CARE HOME ADULTS 18-65
Stocksbridge Neuro-Rehabilitation Centre 2a Haywood Lane Stocksbridge Sheffield South Yorkshire S36 2QE Lead Inspector
Marina Warwicker Unannounced Inspection 2nd August 2006 09:20 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.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 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.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. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stocksbridge Neuro-Rehabilitation Centre Address 2a Haywood Lane Stocksbridge Sheffield South Yorkshire S36 2QE 0114 2837200 0114 2887736 none Not available Active Care Partnerships Ltd 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) Kathryn Sandra Oakley Care Home 24 Category(ies) of Physical disability (24) registration, with number of places Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is for service users who require neurological care. The minimum numbers of staff on duty must comply with the staffing notice dated 6/3/00 and attached (referring to previous name of home; Holly Lodge). 2nd February 2006 Date of last inspection Brief Description of the Service: Stocksbridge Neuro-Rehabilitation Centre is a purpose built service offering respite, assessment and rehabilitation to adults aged 18 – 65years who have an acquired brain injury or neurological condition. The building has therapy rooms, Kitchenette to facilitate independent living skills, lounges for relaxation and access to paved gardens. The centre overlooks the village of Stocksbridge. It is near the bus routes and the local shops. It is also within easy reach of Sheffield city centre and the motorway network. The building has two levels, with a passenger lift providing access to both levels. Rooms and corridors are designed to accommodate wheelchairs. The staffing structure consists of an interdisciplinary team of professionals made up of a consultant neurophysiologist, care manager, service manager, nurses, behavioural technicians, physiotherapist, occupational therapist, speech and language therapist and rehabilitation support workers. The ancillary workers such as the cooks, the domestics and the maintenance persons are also employed to support the service. The basic weekly fee is £2,384.00. This includes, nursing care, therapy input as assessed on admission and on reviews, board, lodging, laundry, house keeping, meals, support when attending out patient appointments and a programme of social and recreational activities to complement therapeutic activities. The fee does not include the cost of hairdressing, chiropody, toiletries, maintenance of private equipment, private telephone, internet access, replacement clothing, footwear and underwear. Stocksbridge Neuro-Rehabilitation Centre is a part of Active Care Partnerships. At the reception area in the main entrance there was a variety of information made available about the parent company Active Care Partnerships for visitors and relatives. There was also a folder with the service users guide specific to Stocksbridge Neuro-Rehabilitation Centre, which gave service specific information. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection of Stocksbridge Neuro-Rehabilitation Centre was carried out on 2nd August 2006 between 9.20 am and 5.10 pm and a further visit was made on 3rd August 2006 between 8.10 am and 11.30 am to conclude the inspection site visit. Five residents and three relatives were consulted and eight staff were spoken to. A further ten relatives have been contacted by post to obtain feedback about the service. Comments received by the Commission for Social Care Inspection will be handled appropriately and shared with the managers once all of the comments are collated. Time was spent observing and interacting with staff and the service users. The managers were present during the inspection. The premise was inspected, which included bedrooms of service users, the communal areas, kitchen, laundry and outdoor areas of the home. Sample records were checked. These were care plans, medication records, service reports and staff recruitment and training files. Throughout the two days the registered manager was informed of the findings and a brief final feedback at the end was given to the manager. What the service does well:
There is information for the prospective service users and their representatives to find out about the facilities made available at Stocksbridge NeuroRehabilitation Centre. This enables the service users to make an informed choice about the service. The infrastructure of the home reflects the service users’ unique needs and aspirations. The staff working at the home are on the whole competent and able to deliver the assessed needs of the service users. Stocksbridge Neuro-Rehabilitation Centre specialises in rehabilitation of people following brain injury or other neurological conditions. Therefore the individualised service user plans detail how the person is to be supported by the interdisciplinary team. The service user plans are determined by the interdisciplinary team assessments and agreed by each service user or their representative. The plans reflect the needs, goals and aspirations of each individual service user. The plans are changed when circumstances of the service users change. The representatives of the service users are included in their daily life if it is appropriate and agreeable by the service users. The care manager and the senior staff have a good understanding of how service users’ personal, cultural, religious diversity affects their participation in the programme, the level of improvement and the achievable outcome of the rehabilitation. The home has a clear and effective complaints procedure, the service users, the visitors and staff knew how and who the complaints should be made to.
