since had regular meetings and telephone conversations to improve communication with these families. Staff have also accessed training in effective communication. From discussions face to face and on the telephone with the inspector, a number of families accept that communications have improved however they feel some of the issues have not been fully addressed. Staff told the inspector that they feel more supported in dealing with the families. People who use the service are provided with three meals a day and a varied menu was available. The home has consulted with the dietetic department at the Primary Care Trust about the menu. (this is covered in more detail in the following section of the report.) Staff spoken to said the meals were of good quality and confirmed a choice of food was available, including fresh vegetables and fruit, this was confirmed by examination of a sample of menus. Staff advised that individuals receiving day services have a cooked meal at the centre. When not attending the day centre staff cook a main meal for the resident(s). DS0000002910.V356046.R02.S.doc Version 5.2 Page 18 Staff were observed assisting the people who use the service to have drinks and to eat a meal, assistance was provided in a sensitive and timely manner. Staff were seen to provide adapted cutlery and had prepared the food to suit the individual. The kitchen was clean, tidy and well stocked. DS0000002910.V356046.R02.S.doc Version 5.2 Page 19 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 and 20. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visit to the home The health needs of some of the people who live at the home has not always been met consistently and gaps in some of the records could risk individuals not receiving the care they need. Medication was generally well managed in the home but service users right to refuse medication was not always appropriately managed. EVIDENCE: All the people who use the service are registered with a GP and records of visits by health care professionals are maintained. Records showed individuals have access to chiropodists, dentists and optician services, with records of any visits being written into their care plans. There was evidence in the individual plans to show relevant health care professionals had been consulted regarding specific care regimes and advice obtained had been incorporated into the relevant plans. However there are concerns from a number of health care professionals that the guidance they have put in place has not always been followed consistently by some staff members. One survey detailed “Improvements are needed for all staff to respect and follow guidelines put in place by external professionals”. DS0000002910.V356046.R02.S.doc Version 5.2 Page 20 There was good evidence that the manager has closely liaised with a number of health and social care professionals in recent months to access services and support for a number of individuals, these include: the clinical nurse specialist, clinical psychologist, psychiatrist, stoma therapist, physiotherapist, dietician, speech and language therapist and orthotic department. Staff have also had training sessions in the team meetings from a number of these professionals to provide them with specific information and support to promote more consistency in the quality of care at the home. In all three care files examined there was a health action plan was in place, not all the documents had been signed by the individual’s representative. Inspection of the supplementary records in the care files identified gaps in the records for some individuals such as weight monitoring, personal care provision and bowel monitoring. This could mean those people are at risk of not receiving the care support or professional input that they may require. At the previous inspection it was identified that the home did not have any equipment to measure the weight of non ambulant individuals; following this the manager has liaised with day services to ensure those individuals are weighed when they are there; however records showed that this had only been carried out for one of the residents in October 2007 although the care plan indicates the individual should be weighed monthly. The manager has taken the decision to stop using specific personal care records however not all the staff are detailing the personal care provision in the daily records as they have been directed to do. In one file there was little evidence to support a concern raised by a relative that her son had not received a daily bath. Professional guidance indicates that one of the individual’s behaviours are triggered by their concerns about having their bowels opened at the home. There is evidence that the acting manager has consulted with the clinical psychologist around staff support in this area and concerns that the individual is reluctant to open their bowels at the home is being managed more effectively with the family. However the records to support bowel monitoring were not maintained regularly; it was not clear that staff had sought information from the day services or relatives to complete the chart, nor if the blank records were an indication that the individual had not opened their bowels or that staff had not completed the record. Given the concerns about the consistency of staff support in managing this service user’s behaviours, it is vital that staff monitor more effectively one of the main triggers for the person’s behaviour problems so that they can anticipate better the care needs of the individual. The food intake records for one individual evidenced that in recent weeks he was regularly refusing his breakfast, the care plan records did not evidence what action was being taken regarding this. The individual’s weight had not been monitored regularly. DS0000002910.V356046.R02.S.doc Version 5.2 Page 21 Concerns had been identified to the inspector by staff and a relative that the dignity of one of the individuals was not being maintained and promoted with regard to their toileting needs and care. The manager confirmed that she had involved the occupational therapy team to support the home in ensuring appropriate style of lavatory facilities/equipment would be provided to resolve this problem. There was good evidence that the home had recently accessed the support of the physiotherapist to review an individual’s moving and handling needs; a range of hoists and mobility equipment have been trialled by staff in the home. There are concerns that at the time of the visit there were two mobile hoists, a large mobility aid and a wheelchair stored in the person’s bedroom which poses a risk to the health and safety management in the room. There was also evidence from discussions with staff that not all staff were using the identified equipment and following safe moving and handling procedures set out in the risk assessment and care plan. Records evidenced that staff have accessed courses in moving and handling; more recent practical training for staff has also been provided by the physiotherapist on the use of the mobile hoist provided for this resident. