CARE HOME ADULTS 18-65
Sharpe House 1 West Road Wiveliscombe Somerset TA4 2JS Lead Inspector
Kathy McCluskey Unannounced Inspection 24th November 2005 11:55 Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sharpe House Address 1 West Road Wiveliscombe Somerset TA4 2JS 01984 629220 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) Jedd International Ltd. Mr Declan Joseph Howlett Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: The home is located in the small town of Wiveliscombe and is situated a short walk from the local community facilities. Sharpe House is a large detached property arranged over two floors. The layout of the home would not be suitable for service users with a physical disability. All bedrooms are single and have hand wash basins. Some bedrooms are located on the ground floor. The home does not have a passenger lift to reach the first floor. The home has dining room, lounge, conservatory, and two bathrooms, domestic style kitchen, laundry room and well-presented garden. Sharpe House is registered with the Commission for Social Care Inspection to provide personal care for up to 10 service users, under the age of 65yrs, who have a learning disability. The home is not registered to provide nursing care. The home is owned by JEDD International Ltd. The registered provider is Mr Declan Howlett. The home does not currently have a registered manager. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day (4.75hrs) by two CSCI Regulation Inspectors Kathy McCluskey and David Kidner. The deputy manager Marek Vaca was available throughout the inspection. At the time of the inspection, 9 service users were living at the home. Five service users were attending placements/activities, though the inspectors were able to meet with the four remaining service users. Two staff members were on duty, including the deputy manager. A tour of the premises took place where all communal areas were seen. A period of time was spent unobtrusively observing interactions between staff and service users. Records relating to care, staffing and health and safety were examined. The inspectors would like to thank service users and staff for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well:
Sharpe House is situated in the heart of the small town of Wiveliscombe in Somerset. The home provides service users with a comfortable environment. Service users are able to choose from a range of communal areas or can enjoy the privacy of their own bedroom. The home has produced a Statement of Purpose and Service user Guide which provides service users and prospective service users with information about the home and the services it offers. The home has clear and consistent care planning systems in place and the home seeks the advice and input of other relevant professionals where required. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 6 The home has a good range of policies and procedures which are available to service users and staff. Some of these have been produced in symbol format for service users. Service users able to express a view stated that they were treated very well by staff. Service users stated that they would raise any concerns with staff if they had any. Interactions between staff and service users were noted to be relaxed and appropriate to the needs of service users. Staff stated that they felt well supported by the registered provider and were positive regarding the training opportunities available to them. What has improved since the last inspection?
At the last inspection, concerns were raised regarding the skills and abilities of staff in caring for service users with a learning disability. At this inspection, the inspectors were able to see evidence that the registered provider had been proactive in addressing this. Staff appeared more confident and were positive about the training and support they had received. All staff have now received training in Somerset Total Communication (STC). At least two staff have received training in Intensive Interaction. Other training has included; abuse awareness, anti-discrimination, principles and values of care, protecting vulnerable adults, promoting choice, health and safety, First Aid, Epilepsy and the administration of related medication, moving and handling, food hygiene, infection control, fire safety. All staff have received training on the safe management of medicines. The deputy manager informed the inspector that he was commencing the NVQ level 3 award in care. On the day of this unannounced inspection, the atmosphere at the home was relaxed and inclusive. Service users appeared comfortable communicating with staff. Staff were noted to respond appropriately to those service users who had limited or no communication. At the time of the inspection, staff were able to demonstrate a good understanding of the needs, abilities and preferences of service users. Since the last inspection, the provision of activities available to service users has improved. As recommended at the last inspection, appropriate activities
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 7 and staff support have been made available for one identified service user in particular. All other service users have a programme of activities both in and outside of the home. Staff duty rotas clearly identify allocated staff for service users who require more one to one support. During the summer, service users enjoyed a holiday at Butlins in Minehead. Two service users chose not to go. Service users informed the inspectors that they had enjoyed the holiday and were keen to share their holiday snaps. The home’s procedures for the management and administration of medication were generally good. As recommended at the last inspection, photographs have been attached to the Medication Administration Records (MAR) to aid identification. A requirement has been raised that the home develops and follows a policy on the administration of ’homely’ remedies. It has been recommended that hand transcribed entries on the MAR charts are confirmed by two staff signatures. Since the last inspection, all staff have received training in the Safe management of medicines and have also received training in the management of Epilepsy and related medicines. Apart from those already mentioned, the inspectors were able to see evidence that appropriate action had been taken to address the following requirements and recommendations of the last inspection; - The kitchen has benefited from a deep clean. - Appropriate checks are maintained for the home’s fire detection systems and lists are maintained for those attending fire drills. - Tap heads in the upstairs bathroom have been replaced with a type which can be safety used by all service users. - Foods were found to be appropriately stored in the fridge What they could do better:
