CARE HOME ADULTS 18-65
St Erme Trispen Truro Cornwall TR4 9BW Lead Inspector
Lowenna Harty Unannounced Inspection 24th July 2006 09:30 St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 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 Miss Dawn Helena Gomersall Care Home 20 Category(ies) of Learning disability (20) registration, with number of places St Erme DS0000009149.V302017.R01.S.doc Version 5.2 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 16th February 2006 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 specialises in providing specialist care for people with autism. The home comprises of three separate, self-contained units. The main house, St. Erme provides accommodation for up to ten adults, the Lodge can accommodate up to nine and St. Michaels can accommodate up to three. There is a separate administrative block with a visiting lounge for service users to meet with relatives and visitors in private. The property is set in its own, extensive grounds, slightly off the road. It is situated in the village of Trispen, which is close to the city of Truro. The properties have been adapted to meet a range of needs and there is some disabled access. Each of the separate units provides service users with single bedrooms and a range of communal spaces, including lounge/ dining areas and kitchens. The registered provider has notified the Commission of its intention to extensively alter and improve the property and the service for the benefit of the service users. Service users representatives have also been informed of Spectrum’s plans for the future. Current fees range from £814.00 per week to £7084. There are variable additional charges to service users for hairdressing, magazines and newspapers, alcoholic beverages, confectionary, private chiropody, dry cleaning, off-site entertainment and stationary. Spectrum provided this information to the Commission on 26 June 2006. Information about the home, including the statement of purpose and previous inspection reports are kept in each of the three units and are available on request, according to information provided by the manager, at the time of the inspection. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an annual key inspection, which took place across two days, on 25 and 25 July 2006 and was unannounced. It lasted for approximately ten hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that service users’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with them and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the service users and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of service users and following this through with interviews with/ observation of them, staff working with them and their relatives or representatives. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, three service users were case tracked. There was evidence of some improvement in care standards at this inspection and work is continuing to improve it further to provide service users with a safe and comfortable service in which they can develop their skills and independence. What the service does well:
Service users are admitted to the home on the basis of an assessment, so that they can be confident it will be suitable for them and meet their needs. No new service users have been admitted since the previous inspection and current service users are undergoing re-assessments as part of Spectrum’s plans to extensively modernise and improve the service, which are in progress. Service users have detailed written care plans, which set out their personal, health and social needs in full and are regularly reviewed. These are shared
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 6 with their relatives and social workers and they are invited to state their views so that they are kept informed about the progress of the service users in the home. Their care plans consider their skills in making decisions with a view to enabling them to develop their abilities in this respect. Service users are helped to maintain valued relationships with their families and friends outside of the home, where possible. Visiting relatives who were interviewed at the time of the inspection confirmed this. Their rights and responsibilities are set out clearly for them, in translated formats so that they know what to expect from the home and what is expected of them as residents. They are provided with an appropriate range of healthy meals and staff assist them to make choices so that they stay well and enjoy the food provided to them. There are satisfactory systems in place to ensure that service users know about their rights to make complaints if they are dissatisfied with the care and services provided to them at the home and to consult with their representatives about the quality of the services the home provides to them. The home provides some of the service users with comfortable and homely surroundings and some service users are able to personalise their private accommodation according to their individual tastes and preferences. The home has extensive, well maintained and attractive grounds so that service users can enjoy peace and privacy. Care staff are selected fairly and on the basis that they are fit and suitable to work with vulnerable adults in a care setting so that service users and their representatives can have confidence in the people caring for them. All staff undergo induction training before they start to work in the home and have good ongoing access to training so that service users can have faith in their skills. The home’s manager is registered with the Commission as a fit and suitable person to run a care home. A new manager is in the process of making an application to be registered, which the Commission has been informed of and in the meantime the existing manager continues to work at the home and is closely involved in the day-to-day management of it so that service users benefit from continuity. There are systems in place to formally consult with service users and their relatives about the quality of the care and services provided, including questionnaires, reviews and opportunities for them to make their views known less formally. Spectrum has responded and is in the process of implementing plans to extensively modernise and improve the service. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Whilst service users’ parents and representatives have been informed about Spectrum’s plans for the modernisation of the service and invited to state their views, there is little evidence that service users themselves have been. Improved efforts are needed to engage them in the assessment and consultation process in light of the major plans that are being made. Care plans should be provided to service users in more meaningful ways, with clear and specific goals, so that they can participate more directly in making decisions about their lives. The home’s current environment places a number of restrictions on service users, so that they lack free access to their