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision, medication, nutrition and general issues; high risk areas had been identified and care plans were in place to support appropriate care provision. The risk assessments for bed rail provision were found to be minimal and did not comply with guidance issued by The Medical Devices Agency; this is covered in more detail in the last section of the report. A small number of staff have accessed training on risk management. Some people who use the service had daily exercise programmes in place devised by a physiotherapist. One of the care plans examined contained an exercise programme however there were no records to support staff were implementing the programme. There was evidence that staff from the home accompanied one of the individual’s parents to a meeting with the dietician, there had been concerns about the diet provided at the home. New menus to meet the specific dietary requirements of the resident were discussed which have now been implemented. Medication systems were examined and policies and procedures were in place, which covered most areas of management. Fourteen of the staff have now completed medication training. Storage of all medications and stock control was found to be satisfactory, the manager has made improvements by providing storage containers for each individual’s medication; the temperature of the storage area is now regularly monitored. None of the people who use the service had been prescribed controlled medication; the home does not have a controlled drugs cupboard which DS0000002910.V356046.R02.S.doc Version 5.2 Page 22 currently poses no issue. At the time of the visit, none of the residents had been prescribed medication which requires refrigeration, as storage in the home is very limited the acting manager has purchased a specific lockable container for such use. Whilst this is acceptable in the short term, the management should look into providing appropriate facilities for storing medication which requires refrigeration. Checks on a sample of medication records showed that improvements had been made; all medications had been signed for, transcribing had improved with two staff signatures now in place and running balances of medication were now being accurately maintained. Copies of the patient information leaflets for each medication from the dispensing chemist were now in place. At the previous inspection a requirement had been made to ensure that “p.r.n.” (as and when needed) medication had guidelines for use in place, this was to ensure staff understood when this medication should be given and to ensure consistency of practice. There was good evidence that guidance had been put in place on a number of individual’s charts, however an individual who had been prescribed a medication for behaviour management five days previously did not have any guidance for staff in place. Given the importance of continuity of practice for this person it is vital that staff are fully aware of when the medication is to be administered. Also a survey from a health professional detailed “I have experience of staff not thinking to give p.r.n. pain relief to people with cold/ flu symptoms or have hurt themselves” Staff told the inspector that three of the people who use the service were currently accepting their medications in food; there was no evidence that this action had been discussed and agreed with their representative, the G.P. or care manager. Covert administration was discussed with the manager and she was advised that this practise must be discussed and agreed in a wider forum including the individual where possible or their representative to ensure that the individual’s right to refuse medication is upheld and to ensure all options have been explored. DS0000002910.V356046.R02.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. However because not all staff have accessed “protect me training” or training in managing challenging behaviours and the arrangements for managing challenging behaviours have been inconsistent at times, people who live in and work in the home are not protected from the risk of harm. EVIDENCE: The home has a formal complaints procedure. There had been no complaints to the Commission since the previous inspection; the home had received eight complaints in this time. Examination of the records evidenced that the process of reporting, investigation and outcome management of complaints was much more robust. The manager had maintained detailed records to support the process. The manager has also maintained detailed records of all her communications with relatives and any concerns raised since she has been in post. Action she has taken to address the issues was documented. This said many of the concerns raised are long standing issues around standards of cleaning, laundry, staffing shortages/ turnover and provision of social activities about which some families remain dissatisfied. Discussions with relatives during and following the inspection visit confirmed that although they consider the manager is trying hard to improve the standards in the home she is limited by funding and organisational constraints. DS0000002910.V356046.R02.S.doc Version 5.2 Page 24 Staff spoken to raised concerns about the levels of