Inspection on 10/05/06 for Talbot Court

This inspection was carried out on 10th May 2006.

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 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Talbot Court 04/09/07

Talbot Court 15/01/07

Talbot Court 30/12/05

Talbot Court 22/02/05

Talbot Court 22/06/04

Talbot Court 03/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME ADULTS 18-65 Talbot Court 1-3 Jervoise Street West Bromwich West Midlands B70 9LU Lead Inspector Jayne Fisher Key Unannounced Inspection 10 and 11th May 2006 10:00 th Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Talbot Court Address 1-3 Jervoise Street West Bromwich West Midlands B70 9LU 0121 525 3508 0121 525 3508 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) Milbury Care Services Limited Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 10 PD and up to 10 LD Date of last inspection 30 December 2005 Brief Description of the Service: Talbot Court is a purpose built bungalow that originally operated as two units, each for five service users. Recently the unit has been operating as one, with the occupants of the home sharing a communal lounge and separate dining area. Internally the two areas are linked. The home provides nursing care for up to ten people with learning and physical disabilities. The unit also offers kitchen, laundry and bathing facilities. The bathrooms have been adapted to offer sensory stimulation. The bungalow comprises of ten single rooms in total, three of which offer an en-suite shower facility. An adapted minibus is available, at an extra cost. This is charged in addition to the weekly fees with the intention of enabling service users to access wider community facilities. A Statement of Purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was provided on 9 May 2006 which are £1,488.37 per week. There are additional charges for aromatherapy, toiletries and hairdressing. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days between 10:00 a.m. and 19:00 p.m. hours on the first day, and 08.45 and 14:00 hours on the second day. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager and nine staff. A visiting professional was interviewed on the first day of the visit; feedback was also received following the visit, from two other professionals via a comment card and telephone conversation. All service users were at home during the inspection, but formal interviews were not appropriate. Therefore the inspector relied upon brief chats, observations of body language, eye contact, gestures, responses and other observations of interaction between staff and service users. Questionnaires were sent to service users prior to the visit but these have not yet been completed. The manager wishes to enlist the help of advocates, rather than members of staff, to assist residents completing these forms. This is an excellent idea and promotes equality. Three residents’ care was case tracked by reading and assessing care documents, observing interactions and by talking to staff, chatting to residents and interviewing professionals. Two meal times were observed and two drug rounds. A tour of the premises was undertaken to assess the standard of the environment. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other documentation was reviewed including a pre-inspection questionnaire completed by the manager and action plan sent by the provider, plus copies of visits undertaken by senior managers and other relevant information. Since the last inspection the Registered manager has left the home. A new manager has been appointed who had commenced employment a week prior to this visit being undertaken. What the service does well: There is a range of information available to prospective and existing service users to enable them to make an informed choice about living at the home. The atmosphere throughout both days was relaxed and friendly. Residents looked comfortable in their surroundings. The manager and staff were welcoming and keen to assist and co-operate with the inspection visit. Their honesty and openness was extremely helpful. Staff strive to assist residents with flexible daily routines based on their own preferences with regard to how they are supported. For instance residents can choose when to go to bed and when to get up. Residents were dressed in clean and modern clothing with accessories and grooming which reflected their individual personalities. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 6 Bedrooms are also decorated and furnished in different colour schemes and contained lots of residents’ own personal possessions. Staff support residents to maintain contact with families thereby promoting important relationships. Staff are proactive in quickly identifying any potential health care complications and seeking advice and treatment. There is a clear complaints procedure for service users and relatives, thereby ensuring individuals views and concerns would be listened to and acted upon. There was positive feedback from staff regarding the new manager and the changes which had already started to take place, for example residents are now able to go shopping with staff on a regular basis. What has improved since the last inspection? What they could do better: Unfortunately, yet again there has been a change in management with both the Registered manager and deputy leaving employment. This together with the high number of staff vacancies and use of agency staff is having a detrimental impact upon the quality and consistency of care given to residents. Staff are not being sufficiently supported, trained, or appropriately supervised and as a consequence poor practices have developed which jeopardise residents’ health, safety and well being. Serious concerns were identified at this visit with regard to medication, recruitment and selection of permanent and temporary staff, and the premises. Care planning and risk assessments had initially improved but progress has been hampered as key staff have left employment. These are not working tools and staff are unfamiliar with the content. It is vital that there is a robust care planning and risk assessment system given the turnover of staff and use of agency staff. Opportunities for recreation, education and leisure had started to improve but progress is also impeded. Staff are striving to support residents with accessing the local community but this is restricted due to staffing levels and the lack of qualified drivers for the minibus. Meals and mealtimes require much improvement with regard to promoting choice; a more varied and balanced diet is needed. The programme of refurbishment and general maintenance is slow and the premises are deteriorating. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 7 A meeting will be arranged in due course with the provider to discuss how improvements will be implemented and the home will continue to be closely monitored. 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. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 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 Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 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 and 2 The overall outcome for this group of standards is judged to be adequate. The Statement of Purpose and service user guide provide residents with clear information regarding services to which they are entitled. There is continuing progress towards ensuring up to date reviews of the needs of service users are being undertaken with the relevant professionals. Supporting documentation and records are of an adequate standard. EVIDENCE: The Statement of Purpose has been recently reviewed to include details of the new manager as is good practice. There is a pictorial service user guide which is displayed within the manager’s office. Since the last inspection all service users have received a review of their needs in collaboration with the community learning disability nurse from the Local Authority. There is one exception. Consultation with the manager and relevant professional confirms that this review is due to be undertaken later in May 2006. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 10 A new service user was admitted to the home on 30 August 2005. A full evaluation of the home’s assessment process could not be undertaken at this visit as relevant documentation could not be located (for example evidence of introductory visits, assessments undertaken by the manager etc.). It is noted however, that at the previous inspection on 25 August 2005, an inspector was able to view assessments undertaken by the Local Authority prior to the admission of this service user. The manager must ensure that where reviews have taken place that any new needs identified must be translated into existing care plans. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 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 and 9 The overall outcome for this group of standards is judged to be poor. The quality of care planning and risk assessment is poor and does not provide staff with all of the information they need to satisfactorily meet the needs of service users. EVIDENCE: Good progress has previously been made in introducing effective care planning and risk management systems. However progress has not been sustained, and in some aspects there has been a deterioration. The previous deputy manager had been responsible for introducing a new care planning system. Care plans were established in August 2005 but as the deputy manager has since left employment it is unclear how these care plans were originally generated and there is no evidence that service users, families, advocates or relevant professionals were involved. Interviews with staff revealed that they were not fully aware of the contents of care plans. The new manager acknowledges that as previously only qualified nurses were involved in care planning, that key staff (such as support workers) had little input and Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 12 therefore valuable knowledge regarding residents’ needs had not always been included. A sample of care plans were examined as part of case tracking. A number of deficiencies were identified. For example, care plans had received a six monthly ‘review’, however this simply consisted of a statement written by staff: “continue as per care plan”. There was no evidence to confirm that service users, families, advocates or other professionals had contributed to this review. Eating and drinking care plans stated that residents’ individual likes and dislikes were to be compiled but these had failed to take place since the care plans were originally generated in August 2005. One resident’s care plan for back pain stipulated that a review be carried out in October 2005; this had not been reviewed until May 2006. There was no care plan in place for one resident’s challenging behaviour or strategies that are in place to manage repeated refusals of medication. One resident’s care plan for tissue viability referred to a skin infection in November 2005 but there was no further confirmation of action taken or outcome. One service user has Autistic Spectrum Disorder (ASD) but there was no specific care plan in relation to this condition or how this impacts upon the resident’s daily life. A care plan stated that the resident had challenging behaviour but did not describe in any detail how this is manifested and there were no behavioural management guidelines. It was reassuring that during interviews staff on duty were able to explain how they employed techniques of distraction. As agreed with the manager it is imperative that care plans are comprehensive and kept up to date particularly since there is a high staff turnover and use of agency staff. Some good attempts have been made at introducing person centred planning but once again as discussed with the manager, these need to be reviewed to ensure that the most appropriate approach has been employed (for example PATH, personal futures planning, life story books and essential life style planning). As identified at the last inspection the home needs to continue to demonstrate through record keeping how individual choices are made (for example with regard to food). There were no care plans in place with regard to how residents are supported to manage their finances. Although there are a range of risk assessments in place, some areas need further improvement. For example, there was no risk assessment in place regarding one service user’s different types of challenging behaviour. There were no risk assessments for one resident regarding travel on the minibus and use of public transport. Risk assessments were in place for scalding from hot bath water, but whilst staff are instructed to check the water temperature, there are no guidelines was to what constitutes a safe temperature. There were risk assessments in place for moving and handling and wheelchair users. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 13 However these also require expansion. For example, wheelchair risk assessments did not include risks associated with posture belts, seating and accessories, nor did they make reference to manufacturer’s specifications regarding use. Hazards identified in Medical Device Alert notices had not been incorporated into these assessments. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 The overall outcome for this group of standards is judged to be poor. Lifestyle outcomes for service users are poor with particular concern being in relation to social inclusion, personal development, meals and mealtimes. More opportunities are needed in order for service users to participate in stimulating activities and social inclusion in order to support and enrich their lives. EVIDENCE: Whilst some improvements have been made during the last year with regard to service users developing social, emotional and independent living skills, not all residents have been offered the same level of opportunity. Daily activities and social inclusion need to be more structured and co-ordinated, with dedicated hours, sufficient staffing levels and staff training. Service users at Talbot Court do not utilise any external day care facilities or educational establishments. All of the service users remain at home during the day. The home has begun working with the Open College Programme/Network and seven of the service users have enrolled and are currently participating in the programme. The remaining three service users are to be enrolled later this Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 15 year. Each of the seven service users working with the Open College Programme has a daily timetable of activities (college plan), however, upon case tracking, these conflict with activities identified for individual service users on another timetable used by staff (‘daily allocation list’). During interviews staff reported that this daily allocation list was established by another manager a couple of years ago. For example, on a Wednesday afternoon one resident is supposed to undertake a shopping task but according to the home activity plan they are to be taken to the pub. On examining the activity monitoring chart, on occasions, neither activities listed in either the college plan or the activity allocation sheet are undertaken, and another task is substituted. During interviews staff clearly lack direction in this area and one member of staff stated that she had chosen an art activity “because all the residents like to do it”, but as observed not all residents were happy to participate in this task, and it was enjoyed by the minority. Some residents would benefit from more intensive interaction on a one to one basis rather than in a group. There is an activities co-ordinator who is also a support worker but there are no dedicated hours on the duty rota allocated to activities, and the member of staff has received no specialist training. There is an activities board in the dining room but this was not kept up to date and staff report that they are still building up a sufficient number of photographs. Feedback from a professional who visits regularly was negative regarding activities offered to residents, which they felt should be more structured. Another visiting professional stated that they felt service users lacked stimulation and that staff could do more but at the same time reflected that the home had experienced a lot of ‘staffing problems’. It was reassuring to see efforts made by staff to encourage service users’ participation in the community. However, this is restricted by the lack of qualified drivers for the mini-bus (there is currently only one qualified member of staff), increased dependency levels of some residents, (for example since January 2006 one resident now requires two staff to support them in the community), and insufficient staffing levels. Upon examination, one service user’s care plan states that they enjoy a particular community based outing on a Friday. Case tracking revealed that this activity had not taken place in the last six weeks. Staff confirmed that service users did not vote in the recent local election; the manager needs to ensure that all residents are enabled to be politically active. Staff fully support residents to maintain links with their families. During a chat with one resident they explained how they keep in touch with their relatives and confirmed that they were supported to visit their previous family home and could also use the telephone. This was confirmed upon examination of daily records and care plans. Two professionals commented positively on the welcome they received from staff when visiting the home. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 16 Daily routines are flexible as observed during the inspection. However, there were some files containing confidential information regarding individual service users which were unsecured in the dining room which compromises residents’ rights. There were also guidelines displayed on one service user’s bedroom regarding application of creams. This compromises dignity and was removed by the manager. Strategies need to be devised to enable staff to support all service users in making choices with regard to meals, particularly those who have increased communication needs. The inspector observed a lunch time meal, staff were not overheard to ask what residents would like to eat for their lunch. One member of staff asked a resident if they would like some ‘pop’ but did not enquire as to what kind of ‘pop’ they would like, and proceeded to give them a cola drink. All residents were to be given tomatoes on toast, until the manager intervened and asked staff to give residents an alternative