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 8 bedrooms, for example. Spectrum has plans to modernise and improve the service so that these restrictions will be decreased in the future, but they need to be implemented. Service users’ risk assessments must reflect the actual restrictions placed on them and there should be improved consultation with them about the levels of restriction placed on them, where ever practicable. Restrictions should be minimal and only in individual service users’ best interests. Spectrum is currently undertaking an internal review of its restrictive practices, but it would be useful to consult with an external agency that specialises in service users’ rights so that they and their representatives can have confidence that restrictions imposed on service users are necessary and legal. Not all service users have benefited from regular access to structured activities in the home and resources in the community on a sufficiently regular basis. This was clearly set out as a need in the care plan of one of the service users who was case tracked, which was not always being met. Some service users’ clothing appeared worn and shabby as a result of their clothes having been torn by another service user. Whilst this situation had been changed so that they would be protected from similar incidents in the future, and arrangements were being made to replace the torn items, they should have been provided with replacements more promptly. Whilst records were in place for most service users to provide evidence that they have ongoing access to healthcare services when they need them, they were missing for one service user, so that staff working with them did not have the information they need to provide ongoing monitoring of their healthcare input and needs. Service users need improved protection from risks due to medication errors. This includes ensuring staff are adequately trained, records are accurate and written procedures to guide staff on how to administer medicines safely are readily accessible to them. Service users should be better protected from abuse, particularly from incidents between each other. The incidents of service users having their clothing torn should have been reported to the external agencies, including the Commission, responsible for co-ordinating strategies to protect service users from abuse. The registered manager would benefit from attending multiagency training in this respect, to gain familiarity with the way in which organisations should work together to protect vulnerable adults from abuse. There should also be improved record keeping with regard to service users’ personal finances where the home assists them, to ensure they are adequately protected from financial abuse. Plans to modernise and improve the home’s environment need to be implemented so that all the service users benefit from comfortable and homely surroundings in which they can develop their skills and independence in the
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 9 future. In the meantime, further improvements should be made to the existing environment, including replacement of worn and mismatching furniture in communal areas. A greater proportion of the care staff should achieve formal qualifications so that service users and their representatives can be assured of their competence to work effectively with them. Systems to protect service users, with particular regard to fire safety in the home need improvement, including the maintenance of up-to-date fire safety risk assessments in each of the units and records of tests of fire safety alarms and equipment. 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.V302017.R01.S.doc Version 5.2 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.V302017.R01.S.doc Version 5.2 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): 2 Quality in this outcome area is adequate. Service users’ needs are assessed, but the process of this should be made more meaningful to them so that they can be more directly involved in making decisions about their lives. EVIDENCE: The registered manager said that there had not been any new admissions to the home and none are currently planned. Service users currently placed in the home are undergoing re-assessments of their needs with regard to Spectrum’s plans to extensively modernise and improve the service. There are written records to support this and letters have been sent to service users’ placing authorities and representatives inviting their views about the proposed changes. There is little evidence of direct service user involvement and consultation with regard to the plans, however, and this should be improved, so that they have opportunities to participate in what amount to major changes in their lives. St Erme DS0000009149.V302017.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. Service users have detailed written care plans, which address their personal, health and social care needs, including needs relating to their age, religion, culture and ethnicity, abilities, gender and sexual orientation but these should be provided to them in more meaningful and accessible formats so that they have greater opportunities to participate in the care planning process. Service users need to be provided with improved opportunities to make decisions about things that are important to them to improve the quality of their lives. Service users’ individual risk assessments should fully reflect any necessary restrictions to protect them and/or other people, which should be minimal and only in their best interests. EVIDENCE: Service users have detailed written care plans but they are not provided to them in accessible or meaningful formats and do not set out clear and specific goals for them to achieve so that they can monitor their progress towards gaining increased skills and independence. Not all of the service users interviewed was aware of their care plans, although relatives who were interviewed said that they attend reviews on a regular basis and are provided with copies of them.