Although improved since the last inspection, the home’s procedures for the recruitment of staff requires further improvement. Enhanced CRB’s were available but it was noted that two references were inappropriate. There was no evidence that they had been obtained by the home or that the authenticity had been checked. As previously mentioned, a requirement has been raised that the home develops and follows a policy on the administration of ’homely’ remedies. It
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 8 has been recommended that hand transcribed entries on the MAR charts are confirmed by two staff signatures. The standards of cleanliness in the home still requires improvement. It has again been required that the registered provider reviews the current arrangement to ensure acceptable standards throughout the home. Action is also required to reduce the risk of the spread of infection. Cloth towels in communal bathroom/toilets, must be replaced with paper hand towels. Bars of soap must not be left in communal bathroom/toilets or the laundry room. As previously mentioned, the provision of activities has improved for service users though the homes recording systems need more detail to ensure that the outcome for service users can be measured. Following a complaint to the CSCI, the home needs to ensure that contacts with family are in accordance with the individual’s plan of care and that detailed records are maintained. Although no concerns were raised by staff, it has been recommended that the registered provider keeps the number of hours worked by staff under review to ensure that there is no detrimental effect on service users or staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 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 Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Prospective service users are provided with the information they need to enable them to make an informed choice about moving to the home. The home has taken appropriate steps to ensure that staff have the skills to meet the needs of service users. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which clearly identifies services offered by the home and ‘additional charges’. Additional charges are met by service users for toiletries, hairdressing, transport some activities and chiropody. The home has two cars and service users currently contribute 50 of their DLA mobility component towards the cost of transport. The homes fee range is between £298 and £565 per week. The CSCI have not been advised of any changes to the Statement of Purpose or Service user guide. At the time of this inspection, the home has one vacancy and the home has not had any admissions since 2002. This being the case, not all standards were assessed at this inspection. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 11 At the last inspection, concerns were raised regarding the lack of staff skills in meeting the assessed needs of service users. It was positive to note at this inspection that staff have received training in Somerset Total Communication (STC) and Epilepsy. Further in-house training has been provided by the registered provider which included; equal opportunities, vulnerable adults, anti-discrimination. Further mandatory training has been provided which is detailed later in this report. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 The home’s care planning system is clear and consistent. Service users are supported to take risks as part of their agreed plan of care EVIDENCE: Two service user care plans were examined in detail. Care plans identified clear information on the individual’s assessed needs, abilities and preferences. Any health needs were also clearly documented. Risk assessments were in place where there was an assessed need. It is been recommended that these are reviewed more frequently as those seen had not been reviewed since September 2004. Care plans had also been produced in symbol format for the benefit of service users. Care plans also contained 6 monthly reviews and copies of formal annual reviews. The inspectors were able to see evidence that service users, their representative and care manager had been involved in the review process. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 13 Two service users at the home are unable to communicate verbally. It was positive to note that since the last inspection, staff have received training in Somerset Total Communication (STC). Four staff, including the newly appointed manager, were attending training on the day of the inspection. Records indicated that at least two staff have received training in intensive interaction. The inspectors were able to observe interactions between staff and service users. Interactions were noted to be appropriate to the needs of service users and service users responded well to the staff. Service users appeared relaxed in the presence of staff and service users, including one who was unable to communicate, were enjoying a laugh and joke with staff. Staff present had a good knowledge of the needs, abilities and preferences of service users. This was