Inspection on 22/05/07 for Swiss House

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swiss House 06/03/09

Swiss House 29/01/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Swiss House 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ Lead Inspector Jayne Fisher Unannounced Inspection 22 and 23rd May 2007 09:00 nd Swiss House DS0000069592.V338841.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 Swiss House DS0000069592.V338841.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. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swiss House Address 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ 01384 573110 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) Select Health Care (2006) Limited Mrs Linda Power Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) The maximum number of service users to be accommodated is 7. 2. Date of last inspection 31 January 2007 Brief Description of the Service: Swiss House is situated in a cul-de-sac off Brierley Hill Road in Wordsley. The home opened in 1993 following the conversion of an existing residential property. Swiss House is close to local facilities and bus routes, allowing easy access to shops and surrounding areas. There are gardens to the front and rear of the property, although the rear patio is mainly used due to the busy road at the front of the house. There is a communal lounge and dining room with a conservatory, which overlooks the rear patio and another house owned by the same owners. There is a lift, which enables access to the first floor. Service users accommodation consists of seven single bedrooms. There are no ensuite facilities. The Home provides care for persons with a range of disabilities including profound and multiple learning disabilities, severe learning disabilities with complex communication and health care needs. A statement of purpose and service user guide are available to inform residents of their entitlements. The manager was unable to supply up to date fee information. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.00 a.m. and 6.30 p.m. and was undertaken by two inspectors with the home being given no prior notice. A pharmacist inspector also visited the home on another day. We spoke with the area manager, registered manager and four staff members. We met all seven residents living at the home although interviews were not appropriate, and we therefore relied upon looking at body language and facial expressions. Questionnaires were received from two relatives. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: What has improved since the last inspection? New owners took over the running of this home on 12 March 2007 and a number of improvements have already taken place. In addition the management team have been supported to understand the changes that they need to make and have actively tried to meet the many requirements made at previous inspections. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 6 Improvements which have already taken place include: providing residents with a range of information about the services to which they are entitled, and carrying out very comprehensive and detailed assessments to ensure that their needs can be identified and met. In addition there are now detailed assessments in relation to peoples’ health care needs. Staff are introducing person centred plans, and there are pictorial menus and complaints procedure in an effort to help residents’ understanding about the services they receive and can access. Previously there were no residents’ meetings held but now these have been introduced and so far, one meeting has been held. The manager and her team are now accessing the support from a range of specialists to obtain advice and support in how to meet residents’ complex needs. A speech and language therapist and an epilepsy nurse are currently involved with regard to two residents and there are plans for them to help all of the people living at the home. Assessments have also been undertaken by occupational therapists and other specialists with regard to stimulation and relaxation activities. There are better systems in place to safeguard and protect residents which include more monitoring and auditing of peoples’ finances. Arrangements for the administration of medication are good and there are now safer systems for storage, only slight further improvements are needed. The environment is starting to be improved and the hallway, stairs and landing has been redecorated and fitted with new carpet. The double bedroom has now been established as a single room and the existing resident will therefore not have to share his room with a new person. The cellar has also been decorated and there are further plans for refurbishment. Specialist training for staff is now starting to be made available and there are plans for a range of courses for staff to undertake. Improvements are also being made with regard to the number of staff meetings which are held and staff are starting to receive more frequent supervision, which enables better delivery of care to residents. The new owners have a comprehensive quality assurance system that is now starting to be introduced so that people can be assured that their views are taken into account and they have some control over the development of the home in which they live. What they could do better: Whilst a number of improvements have been seen, there are still some issues which need to be resolved in order for residents’ quality of life to be improved and their health and safety not jeopardised. We had serious concerns regarding the safety of bedrail equipment and systems in place to control Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 7 infection that required urgent action which the new owners agreed to undertake immediately. There are plans to introduce new systems for care planning and risk assessments so that staff are given more guidance regarding how to support residents. At present information contained within care plans is either insufficient or conflicting. Whilst staff are aware of residents’ preferences they are still struggling in how to support people with making choices. Hopefully once communication packages have been introduced they will enable staff to help residents in their decision making. Residents need to be helped to participate in more meaningful and stimulating activities. Although advice has been sought from professionals regarding relaxation and stimulation, this has yet to be fully introduced into activity programmes. In addition a wider range of sensory equipment is still needed as recommended by the specialists. Residents’ access into the community is limited and in one person’s case is severely restricted. There is neither the number of staff needed, or the correct equipment, to help this resident in going out in the local community. Whilst the management have tried to resolve these issues, this has been going on for a considerable period of time and more proactive action is needed. It has been identified that the building is not wholly suitable for people who have limited mobility. The new owners have therefore agreed not to admit anyone who has a physical disability. All residents have some problems with their mobility and the narrow corridors and doorways can make the use of a wheelchair problematic. The passenger lift can only be accessed via steps or by taking residents through the kitchen area. Residents are not able to have a choice of either a bath or a shower. At present some residents are not able to access the assisted bath as it has once again become broken and is awaiting repair. The new owners are awaiting credit checks to be carried out as the contractors had previously refused to carry out repairs due to problems with the former owners. At present some areas of the home also can compromise residents’ dignity and privacy. There is currently insufficient numbers of staff to meet the needs of all of the residents. The manager is covering a number of shifts herself to overcome the staffing deficiencies. This inevitably is slowing down the progress of the home towards providing residents with a better quality of life. Improvements are needed with regard to health and safety practice, maintenance and service checks on equipment to ensure that it is safe to use and fire safety. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is now an informative statement of purpose and service user guide in place although both need slight expansion to provide residents with more information about the service. All existing residents have now all been thoroughly assessed in order for staff to be able to ensure that they can meet their needs. Terms and conditions of occupancy are being drawn up with the new owners but residents have yet to be issued with the fully completed documents. EVIDENCE: We looked at the statement of purpose and service user guide which have been produced by the new senior management team. These documents contained lots of information but there were a couple of areas which needed expansion as we discussed with the manager. For example, there are no details of the size of rooms or relevant qualifications and experience of the registered provider in the statement of purpose. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 11 The home was formerly registered to provide care for people who also had physical disabilities. This category of registration has been removed at the point that the new owners took over because the building is not wholly suitable. There are however some existing residents who do have a physical disability. The new owners have plans to refurbish bathrooms to make these more accessible for people. Despite this, there will be some parts of the building which will not be entirely suitable for wheelchair users and structural changes may not be viable. We have therefore agreed with the area manager that these limitations need to be clearly defined in the statement of purpose. The service user guide also provides useful information to prospective and existing residents. However details of funding arrangements and payment of fees need to be included as well as any additional costs which may be incurred by the resident. It is also recommended that this is reproduced in a format suitable for residents. The area manager told us that there are plans to do this and we discussed how these documents could be personalised further with the addition of photographs. The new owners have introduced assessments tools so that new and existing residents’ needs can be measured and met. We looked at these and were pleased to see how much detail that the management team had included in the tools. They were very comprehensive. There were only a couple of areas which needed amending. For example, one person’s dependency level was assessed as medium, but upon further discussion with the manager, she agreed that he should be assessed as high dependency. There were lots of instances were residents’ had been assessed as ‘non-communicative’. This does not fit in with the social model of disability. The manager stated residents can communicate through body language and facial expressions but sometimes choose not to do so making it difficult for staff to determine their level of satisfaction. It would be an idea to include this in the assessment rather than the terminology that is used. We saw that residents have been issued with new contracts; there are some details which still need to be inserted into the contracts such as fee levels and specific details regarding additional charges. The manager told us she the former owners never supplied her with the details of residents’ fee levels. The area manager told us that this information had now been received and she would ensure that this was relayed to the manager. Swiss House DS0000069592.V338841.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments lack sufficient guidelines for staff regarding how to support residents’ which has the potential to place residents at risk and has resulted in inconsistencies. Person centred plans are now being completed, although staff require training in order to fully comprehend the systems they are attempting to implement. Detailed communication programmes need to be established in order to help staff support residents with decision making. EVIDENCE: For a long period of time the care planning and risk assessments systems at the home have been judged to be of a poor standard. The management team told us that they are currently in the process of introducing the systems which have been provided by the new owners. So far they have nearly completed one person’s care plans, and are starting on another residents. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 13 It is acknowledged that this will take a while to successfully complete and we look forward to evaluating the new systems when they have had a chance to be fully completed and embedded into the running of the home. We looked at a range of existing case files and found a number of shortfalls. One person has had increasing mobility problems (since 2005) and sustained a broken femur in a fall last year. There is a letter dated 24 August 2006 from a physiotherapist making recommendations. These have not been incorporated into a care plan and no records to confirm that staff are following the advice given. The ‘physical safety’ assessment completed by management states that the resident is ‘not to be left alone at any time’. We interviewed a member of staff who when working as a waking night carer during the last week told us that the resident had not wanted to stay in bed and became distressed so that he remained in the dining room with her. She said “he stayed in the dining room, I still did my checks as normal, but after I checked each resident I returned to the dining room to see if he was alright. I told the manager as I had not been able to complete all my jobs. I didn’t call the sleeping in member of staff as there wasn’t a problem. I know that he would have been alright to leave for a few minutes as he takes over five minutes to get out of his wheelchair”. When we told the supervisor she acknowledged that the staff member should have called the sleeping-in member of staff to support the resident whilst the night carer completed her duties. (The manager has told us that she has applied for extra funding for two waking night staff because the resident needs extra support). One resident is prone to pressure sores. We talked to the manager about night time management and she told us “We’re not going in every two hours (to turn him), I know it supposed to be the norm but the tissue viability nurse has told us it’s a fable. Her advice is once during the night”. The records completed by night staff do not demonstrate that this advice being followed. In addition the care plan which was established by the manager in April 2007 states that staff are to turn twice nightly. The care plan must therefore be reviewed to ensure that the correct advice given by the tissue viability nurse is included. Not all residents had detailed care plans in place regarding pressure area care and epilepsy. We saw another care plan in place regarding nutrition which was implemented in May 2005. It had not been updated and contained information regarding a nutritional supplement which ceased to be used ‘a long time ago’ according to the manager. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 14 The new owners have introduced person centred planning booklets which management told us are nearly completed. However during interviews staff could not fully explain the principles of person centred planning. One person said “it’s information that is personal to them”. Staff need to be better informed as to the ethos of person centred planning approaches and agreed that they needed more training. Case files do not contain detailed communication packages which are needed to support residents who have very complex needs. The supervisor told us that she has enlisted the support of a speech and language therapist for one resident to build a communication passport. It is recommended that all residents are referred for this type of support. This will further help staff assist residents in decision and choice making. We looked at risk assessments and found that as with care plans, new systems have not yet been fully introduced. For example, although there were moving and handling risk assessments contained within the assessment proforma which had been completed, this needed to be expanded as it included no information regarding the use of posture belts or all of the risks associated with the use of wheelchairs and seating accessories as identified by the Medicines and Healthcare products Regulatory Agency (MHRA). Five residents have bedrails in place. When we looked at risk assessments they did not identify all of the needs of the resident and the risks that can be generated by the combination of using the bedrail, the bed and the mattress. There were no control measures identified in respect of ensuring that only trained staff fit the bedrails and that full maintenance checks are carried out. We identified a number of significant risks with regard to the bedrails which were in use which required immediate action. (See further comment in standard 24). It is recommended that the manager obtains the up to date guidance and poster regarding bedrails from the MHRA. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Social, educational and recreational activities do not meet individual needs. Although advice has been taken from specialists with a list of activities for each resident being drawn up, as yet these have not been fully introduced. Residents access to the local community is severely restricted, some more than others. Staff support residents to maintain important links with their families. Residents are provided with a varied and balanced diet with staff fully aware of their allergies, likes and dislikes. Although some further consideration needs to be given as to how to enable residents to make choices. EVIDENCE: Since the last inspection recommendations made by specialists with regard to activities, have been incorporated into ‘activity menu’ lists for each resident. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 16 These were only produced on 30 April 2007 and management told us that they have not yet had a chance to introduce these into the home. Despite efforts made by management, some of the sensory equipment recommended has not yet been obtained and the area manager gave further advice to staff. One person’s assessment stated that he likes using a variety of instruments; the supervisor told us that they only have a tambourine and bells at the home and agreed that more equipment would be beneficial. We saw one recommendation which had been made in 2005 by an Occupational Therapist (O.T.) had not received appropriate action. The manager said that she was unaware that this had been made and agreed to look into it. We looked at a variety of activity records completed by staff. There had been an improvement in May 2007. We saw that there were a limited amount of stimulating activities provided for residents despite them having a range of interests according to their preferred likes and dislikes. For example, we looked at one person’s activities during the week and apart from going to his day centre, his activities had only consisted of watching television and a ‘music session’. Another person’s activities consisted of watching television, music and sensory sessions in his room (although upon checking he has only very limited sensory equipment) and ‘one to one’ with carer (although no explanation as to what this consisted of). As yet there is no monitoring or evaluation of activities which are provided. We asked staff how they planned residents daily activities. One staff member said “I look in their folders at the pictures”. There is a pictorial activities programme contained within each person’s case folder but this is the same for each resident. The manager agreed that individualised activity programmes need to be developed and said that she would purchase a pictorial activity board. We looked at residents’ access into the community and were disappointed to find that this has been severely restricted for people, some more than others. The manager told us “we have only two drivers (for the mini-bus), it does become a bug-bear, you split yourself in three, which ever the need is first I do, I’m hoping it’ll get better”. She responded “it obviously has impacted on their outings, especially when X is on holiday. I wish we could have another driver. They don’t lose time from their day centres but they can’t always go out into the community and they all do enjoy going out”. Staff told us that at present the home’s vehicle is being repaired and that they are using a minibus from another care home. We did not see any evidence from the records we looked at that residents were supported to use public transport. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 17 We were very concerned to see that one person has not been out for a considerable period because of the unsuitability of his wheelchair. One staff member told us “we can’t take X out because he is a danger to himself. I’m not sure how long it’s being going on for, I know he has been out a couple of times since I’ve been here”. The member of staff had started working at the home in October 2006. The manager told us that the resident had been reassessed for a new wheelchair (the supervisor thought this to be in the summer of 2006) and at that time they had requested extra seating accessories for safety, but these had not been fitted. The manager said that the unsuitability of the wheelchair had been raised with the social worker at a review meeting in March 2007 and despite their attempts to obtain a reassessment, this had not taken place. When we asked the manager told us “I think he’s been out a couple of times since March 2007”. The supervisor contacted the relevant agency on the day of our visit to reinforce the urgency of this situation. We looked at another residents’ community outings. The manager told us that he does not attend a day centre but is taken to a tranquillity session twice weekly. We could not find any evidence of the visits to this resource during a one month period from the records we looked at. We saw that his access into the local community was intermittent during this period. According to records he had not been out during two weeks, but had been out twice during another two week period. One relative who completed a comment card told us “could do with more trips”. Residents still pay for their own holidays and the new senior area manager has told us that she is going to pursue funding for this from the Local Authority. Both relatives who completed our questionnaires praised the staff and one person said that they were notified immediately when her daughter was unwell. There was lots of evidence of family involvement from the records we looked out and through discussions with staff. Although staff told us that they encourage residents to participate in household tasks by observations such as watching staff in the kitchen preparing their meals, we could not find any evidence of this from the activity records we looked at. There are lots of consent forms regarding key holding and opening of residents’ mail and these are pictorial. The majority have been signed by a member of staff and families on behalf of the resident. The manager told us that there is one person’s outstanding because she does not have any family. We told the manager about the new changes in legislation which allow staff to make decisions on behalf of residents if this is in their best interests and therefore it would be acceptable for staff to sign these forms on her behalf. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 18 Staff were seen to be respectful and aware of promoting residents’ privacy when carrying out personal care tasks which was undertaken in residents’ bedrooms. We see that there are now pictorial menus in place which give two choices for the main meals. The evening meal of fish pie was being freshly prepared by staff. During interviews staff could clearly identify residents’ individual preferences and their known allergies. Despite there being choices available, when we looked at food intake records in general residents eat the same meals. The supper time option was not always recorded. We asked staff how they enabled residents to choose from the options on the menu plan. A member of staff told us “X is the only one you can ask, the only way you would know is if you gave them the two meals and see what they would go for”. We recommended that perhaps ‘taster’ sessions could be organised from time to time in order that staff could assess whether residents’ tastes have changed and give them the opportunity to try different foods. We asked if residents go food shopping and were told “no, I don’t know why, Linda always goes on her own”. We looked at one person’s nutritional screening tool which had recently been reviewed in May 2007. Part of the tool had not been completed with regard to the resident’s medical condition, and the scoring had not been accurately calculated. The body mass index calculation was less than 20 and equated to a score of 2 which had not been included in the overall total score. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More efforts are needed to ensure that residents’ receive personal support in a way that meets their individual needs and preferences. There are good systems in place to monitor most of the health care needs of residents, only slight improvements are needed. Medication management offers suitable safeguards to residents so that they receive their medication safely. EVIDENCE: We saw from records that residents’ preferences are followed by staff with regard to getting up and going bed times. Residents’ looked comfortable in their surroundings and responded positively with smiles when being addressed by staff. We could only find a ‘general oral policy care’ procedures in residents’ case files and explained to management that detailed care plans needs to be developed. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 20 Assessments have been carried out with regard to residents’ ‘sleeping and rest’ but these have not yet been transferred into care plans. One person’s assessment stated ‘night staff to check to make sure X is clean and comfortable’. There were no specific guidelines as to how many checks are needed. The manager told us that night checks are carried out according to residents’ individual needs and said that for example one resident only needs one check during the night. However when we looked at records we saw that she was being checked up to three times. According to the manager another resident only needs a change of position once during the night (as per advice given by the tissue viability nurse), however we saw that he was being turned by staff up to two or three times during the night and checked on an hourly basis. We recommended to the manager that a review of night time checks is reviewed to ensure that they reflect the needs of the resident and that clearer guidelines are given to night staff. Residents do not have sufficient technical aids and equipment to maintain maximum independence. As we have already stated one person’s wheelchair is unsuitable and is restricting his liberty. There is no level access shower and the assisted bath has been out of use for at least two months. At present the majority of residents can only be bathed by lying on the bath board with staff using the shower head attachment to wash them. This is wholly unsuitable. There have been some improvements with regard to health care management. Since we last visited the new assessments have been completed which have included continence and tissue viability assessments. Night staff are now more consistently recording when they are turning residents to promote pressure area care. We saw that residents have received regular eye tests, dental checks and hearing checks. There are also regular appointments with doctors and district nurses. Residents are receiving monthly weight checks. Staff are only recording brief details with regard to epilepsy seizures. Management explained that they have sought the advice from the epilepsy nurse and she has drawn up an seizure diary and will be producing a detailed protocol in respect of management of one resident’s epilepsy. It was stated by management that all residents will be enabled to have this advice support. We saw that residents have ‘Priority for Health Screening’ booklets but were told that these are not yet fully completed. The new area manager has made contact with the relevant agencies to request their assistance with completion of this booklet. The manager has introduced a procedure for health care screening as previously requested. She has also written to the practice nurse for written confirmation that her advice was that residents would not access routine screening for breast and testicular cancer unless staff had identified there was a problem. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 21 As we discussed with management, all residents should have access to these routine checks whether or not staff have identified a problem. If necessary the support of the community learning disability nurse should be enlisted. Pharmacist Inspector: During the inspection the manager was spoken with who was very helpful. Four service users’ medicine charts were looked at and one service users care plan. A medicine policy was available which was accessible to staff. It included information on how to administer medication, however it did not reflect how medication was actually administered to service users in the service. There were also procedures for the receipt and disposal of medication, selfadministration and ordering of medication. There was no procedure to follow in the event of an error involving medication. Medication storage was within a locked medicine trolley attached to a solid wall and a separate cupboard was used for extra storage. A lockable container was available to store medication in the refrigerator. A separate locked cupboard was available for storing controlled drug medication, which requires special storage. The temperatures of all storage areas were recorded, which was seen to be within the recommended temperature range for safe medication storage. Staff who administer