CARE HOME ADULTS 18-65
St Erme Trispen Truro Cornwall TR4 9BW Lead Inspector
Lowenna Harty Unannounced Inspection 16th February 2006 09:30 St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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 St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Erme Address Trispen Truro Cornwall TR4 9BW 01872 263355 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) Spectrum Ms Kerry Turner Care Home 20 Category(ies) of Learning disability (20) registration, with number of places St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. St Erme House - up to 10 adults with a Learning Disability (LD) The Lodge - up to 9 adults with a Learning Disability (LD) St Michaels - up to 3 adults with a Learning Disability (LD) Total number of service users not to exceed a maximum of 20 Date of last inspection 27th August 2005 Brief Description of the Service: St. Erme house is a care home providing accommodation and personal care for up to 20 adults with a learning disability. The home is run by Spectrum, an organisation that provides specialist care and services to people with autism. The home comprises of three separate, self-contained units. The main house provides accommodation for up to 10 service users. The remaining units accommodate the rest. The properties have been extensively adapted in order to provide for the needs of individual service users, as far as possible. There are two self-contained flats, for example, and there are ongoing plans to adapt and develop the service, based on service users’ changing needs. All the service users have their own bedrooms although most have shared bathrooms. All of them are able to access a range of communal living spaces, including lounges, external grounds, and kitchens and dining facilities. There is some disabled access and scope for further adaptations, if required. There is a separate administrative block, with a visitors’ room, which can be used be service users and their relatives, when they visit. This provides them with additional privacy and space to meeting in the main buildings. The service is situated in its own extensive grounds, slightly off the road, in the village of Trispen, which is near to the City of Truro. Spectrum provides transport, including people carriers with suitable adaptations to meet service users’ needs. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 16 February and was unannounced. It lasted for approximately six hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The inspection consisted of several different activities. The principle method used, was case tracking. This involves selecting a small number of service users and reviewing all aspects of their care in detail, including care records and care plans, interviews with staff working with them and interviews or observation of the service users themselves. At this inspection, three service users were case tracked. One was chosen from each home. Other inspection methods involved brief interviews and observation of service users in the three units; an inspection of the premises, interview with a staff member and observation of staff interaction with service users, inspection of health and safety and other records and discussion with the home’s registered manager. Overall the home provides service users with a good and improving, standard of care. Spectrum has developed innovative ways of helping some service users with extremely complex needs to live in a community based setting. What the service does well:
Service users have comprehensive written care plans, which set out their personal, social and healthcare needs clearly and detail, so that staff know how to work with them. This includes attention to issues such as their backgrounds, culture and religion, so that their diverse needs can be acknowledged and respected. Service users care records and care plans indicate their likes and dislikes so that staff have information on how to assist them in ways that they prefer. They are supported and encouraged to maintain and develop positive relationships with their relatives and friends, in accordance with their individual care plans and risk assessments. The home has a comfortable visitors’ room, where service users and their visitors can meet in private. Senior managers from within Spectrum provide staff with training and guidance on how to safely
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 6 support service users with regard to their relationships with others in and out of the home. Service users are encouraged to take part in planning, shopping and preparing meals, so that they develop important skills and independence. They are encouraged to eat a varied and balanced diet so that they stay healthy. Their food preferences and dietary needs are noted and accounted for in menu planning, so that they are able to enjoy their meals. Service users were seen assisting in the kitchens during in the inspection. Those interviewed indicated that they are satisfied with the meals provided to them. Service users’ personal care needs are considered in their care plans and staff have detailed instructions on how to assist them, so that they develop and maintain their independence. Service users appeared physically well cared for and fashionably dressed at the time of the unannounced inspection. They are assisted to access a range of NHS professionals from outside of the home, to maintain their physical and mental health, including routine screening appointments, to which they are entitled. Their specialist healthcare needs are considered as part of their individual care plans and care records indicate that they are followed up appropriately. There are some good systems in place to protect service users from abuse and those who were interviewed at the time of the inspection indicated that they feel safe in the home. Staff have good written guidance from the various local agencies responsible for working together to protect service users and are given guidance on how to protect them, as part of their induction and ongoing training. Staff are recruited on the basis that they are safe and suitable to work with vulnerable adults in a care setting. The home has been extensively adapted in ongoing attempts to meet the individual needs of service users with wide-ranging needs and disabilities. This has included the provision of self-contained, more independent accommodation within the service, for some of them, for example. Staff have good access to ongoing training and because of the size of the staff team there is a good range of skills and abilities amongst those on duty at any one time, to ensure service users’ safety and well being. The home is generally well managed for the benefit of the service users. The manager is qualified, experienced and registered with the Commission as a fit and suitable person to work with service users in this setting. What has improved since the last inspection?
