CARE HOME ADULTS 18-65
St Erme House Trispen Truro Cornwall TR4 9BW Lead Inspector
Lowenna Harty Unannounced 27 September 2005 09:30 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 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 Stationary 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 House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Erme House Address Trispen Truro Cornwall TR4 9BW 01872 265555 Telephone number Fax number Email 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 Mrs Kerry Turner Care Home 20 Category(ies) of Learning Disability (20) registration, with number of places St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1) St Erme House - to include up to 10 adults with a Learning Disability (10) 2) The Lodge - to include up to 9 adults with a Learning Disability (9) 3) St Michaels - to include up to 3 adults with a Learning Disability (3) 4) Total number of service users not to exceed a maximum of 20 Date of last inspection 11 Nobember 2004 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 serivce users with single bedrooms and a range of communal spaces, including lounge/ dining areas and kitchens. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place across two days, on 27 and 30 September. In total it lasted for approximately fourteen hours and was unannounced. 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 of inspection 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, interviews with relatives and an external professional visiting service users and discussion with the home’s registered manager and a senior manager from Spectrum. Two sets of relatives were interviewed. Their comments, which were mainly positive, have been included in the summary and main body of the report. Overall the home provides service users with a good standard of care. Spectrum has developed innovative ways of helping some service users with extremely complex needs to live in a community based setting. The inspector would like to thank the service users, relatives, visiting professional, registered manager and staff for their kind assistance in the conduct of this inspection. What the service does well:
Service users are admitted to the home on the basis of detailed assessments, which consider their health and social care needs including their likes and dislikes and their cultural backgrounds. This information is used to develop comprehensive written care plans for each service user. Service user’s care plans work towards helping them to develop their skills in making decisions and ordinary activities of daily living such as shopping and cooking. They are able to undergo home-based tuition in life and living skills through a visiting tutor from a local college. Each service user has a detailed written risk assessment with guidance for staff working with them on how to help them safely. The focus is on managing challenging behaviours and complex needs in positive, low-key ways, wherever possible. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 6 There is a high level of interaction between service users and staff, which was very evident throughout the inspection. Most service users require high levels of staff input to help them carry out their care plans in safe ways. The home has four buses and a car to help service users to access facilities in the local community. These come with appropriate safety equipment and guidance for staff so that they can take service users out safely. Service users were observed coming and going from the home throughout the two days of the inspection, as they undertook a range of activities in the home and in the local community. Service users’ visitors and relatives are made welcome and this was confirmed by visiting relatives at the time of the inspection. There is a visitor’s room, separate to service users’ accommodation, in the main administration block, where family visits and reviews can take place in privacy and comfort. Staff maintain contact records between service users and relatives to ensure that contact is maintained in accordance with their care plans. Service users are assisted to access a range of local NHS healthcare providers and there are examples of good healthcare arrangements in place to meet the needs of service users with very complex needs. This includes ensuring access to a specialist assessment for one service user to consider their environmental needs in light of their disability. The home has a written complaints procedure, which is included in the home’s statement of purpose and has been circulated to service users’ representatives. It is also included in the service users’ guide, which has been provided to some service users in translated formats to enable them to access the information more easily. The home’s premises provide a range of different types of accommodation to service users who have a wide range of different needs. There have been extensive adaptations to the property to make it suitable for service users with some very challenging behaviours and complex needs. The registered manager monitors staff training needs and because of the large numbers of staff working at the home at any one time, there is a good range of experienced and trained staff to ensure service users’ needs are met. What has improved since the last inspection?