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 6 The home has written policies and the staff are trained to safeguard service users from abuse, neglect, discrimination, self-harm and degrading treatment. Each individual accommodation reflects the service users’ specialised needs. The centre provided a range of comfortable, safe and fully accessible shared spaces for both activities and private use. One service user said how much s/he liked sitting outside in the patio area. The staff in general are competent and knowledgeable to carry out the tasks required to support and care for this specific service user group. The service manager and the clinical manager foster an atmosphere of openness and respect in which the service users, staff, families and friends feel valued and listened to. The management promote quality assurance and quality monitoring system, including provision for asking service users and families for their opinions of the service they provide. What has improved since the last inspection? What they could do better:
The rehabilitation support workers (RSWs) need training on aspects of infection control since there were some unacceptable practices with regards to spread of infection. There is a lack of drivers to make effective use of the home’s mini-bus. The service users, relatives and the staff identified this. The managers were aware of this. The kitchen was in need of repair and redecoration. The service manager informed the inspector that this work has been scheduled to be complete in September this year. Comments were made of the lack of slings for the bath hoists and that it made bathing of service users difficult. The registered manager said that she had already been aware of this and assured the inspector that action has been taken to address this problem. The service users should be consulted on cooked breakfast and provisions need to be made to accommodate any request for cooked breakfasts. The care staff said that they were expected to carry on washing laundry through the night once the laundry assistants finished work in the afternoon. The inspector spoke with both managers and requested that alternative
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 7 arrangement be sought to cover laundry in the evenings and the night times as the present arrangement seems to compromise the time available for care delivery. The staff explained often the dependency levels of service users did not allow time for laundry duties and this was causing ill feeling between staff. There are sufficient numbers and complementary skills of staff to support the service users during daytimes however, nights and weekends staffing levels need to be reviewed. Staff recruitment, induction details need to be updated. The administrator completed this following the site visit and informed the Commission for Social Care Inspection. Service users and the relatives commented that during weekends there were no activities and that the service users were bored. They inquired why the occupational therapy and physiotherapy were stopped at the weekend. One person suggested that ‘Instead of cramming everything between Monday to Friday, why don’t they spread it out over seven days’. The manager was made aware of this. However she said that she would look into the comments. Staff supervision was carried out ad hoc and staff were not quite sure whether they had been to supervision meetings or an informal chat with the senior staff. Some staff could not remember having supervision. Support workers were frustrated with the NVQ assessor with his/her reliability and commitment. The manager was aware of this and action has been taken to rectify this. Staff said that they would benefit by formal training on Palliative care, Tissue viability, Vena puncture/ phlebotomy, Infection control and Continence care. The managers agreed to address the above issues in a timely manner and comply with the requirements. 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. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 8 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 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. Information for prospective service users and their representatives to find out about the facilities is made available at Stocksbridge Neuro-Rehabilitation Centre. This enables the service users to make an informed choice about the service. The infrastructure of the home reflects the service users’ unique needs and aspirations. The staff working at the home are competent and able to deliver the assessed needs. EVIDENCE: Four service user files were checked and four Rehabilitation support workers (RSWs) and other therapy staff were consulted. The service user guide sets out clear information about the service provided by the centre. The four service users files had full needs assessments by the care manager and referral letters from the hospital staff. The manager said that the staff competency in meeting the needs of the service users was monitored at the fortnightly interdisciplinary team meetings. The service focused on rehabilitation of the service users therefore individuals’ needs and aspirations were taken seriously and realistic goals were set and agreed by the service users. Two relatives said that the service users have
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 10 opportunities to terminate their stay if they felt the centre was not helping them. Therefore for their relatives, trial visits were not appropriate. All four service users were funded by Primary Care Trusts (PCTs), and the contracts were drawn up between the individual PCTs and Stocksbridge NeuroRehabilitation Centre. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. The service user plans are determined by the interdisciplinary team assessments. The plans reflect the needs, goals and aspirations of each individual service user. The plans are changed when circumstances of the service users change. The representatives of the service users are included in daily life if it is appropriate and agreeable by the service users. The service user plans are used as yardsticks for judging whether appropriate support is being delivered from the centre; by both care managers i.e. placing authorities, social workers and the funding authorities. EVIDENCE: Four service user files were checked. Each had an individual care plan, which included treatment, rehabilitation and facilities to be provided, by the home. Discussions took place with regards to individualised procedures for service users who were likely to be aggressive or cause harm to oneself or others. The
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 12 staff and the manager said that they focused on positive behaviour of individuals, their ability and willingness to co-operate when addressing such issues. They also added that they followed the home’s policies on dealing with aggression. The staff were observed to practice such procedures during the days of inspection site visits. During staff interviews and consultation with the service users and their relatives it was established that the staff helped service users make decisions about their own lives by providing information, encouragement and support with communication. The service manager said that the ‘residents meetings’ were used to involve the service users and invite their participation, contribution to the running of the home and its policies. There was documentary evidence to support this. During the days of the site visits the interdisciplinary staff team were seen helping service users to take responsible risks under supervision. The therapists gave service users training about their personal safety. One of the service users said through risk management strategies s/he was now able to carry out several activities of daily living such as washing clothes, making snacks and going out. The relatives were confident that any information the staff had access to on the service users would be treated with utmost confidence. The staff also knew when information was given to them in confidence they must be shared with the line manager according to the homes policies and the Data Protection Act 1998. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. The rules and daily routines at Stocksbridge Neuro-Rehabilitation Centre respects service users’ individuality, dignity and privacy. It promotes the service users’ wellbeing and independence. The care manager and the senior staff have good understanding of how service users’ personal, cultural, religious diversity affects their participation, improvement and rehabilitation. The service users are offered a choice of menu and encouraged to eat healthily. EVIDENCE: The service users said that they were given opportunities to re-learn and use practical life skills. One service user said “Can’t remember what it was like but I am getting there” Most service users had multiple needs and the interdisciplinary team helped to manage and treat their needs.