ascertained through observation and on discussion with staff present. Regular monthly meetings are held for service users with minutes maintained. The minutes of the most recent meeting held on 14/10/05 were seen. Topics discussed included menus, the complaints process, staffing and obtaining a cat for the home. Two service users spoken with informed the inspectors that they found the meetings useful and that they were chaired by the registered provider, Declan Howlett. Other comments made by the service users were that they ‘got to choose the menu’ and that they were ‘treated very well by the staff’. Service users also stated that they were encouraged to raise any concerns that they might have. The inspectors were informed that there were no service users currently using the services of an advocate. Through discussions with the home, this had previously been recommended by the CSCI for one service user in particular. All records pertaining to service users are securely stored. Service users have access to their personal records in accordance with the Data Protection Act 1998. Service users and visitors have access to the home’s policies and procedures, some of which are available in symbol format. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 16 The range of activities and staff support have improved since the last inspection. Staff need to ensure that records are more clearly maintained. EVIDENCE: All service users at the home have a programme of activities which is agreed and incorporated in to their plan of care. All but one service user utilises the Six Acres Resource Centre in Taunton and some attend Work Power. The inspectors were informed that transport is provided by Six Acres and that the home also has a vehicle to transport service users. As previously mentioned in this report, service users contribute a percentage of their DLA to fund transport. Service users able to express a view informed the inspectors that they were happy with their programme of activities outside of the home though some stated that they ‘looked forward to their days off!’ The inspectors focused on activities available for those service users with more complex needs as some concerns were raised at the last inspection. It was
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 15 positive to note that a more structured and varied programme was in place and that additional staff support had been made available. A range of sensory equipment was seen for one service user and, since the last inspection, an appropriate area in the garden has been developed for the service user to enjoy. Service users, especially those with more complex needs, appeared more relaxed at this inspection and the atmosphere felt more inclusive. Service users are supported and encouraged to pursue their own interests and to make use of local community facilities. Some examples included; walks, ‘fun-fitness’ at a local school, skittles, discos and visits to the local shops and pubs. This was evidenced through discussion with staff, service users and on examination of records. Records of activities are maintained in service user files. It has been recommended that more detail is recorded regarding the activity undertaken and the outcome for the individual, ie; whether they enjoyed the activity, experienced difficulties etc. During the summer all but two service users, who chose not to go, enjoyed a five day holiday at Butlins at Minehead. Service users who were able to express a view informed the inspectors that they enjoyed their holiday and were keen to share their holiday snaps. Service users able to express a view informed the inspectors that their visitors were made to feel welcome at the home. During this inspection, the inspectors investigated concerns raised by one relative that they did not receive regular phone calls from their relative even though this had been agreed in the plan of care. On examination of records, there was no evidence that the service user had been supported to contact their relative. Staff spoken with confirmed that this did happen though there was no documented evidence to support this. A communication book was in place for this purpose, but had not been completed since December ‘04. No evidence was seen in daily records seen from October ’05 to date. Staff were advised to ensure that appropriate records were maintained in line with the individual’s plan of care. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users have access to a range of appropriate healthcare professionals. Staff offer appropriate levels of support to service users to meet personal and healthcare needs. The home’s procedures for the management and administration of medication are generally good. EVIDENCE: In accordance with the individual’s agreed plan of care, and or request, staff support service users to meet personal care needs and to attend health care appointments. Staff able to express a view stated that ‘staff treated them very well’. Staff spoken with demonstrated a good knowledge on the needs and preferences of service users with regard to assistance with personal care. All service users have an allocated key worker and those spoken with were aware of who their key worker was. All service users are registered with appropriate healthcare professionals and the advice and input of specialist professionals is sought where required. The home maintains detailed individual records relating to the health care needs of