Service users’ guides, which also function as statements of terms and conditions for service users now contain information on the fees payable and specify each service user’s bedroom. They have been produced in pictorial and photographic formats to provide service user with more meaningful and accessible information. Goal plans have now been introduced to the care planning process so that service users and their representatives can be clearer about the purpose of their placements at the home and maximise opportunities for developing their independence and skills.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 7 Consultation with service users and their representatives about the quality of services provided has improved. Questionnaires have been circulated to service users in formats suitable for their needs and their representatives and families. The results have been collated, analysed and included in the home’s statement of purpose. The results have also contributed to the planning for the future development of the home and service. Systems for managing service users’ medication in the home have improved. Spectrum has introduced new administration methods and updated its written procedures to improve guidance to staff handling service users’ medication, which should reduce the risk of medication errors. New furniture was placed in the service users’ lounge in the main house at the time of the inspection, to make it more homely and comfortable. There were maintenance workers on site at the time of the inspection making repairs to a service user’s broken door. There is now an annual development plan for the home, which sets out plans for the improvement of the service in the future, with particular regard to the home’s physical environment. Spectrum has introduced a computerised system for storing staff recruitment and selection records, so that the registered manager can be confident that staff working in the home are suitable to work in a care environment and relay this to service users and their representatives. What they could do better:
Whilst care plans are comprehensive, based on those that were inspected in detail, one service user had health care needs, which were identified in other documents that had not been addressed in the care plan. Service users’ care plans should address all their health care needs and set out clearly how they will be met to reassure and inform service users and their representatives. One service user’s care notes suggested that they may be able to participate more fully in the care planning process than they do currently and this should be explored further. Service users are not currently routinely provided with independent advocates. Most have family members and professional representatives, but they should be provided with independent advocates to protect their rights and best interests. This is particularly necessary for service users who have communication difficulties and in terms of agreeing risk assessments and plans to manage particularly challenging behaviours. In two of the units, service users’ daily care records are in the form of a tickbox sheet, which does not demonstrate adequately, on a daily basis, how service users make choices or that they are provided with access to activities in and out of the home in accordance with their agreed care plans. Service users with communication difficulties are not routinely referred for specialist input to assess and develop their speech and language abilities. Notes on one service user’s file suggested that this was an identified need in
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 8 the past, which had not been followed up. All service users who would benefit should be referred for specialist speech and language therapy assessments. One service user, whose case was tracked, currently makes use of an external area of the home at certain times, which requires a written risk assessment and risk management plan to ensure that they are safe from injury. Whilst arrangements for ensuring contact between service users and the home are good, contact arrangements between the home and the parents of one service user whose case was tracked, need to be agreed in writing and followed up to support the current contact records in place. One service user has been provided with a specialist assessment with particular regard to the most suitable environment for them, so that the home can be adapted accordingly. This should be extended to all those who would benefit, to inform future plans for development of the service. Staff handling medication should be provided with safe handling of medicines training, in addition to the in-house training provided by Spectrum, to ensure that service users are better protected from medication errors. Systems in place to protect service users from the risk of fire need to improve. The home’s fire safety risk assessment needs to be place on the fire safety file so that it is readily accessible to managers and staff. There need to be records of monthly evacuations and weekly tests of all fire alarms, equipment and the home’s emergency lighting system. Systems in place to protect service users from the risk of infection also need improvement. At the time of the inspection, there was some household rubbish in black bins outside one of the units, which should not have been there. The written guidance for staff to prevent the spread of infection should be reviewed and updated and staff should be provided with training. Hand washing facilities, in particular, need improvement as several tap heads have been removed from service users’ bathrooms. There should be suitably designed taps in place to reduce risks of service users flooding the building but enable them to wash their hands properly, when they need to. All staff handling food need to undergo training in basic food hygiene to protect service users from the risk of food borne infections. The home’s annual development plan needs to include timescales and costs for the future development and improvement of the home so that they can be monitored and progressed for the benefit of the service users. 