challenging behaviour exhibited by a resident in the home. The manager has been instrumental in trying to arrange the provision of a safety appliance for an individual. Most of the staff surveys detailed concerns around this matter. One staff member wrote “I and other staff members, are frequently frightened for the safety of the service user with challenging behaviour as well as our own safety. Staff frequently suffer from being hit, kicked, head butted and being bitten. This is now a regular occurrence and although the service user is to move to other provision, in the meantime we remain unprotected from this violence and aggression. This has led to low moral in the staff team and unwillingness to pick up extra shifts.” Following the last inspection, challenging behaviour training had been provided to twelve staff in April 2007, some of these staff have now left the service and many staff reported through surveys and in discussions that they felt they had not received sufficient training to equip them for the challenges they faced. Staff have had support however from the nurse specialist from the community learning disability team and clinical psychologist in how to follow clear strategies to provide more continuity in behaviour management. Information received prior to the site visit and discussion with the manager indicated the home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. When asked about abuse, what it was and what they would do if they suspected or saw any abuse, staff stated that they would report it to the manager. Training records evidenced that six staff had accessed safeguarding training with the local authority; not all the staff have accessed “protect me’ training which is provided by the organisation. Staff at the home manage pocket money accounts for all the people who use the service. Records to support the management of these accounts were clearly maintained with receipts held for any transactions carried out on behalf of the individuals. Those checked balanced with the cash held. DS0000002910.V356046.R02.S.doc Version 5.2 Page 25 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, 27, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is decorated and refurbished to a good standard, thereby providing people with a safe and comfortable home to live in although more regular cleaning/ replacement of some of the carpets would provide a more pleasant environment. Work is in hand to provide specialist toilet facilities which will meet the assessed needs of individuals. EVIDENCE: The home has a warm and homely atmosphere, people who use the service were observed to be settled and comfortable in their surroundings. All areas of the home were seen to be very clean and tidy with the exception of the carpets in the corridor and dining area .The carpets were stained and staff were undertaking spot cleaning regularly, the manager said she had arranged some weeks previously for an external cleaning contractor to clean the carpets but on the day of the visit these were found to be unsightly. The home was free from any offensive smells. It was well decorated and maintained, the furniture and fittings were of good quality. DS0000002910.V356046.R02.S.doc Version 5.2 Page 26 All bedrooms seen were clean and tidy and were furnished and decorated in a homely style. Many individuals had their bedrooms furnished with a range of personal items. The manager has improved the storage of paperwork in the home. She has reorganised her office space however this remains limited as the bed for the night sleeper takes up the majority of space in the room. The lighting in the office was not adequate and requires improvement. Improvements to the toileting facilities to meet the needs of one of the people who use the service are in hand as previously detailed in the report. Other improvements such as new flooring in the bathroom and new bath sides are on order. A new industrial style washing machine has been provided in the laundry room. A tour of the home showed the environment is suitable for the needs of people with physical disabilities. Doorways to bedrooms, communal space and corridors are wide enough for people in wheelchairs or people with walking aids. Discussion with the staff indicates that there is a wide range of equipment provided to help them move and handle people safely and to encourage resident’s independence within the home. This includes a mobile hoist, bath aids, stand aids, slide sheets, moving belts and handrails. However the provision of adequate storage space in the home must now be addressed to meet the changing needs of the people who use the service and the increased provision in the home of moving and handling equipment. A gate has been provided on an individual’s bedroom doorway to prevent another individual entering and moving his belongings. This was a request through the family and care management. A risk assessment has been put in place. New photographs of the people who use the service had been put up in the hallway, staff told the inspector how careful they had been to capture a positive likeness, which they clearly had. New mobiles had been provided in the sitting room which staff reported the people who use the service liked to watch. A fire risk assessment was in place and the manager had reviewed this within the last twelve months. The manager confirmed that the garden had looked very attractive in the summer months and people who use the service had enjoyed spending time outside. She said that one of the relatives is providing a summerhouse and some sensory/ interactive play equipment for the garden area which they hope to have in place by the spring. DS0000002910.V356046.R02.S.doc Version 5.2 Page 27 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, 35 and 36. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staff have experienced difficulties in managing the needs of all the individuals consistently due to the significant change in dependency levels and staff turnover. Staff have received much more training however concerns about moving and handling practices, communication and management of challenging behaviours are placing residents at risk. The staff vetting procedure is sufficiently robust to ensure the safety of the people who use the service. EVIDENCE: The inspector was informed that the home has 12 permanent staff, five of these work part –time. The manager said that there had been significant staffing problems over the last eight months with six staff having left the home, some of whom were relief and bank staff. The home employs relief care staff and has also used agency staff during this time. Many of the staff who have left had worked at the home for a considerable length of time; the number of new staff employed and use of relief/ agency staff during this time has therefore not always supported consistency and continuity of care for the people who use the service. DS0000002910.V356046.R02.S.doc Version 5.2 Page 28 The information from the AQAA document and discussion with the acting manager explained the number of staffing hours provided and the dependency levels of the people who use the service. Written and verbal feedback from the staff and relatives state that they feel there is not currently adequate staff rostered to support individual needs. Staff have the responsibility of cleaning the home, laundry, gardening, shopping, preparation of meals, supporting people to attend appointments, activities, and in addition to this attend to the residents care needs and complete relevant documentation. In the recent months concerns around one of the residents behaviours led the management to secure extra funding of ten hours per week, this was considered by the manager to be used in the mornings Monday – Friday for two hours from 7a.m. until 9a.m. to support the routines at that time. There was evidence from the rota that these extra hours had not always been covered, two out of the three shifts for the week of the site visit were not covered. The manager confirmed that the individual was regularly being returned from the day centre and that this was impacting of the provision of activities/ social outings for the other people residing at the home; there was no evidence that further staff had been rostered if this occurred. Given the increase and severity of incidents and injuries to staff in recent weeks and that many staff did not feel confident and competent in dealing with the levels of challenging behaviours an immediate requirement was issued to review the staffing whilst the resident was in the building. Following this the inspector was informed that the manager had been directed to spend more time working on the floor supporting the staff, the extra two hours in the morning had been covered, the day services would ensure they had staffing levels in place to manage incidents and also feedback from the home and health professionals indicated that the resident had responded well to the new medication regime in place. The hours provided by the home would appear sufficient at this time however it is important that the management monitor and review these regularly and provide extra staff if necessary. The manager has taken action to try and improve communication systems in the home. Staff meetings are held monthly. Ten staff completed a course in effective communication in November. She has communicated more regularly with all of the relatives and changed the staff handover systems. Staff felt the improvements were positive and they were better informed of any changes. One relative felt that communications between the home and the day services could be improved and another said “we still find staff start work without reading the daily diary”. There was further evidence from relatives and health care professionals that shift handovers still needed to be improved. A recruitment and selection policy and procedure and equal opportunities policy was in place. Checks of two staff files showed that Pova checks, CRB DS0000002910.V356046.R02.S.doc Version 5.2 Page 29 checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. One other staff file showed that the employee had started work before their CRB check had been obtained by the home; the home had obtained a POVA check. This person had been employed as a support worker and had been supervised by the senior staff member on duty to ensure that they did not have unsupervised contact with people who use the service. Staff access a corporate induction programme; the programme meets Skills for Care Common Induction Standards and the existing Learning Disability Award Framework (LDAF). Records were in place to show that four of the recently recruited staff had worked through the programme, signatures for completion of the modules were in place. Two of the staff surveys detailed that they considered the induction programme was thorough; they had completed the workbooks however felt that they had learnt more from working with staff on the floor given the complexity of needs of the people who use the service. The home currently has met and exceeded the target of having at least 50 of care staff trained to level 2 NVQ. Eight of the staff (66 ) have now achieved this qualification . The acting manager has developed a current training plan for the staff and records of training accessed by staff were found to be up to date and well maintained. Safe practice training including; moving and handling, first aid, food hygiene and fire safety was in place and records evidenced staff are up to date with this training. Update training is provided every three years. The majority of staff have now completed the safe handling of medications course with evidence that further staff are currently working through the modules. Some staff have accessed risk assessment training and the manager has arranged for staff to complete training in infection control and health / safety over the next few months. A requirement was made at the previous report to provide training for staff that was resident specific and relevant to the care of persons with complex learning and physical difficulties. Comments on surveys from health professionals detailed, “staff need considerable retraining” and another one commented “staff need further training”. There was good evidence that in recent months the acting manager has tried to address this, staff have accessed