medication had completed a ‘Safe Handling of Medication’ course. A document was seen which had been signed by members of staff agreeing to administer medication to service users. The manager said that none of the service users managed their own medicines. A staff meeting was in progress, which was attended by a nurse specialist in epilepsy in order to review the healthcare requirements of individual service users with regard to their treatment. Staff showed good understanding of epilepsy and its treatment. The current months medicine charts were seen, which were pre-printed by the pharmacy. The medicine charts did not state the allergy status of the service users. The medicine charts were all recorded with a staff signature to document administration of medication. The medicine records seen were accurate. The receipt of medicine was recorded onto the medicine charts. A disposal record was available at the inspection, which showed that unwanted medication was safely returned to the pharmacy. The care plan for one service user was seen together with their medicine chart. There was a printed document that showed the current prescribed medication. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 22 The service users healthcare information for medication were generally recorded and up to date, for example there were records for ‘Health and GP Records’ which detailed any visits made by a healthcare professional with a reason for the visit. A care plan for medication was available dated 21/5/07, however it did not detail that a district nurse visited the service user twice a week to administer a rectal preparation. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new complaints procedure and information now available for people to understand how to access this process, (although consideration needs to be given as to how this is explained to residents). There are procedures in place to protect residents from abuse, only slight improvements are necessary. EVIDENCE: The new owners have introduced a comprehensive complaints procedure and this has been reproduced in a pictorial format for residents. Two relatives who completed comment cards stated that staff responded to any concerns raised. One person stated “I have been given guidance on this issue also there is a copy in the home”. We asked the supervisor how the new procedures had been explained to residents and she told us “we’ve not shown them the new complaints procedures yet”. Residents’ meetings have now been instigated and one meeting has so far taken place. These forums would be an ideal place to inform residents’ of their rights. We also discussed how if residents raise items during these meetings, that it is good practice to record what action has been taken by staff to address them. For example, one person requested a height adjustable bed and the manager told us that this was going to be discussed at a forth coming review meeting. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 24 There have been no complaints received by the home or by the Commission for Social Care Inspection within the last twelve months. We saw that the owners have also introduced new policies and procedures regarding vulnerable adult abuse. There was also a copy of the latest edition of the Local Authority multi-agency procedures ‘safeguard and protect’ available at the home. During interviews staff gave appropriate responses as to how they would deal with any potential incidents of abuse. Not all staff have received training in vulnerable adult abuse awareness. There are care plans in place regarding behavioural management strategies but the one we looked at had not been reviewed since it was introduced in June 2006. There was no evidence that the strategies advised have been discussed and agreed within a multi-disciplinary team. We looked at residents’ finances and carried out an audit of money which tallied with the records maintained. The recording and accounting systems are much improved and there is now an internal auditing system. Residents have personal inventories containing details of their valuable and personal belongings. We suggested that dates are entered as to when items are purchased or destroyed, to make auditing easier. One resident has brought her own bed but this was not included in the inventory and we have asked for it to be added. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises is homely but there are insufficient aids and adaptations to meet peoples’ needs and in one instance, residents’ safety has been jeopardised. Infection control requires development to safeguard residents from the risk of infection. EVIDENCE: We toured the building and saw that the new owners have started to undertake some improvements to the building. The hallway has been redecorated with new carpet fitted to the stairs and landing. Audits have been completed with regard to the furniture and furnishing contained within residents’ bedroom and whether or not they meet the National Minimum Standards (NMS) requirements. The double bedroom has been changed to a single bedroom which means that the existing resident will not have to share his space with someone else. The cellar has had new flooring and been decorated. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 26 The new owners have agreed not to accept any new residents with a physical disability. However all existing residents have some physical disability and five require the assistance of a wheelchair inside the home. The building has major shortfalls such as narrow corridors and doorways that make the use of a wheelchair problematic, uneven floors and a number of ramps that represent a tripping hazard to residents, access to the lift is either down two steps or inappropriately and contrary to infection control guidance, through the kitchen. It is recommended that the new owners undertake an assessment of the building, aids and adaptations in order to determine whether any further equipment or building work is necessary to make the premises more suitable for the persons living there. There are a number of requirements which remain outstanding from previous inspections and these have been changed to recommendations as the new owners have given an undertaken that these will be carried out. The senior managers have agreed to send an updated maintenance and refurbishment programme to the Commission. When we looked at residents’ bedrooms we saw that these were decorated to a good standard however we had serious concerns regarding the bedrails which were in use. In some instances the bedrails were not long or high enough to prevent the resident from rolling out of the bed, a pressure relieving mattress had been fitted on top of a divan mattress but bedrails had not been adjusted to accommodate the extra height and this had not been identified in the risk assessment. There were no assessments to ensure that the bedrails fitted were compatible with the beds used, (being mostly bedrails designed for divan beds but fitted to wooden beds). The bedrail and fittings were not secure and altogether could be easily lifted off the bed. One person’s bedrail was very flimsy and bent easily, staff had tried to make this more secure by wedging an armchair against the bedrail. Only one side of the bed had a bedrail fitted. The brackets on another resident’s bedrails had been fitted up side down. The majority of bedrails posed a risk of entrapment to residents due to the number of gaps. The supervisor confirmed that the handyperson responsible for fitting the bedrail had not received suitable training. The area manager agreed to undertake immediate action. There was a limited amount of sensory equipment seen in residents’ bedrooms in some cases the fibre optics were not working and needed batteries replacing. Some Kirten chairs looked worn and stained. We were disappointed to find that the assisted bath out of use once again (this had previously been out of use for nine months last year). The majority of residents are unable to have a bath. They have to lie on top of the bath (fitted with a bath board) in order to for staff to bathe them using a shower head attachment. We were told that the contractors had refused to carry out the repairs as the previous owners had not paid their bill. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 27 The area manager told us that the bath would be repaired in the near future once the contractors had run credit checks and that there were plans to refurbish the bathroom. Only one resident has a height adjustable bed and it is recommended that all residents’ are assessed as to whether they need this type of equipment. Previous concerns were raised regarding the toilet frame which has now been assessed by an O.T. and as recommended other products are being looked at and a contractor has been contacted. A number of written risk assessments were displayed in communal areas including two in the bathroom. It is suggested that these do not promote a homely atmosphere and compromise people’s dignity. There was a plastic patio chair located in the bathroom; the supervisor told us that this had been placed in the room as there was nowhere to store residents’ belongings whilst they are bathing. We raised a serious concern regarding the offensive odour in one residents’ bedroom. The manager told us that this was because the resident has behavioural problems. We required urgent action to be taken. Generally the home was clean. There are some outstanding infection control issues. The clinical waste bin has not been fitted with a lock and is located in an easily accessible area. There was no cleaning schedule in the laundry, the manager told us that it was held in the kitchen but it could not be located in this area. Information hazardous to health (COSHH) also needs to be stored in this area. There was a bar of soap in the bathroom instead of liquid soap and when we removed the bath rail the bath underneath was dirty and required cleaning. The ironing board was being stored in the toilet and had a stained cover. This should be stored in a more suitable location and a new cover purchased. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff require a range of specialist training in order to meet residents’ complex needs, some progress is now starting to be seen. There are insufficient staff to meet residents’ needs and this is impacting upon their quality of life. EVIDENCE: The home currently employs fourteen support staff plus one driver/ handyperson and a manager. Nine staff have received training in epilepsy awareness and seven staff have been trained in cerebral palsy awareness. Training regarding incontinence awareness or tissue viability has yet to provided although the manager told us that this is going to take place in the near future and further training is planned epilepsy, cerebral palsy and dysphagia. As already stated staff need training in person centred planning and the Mental Capacity Act 2005. When we spoke to staff they were quite vague about what training they had been provided with. One person said “I’ve got some certificates but I don’t know what I’ve done”. Another said “I’ve done first aid training and there’s another couple, but I can’t remember the names”. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 29 The senior area manager has informed us that a training assessment will be carried out for the whole staff team and a training development programme will be forwarded to the Commission. Staff have now been provided with job descriptions and copies of codes of conduct. We looked at duty rotas. There has been no change in staffing levels despite concerns being raised as previous inspections. There are still only three or four staff on duty per day time shift. The manager is not always supernumerary, and admitted that although she allocates three of her five working days as ‘office’ days, she frequently has to cover other duties and does not always alter the rota to reflect the changes. When we looked at the duty rota for a two week period the manager had only been able to identify one shift as supernumerary and the remaining four shifts were covering support workers duties. The manager told us that she had tried to secure extra funding for a resident with increased needs in November 2006 but had still not received a satisfactory response from the Local Authority. It was stated that an extra waking night staff is desperately needed in order to provide support for this resident. The lack of social stimulation, activities and outings can also be attributed to staffing shortages. All seven residents have been assessed as high dependency and all require one to one support when in the community, some also need this within the home. Staffing levels require review. According to records there was only one staff meeting held in 2006. Two meetings have been held this year with a further planned this month. No new staff have been recruited since the last inspection. Therefore we could not evaluate recruitment and selection procedures this will be undertaken at the next inspection when a new member of staff has been recruited. We were told that staff are in the process of signing new terms and conditions of employment. We looked at a sample of current staff personal files and found that these contained the majority of information required by the Care Homes Regulations 2001. Most of the staff had been employed for over two years. The last member of staff to be recruited started work in October 2006. She told us that she had not received any induction and foundation training by an accredited learning disability awards framework (LDAF) provider. There is a long outstanding requirement to provide this training and it is recommended that consideration is given to providing it to all existing staff. In-house induction records were poor. So far only one member of staff has received training in equal opportunities and disability equality. Each member of staff has a training development assessment and profile although these need updating to reflect further training which has been undertaken. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 30 Some improvements are being made with regard to increasing the frequency of staff supervision sessions. However, as yet not all staff are receiving bimonthly supervision sessions or have had a minimum of six per year. An annual appraisal system still needs to be implemented. We saw one person had received supervision with the manager in February 2007 when they had raised an issue regarding a resident and their attitude. The manager had recorded that she would arrange a meeting to resolve the issue with both parties. There were no records to demonstrate what further action was taken. The manager told us that she had resolved the issue but admitted that she had failed to record what action she had taken. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 31 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Overall although some improvements are starting to be seen, there are still weaknesses in the day to day management systems which have led to residents’ health, safety and welfare being jeopardised. EVIDENCE: The manager has worked in care since 1988 and has an NVQ IV in care. She had not attained management qualification but told us that she has now been enrolled on a suitable course which will be starting in due course. The manager admitted that there were gaps in her knowledge and skills that she needed to update. She has not yet been on the epilepsy training but is planning to do so. We asked about the Mental Capacity Act 2005 and she said “I haven’t seen anything on it yet”. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 32 It was also noted that had limited knowledge regarding ‘Inspecting for Better Lives’ (a good practice document compiled by the CSCI), she told us “to be honest I haven’t read it all. I haven’t had time, we’ve been taking work home”. She was unaware of the changes in legislation in relation to Inspecting for Better Lives and enquired of the National Minimum Standards “do they come out every year?”. When asked how the home could improve one relative who completed a comment card said “it can’t really, given the many constraints”. The weaknesses in management processes can be partly attributed to the manager having insufficient time when she is supernumerary and having to cover for the deficiencies in the numbers of staff employed to support residents. This inspection has highlighted that improvements are starting to take place but there are still a number of areas where further work is needed which will hopefully be achieved now that new owners have taken over, and will be offering more support to the manager. The financial difficulties also experienced by the former owners which has impacted upon the quality of service provided to residents is starting to be addressed. Mrs. Power demonstrated that she is keen to make the necessary changes and drive forward the improvements the new owners wish to make. The manager told us that she is starting to implement the new owners quality assurance systems. Questionnaires had been sent out to relatives and stakeholders plus there are pictorial questionnaires for residents to complete. The manager said she has not yet had time to analyse the responses and an annual development plan has yet to be established. When looking at health and safety practice we raised a number of concerns including those already mentioned in relation to unsafe bedrails and poor infection control practice these included: no recorded fire safety training for staff since April 2006 no records of recent fire evacuation drills no evidence of an up to date gas safety check excessively hot water temperatures in the laundry (80 C), upstairs toilet and in some residents’ bedrooms (no checks had been undertaken for the last two weeks) substances hazardous to health (COSHH) found unsecured in the kitchen. We saw that the handyperson checks the bedrails on a weekly basis (but these checks failed to identify the serious hazards with regard to the equipment), plus these and the wheelchair check records were inadequate being signed as “o.k.” rather than confirming exactly what the checks entailed. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 33 The area manager told us that contractors would be checking the gas and water temperatures as a matter of urgency. There is now a written lift policy which includes emergency release procedures and the manager has arranged for training to take place. The kitchen cleaning schedule has now been expanded. It was difficult for us to gain an overall picture with regard to staff training. We looked at training certificates and found these were either out of date, or were not in place to cover all of the required mandatory training needed by staff. We have already discussed this with the senior management team who have given us an undertaking that they are going to repeat all training for staff in the near future as they felt that previous training provided was not to the standard they usually expect. As already stated, they have promised to send us an updated training plan. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 34 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 X 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 1 X 2 X X 1 X Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 35 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 YA6 Regulation 15 Requirement There must be a detailed plan in place as to how the residents’ needs in respect of health and welfare are to be met, thereby ensuring that residents’ health safety and welfare is not jeopardised. For example with regard to mobility and night time management/routines. To provide more opportunities for service users to engage in local, social and community activities which must be based on their individual preferences and needs – thereby promoting and making proper provision for their health and welfare. Timescale for action 01/09/07 2. YA13 16(2)(m) 01/09/07 Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 36 3. YA24 13(4)(c) To assess all of the bedrails currently in use and make sure that they are suitable for the beds they are being used upon. Where appropriate bedrails must be replaced in order to reduce the risks to residents including the risk of entrapment Immediate You are required to carry this out immediately and to inform the Commission of actions taken by 25 May 2007. 25/05/07 4. YA30 12(1)(a) To eliminate the malodour in bedroom no. 4 and ensure that the resident is clean and free from odour at all times Immediate You are required to inform the Commission of what action you have taken to address the above concern with 48 hours of the inspection visit. 25/05/07 Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 37 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 YA1 Good Practice Recommendations To expand the statement of purpose to include all details required by the Care Homes Regulations 2001, Regulation 4 and Schedule 1 for example details of room sizes and qualifications and experience of the registered provider. It is recommended that the Statement of Purpose includes information regarding the current limitations of the building in relation to existing residents who have a physical disability. To expand the service user guide to ensure that it contains all of the details required by the Care Homes Regulations 2001, Regulation 5 such as details regarding fees and who will be responsible for paying them and information regarding additional charges. To consider producing the service user guide in formats suitable for residents. 2. YA5 To continue to fully complete and issue new statements of conditions of residency to all residents. These should contain details of fee levels and be more explicit as to what is considered an additional charge. The Home should continue to introduce and complete a person centred approach (such as essential life style planning) and reproduce care plans in formats suitable for service users. To ensure that care plans are reviewed at least six monthly, or as and when residents’ needs change with the involvement of the resident, relative, advocate and other significant professionals. 3. YA6 Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 38 4. YA7 To continue to pursue referrals to speech and language therapists with regard to support in establishing communication passports for all residents. Care plans should contain aim and objectives with regard to how residents are supported in making decisions and choices. 5. YA9 To review, update and expand written risk assessments to ensure that any unnecessary risks to the health and safety of residents are identified and so far as possible eliminated for example with regard to the use of wheelchairs (advice given by the MHRA should be incorporated into these assessments). To review the risk assessment proforma currently used for assessing risks relating to bedrails. Advice given by the MHRA should be incorporated into this document. To obtain a copy of the latest guidance issued by the MHRA entitled ‘safe use of bedrails’ DB2006(06) which is a detailed 30 page publication and includes a poster which should be displayed. 