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 House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 2 & 5 Prospective service users’ needs are assessed in detail so that they can be properly met in the home’s setting. Service users are provided with individual written statements of terms and conditions so that they and/or their representatives can be sure of their rights and obligations. EVIDENCE: Of the three service users whose records were examined in detail, each held detailed assessments. Two of the service users had been resident in the home for several years and there was sufficient background information on their personal files to guide staff working with them. One had been recently admitted to the home and there was detailed assessment information on their file relating to their admission to the home. The home’s statement of purpose contains information on the admission process and makes clear that admission is on the basis of assessment. The assessment format covers all aspects of service user’s health; personal and social care needs, including their preferences, skills, decision-making abilities and cultural needs. The home’s service users’ guide also functions as a statement of terms and conditions for service users. These now contain information on the fees, rooms to be occupied and services available to them. They have been provided to service users in translated formats, including pictorial versions, where necessary. Copies are held on their individual files.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 11 St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8 & 9 Improvements are needed to care planning and record keeping, to demonstrate that service users’ needs are properly met. Service users need better opportunities to make decisions about their lives although formal consultation with them and their representatives has improved. Individual risk assessments need improvement to ensure that service users are adequately protected. EVIDENCE: Each of the three service users, whose records were reviewed, had detailed written care plans on their personal files. These were regularly reviewed and formal reviews, involving service users’ parents and placing authorities were in progress at the time of the inspection or had been booked to happen shortly. Care plan formats cover most aspects of service users’ health, personal and social care needs, including their cultural needs and now have individual goal plans. There were some notable instances where identified needs had not been included in the written care plan, however, with regard to one service user’s particular health care needs. Records on one service user’s file suggested that they may be able to participate in the care planning process more than they currently do. Service users are not currently routinely provided with advocates in situation where they are not directly involved in their care planning.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 13 Service users’ care plans address their abilities to make decisions, their likes and their dislikes. Some are assisted to develop their life and living skills through formally accredited training with an independent trainer from a local college, who provides them with home tuition. There are some examples of how they are assisted to make decisions about their lives but daily care records in two of the houses do not provide sufficient information to demonstrate this fully. Service users with speech and language difficulties are not currently routinely provided with access to specialist services, although some care records indicate that they would benefit from them, so that they can maximise their potential to participate fully. Consultation with service users and their families has improved, with the introduction of formal quality assurance questionnaires for service users and their representatives. Their parents are invited to attend reviews and sign up to their care plans. Service users’ questionnaires have been drawn up in translated and pictorial formats. The results have been collated and are published in the home’s statement of purpose. Service users have detailed, individual risk assessments, which set out strategies for staff to manage challenging behaviours in low-key, positive ways. Whilst generally comprehensive, one service user’s risk assessment did not adequately address the use of an external area to assist them with particular behavioural difficulties. Service users are not currently routinely provided with access to external advocates to sign their agreement with strategies that may be considered restrictive but necessary to protect them and/others. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 11, 12, 13 & 15 Service users are encouraged to develop their skills and abilities but their participation in activities in and out of the home needs to improve. They are assisted to develop appropriate relationships with people in and out of the home although some improvements are needed in this. EVIDENCE: The care plans of the three service users whose records were reviewed consider their skills in activities of daily living, such as shopping and housework. Service users are encouraged to participate in cleaning, cooking and shopping tasks in the home. Some are engaged in formally accredited training to develop their skills with a visiting tutor from a local college. Service users’ individual care plans consider their likes and dislikes with regard to activities but daily care records in two of the units do not provide adequate evidence of their involvement with a range of activities in and out of the home, in accordance with their written care plans. Staff are deployed to work individually with service users, where necessary and were observed closely