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 17 service users and the inspectors were able to see evidence that relevant professionals were involved with individual’s care where appropriate. Since the last inspection, one service user with complex needs has received input from a speech and language therapist. This is felt to be positive. The inspectors examined the home’s procedures for the management and administration of medication. Since the last inspection, all staff have received external training on the management and administration of medicines and have also received training from a district nurse, on the management of epilepsy and administration of rectal valium. This was ascertained by examination of staff training records and on discussion with staff. Medicines were found to be securely stored and pre-printed Medication Administration Records (MAR) had been appropriately completed. As recommended at the last inspection, photographs of service users have been attached to MAR charts to aid identification. It was noted that hand transcribed entries on the MAR charts had not been confirmed with two staff signatures. This was discussed with the two staff members at the time of the inspection. Detailed information from a G.P was available for one service user regarding the gradual reduction in a prescribed medicine and appropriate entries had been recorded on the MAR chart. It was advised at the time that a copy of this information was also maintained in the service user’s care plan. The home maintains records relating to medicines returned to the pharmacy and it has been recommended that the reason for return is also documented. Individual named ‘pots’ are used for any ‘spoiled’ or refused medicines, which would be returned to the pharmacy. Unless otherwise stated by the dispensing pharmacy, these medicines can be stored in one labelled bottle. Staff did not appear clear on the procedures for dispensing ‘homely’ remedies. This was discussed at the time of the inspection. The home must ensure that there is a clear procedure in place and that written confirmation is received from individual’s G.P’s on the permitted use of identified ‘homely’ remedies. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home’s complaints procedure enables service users to raise concerns. Appropriate action is taken by the home to address complaints. The home has systems in place to reduce the risk of harm or abuse to service users. EVIDENCE: The home displays a clear complaints procedure in a prominent position within the home. This is also displayed in symbol format and includes the contact details of the CSCI. Service users spoken with who were able to express a view, informed the inspectors that they would not hesitate in raising concerns with staff if they had any. One service user provided the inspectors with an example where appropriate action had been taken to address. The home’s complaint records indicated that one complaint had been received since the last inspection. This related to concerns regarding the behaviour of one service user. The CSCI were also involved in investigating this and were satisfied that the home had taken appropriate action to address. Two complaints have been raised directly with the CSCI. One is currently in the process of being investigated. - Concerns raised were as follows; - Staff at the home working long hours - Skills and abilities of staff - Lack of leadership/communication
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 19 Staff spoken with were aware of the home’s whistle blowing policy and advised the inspectors that they would not hesitate in raising any concerns. Training records indicated that all staff have received recent training in abuse/vulnerable adults. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Service users can choose from a range of communal areas or can spend time in the privacy of their bedroom. Although some improvements have been noted, the home’s cleaning arrangements need reviewing to ensure all areas are maintained to an acceptable standard. EVIDENCE: All communal areas and seven bedrooms were seen at this inspection. The home would not be suitable for service users with mobility difficulties. The home is not registered to accommodate service users with a physical disability. Sharpe House is a large detached property situated in the heart of the small town of Wiveliscombe. Local shops and bus routes are within a short walking distance of the home. Furniture and fixtures are domestic in style. The registered provider had previously stated that there were draft plans in place to improve the environment. No improvements were noted to have taken place since the last inspection. Carpets in two areas, brought to the attention of the deputy
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 21 manager at the time, required attention to ensure that they did not pose a tripping hazard to service users or staff. Accommodation is provided over two floors and some of the ground floor bedrooms and communal areas are accessed by steps. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 22 Service users at Sharpe House have access to a range of communal areas. The dining room has two tables each seating six and a smaller table seating two. This room also has a sofa, armchair, T.V and video. There is also a lounge area with T.V and video. This room leads into a large conservatory area. This area appears somewhat sparse and was not seen to be utilised on the day of the inspection. The kitchen & laundry area are domestic in style and appear well equipped. As required at the last inspection, the kitchen has benefited from a deep clean. Service users have access to a good sized garden. The home has a no smoking policy. Service users wishing to smoke are able to use the garden area. The home has suitable sleeping-in accommodation for staff. All service users are accommodated in single bedrooms, which are fitted with wash hand basins. No bedrooms are fitted with en-suite facilities. Bedrooms seen at this inspection were comfortably furnished and it was evident that service users are encouraged to personalise their rooms. The home has two bathrooms, one on each floor. Each are fitted with a shower attachment. As recommended at the last inspection, the provider has replaced tap heads in an identified bathroom thus ensuring that these can be utilised safely by all service users. Cleaning is carried out by care staff and, where appropriate, service