6. YA12 To fully implement all of the recommendations made by the Therapy and Enabling service and the Profound and Multiple Learning disability team with regard to relaxation and stimulation including purchasing a wider range of sensory equipment. To consider introducing individualised activity programmes and a system for evaluating and monitoring activities which are undertaken. To obtain a pictorial activities board. 7. 8. YA13 YA14 To enable residents to have access to and a choice of using public transport. To continue with attempts to try to ensure that the cost of residents’ annual holiday is provided as part of the basic contract price. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 39 9. YA16 To continue to ensure that any restrictions on choices are negotiated with all individual service users and advocates. Outcomes to be recorded in service user plans and reviewed regularly: for example the decision to not to provide bedroom door keys, front door keys, and the opening of service users mail. If residents cannot give their consent, then staff should consider making decisions in their best interests as in compliance with the Mental Capacity Act 2005. To give more consideration as to how residents can be actively involved in the shopping and preparation of their food. To ensure the supper option chosen by residents is more consistently recorded. To ensure that nutritional screening tools are accurately completed. 10. YA17 11. YA18 To review the practice of hourly (or other regular) checks undertaken during the night for service users. (If this level of monitoring is deemed necessary it must be discussed and agreed as part of a multi-disciplinary team with outcomes and guidelines for staff to be documented in individual care plans). To continue to pursue other professionals to assist in the completion of Priority for Health screening tool (and for support staff to complete relevant sections of the booklet where required). To continue to pursue screening for breast, cervical and testicular cancer (enlisting the assistance of the community learning disability nurse if possible). 12. YA19 13. YA20 1. It is recommended that the current medicine policy is reviewed and updated to ensure that the health and welfare of service users taking medication are safeguarded. 2. It is recommended that all service users allergy status is documented on their medicine record charts in order to ensure the safety of service users. 3. It is recommended that district nurse visits to administer medication is recorded and documented in Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 40 the service users care plan to ensure that service users healthcare records are accurate. 14. YA22 To introduce systems to ensure that residents are made aware of how to raise concerns and complaints and are shown the new pictorial complaints procedure. It is suggested that if residents make requests during meetings that records are maintained as to what action has been taken by staff. 15. YA23 To ensure that residents’ personal inventories include the dates when the items are purchased, and when they are destroyed or removed from the home. To add the purchase of one resident’s bed to her inventory. To review and update behavioural management strategies and where necessary and discuss these within a multidisciplinary team. 16. YA24 To carry out an assessment of the premises, aids and adaptations in order to identify whether any further equipment or alterations are needed in order to meet the needs of the existing residents who have a physical disability. To progress with audit of the premises from which a written programme of refurbishment and redecoration must be produced together with timescales for completion. A copy must be forwarded to the Commission for Social Care Inspection. To replace window frame in the former shared bedroom where seal has perished. To repair uneven floorboards in communal corridor on first floor. To repair and make good uneven tarmac driveway and patio crazy paving. To pursue repair of the assisted bath and provide residents with a range of bathing facilities to meet their needs and preferences. To fit pass/privacy locks to all toilets and bathrooms. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 41 To ensure that there is suitable storage in communal bathrooms for storing residents’ personal belongings whilst they are bathing. 17. YA30 To ensure clinical waste collection bin is fitted with a lock and kept in a locked area. To ensure there is a supply of COSHH (control of substances hazardous to health) information in the laundry area. To ensure that there is a laundry cleaning schedule which should be held in the laundry area. To ensure that communal bars of soap are not used. 18. YA32 To provide staff with a range of specialist training in: Incontinence awareness, cerebral palsy, epilepsy, tissue viability, the Mental Capacity Act 2005 and person centred planning. To carry out a review of staffing levels in order to ensure that there are sufficient staff on duty to meet all residents’ needs and to forward a copy of the staffing proposals to the Commission. To ensure that the duty rota is kept up to date and clearly identifies which of the Registered Manager’s hours are supernumerary and which are direct care giving. 20. YA35 To consider whether existing staff would benefit from induction and foundation training by an accredited learning disability awards framework (LDAF) provider. To ensure that all staff receive equal opportunities including disability equality training. To complete an up to date training needs assessment for the staff team and establish a training and development plan. A copy to be forwarded to the Commission. To establish an up to date training and development assessment and profile for each member of staff. 21. YA36 To continue to increase the frequency of staff supervision to six a year. To continue to implement an annual appraisal system Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 42 19. YA33 22. 23. YA37 YA39 To ensure that the Registered Manager is supported to achieve an NVQ IV in management. To continue to fully implement effective quality assurance and quality monitoring systems based on seeking the views of service users, stakeholders, families and advocates. The results of surveys should be analysed and published and made available to people. There should be an annual development plan for the home based on a systematic cycle of planning-action-review. 24. YA42 To ensure that there are regular fire evacuation drills undertaken which include staff and residents. To ensure that there is an annual inspection and service of all gas appliances which is carried out by a CORGI registered gas engineer. To ensure that water temperatures do not exceed safe limits and that action is taken when these are identified as being unsafe with written records maintained. To ensure that substances hazardous to health (COSHH) are held securely when not in use. To ensure that more thorough checks of all equipment are undertaken for example with regard to bedrails, hoists and wheelchairs with detailed records maintained. Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Swiss House DS0000069592.V338841.R01.S.doc Version 5.2 Page 44 - 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. 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