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 15 interacting with service users in a variety of activities in the course of the inspection. The home has four buses and a car to transport service users in the community. There is clear guidance for staff and specialist equipment is provided to enable them to help service users access the community safely. Service users were observed going out to various locations in the course of the inspection although in two of the houses, there was a lack of evidence of service users accessing activities in the local community in accordance with their care plans. Service users’ care plans consider their personal and family relationships and visitors are welcome to the home in accordance with the home’s statement of purpose. Relatives were visiting service users at the time of the inspection and said that they are always made welcome in the home. Senior managers from within the Spectrum organisation provide staff with specialist guidance on assisting service users with personal relationship problems, where necessary. There is a visitors’ room in the administration block, where relatives can meet with service users in comfortable surroundings, separate to the main units. There are records of the home’s contact with service users’ family representatives, although there needs to be improved agreement on the frequency of contact with regard to one of the service users whose records were reviewed at the inspection. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 19 & 20 Improvements are needed to ensure service users’ healthcare needs are fully met and to protect them from medication errors. EVIDENCE: Service users’ health care needs are addressed in their individual care plans and there are records of their contact with a range of local NHS healthcare providers. One service user is receiving input from a private consultant for highly specialist needs. A service user with very complex healthcare needs has the specialist input and equipment they need to keep them safe. Staff working with them have undergone specialist training to work with them. Another has undergone a specialist assessment with an occupational therapist, which should be extended to other service users who would benefit from this. Service users with speech and language difficulties are not routinely referred for specialist input to develop their skills and one service user’s care records suggested that this was needed. Specific healthcare needs for one service user, whose records were reviewed, were not addressed in their care plan. There have been improvements to the arrangements in place for managing service users’ medication, with the introduction of a new system and record keeping. The home’s written procedures to guide staff administering medication have been reviewed and updated and are now available to staff.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 17 Not all staff handling service users’ medicines have received safe handling of medicines training, beyond that provided in-house by Spectrum. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 22 There are systems in place to ensure service users’ views are listened to and acted on. EVIDENCE: The home has a written complaints procedure, which is included in the statement of purpose and circulated to service users’ representatives. It is also included in the home’s service users’ guide, which has been provided to service users in translated formats. There is a quality assurance programme in place. Service users’ families and representatives have been consulted on the quality of services the home provides and service users have been invited to complete questionnaires, which are provided for them in alternative formats. The results have been collated and included in the home’s statement of purpose. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 standard(s) 24, 29 & 30 Improvements are needed to make the home’s environment safer and more suitable to meet service users’ needs, with particular reference to their specialist needs. Improvements are needed to ensure that service users are protected from infection. EVIDENCE: Maintenance workers were undertaking repairs to the property at the time of the inspection and new living room furniture was placed in the main house to make it appear more homely for service users. The home’s environment provides service users with differing styles of accommodation, which meets the needs of some of them. One of the service users whose records were reviewed in detail benefits from living in a homely, self-contained flat, with independent access to a kitchen, bathroom and lounge. Others, however, are provided with more sparse accommodation, which has been designed with reference to safely managing people with behavioural difficulties. One service user has undergone a specialist occupational therapy assessment, which set out recommendations for the kind of environment that would most meet their needs. Other service users would benefit from similar assessments so that the home’s environment can be suitably adapted for them.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 20 The home’s environmental risk assessment was completed, to ensure that risks to service users are identified and eliminated. Records associated with fire safety were inadequate, however. The home’s fire safety risk assessment was not on the fire safety file at the time of the inspection. Records of monthly evacuations and weekly alarm and equipment tests were lacking. Service users with specialist environmental needs in relation to their behavioural difficulties are catered for in part, although more would benefit from specialist assessments around this. Spectrum has made extensive adaptations to the property to enable some service users to remain in a community setting, where they might otherwise require more secure environments but this may adversely impact on some service users who do not present with highly challenging behavioural difficulties. There is now an annual development plan in place, to address this but it needs to contain timescales and costs and be shared with service users and their representatives. There are written procedures to guide staff on the prevention of the spread of infection, but these should be reviewed and updated to ensure the home is kept clean and hygienic. The main house has an industrial washing machine and sluice facility and staff use dissolving sacks to transport laundry safely. Staff are not currently routinely provided with infection control training and not all those who handle food have undergone training in basic food hygiene. The home appeared mainly clean and tidy at the time of the inspection although there were some bags of rubbish outside the front door of the main house, which should not have been there. More attention needs to be paid to effective hand washing to protect staff and service users from infection. Several bathrooms have had tap heads removed. Alternative solutions need to be put in place to ensure that all service users are encouraged to maintain good hygiene at all times. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 The home has fair, safe and effective recruitment practices to ensure staff are suitable to work with service users. Staff training needs improvement. EVIDENCE: Spectrum has invested in a computerised record system, which has been installed across its services and now provides access to information on staff to demonstrate that they are recruited and selected on the basis of fair and safe recruitment methods. Copies of staff application forms, interview records, references and criminal records bureau checks are now readily available for inspection. These demonstrate that staff are suitable to work with vulnerable service users. The registered manager has undertaken a staff training needs analysis and drawn up a training plan for the service. New staff undergo structured induction training at Spectrum’s head office and further induction to the houses they are working in before they commence work with service users. Spectrum provides them with access to NVQ training and a range of short courses to develop their knowledge and skills. There are sufficient staff on duty at the property at any time to ensure there is an adequate mix of skilled and experienced staff. More staff need training in the safe handling of medicines,
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 22 however, and they should be provided with training in infection control. All staff handling food should have basic food hygiene training. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 The home has a quality assurance system in place to ensure service users and/or their representatives are adequately consulted on the home’s development. Improvements are needed to protect service users’ health and safety. EVIDENCE: Service users’ parents and representatives have been consulted in writing on the quality of the services provided to them. Service users have been consulted, using questionnaires in alternative formats. The results have been collated and are contained in the home’s statement of purpose. Service users’ parents and representatives are invited to attend their individual care planning reviews. The home’s environmental risk assessment is complete and up-to-date, but improvements are needed to protect service users from fire hazards and infection, as previously mentioned in this report.
St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 24 St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x 2 2 Standard No 11 12 13 14 15 16 17 2 2 2 x 2 x x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Erme House Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 26 No 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 7, 12 & 13 Regulation 12(1) Requirement There must be clear evidence that service users are provided with access to activities and community resources in accordance with their individual care plans. Service users who would benefit, must be provided with assistance to access specialist input to develop their communication skills. Service users individual risk assessments must fully address all risks to their health and safety, including the use of external areas to address particual needs. The registered manager must ensure that there are adequate fire precautions, including an accessible fire safety risk assessment, clear records of monthly evacuations and weekly alarm and emergency lighting tests. The registered provide must ensure that there are suitable measures in place to prevent the spread of infection including training for staff, the safe containment of household waste Timescale for action 01/12/05 2. 7 & 19 12(1) 01/12/05 3. 9 & 42 12(1) 13(4) 01/12/05 4. 24 & 42 23(4) 01/11/05 5. 30, 35 & 42 13(3) 01/01/06 St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 27 6. 30 & 35 13(3) 18(1) and provision of proper handwashing facilities for service users. All staff handling food must undergo training in basic food hygiene 01/01/06 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. 2. 3. Refer to Standard 6 6 6&9 Good Practice Recommendations Service users health care needs should be fully included in their care plans, alongside clear information as to how they will be met. Service users should be enabled to participate more fully in the care planning process wherever this may be possible. 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 individual risk assessments and action plans. There should be a record of agreed levels of contact between the home and the service users relatives to support the homes existing contact records. All service users who would benefit from them should be provided with specialist occupational therapy assessements with regard to the type of environmental adaptations they need. All staff handling medication should undergo training in the safe handling of medication in addition to the in-house training currently provided. The homes annual development plan should contain timescales and costs of planned changes. 4. 5. 15 19, 24 & 29 20 & 35 24 6. 7. 8. St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection 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
© 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 St Erme House D52-D04 S9149 St Erme House V245616 270905 Stage 4.doc Version 1.40 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