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 14 The care plans referred to service users spiritual beliefs and the staff said that they helped to facilitate if they wanted to attend church or see a minister of church. During conversations with the service users and the staff it was evident that as part of the rehabilitation programme the service users were given opportunities to take part in activities, which they had been engaged in prior to entering the rehabilitation centre. Since most of the service users lived out of Sheffield they were encouraged to re-establish contacts in the local communities including Sheffield City opportunities. The staff said that they supported those service users who wished to become part of the local community as long as it was part of their agreed plan of rehabilitation. There were comments made with regards to the lack of drivers to make effective use of the home’s mini-bus. The managers were informed of this. The staff and the relatives said that the service users were encouraged to pursue their own interests and hobbies once they were ready and receptive. During the site visit it was noted that the families and friends of service users were welcomed and their involvement in daily routines and activities were encouraged by the staff with the service users’ agreement. It was observed that the staff entered the bedrooms of the service users only with the individual’s permission. Although the service users had unrestricted access to the rehabilitation centre and its grounds, some restrictions were imposed on certain individuals as part of the agreed care programme by the interdisciplinary team. The staff said that it was identified that the service users preferred to have breakfast from the kitchenette attached to the dining room. The service users were offered cereals and toast as their choice. There were suggestions made that the service users should be offered a cooked breakfast at least at the weekend. The lunch and dinner were prepared in the kitchen. The service users were offered a choice of suitable menus. The therapy staff supported some service users by helping them to plan, prepare and have meals by themselves. The service users were given plenty of time to feed themselves, therefore the meal times seemed lengthy. Staff were around to help those who needed help with feeding, discretely. The nurses said that the nutritional needs of individuals were regularly reviewed including risk factors associated with weight loss, obesity and eating disorders. Some service users were artificially fed and supported by staff. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 15 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 and 21 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. Stocksbridge Neuro-Rehabilitation Centre specialises in rehabilitation of people following brain injury or other neurological conditions. Therefore the individualised service user plans detail how the person is to be supported by the interdisciplinary team. The service users are accepted only on the basis that the staff are competent and qualified to meet the assessed personal, healthcare and nursing care needs. EVIDENCE: The service users and the relatives said that the staff provided sensitive and flexible personal support and nursing care to maximise privacy, dignity, independence and control. Two service users commented “Staff are very helpful and they listen to me”. The staff said that the general practitioner visited each week and service users’ health was monitored. Therefore potential complications and problems were identified and dealt with at an early stage.