courses in: communication, Autism, eating/ drinking, stoma care, rectal diazepam, and epilepsy. Training for staff in the specific communication methods of one resident is being arranged. Discussion with the staff revealed they were generally very positive about the learning and development they had been able to access although some comments in staff surveys regarding the training provided at the home DS0000002910.V356046.R02.S.doc Version 5.2 Page 30 included “ The training we receive is comprehensive but I feel that it does not always reflect the needs of our service users (i.e. profound multiple learning difficulties) and tends to be aimed at higher ability service users” and “The training we get is standard and often unrelated to our service users”. Therefore it is important that the acting manager ensures that the training courses staff are accessing are relevant to the service user group at the home and that she is able to spend time working with staff to ensure that the information and skills learnt can be put into practise to improve the quality of care and provide more consistency. None of the staff had had an appraisal. A staff supervision programme was in place and each staff member received supervision from the acting manager or area manager in her absence. Examination of a sample of supervision records showed some staff were not in receipt of regular supervision as a minimum of six times a year. This remains an outstanding requirement from previous inspections and action must now be taken to address this. This is needed to ensure staff receive the support and direction they need and to ensure staff receive feedback on their performance. DS0000002910.V356046.R02.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements were noted with some aspects of the management and organisation of the home. However individual’s health, welfare and independence would be increased with improved management of challenging behaviours, care documentation, activity provision, care plan information, monitoring of staff practice, regular review of staffing levels and the full implementation of a structured quality assurance programme. EVIDENCE: The manager has been in post since March 2007.She has considerable experience in working with people with learning disability; this is her first manager’s position. Unfortunately the manager was unavoidably absent from the home during May and June and during that time the area manager provided management cover at the home. DS0000002910.V356046.R02.S.doc Version 5.2 Page 32 The manager confirmed that when she had taken over from the previous manager there were significant areas for improvement identified within the home. It must be said that the manager has also had to deal with some very complex issues such as: improving relations with some of the families due to the long standing concerns, managing the care for the resident with very challenging behaviours, improving the working practices of an existing staff group many of whom have been resistant to change and managing the significant staff turnover. It was evident at the site visit that the manager remains very committed, positive and enthusiastic to the challenges of her post. Health professionals comments included “ There are some good staff at the service and the new manager is motivated to develop the quality of the service however she has met considerable resistance from some staff members” and “There are factions within staff teams that actively undermine their peers; the manager lacks support”. Staff comments around management support include “I believe the manager supports as much as she is able, there were a great many things wrong with the building when she was appointed and she is getting them sorted, equally there was evidence of poor practice in some areas but this is now much improved” and “I am proud to be a part of the team at Mencap. My manager is absolutely brilliant, although there are a lot of staff who don’t like the changes she has made and have made it very difficult for her, she is trying to improve the standards in a very professional manner”. The manager has very limited support from the senior staff in the home to be able to effectively delegate any of her management and administration duties and therefore she has been fully responsible for improvements and maintenance of these systems. It is also important that the manager has enough time to work “on the floor” with staff to monitor and improve their practice and to clearly get to know all the individual resident’s current needs to be able to complete the new care plan documentation. Evidence from this inspection demonstrates that she has tried very hard to accomplish many of the improvements needed but requires more management support to effectively improve the quality of care provision in the home and fully action all the outstanding requirements. The manager has reorganised her office, and has made the most of the limited space. A new computer system has been provided and the manager is keen to improve her computer skills. Some admin support has been provided from Mencap area office for typing and the manager needs to organise her work to make effective use of this support. The manager has started to implement a formal quality assurance programme in the home in line with the corporate programme. Comprehensive audits are to be carried out monthly; there was evidence that these had been completed in the home in July and October. Mencap has external assessors who visit their DS0000002910.V356046.R02.S.doc Version 5.2 Page 33 homes and following an assessment a detailed report on their findings is provided; a visit was carried out to the home on the 29/11/07.Surveys had been sent out to all relatives. Regulation 26 visits take place monthly and reports are provided of these visits. Regular staff meetings have been held. A decision has been made not to hold group relative meetings given outstanding issues and regular meetings/ communications have been made with the individual families. The home has developed a continuous improvement plan for this year, which covers the requirements identified in the previous inspection report. It is important that a structured plan is also put in place to monitor the quality of care and services provided to people who use the service, and to have systems in place to show how individuals, staff and relevant others for example; relatives, social services care managers and healthcare professionals are consulted about care delivery arrangements. The manager has yet to produce an annual development plan which details how they consult with people and the outcomes of this consultation. A report then needs to be produced showing how the comments from these individuals have shaped or altered the practices within the home, and show how the home is run in the individual’s best interests. General health and safety was maintained via adherence to policies and procedures, staff training and the maintenance of equipment. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment and checks were all in place and up to date and the fire risk assessment had been updated. Records showed that staff had not accessed a fire drill in the last twelve months. General environmental risk assessments were in place. Records of accidents were maintained with evidence that they had been followed up by the manager. Hot water temperatures in the home are regularly monitored and maintained at acceptable levels. Four individuals in the home have bed rails in place. There was evidence that risk assessments were in place however these were found to be very basic and did not cover all areas identified in the guidance issued from the medical devices agency to ensure the individual’s safety. There was no evidence that the rails were being checked on a regular basis in line with this guidance. As indicated in other sections of this report the manager had devised a training plan to incorporate safe practice training, including updates. Records showed staff had accessed required training; however there was evidence that not all staff were following the moving and handling practices set out in the care plan for one resident which must be addressed to protect the safety of the resident and the staff concerned. Storage of two mobile hoists, a stand aid and a wheelchair in one individual’s room poses a risk to the health and safety management in the room and is not DS0000002910.V356046.R02.S.doc Version 5.2 Page 34 providing a homely, comfortable environment for that person. Appropriate storage areas for large items of equipment must be provided. DS0000002910.V356046.R02.S.doc Version 5.2 Page 35 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 2 2 X X 2 X DS0000002910.V356046.R02.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) Requirement Timescale for action 30/04/08 2. YA36 18 (2) 3. YA36 18 (i) 4. YA5 5 (1) (b) The registered person must ensure that individual plans are reviewed with the service user, significant professionals and family, friends and advocates every six months, so that all their needs are met as they change. Timescale of 28/09/05,01/06/06 and 30/04/07 not met. The registered person must 31/05/08 ensure that the frequency of staff supervision is a minimum of six times a year (pro rata for part time staff) so that staff receive appropriate levels of support and direction. Timescale of 28/09/05,1/6/06 and 30/04/07 not met. The registered person must 31/05/08 ensure annual appraisals are completed and that these give clear information on the training and development needs of the worker which will ensure training plans and priorities reflect the training and development needs of the staff team. Timescale of 30/04/07 not met. Each resident must be given a 31/05/08 DS0000002910.V356046.R02.S.doc Version 5.2 Page 37 5. YA1 5 (1) (b) 6. YA23 13(6) 7. YA19 13 personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. Information must be updated when there is any change to fees or charges. It is important that this fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations. Timescale of 31/03/07 not met. The registered person must 30/04/08 revise the homes service user guide to provide general fee information and to provide details of the registered manager and current staffing. The guide must be produced in more accessible formats to ensure residents or their representatives have access to all the information they need to help them decide if the home is right for them. Timescale of 31/03/07 not met. The registered person must 31/03/08 implement a system in the home whereby incidents of challenging behaviour are reviewed with a view to informing best practice in such circumstances. Information obtained must then be used to inform and support individual risk assessments and behaviour management plans to protect the rights of residents and to ensure their welfare and safety. Timescale of 13/03/07 not met. The registered person must 30/04/08 purchase or make available other arrangements, which ensure DS0000002910.V356046.R02.S.doc Version 5.2 Page 38 8. YA20 9. YA23 10. YA23 11. YA38 residents with mobility problems can be weighed. Care plans should detail how often individuals should be weighed. This is needed to ensure the health and welfare of individuals is promoted and any issue with weights are identified. Timescale of 31/03/07 not met. 13(2) The registered person must ensure detailed written guidance for use of as and when (PRN) medication is in place. This is important because staff need to understand when this medication should be given and to ensure consistency of practice. Timescale of 13/03/07 not met. 13(6) The registered person must ensure staff identified in the homes training log as needing ‘protect me’ training, receive this training. This is needed to ensure staff know how to recognise poor practice and to ensure they are aware of and understand the systems in place for reporting and investigating adult protection matters. Timescale of 30/04/07 not met. 13(6)18(i) The registered person must ensure all staff are provided with challenging behaviour training by a competently trained person to ensure staff have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way and to ensure the welfare and safety of both residents and staff. 