Service users’ care plans address their individual healthcare needs better, based on those that were reviewed at this inspection, and provide improved
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 7 information to staff on what they need to do to help them. Those who have difficulty in communicating their wishes or are unable to participate directly in care planning for other reasons have now been referred to a local advocacy project and two of them now have independent advocate, so that they have someone from outside of Spectrum and their immediate families, to oversee their best interests. Service users who would benefit have now been referred for specialist assessments of their speech and language and environmental needs, so that staff gain up-to-date information on how to assist them to participate more directly in decision making about important aspects of their lives. There are also plans to provide improved training to staff on communicating with service users. Risk assessments appear to be more full and complete and consider all activities that service users take part in. This gives staff the information they need to be able to support service user to take risks to develop their skills and independence in a safe way. Service users’ contact records provide clearer information to guide staff on contact agreements with service users’ relatives, so that they can be followed through, in ways that they would prefer. One service user has a video telephone link with their relative, so that they can maintain regular visual contact with them, which they value highly. Some tap heads have now been fitted to service users’ bathrooms as part of an ongoing plan for improvement of the service. These are important in terms of helping service users to maintain their dignity with regard to their personal care, as well as encouraging good hygiene, which is important in preventing the spread of infection. The home’s annual development plan sets out medium to long-term plans to improve the home’s environment for service users, so that more of them benefit from accommodation, which is individually set out to meet their needs. Those who would benefit, have been referred for specialist assessments of their environmental needs, as previously mentioned, so that plans to develop the home for the future can better take into account their individual needs in this respect. There were some improvements to hygiene in the home at this inspection, including provision of tap heads in some bathrooms, as already mentioned, and better facilities for storage of household rubbish so that the external premises appeared cleaner and tidier. The introduction of a new five-day induction course for staff means that recently recruited staff are provided with infection control and basic food hygiene training as standard, before they commence work in the home, so that they are better equipped to provide service users with a clean and safe environment. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 8 Subject to the specific improvements mentioned in this report, staff have good access to ongoing training and the recent introduction of an improved induction training programme for new staff has meant that they are better trained to work safely and effectively with service users. There have been improvements to make the home’s environment safer for service users, including completion of the home’s fire safety risk assessment and improved records of fire safety tests and evacuations. What they could do better:
Service users’ care plans should be given to them in formats that they can understand, so that they are aware of the decisions that are being made, which affect their lives, as far as is possible. They have been given copies of their service users’ guides in this way and this needs to extend to other key documents. Service users should also be invited to sign up to their care plans, to show that they agree with them, if they are able to do so. There are still service users awaiting independent advocates and Spectrum should continue to pursue all options for this, on behalf of those service users who are unable to participate directly in the care planning process. The home’s manager needs to ensure that referrals to specialist agencies and planned training for staff in relation to assisting service users with needs in relation to their communication and environment are followed through. This is necessary to ensure that opportunities for service users to participate in making important decisions about their lives are maximised. Some service users’ records, of those whose cases were tracked, showed that they do not always take part in activities and access resources in the local community in accordance with the goals set out in their individual care plans. One service user’s care plan specifically stated that they should be assisted to access a wider range of activities in the community, but their daily care records indicated that this had not happened in the week previous to the inspection. Whilst some tap heads have been replaced, there are still some bathrooms that require them and the planned improvements need to continue until they are complete in this respect. Service users need to be better protected from possible harm due to medication errors. This includes ensuring that records are kept accurate and up-to-date and providing adequate training to staff so that they can safely and confidently assist service users with their medicines. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 9 The home’s internal procedures for protecting service users from abuse need to be reviewed and updated so that staff have up-to-date guidance in this respect. The home’s registered manager should attend local multi-agency training so that they gain confidence and knowledge of how different local agencies work together to protect service users from abuse, which they can pass on to staff working in the home. Specific improvements are needed to make the home more comfortable and homely pending implementation of Spectrum’s longer-term plans for the service, so that service users benefit in the short-term, also. This includes provision of improved flooring in those areas in which it continues to appear worn and/or institutional; replacement of worn and mismatching dining room furniture in one of the buildings and repairs to bedroom doors that squeak loudly on being opened and shut. Further improvements are needed to make the home hygienic for service users so that they are protected from risks of infection. Written procedures need to be revised and up-dated to give more effective guidance to staff. Those longerserving staff, who have not had it, should undertake training in infection control and basic food hygiene and doors between laundry areas and kitchens should be kept closed at all times to prevent the risk of cross-infection. More staff should be qualified to the minimum recommended standards than are currently, so that service users and their representatives can be confident of their competence. Whilst fire safety records have improved, records of weekly fire alarm tests need to be kept up-to-date to demonstrate to the home’s manager that they are checked regularly and kept in sound working order. 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. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 10 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 St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 11 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): None of these standards were inspected at this inspection. EVIDENCE: There have not been any admissions or discharges to the home since the previous inspection, according to the registered manager and the home’s records confirmed this. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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 & 9 Service users’ needs and goals are fully reflected in their care plans but they need to be shared with them more effectively. Service users have some opportunities to make decisions about their lives, but this needs further improvement so that they can participate more fully. Service users are supported to take risks in a safe way so that they can develop their skills and independence. EVIDENCE: Service users’ records indicate that they have detailed care plans, which address their health, social and personal care needs, including needs relating to their individual and diverse backgrounds such as their religion and culture. There was evidence, at this inspection, that service users’ healthcare needs are considered as part of the care planning process and there was clear information on how they would be met on the files that were reviewed. Care plans are not currently routinely provided to service users in translated formats, in the same way as, for example, their service users’ guides and this should be done. They should also be encouraged to sign their agreement of them, in situations where they are able to do so. Spectrum has referred service users to a local advocacy agency and two service users now have
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 13 independent advocates, nevertheless, this remains an outstanding need for several, who have communication or other difficulties, which make it difficult for them to participate in the care planning process. There are records of service users’ individual likes and dislikes on their personal files, in their care plans. There are letters to show that they have been referred to a local advocacy agency. Those who would benefit have also been referred for specialist assessments with regard to their communication skills and environmental needs and there are plans for staff to undergo training to improve their skills to work with people who have difficulty in communication, which need to be implemented, so that service users can benefit, pending their specialist assessments. Evidence that service users are involved in making key decisions in their lives needs to be improved with regard to their participation in the care planning process, as previously mentioned. Risk assessments for service users reviewed at this inspection were complete and detailed and addressed all risks to their health and safety, including specific activities in and out of the home, that they take part in on a regular basis. Service users are assisted to take responsible risks to develop their skills and independence, in accordance with their written care plans. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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): 12, 13, 15, 16 & 17 Service users need to be assisted to take part in activities in accordance with their individual care plans. This include activities outside of the home, in the local community. Service users are assisted to maintain and develop relationships in accordance with their individual needs and risk assessments. Service users are provided with good information on their rights and responsibilities and what they can do if they feel they are not being respected. They are provided with a varied, balanced diet so that stay healthy. EVIDENCE: Evidence that service users are assisted to take part in activities in accordance with their preferences and their care plans was lacking in some cases. Daily care records did not match up with the goals and targets set in at least one of the service users’ records, of those whose notes were reviewed. This was particularly noticeable in relation to their access to individual activities in the community. One service users’ care plan goals specifically stated that they should be assisted and encouraged to access a range of activities in the local community, but their daily care records suggested that they had only been out of the home’s grounds once in the previous week.