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 16 Due to the service users mental/neurological status they were unable to selfmedicate. These decisions were made following risk assessments and therefore the nurses administered the medications to the service users. Records were kept of all medicines received, administered and disposed of to ensure that there was no mishandling. The RSWs said that at handover the nurses informed them if there had been any change of medication to service users and explained the side effects and requested them to be reported. The staff said that they have not had any training on death and dying of service users. They commented ‘since this is a unit offering rehabilitation to young people, the need for training on end of life care seems pointless’. Staff agreed that death comes at any age and that it is good practice to prepare and receive training to deal with such unexpected events. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from service users, relatives, staff and by checking the relevant documentation. The home has a clear and effective complaints procedure, the service users, the visitors and staff knew how and who the complaints should be reported to. The home has written policies and the staff are trained to safeguard service users from abuse, neglect, discrimination, self-harm and degrading treatment. EVIDENCE: The manager said that the service users were encouraged to voice their concerns and the staff encouraged the service users and their families to have discussions about areas they may be concerned about. The service users’ meetings too encouraged comments about the service they receive. A record was kept of all issues raised by service users, relatives or any others. The staff have had training on protection of vulnerable people. The four staff interviewed were able to verbalise the action to be taken in the event of an abusive situation. The service manager was responsible for the training on Protection of vulnerable adults and the staff said that they had enjoyed the training and that they found it informative, relevant and interesting. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 25, 27, 28, 29 and 30 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from touring the premise, speaking to relatives, staff and by checking the relevant records. Stocksbridge Neuro-Rehabilitation Centre offers accommodation to people who require therapy and activities to facilitate improvement or maintenance in the levels of cognitive development, physical improvement, progress in selfesteem and enhancement of social interaction. Therefore the centre provides suitable specialist adaptations and equipment to help achieve the individually assessed needs. Personal care facilities meets the cultural requirements of those live in the centre. Each individual accommodation reflects the service users’ specialised needs. The RSWs need training on aspects of infection control since there were some unacceptable practices with regards to spread of infection. The centre provides sluicing facilities, disinfectors and laundry so that the service users are able to live in an environment, which is home-like and at the same time fit for its stated purpose i.e. rehabilitation. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 19 EVIDENCE: On the days of the inspection site visits, Stocksbridge Neuro-Rehabilitation Centre looked comfortable, safe, bright, airy, clean and free from offensive odour. There was sufficient lighting, ventilation and the heating. The staff and the service users said that the centre offered access to local amenities, transport and support services to suit the individual needs and personal life style. All bedrooms were single occupancy and were wheelchair friendly. The bedrooms were individualised. They had furniture and fittings to suit the individual service user’s stage of the rehabilitation programme. Therefore some bedrooms looked sparse and the others looked full of personal belongings. The bedrooms had locks and some service users used the cooking facilities. The service users had access to sufficient numbers of toilet and bathrooms. These too had locks on the doors. The centre provided a range of comfortable, safe and fully accessible shared spaces for both activities and private use. One service user said how much s/he liked sitting outside on the patio area. One service user said “ I like my room and its good to sit outside whenever I want” There has been some reorganisation of floor space, which has provided the staff with facilities for storing personal belongings and having their break away from the work environment. The staff and the service users said that there was enough facilities for the safe use of equipment however, comments were made of the lack of slings for the bath hoists and that it made bathing of service users difficult. The manager was informed of this comment and she had already been aware of this and assured the inspector that action has been taken to address this problem. The laundry facilities were sited away from the food store and the food preparing areas. The washing machines had programmes to meet the disinfection standards. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 The overall quality in this outcome area is: Adequate. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. The interdisciplinary staff at the centre are accessible, approachable, good listeners, communicators, reliable, motivated and interested in what they do. The staff in general are competent and knowledgeable to carry out the tasks required by them to support and care for this specific service user group. There are sufficient numbers and complementary skills of staff to support the service users during daytimes however, nights and weekends staffing need to be reviewed. The staff team also reflects the cultural, gender composition of the service users. EVIDENCE: Two relatives, three service users and four staff were consulted with regards to this outcome group. The staff said that they knew their limitations and sought help from the nurses or the other professional with specific expertise for guidance. The Staff team consisted of Lead clinicians (Consultant Clinical Neuropsychologist, First level nurses, State registered physiotherapists, Occupational therapists, Psychologists, Speech & Language therapists),
Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 21 rehabilitation support workers, housekeeping staff and maintenance team. It was noted that the staff structure promoted and provided a person centred quality care to the service users. There were comments made by care staff that they were expected to carry on washing laundry through the night once the laundry assistants finished work in the afternoon. The inspector spoke with both managers and requested that alternative arrangement be sought to cover laundry in the evenings and the night times as the present arrangement compromises the care delivery time. The staff explained often the dependency levels of service users did not allow time for laundry duties and this was causing ill feelings between staff. To test the compliance of recruitment four Staff files were checked and the following were noted. • • • • • • • • Gaps in the employment history were not explored and reasons not recorded. Overseas staff did not have an application form. Staff induction training records were not completed. Not all staff had letters of job offer from the manager. The CRB checks did not clearly state that they were enhanced. Some staff had not signed the medical declaration. Not all staff had photographic identification. Staff had not signed their terms and conditions, as these were under negotiation with the management. Six staff were interviewed, relatives and service users were consulted with regards to staffing levels, training and supervision of staff and the following information was obtained. This information was then verified with the documentary evidence at the home and management were informed of the findings. • Staffing skill mix on night duty needed reviewing with the view to increasing the nursing staff number from one to two. • Since the centre is focused on rehabilitation and returning individuals back into the community, the level of dependency does not change due to the turnover of service users. RSWs on night duty were expected to work in the laundry but the dependency levels of service users often made this difficult. When night staff were unable to carry out laundry work there was ill feeling between the day laundry assistants and the night RSWs. • Often the same staff rang in sick at the weekend and did not allow adequate time for nurses to organise cover for the sickness. • A suggestion was made to employ a ‘Tea Lady’ so that the RSWs could carry on with the care during daytime. • Staff supervision was carried out ad hoc and staff were not quite sure whether they had been to supervision meetings or an informal chat with the senior staff. Some staff could not remember having supervision. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 22 • • • Rehabilitation support workers were frustrated with the external NVQ assessor with his/her reliability and commitment. The manager was aware of this and action has been taken to rectify this. Staff said that they would benefit by formal training on Palliative care, Tissue viability, Vena puncture/ phlebotomy, Infection control and Continence care. All staff interviewed said that they had received training on moving and handling, health and safety, fire safety, basic food hygiene and adult protection. They also said that they have had training on understanding brain injury, Management of behavioural problems and recent development in neuro rehabilitation. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.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, 38, 39, 40, 41, 42 and 43 The overall quality in this outcome area is: Good. The above judgement is based on the information gathered from relatives, staff and by checking the relevant documentation. The service manager and the registered manager foster an atmosphere of openness and respect in which the service users, staff, families and friends feel valued and listened to. The management promote quality assurance and quality monitoring system, including provision for asking service users and families for their opinions on the running of the centre and take action on the results of the surveys. EVIDENCE: The registered manager is an experienced, qualified and competent person. She has completed the Registered Manager Award. The registered manager communicates a clear sense of direction and leadership which the staff, the service users and relatives understand and respect. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 24 The service manager said that there was an annual development plan for the maintenance, repair and replacement of renewables. Regular service users and relatives meetings had been organised and there was evidence of action taken through such consultations. The managers said that they have had visits from the local fire service and the environmental health officers and that they had been generally satisfied with the arrangements within the home and had made recommendations. The service manager said that the recommendations were being actioned. The kitchen was in need of repair and redecoration. The service manger informed the inspector that this work has been scheduled to be complete in September this year. CCTV cameras were used for security purposes and these did not encroach on the life style of service users. Relatives and some service users commented that during weekends there were no activities and that the service users were bored. They inquired why the occupational therapy and physiotherapy were stopped at the weekend. One person suggested that ‘instead of cramming everything between Monday to Friday why don’t they spread it out over seven days’. The manager was made aware of this and she responded that for many of the service users’ weekends were for resting from the rigorous therapy during the weekdays. The management had ensured that risk assessments were carried out for all safe working practice. All accidents, injuries, incidents and any deaths were recorded and reported to the appropriate bodies. The service manager said that there was a business and financial plan for the home and that it was audited and monitored by the head office. The insurance certificate on display was current and covered any loss or damage to the assets of the business. The service users, relatives and the staff understood the lines of responsibility within the home. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 3 3 2 3 3 3 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA14 Regulation 16, 12 Requirement The service users must be provided access to the minibus as far as it is practicable by employing competent drivers, so that they are able to participate in local and community activities. Service users must be offered cooked breakfasts as part of their choice. Staff must receive formal training on dealing with death and dying of service users and Palliative care. The management must provide adequate number of slings for the bath hoists. So that the staff are able to move and handle service users. All staff must receive training in Infection control, Tissue viability and continence care. Nurses in charge of each shift must supervise and monitor care practices of the RSWs. The management must have the necessary information on the staff employed by them. The information must comply with regulation 19 and Schedule 2 of the Care Home Regulation 2002.
DS0000048612.V304043.R01.S.doc Timescale for action 29/09/06 2. 3. YA17 YA21 16 18 29/09/06 27/10/06 4. YA29 16 29/09/06 5. YA32 18 27/10/06 6. YA34 19 27/10/06 Stocksbridge Neuro-Rehabilitation Centre Version 5.2 Page 27 7. YA35 8. 9. YA36 YA33 Previous requirement time scale31/03/06 12, 13, 18 All staff must receive structured induction and there must be documentary evidence to support this. 18, 19 All staff must receive supervision at regular intervals. 18 Staffing levels at night times and during weekends must be revised to meet the needs of the service users. 27/10/06 29/09/06 29/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V304043.R01.S.doc Version 5.2 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!