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 13 During the inspection service users were observed to make some choices, for example about what to eat at breakfast time and their care plans consider their skills in making decisions. The registered manager has advocated with the local NHS services towards assisting service users without speech to access speech and language therapy services so that they may be able to participate in decision making more actively. There are considerable restrictions on choice for service users, however, mainly because of the institutional environment of the home. Service users are unable to access their own bedrooms independently, for example. Their rooms are lockable but only staff hold keys to them. The home’s manager said that Spectrum is currently undertaking an internal review of all its restrictive practises towards service users to ensure that any restrictions placed on them are necessary and in their best interests. It would be useful to externally validate the findings of this. Service users have detailed written risk assessments, which parents who were interviewed said are shared with them, but they are not provided to service users themselves in accessible formats and not all restrictions, for example environmental restrictions, were addressed in those inspected. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. Service users are assisted to access varied and appropriate activities in the home and in the local community but these are not always frequent enough. Service users are assisted to maintain valued relationships so that they enjoy a good quality of life. They are provided with information about their rights and responsibilities so that they are aware of what is provided and what is expected of them as residents. They are provided with healthy meals so that they stay well and enjoy their meals. EVIDENCE: Observation of service users at the time of the inspection revealed that standards are variable with regard to service users’ access to activities. Some were actively engaged in individual or group activities with staff but others appeared to lack purposeful occupation. Daily care records reinforced this. Some service users appear to have very active daily lives but one of those case tracked was not being provided with activities in accordance with her care plan, which stated that they should be assisted to access more activities outside of the home and be provided with increased structure to their day in order to reduce their anxiety levels. Staff support service users to access a variety of resources in the local community, including shops, beaches, places of local interest and sporting
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 15 facilities. This was confirmed through daily care records, observation during the inspection and interviews with service users and their relatives. Service users’ care plans and risk assessments consider their needs with regard to their developing and maintaining relationships with their families and friends, including issues relating to their sexuality. Relatives who were visiting service users at the time of the inspection said that there are no restrictions on visits and they are encouraged to continue to be actively involved in service users’ lives. Service users’ rights and responsibilities with regard to their placements in the home are clearly set out in service users’ guides which are provided to them in appropriate formats so that they are aware of what is expected of them as residents. Service users were observed enjoying healthy meals and making choices about food during the inspection. Those interviewed said that they are satisfied with the food provided to them and daily care records provide evidence that they are provided with a range of varied and appropriate meals so that they maintain good physical health and enjoy their meals. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. Service users require improved support with regard to their personal care so that they are assisted to look well presented and tidily dressed. Improvements are needed with regard to ensuring their physical and emotional healthcare needs are monitored and met and to protect them from potential harm due to medication errors. EVIDENCE: Staff are provided with clear written guidelines on how to support service users to maintain their personal appearance and hygiene and there have been improvements to the home in that all bathrooms were being fitted with taps at the time of the inspection. Some service users’ clothing appeared rather old and worn and the registered manager said that another service user had torn their clothes. Changes had been made to ensure that service users would be protected from this happening in the future and the registered manager said that arrangements were being made to replace service users’ clothing urgently. A service user was observed being assisted to access local healthcare services at the time of the inspection and visiting relatives confirmed that service users have good access to local NHS healthcare services they need. Records of healthcare needs and services provided to service users were in place for most of them, but were unavailable for one who was case tracked. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 17 Medication procedures in one of the units were not accessible at the time of the inspection, so staff did not have the necessary written guidance to hand. Staff training in respect of medication is insufficient to ensure that they handle service users’ medicines safely and there have been several incidents of medication errors reported to the Commission since the previous inspection. Medication records were inadequate in one of the units and the staff specimen signature sheet was incomplete in another. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 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 & 23 Quality in this outcome area is adequate. There are satisfactory arrangements in place to enable service users and their relatives to make their views known and to ensure that they are taken seriously and acted upon. Improvements are needed to ensure that service users are adequately protected from abuse. EVIDENCE: Service users have copies of the home’s formal complaints procedure provided to them in appropriate formats. Visiting relatives said that their views and opinions were listened to and taken seriously and that they would have no concerns about making formal complaints if necessary. The home seeks the views of relatives and placing authorities through annual questionnaires, completed copies of which, were available at the inspection. The home’s internal procedures to guide staff on how to protect vulnerable adults from abuse have been updated and improved and staff recruitment records indicate that they are employed on the basis that they are suitable to work with vulnerable adults in a care setting. The registered manager should attend local multi-agency training on the protection of vulnerable adults from abuse, however, and ensure that all incidents, including incidents between service users are reported to the appropriate department of adult social care and the Commission, in line with the home’s procedures and best practice. An example of where this did not occur was the tearing of service users’ clothing by another service user. Records of service users’ personal finances, where the home holds and manages them, should provide a clear audit trail, to ensure that they are adequately protected from financial abuse, as they were inadequate for one of the service users case tracked. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. The home’s environment is overly institutional in many parts so that service users do not benefit from a comfortable or homely place to live in. Spectrum has plans in place to extensively modernise and improve the service for them in this respect. There are satisfactory systems in place to maintain hygiene in the home. EVIDENCE: The registered manager described plans to extensively modernise and improve the accommodation provided to service users, which are currently in progress. In the meantime, the accommodation provided to individual service users is variable. In parts, the home provides them with comfortable and homely surroundings and they are able to personalise their private accommodation according to their individual tastes. Other parts are very institutional and restrict their freedom of movement. Whilst there have been some improvements, notably the provision of tap heads in the bathrooms, more could be done in terms of replacing worn and mismatching furniture to make the home more comfortable pending implementation of the improvement plans. Hygiene in the home has improved. New staff undertake infection control and basic food hygiene training as part of their induction and existing staff have good access to ongoing training in this respect. The home appeared clean and
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 20 tidy at the time of the inspection and staff were observed using safety equipment provided. Laundry doors are marked to be kept closed where they lead off from food preparation areas and there are suitable laundry facilities to manage heavily soiled laundry and to prevent infection spreading through the home. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. A greater proportion of the staff team should achieve formal qualifications so that service users can have confidence in their competence. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. They have good access to ongoing training, so that service users can be confident that they have the training they need to be able to work safely in the home. EVIDENCE: The registered manager said that fewer than half of the care staff have formal qualifications at the minimum recommended level although most are working towards achieving them. Records of staff training confirmed this. A staff member who was interviewed said that they were treated fairly when they were recruited. Staff recruitment records show that recruitment is fair and effective in that job applicants are tested against pre-set criteria, having submitted an application form and safe in that checks are made that they are suitable to work with vulnerable adults in a care setting. A staff member who was interviewed said that they received formal induction training on taking up their post and that they have good access to ongoing training so that they can develop their knowledge and skills. The manager has drawn up a team training plan for the home, which was reviewed at the time of the inspection and there are records of training undertaken by individual staff,