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 15 Service users’ care records and records of contact agreements show that they are assisted to maintain appropriate relationships with relatives and friends in and out of the home. Senior managers from within Spectrum are available to provide staff with guidance on how to support service users in their personal relationships. Service users are encouraged to maintain ongoing contact with their relatives. There is a visitor’s room in the administration block for them to receive visitors in privacy and comfort and one of the service users has a telephone with a video link to their relative, so that they can maintain regular, visual contact. Service users’ rights and responsibilities in relation to their placements in the home are clearly set out in their individual service users’ guides, which include information on the home’s complaints procedure, should they feel dissatisfied with the services provided to them. These are given to service users in translated formats and signed by them, to indicate their agreement with them. More detailed copies are sent to their personal representatives and placing authorities. Service users personal and healthcare records consider their dietary needs and personal preferences. Service users are encouraged to participate in planning, shopping for and preparing meals for the houses, as part of their ongoing care plans. They were observed accessing kitchens and taking part in domestic tasks at the time of the inspection. Records of food served indicate that service users are encouraged to eat a range of varied, healthy, mainly home prepared meals so that they stay physically healthy. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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 & 20 Service users are assisted with their personal care but should be provided with more opportunities to exercise choice and independence in this respect. Their physical and emotional healthcare needs are well met. Further improvements are needed to protect service users from harm due to medication errors. EVIDENCE: Service users’ care plans and daily care records provide detailed information to staff on their personal care and support needs. Service users appeared well cared for, smart and appropriately dressed at the time of the inspection. More bathrooms now have tap heads attached, of a type that enables service users to use them independently, but not all. Tap heads should be affixed in all bathrooms and toilets to ensure service users’ dignity and encourage good hand washing so as to prevent the risks of infection in the home. Service users’ personal care records and healthcare records indicate that their physical and emotional healthcare needs are considered and regularly reviewed. They are assisted to access a range NHS healthcare providers according to their individual needs and records are maintained in this respect so that staff are informed of how best to support and care for them. As previously mentioned, those who would benefit have been referred for specialist assessments in relation to their environmental needs so that they can be met appropriately.
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 17 There were errors noted on one service users’ medication records, in that some signatures were omitted, so that it was unclear as to whether they had been given their prescribed medication. Whilst the home’s medication systems have been changed and new procedures written, staff lack access to safe handling of medicines training that provides them with sufficient knowledge to safely manage service users’ medicines for and with them. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 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): 23 Some improvements are needed to protect service users from abuse, neglect and self-harm. EVIDENCE: The home has copies of the local multi-agency procedures for the protection of vulnerable adults from abuse, as well as copies of the procedures from service users’ placing authorities, so that staff can refer to them, should the need arise. Staff are recruited on the basis of fair, safe and effective recruitment and selection methods to ensure that they are suitable to work with vulnerable adults in a care setting. They have good access to in-house training on how to protect service users from abuse. The home’s internal procedures need to be reviewed and updated, however and the home’s registered manager should undertake multi-agency training on the protection of vulnerable adults, so that they develop knowledge and confidence in working with other agencies in this way and pass this on to staff working in the home. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Improvements are needed to make the home’s environment homely and comfortable for service users. There are plans in progress to improve the environment so that it accords with service users’ specialist needs. Further improvements are needed to ensure good hygiene in the home. EVIDENCE: The home’s annual development plan sets out plans to improve the home’s environment for service users in the future and there is an ongoing programme of maintenance work in respect of the existing premises. Nevertheless, several improvements are needed, pending the implementation of the longer-term plans for the service to make it comfortable and homely for service users in the short-term. This includes provision of less institutional, more attractive flooring throughout all of the buildings, tap heads on all bathroom taps, as previously mentioned, improved dining room furniture in one of the buildings and repairs to squeaking doors. The home has been extensively adapted to try to accommodate the range of needs presented by service users, as far as possible, so that some service users have self-contained accommodation within the service, for example. Those who would benefit have been referred for specialist assessments of their