users are encouraged/supported to clean their own bedrooms. The standard of cleanliness in a number of bedrooms and some communal areas seen at this inspection were again noted to be below an acceptable standard. Whilst staff confirmed that they were able to manage the basic cleaning of the home, more in-depth cleaning, such as skirting boards, window sills, removing cobwebs etc were not being done. The shower curtain in the upstairs bathroom was mouldy as was the sealant around the bath. Although liquid soap was seen to be available in the kitchen and communal bathrooms/toilets, paper towels were not always available. Cloth towels were noted in some areas. Used bars of soap were found in the downstairs bathroom and the laundry area. A selection of ‘communal’ toiletries were found in the downstairs bathroom. These issues were brought to the attention of the deputy manager at the time of the inspection. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Staff skills and abilities have improved since the last inspection and this has a positive outcome for service users. Staff numbers on duty reflect the assessed needs of service users. Hours worked by staff should be kept under review. The home’s staff recruitment procedures are much improved, though further improvements are required. EVIDENCE: The home has recruited additional care support staff since the last inspection. Copies of a 4 week staff rota were made available to the inspectors. On examination, it was noted that staff are working an average of 42 hours per week plus at least 2 sleep-in duties a week. Duty rotas indicate that staff have an average of 3 days off a fortnight. No concerns were raised by staff at the inspection regarding their working hours. Staff indicated that it was their decision to work extra shifts. The registered provider should keep individual’s working hours under review to ensure that this does not have a detrimental effect on either service users or staff.
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 24 The inspectors were informed at this inspection that the home is in the process of recruiting two further staff. When asked, staff stated that they felt there were sufficient numbers of staff on duty throughout the day and night. Staff stated that they had been encouraged/instructed by the registered provider, to have additional staff where required. This is felt to be positive. Duty rotas indicate that staff cover varies during the day to meet the social needs of service users. As a minimum, it appears that throughout the day there are two staff on duty. Nights are covered by two sleep-in staff. Duty rotas also identify an on-call contact 7 days a week. Staff are also allocated for 1:1 sessions for particular service users. All staff are issued with a job description which clearly identifies roles, responsibility and lines of accountability. As the home has recruited staff from overseas, the registered provider has developed a more in-depth induction programme to ensure that specific areas are covered. At the last inspection, concerns were raised regarding the skills and experience of staff employed. Since the last inspection, the registered provider attended the CSCI office where these concerns were discussed in more depth. At this inspection, it was positive to note that appropriate training for staff had either taken place or was in the process of being arranged. All staff have received training in Somerset Total Communication (STC), at least two staff have received training in Intensive interaction. All staff have received training in the management and administration of medication and epilepsy. Regular inhouse training has been provided by the registered provider which included the principles and values of care, anti-discrimination, protecting vulnerable adults, promoting choice, health and safety. The inspectors noted that staff appeared more confident in their interactions with service users and were able utilise their skills. This had a positive outcome for service users. Staff were observed communicating with staff in an appropriate manner. Service users appeared relaxed in the presence of staff and enjoyed a ‘laugh and joke’ with staff. As previously mentioned in this report, staff were able to demonstrate a good knowledge/awareness of the needs, abilities and preferences of service users. The home’s recruitment procedures were noted to be much improved. The files for the two most recently employed staff were examined. Both contained all information as required in Schedule 2 of the Care Home Regulations 2001, including appropriate CRB checks. It was noted however, that two references were addressed ‘to whom it may concern’, and neither were dated. The registered provider is reminded that this type of reference is unacceptable.
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 25 On examination of staff files, the inspectors were able to see evidence that staff receive regular supervision sessions. Regular meetings are held for staff with minutes maintained. Staff spoken with were positive regarding the support they received. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 26 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The home does not currently have a registered manager. The home’s procedures for ensuring the health and safety of service users and staff has improved. EVIDENCE: The home has experienced a period of instability recently due to changes in staff and the fact that the acting manager had recently left her post. At this inspection, service users appeared more relaxed. Staff and service users stated that the registered provider had spent a considerable period of time at the home in the absence of a manager, and that they had found his support helpful. A new manager has recently been appointed and was attending a training day, in Somerset Total Communication, on the day of this inspection. In the absence of a manager, not all standards were assessed.
Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 27 In accordance with Regulation 26 of the Care Home Regulations 2001, the registered provider has carried out formal monthly visits to the home. As previously mentioned, in the absence of a manager, the CSCI are aware that the provider has visited the home several times a week. Reports relating to the Regulation 26 visits have been submitted to the CSCI which demonstrated that appropriate records were audited and that the views of service users and staff were sought. During this inspection, the inspectors were able to see that records pertaining to service users were seen to be appropriately stored. Service users have access to their personal files in accordance with the Data Protection Act 1998. Following a tour of the premises, the following records were examined relating to the health and safety of service users, staff and visitors to the home. FIRE SAFETY – The inspectors were able to see evidence that the requirement of the last inspection had been addressed. Fire detection systems and emergency lighting had been checked weekly. The last test was recorded as 17/11/05. Systems were checked by an outside agency in August 2005, as were fire extinguishers. The inspectors were able to see evidence that staff had received up to date fire training. Monthly fire drills are conducted for staff and service users. This was last carried out in October 2005. ELECTRICAL SAFETY –The home has an up to date electrical hardwiring certificate which is due to expire this month. Annual portable appliance testing was not examined at this inspection GAS SAFETY – The home’s last annual gas safety check was conducted on 26/01/05. ACCIDENTS – The inspectors were informed that the home had no recorded accidents since the last inspection. FIRST AID – Training records seen at this inspection indicated that all staff had received up to date training in First Aid. FOOD SAFETY – The inspectors were informed that staff involved in the preparation of food have an appropriate food hygiene certificate. Staff training records seen by the inspectors confirmed this. As previously mentioned in this report, since the last inspection, the home has benefited from a ‘deep clean’. All foods stored in the fridge had been appropriately covered and labelled. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 28 CONTROL & STORAGE OF SUBSTANCES HAZOURDOUS TO HEALTH (COSHH) – At the time of this inspection, all cleaning substances were seen to be appropriately stored. The home maintains appropriate COSHH records which were last reviewed on 12/03/05. The home’s business and financial plans were not requested for this inspection. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 x 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Sharpe House Score 3 3 2 N/A Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x DS0000046271.V253711.R01.S.doc Version 5.0 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The registered person must ensure that the home has a clear homely remedy medicines policy and that this is understood and followed by staff. A copy should be forwarded to the CSCI. The registered person must ensure that carpets in the two identified areas are made safe The registered person must review the homes cleaning procedures to ensure that all parts of the home are maintained to an acceptable standard. (Previous timescale of 15/07/05 not met) The registered person must ensure that cloth towels in communal bathrooms/toilets are replaced with paper hand towels and that bars of soap are removed. The registered person must ensure that robust staff recruitment procedures are followed. References must be applied for by the registered person who must be satisfied as
DS0000046271.V253711.R01.S.doc Timescale for action 30/12/05 2 3 YA42YA24 YA30 13(4) 23(2)(d) 30/12/05 30/12/05 4 YA30 13(3) 10/12/05 5 YA34 19 & Schedule 2 10/12/05 Sharpe House Version 5.0 Page 31 to their authenticity. 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 3 4 5 6 Refer to Standard YA7 YA9 YA12 YA15 YA20 YA33 Good Practice Recommendations The registered person should ensure that the services of an advocate are sought for an identified service user. The registered person should ensure that individual’s risk assessments are reviewed more frequently. The registered person should ensure that more detail is recorded relating to service user activities to ensure that the outcome can be measured. The registered person should ensure that family contacts are carried out in accordance with the individual’s plan of care. Records should be maintained. The registered person should ensure that hand transcribed medicines on MAR charts are confirmed with two staff signatures. The registered person should keep individual staff working hours under review to ensure that this does not have a detrimental effect on service users or staff. Sharpe House DS0000046271.V253711.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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