St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 22 which were also reviewed. Staff rotas indicate that there is a good skills mix among staff on duty so that service users can be safely cared for. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. The home’s manager is registered with the Commission as competent and fit to manage a care service. There are plans in place to change the management arrangements, which the Commission has been informed of and in the meantime the existing registered manager continues to be employed there. There are satisfactory systems in place to monitor the quality of the services provided so that it can be improved for the benefit of the service users. Improvements are needed to protect service users’ health, safety and welfare, with particular reference to fire safety in the home. EVIDENCE: The registered manager was present during the inspection and remains closely involved with the home. There are plans to replace her with a manager who is very experienced within the Spectrum organisation, which the Commission has been notified of. This person is in the process of completing an application to take over as registered manager. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 24 Service users and their relatives are consulted formally about the quality of the services provided by the home on a regular basis and records in the home were available as evidence of this. Service users’ relatives who were interviewed confirmed that they are able to state their views on the quality of the care and services provided formally and informally. Spectrum has responded and is in the process of modernising and improving the service for the benefit of the service users. Whilst there are systems in place to protect service users from risks to their health and safety, including staff training and written procedures to guide them on how to work safely and effectively, fire safety risk assessments were not up to date in all three units and records of tests of fire safety alarms and equipment were not completed regularly. St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 2 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 3 X 3 X X 1 X St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 26 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 YA7 Regulation 12(2) 23 Requirement Service users must not be subjected to undue restrictions on their movement and freedom, with particular reference to the home’s environment and access to their bedrooms. Risk assessments must reflect restrictions placed on service users, which must be minimal and only in the interests of their welfare. All service users must be provided with access to activities in and out of the home in accordance with their needs and as set out in their individual care plans. Healthcare records relating to all service users must be available in the home at all times. The registered provider must make arrangements for the safe management of service users’ medicines, including the maintenance of up-to-date and accurate records. This requirement has been renotified. The previous date set for compliance was 01/04/06. It is of concern to the Commission
DS0000009149.V302017.R01.S.doc Timescale for action 01/01/07 2. YA9 12(2) 13(7) 01/01/07 3. YA12 12(1) 01/01/07 4. 5. YA19 YA20 12(1)(a) 17(1)(a) 13(2) 01/10/07 01/10/07 St Erme Version 5.2 Page 27 that compliance has not been achieved. 6. YA23 13(6) 37(1)(e) 17(2) Service users must be protected 01/10/06 from harm and abuse in accordance with the home’s written procedures. This includes notification of incidents between service users that are abusive to the appropriate agencies and ensuring that a clear audit trail is maintained in respect of service users’ personal finances, where they are managed by the home. Service users must be provided 01/01/07 with a comfortable and homely environment, which meets their needs and encourages privacy, dignity, choice and freedom of movement. Fire safety risk assessments and 01/10/07 records of weekly fire alarm tests must be kept up-to-date. This requirement has been renotified. The previous date set for compliance was 01/04/06. It is of concern to the Commission that compliance has not been achieved. 7. YA24 12(1) 12(2) 12 (4) 16(2) 23 23(4) 8. YA42 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 YA2 YA7 Good Practice Recommendations Service users should be provided with improved opportunities to participate directly in the assessment process, with particular reference to the re-assessments currently in progress as part of the registered providers modernisation and improvement plans. Service users’ care plans should be provided to them in
DS0000009149.V302017.R01.S.doc Version 5.2 Page 28 2.
St Erme YA6 3. 4. YA7 YA9 5. 6. YA18 YA20 meaningful formats, which are directly accessible to them, with clear and specific goals. Service users’ risk assessments should be provided to them in meaningful formats, which are directly accessible to them, as far as is practicable. The registered provider should validate its internal review of restrictive practices with a recognised external agency that specialises protecting and supporting the rights and best interests of adults with learning disabilities. Service users’ clothes should be replaced promptly when they become worn or damaged. 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 registered manager should attend multi-agency 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 and replacement of dining room furniture, where it is worn and mismatching. At least 50 of the staff team should be qualified to NVQ level 2 or above. 7. 8. YA23 YA24 9. YA32 St Erme DS0000009149.V302017.R01.S.doc Version 5.2 Page 29 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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