St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 20 environmental needs on the basis of the most current knowledge and research on the needs of people with autism. Specific improvements are needed to improve hygiene in the home, including more detailed and up-to-date written procedures to guide staff on safe practice and improved access to training in infection control and food hygiene for staff that have not had it. The home appeared tidier outside, with improved facilities to contain household waste, but more bathrooms and toilets need tap heads to encourage good hand washing. Laundry doors, which open onto kitchens, should be kept closed at all times and alternative entrances used, to prevent cross-infection risks as some of them were open at the time of the inspection. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 A greater proportion of the home’s staff team should have formal qualifications so that service users can be confident of their competence. The staff team is well trained to meet service users’ needs. EVIDENCE: There are records of staff qualifications on the home’s computer system. At present slightly less than the recommended level of 50 of the staff team is formally qualified to NVQ level 2 or above and this proportion should be increased so that service users and their representatives can be confident that the people caring for them are competent to do so. Subject to those specific training needs already mentioned in this report, the home’s records demonstrate that staff have good access to ongoing training to ensure service users’ safety and well being. Because of the size of the staff team working at the home, there are always trained staff on duty at any one time, to meet service users’ needs. A new five-day induction programme has been introduced to ensure that recently recruited staff have essential training to enable them to work safely in the home. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 22 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): 37 & 42 The home is well managed for the benefit of the service users. Specific improvements are needed to ensure that the environment is kept safe for service users. EVIDENCE: The home’s manager is experienced, qualified and competent to work with service users in this setting. She is registered as manager with the Commission and undertakes regular training to update her knowledge and skills. Service users’ safety needs are considered and addressed in their individual risk assessments and the home’s overall environmental risk assessment. Staff have good access to training and information on all aspects of health and safety, apart from those previously mentioned in this report. The home’s fire safety risk assessment was complete and readily available at this inspection. There were clear records of monthly evacuations and emergency lighting tests although records of weekly fire alarm tests still need improvement. St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X X X X 2 X St Erme DS0000009149.V284085.R01.S.doc Version 5.1 Page 24 Yes 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 YA12 Regulation 12(1) Requirement There must be clear evidence that service users are provided with access to community resources in accordance with their individual care plans. This requirement is re-notified from 01/12/05 to enable full compliance. There must be clear evidence that service users are assisted to access resources in the community in accordance with their individual needs and goals laid down in their care plans. Tap heads must be provide on all toilet and bathroom sinks to maintain service users’ dignity. The registered provider must make arrangements for the safe management of service users’ medicines, including the maintenance of up-to-date and accurate records. Further improvements are needed with regard to maintaining good hygiene in the home, including revised written procedures for staff; closure of doors connecting laundry to kitchen and training for all staff.
DS0000009149.V284085.R01.S.doc Timescale for action 01/04/06 2. YA13 12(1) 01/04/06 3. 4. YA18 YA20 12(4)(a) 13(2) 01/06/06 01/04/06 5. YA30 13(3) 01/04/06 St Erme Version 5.1 Page 25 6. YA42 23(4) Records of weekly fire alarm tests must be kept up-to-date. 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Service users should be enabled to participate more fully in the care planning process wherever this may be possible. This includes the provision of care plans to them, in translated formats, which they can access directly. Service users, who are able to do so, should be invited to sign up to key documents, such as their care plans. Service users who are unable to directly participate in care planning and/or who have communication difficulties, should be provided with independent advocates, particularly with regard to agreement of their care plans. Plans to assist service users to obtain specialist input with regard to their communication skills so that they can make decisions about their lives as independently as possible, need to be followed through and implemented. This includes access to external professionals and trained staff within Spectrum. All staff handling service users’ medicines should undergo training in the safe handling of medicines in addition to the in-house training currently provided. The home’s internal procedures for the protection of vulnerable adults from abuse should be reviewed and updated. The registered manager should attend multiagency training on the protection of vulnerable adults. The home’s environment should be made more comfortable and homely for service users pending implementation of the annual development plan. This should include provision of more attractive/ domestic-style flooring throughout, replacement of dining room furniture, where it is worn and mismatching and repairs to squeaking bedroom doors. All remaining staff, who have not had it, should be provided with up-to-date training in infection control and basic food hygiene At least 50 of the staff team should be qualified to NVQ level 2 or above.
DS0000009149.V284085.R01.S.doc Version 5.1 Page 26 2. 3. YA6 YA6 4. YA7 5. 6. YA20 YA23 7. YA24 8. 9
St Erme YA30 YA32 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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