24 (1)(2) The registered person must ensure that an annual development plan for the home is produced. This must show how individuals, relatives and other key people are consulted about services provided by the home DS0000002910.V356046.R02.S.doc 31/03/08 31/05/08 15/04/08 31/05/08 Version 5.2 Page 39 12. YA13 15 16(2)m and n 13. YA14 16 m and n 14. YA19 13(b) 12(1) 15. YA19 12(1) 16. YA19 12(1) and any action taken to address any issues raised by these individuals and any internal or external audits. A summary report must be made available in the service user guide. Timescale of 31/03/07 not met. The registered person must ensure that activity plans are updated to reflect the individual’s current needs and preferences. Records of activities the individual has participated in need to be completed to support the plans. This will better evidence that the home is supporting service users to meet their social needs. The registered person must ensure that people are able to take a 7 day holiday or a series of one day outings as part of their contract price so that they are enabled to take a break from the home and the people they live with. The registered person must ensure that guidance put in place by external professionals is followed consistently by all staff. This will better ensure that people who use the service receive the care that they need. The registered person must ensure that supplementary records such as bowel charts are completed appropriately to ensure the staff are monitoring effectively the health needs of the individual. The registered person must ensure that records are completed by staff to demonstrate that exercise programmes put in place for individuals by health professionals are being implemented. This will better DS0000002910.V356046.R02.S.doc 31/03/08 31/05/08 31/03/08 20/03/08 20/03/08 Version 5.2 Page 40 17. YA20 12 (2)(3) 13 (2) (6) 18. YA30 23(2)d 19. YA29 23(2)l 20. YA27 23(2)n 21. YA24 23(2)c 22. YA33 18 ensure the health needs of individuals are being met. The registered person must ensure that to protect the individual’s rights to refuse medication, medication is only given covertly when it has been agreed in a multi agency forum that this is in the best interest of the individual and signed agreement has been obtained from health professionals. Staff must have clear guidance on when to administer the medication in this way. The registered person must ensure the carpets in the communal areas are adequately cleaned to provide a clean and hygienic environment. The registered person must ensure that alternative and appropriate storage is provided for the moving/ handling and mobility equipment stored in an individual’s room. This will better protect the health and safety of the staff and provide a more homely environment for the individual. The registered person must ensure that appropriate toilet facilities are provided in the home to meet the needs of the individual people at the home. The registered person must ensure the lighting in the manager’s office is appropriate for her work. The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support the individuals assessed needs at all times. Staffing levels must be regularly reviewed to reflect individuals changing needs. DS0000002910.V356046.R02.S.doc 15/04/08 31/03/08 15/04/08 15/04/08 15/04/08 31/03/08 Version 5.2 Page 41 23. YA42 23(4) 24. YA42 13(5) 25. YA42 13(4) The registered person should 31/03/08 ensure that staff take part in fire drills at the home at least annually this will ensure the staffs response to a fire alarm can be assessed and further training be provided if necessary. The registered person must 15/03/08 ensure that all staff carry out safe moving and handling practices as identified in the individual’s care plans and risk assessments. This is to minimise the risk of injury to the individual and staff. The registered person must 15/04/08 ensure that risk assessments accurately determine whether an individual initially requires bed rail provision and evaluations must determine the continued need for them. Bed rails and protectors must be fitted and checked in line with manufacturers instructions and Medical and Healthcare products Regulatory Agency (MHRA) guidelines. This is to minimise the risk of injury to service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA7 YA9 YA14 Good Practice Recommendations The registered person should put in place care plans and risk assessments which reflect the principles of person centred planning. The registered person should provide support workers with relevant training in developing and implementing activity and leisure programmes for people with complex needs thereby ensuring individuals have access to meaningful DS0000002910.V356046.R02.S.doc Version 5.2 Page 42 3. YA1 4. 5. YA6 YA6 6. 7. YA18 YA23 8. 9. YA33 YA35 occupation. The registered person should ensure a copy of the home’s statement of purpose is available at all times to ensure people have access to appropriate information about the home. The registered person should ensure that health action plans are signed by all relevant parties to demonstrate their involvement and agreement. The registered person should ensure that all people who use the service have an allocated key worker who can develop a positive relationship with the individual and their family. The registered person should ensure that daily records evidence personal care provision for the individual to ensure these care needs have been met. The registered person must ensure that records of challenging behaviour incidents record in detail the action staff have taken in response to the incident. This will better ensure the records can be analysed affectively with a view to informing best practice and continuity of care. The registered person should ensure the systems for handover in the home are effective to provide staff with current information relating to individual’s needs. The registered person should ensure that the service specific training provided to staff is relevant to the service user group in the home. DS0000002910.V356046.R02.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000002910.V356046.R02.S.doc Version 5.2 Page 44 - 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. 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