choice. Another resident is on a gluten free diet and was given a pot noodle instead of the fish meal indicated on his menu plan. The staff member stated that she had given the different meal because there was no fish available, but conceded that she had failed to ask the service user if this was their preferred alternative. During interviews staff stated that they relied upon their knowledge of individual residents’ likes and dislikes, however, as already stated in this report, these are not documented. In addition, if using this strategy, different types of foods should be regularly introduced in order to ascertain if residents’ preferences have changed. The high staff turnover and use of agency staff necessitate the need for robust care planning. A more varied and well balanced diet needs to be introduced. For example, on the first day of the inspection none of the meals provided contained any vegetables. On the second day of the visit, staff were preparing to serve potato waffles and battered fish and fish fingers for lunch, when asked about choices, it was said that residents could have either mushy peas or gravy. There is only one choice of meal displayed on the daily menu. On examination of one resident’s food intake sheets, they had eaten cheese and potato pie on three evenings in eight days and had had chicken meal on two consecutive evenings. During this period only one evening meal correlated to the option depicted on the menu. Food intake sheets are not being consistently completed by staff and neither are sizes of food portions. Nutritional screening tools are in place but it was unclear as to whether assessments had incorporated the resident’s actual body mass index (BMI). Information contained within some residents’ nutritional screening tools conflicted with information contained within other screening tools (for example the Waterlow score). According to one resident’s care plan they are supposed to be on a low sugar, low fat and high carbohydrate diet, however staff were unaware of the contents of this care plan and as a result the resident is receiving a high fat diet. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 17 Any other items discussed and/or monitored are contained in the Requirements section of this report. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 18 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 and 20 The overall outcome for this group of standards is judged to be poor. Systems for personal and healthcare support are poor as the procedures for the administration and control of medication potentially place service users at risk. EVIDENCE: Through records, observations and discussions with staff and the manager, it was identified that the service is trying to ensure that personal support is provided which ensures that principles of privacy, dignity and independence are adhered to. Service users’ preferred night routines are contained within care plans. Residents can withdraw to their room for privacy, choose their own clothing, etc. Registered Nurses deliver all of the nursing care within the home, and other specialists are utilised as needed. Service users were said to receive personal care/support in the way they prefer/require, although this may not be fully evident from the personal records being maintained for example opposite gender care. One resident has stipulated that they do not wish to receive checks during the night time which has been risk assessed. However, the corresponding care plan states that the resident is to receive two checks during the night one of which includes a check by a member of staff knocking on their bedroom door Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 19 at 2.00 a.m. There are no records completed by night staff to confirm whether or not this is occurring. There was some positive feedback from a visiting professional with regard to how staff meet the health care needs of service users. It was stated that staff react quickly when alerted to potential problems such as seizures or bruising. During interviews staff and the new manager gave positive responses to how they proactively seek medical advice; for example on the day of the visit one resident was taken to visit the general practitioner as staff had identified an issue, another service user was attending a hospital appointment for on-going tests. There were up to date routine health care checks which are monitored via a useful health care check sheet. Whilst there was a care plan in place for one service user with regard to tissue viability, it was not possible to determine whether they were receiving the three to four hourly changes of position during the night time as dictated by the care plan, as there were no turning charts or confirmation contained within reports written by night staff. Some information contained within Waterlow scores was conflicting. For example on 1 September 2005 one resident who was scored as ‘9’, was said to be obese and had oedematous skin. A further assessment dated 3 November 2005 was scored as ‘3’, and stated that the same resident had healthy skin and their weight was ‘above average’. There were numerous serious concerns identified in respect of medication at this visit. For example, one service user according to instructions handwritten by staff on the medication administration record (MAR) sheet, is to be administered Lorazepam 1 m.g. up to twice daily as PRN (as and when required). Two staff signatures had not been obtained to confirm these instructions had been correctly entered on the MAR sheet, neither was there a record of receipt of the medication into the home. The medication profile and medication review notes completed by staff within the individual’s care plan contained the same instructions. However, a letter received from a Consultant Psychiatrist following a visit on 13 December 2005 stated that the resident is to receive Lorazepam, 1 m.g. up to four times daily. There were gaps contained within MAR sheets although upon further checking medication had in fact been given. Staff had written instructions for PRN administration on MAR sheets which conflicted with computerized instructions issued by the prescriber, which stated that medication was to be administered three times daily. Staff had altered the administration time of one drug (Lamotrigne 25 mg. b.d.) from 8.00 a.m. to 20.30 but there was no confirmation in the nursing notes or elsewhere as to why they had made these changes. Staff had written instructions on the reverse of the MAR sheet for two drugs to be administered at a later time (due to am impending blood test): Lamotrigne 50 m.g. and Carbamazepine, however according to MAR sheets these were administered at the usual time. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 20 Discrepancies were found throughout the Controlled Drugs register. Recording was poor and unclear. Errors in recording had been made but had not been checked by a staff member other than the person responsible for the error. Routine checks by two qualified nurses or other authorized members of staff are not being carried out. On the day of the visit administration of a Controlled Drug was observed. The nurse in charge failed to follow good practice: whilst the administration was witnessed by a support worker the same worker was not asked to witness the measuring and checking of the dose prior to this being administered to the service user. Only a small number of staff have received accredited training in the safe handling of medication (only staff who have received this training should ideally act as witnesses). Another serious concern related to the administration of Oramorph PRN. The nurse in charge went to administer this Controlled Drug but upon checking, found that there was no record of the drug on the MAR sheet. It was stated by the manager (who had consulted with the permanent member of staff responsible for medication), that in the first instance Diazepam should be administered to the service user and then Oramorph at a later time, however there were no written PRN guidelines to this effect. On some occasions written PRN guidelines contained no information regarding maximum dosage. It was pleasing to see that the local pharmacist had visited on 2 May 2006. Shortfalls had been identified in the pharmacist’s report but had not received action. On the first day of the visit the nurse in charge had dispensed a number of drugs from the monitored dosage system into tots and had proceeded to cut up pieces of paper upon which service users’ names had been written and then placed into the tot, presumably awaiting administration. As explained this is poor and unsafe practice. Keys to medication cupboards, fridges and the treatment room were not held separate from other master keys and there was no staff handover sheet. It was concerning to find that there were no recorded checks of the drugs fridge temperature for nearly a month prior to the arrival of the new manager. The treatment room contains a hot water boiler and was exceedingly warm. The temperature needs to be checked and recorded on a daily basis. It was reassuring to see that the manager was already dealing with one issue of staff leaving medication with a resident for up to four hours who routinely refuses to take medication in front of staff. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 21 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 outcome for this group of standards is judged to be poor. The systems for protecting service users are poor and places them at possible risk of harm or abuse. EVIDENCE: Since the last inspection there have been no complaints. The procedure is currently on display within the home and is in an appropriate format for the service users. A copy of this procedure is also contained within the statement of purpose. Feedback from a visiting professional confirmed that they were aware of the home’s complaint procedure. There is an adult protection policy and procedure. According to the central training matrix thirteen of the twenty two staff team have received training in vulnerable adult abuse. Allegations of abuse have been dealt with appropriately in the past by management adhering to multi-agency procedures. One allegation of abuse has been received since the last inspection which was not upheld. Relevant parts of the service user’s care plan was updated as a result in respect of support mechanisms. There is however a serious shortfall in the arrangements for protection of vulnerable adults as a result of the lack of an effective recruitment and selection procedure which jeopardises residents’ safety. There were serious concerns identified with regard to the employment of agency staff who have not received a Protection of Vulnerable Adult (POVA) check. In addition agency staff have been employed who had not received a criminal record bureau disclosure or a POVA check within the last twelve months. See further comments in standard 34. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 22 An evaluation was undertaken of the practices regarding service users’ monies and financial affairs. Apart from failing to obtain two staff signatures for all financial transactions undertaken on behalf of residents, there are good recording and checking systems. A sample of monies held balanced accurately with financial records. There is one area which needs to be reviewed in respect of residents paying for their own meals whilst out in the community in place of meals provided by the home. As stated this practice must either cease for be formally agreed with the service user, advocate and Local Authority commissioning unit. It is noted that information provided by the manager confirms that service users continue to incur an additional charge of between £15.00 - £5.00 per week for use of the minibus. As already stated access to this vehicle is said to be restricted because of the lack of qualified drivers. This practice must therefore be reviewed and service users reimbursed if necessary. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 23 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 and 30 The overall outcome for this group of standards is judged to be poor. Overall the premises are homely and comfortable. However the quality of décor and furnishings is continuing to deteriorate and is regarded as poor in certain areas, which together with unsatisfactory infection control/food hygiene practice, has the potentially to make this an unsafe environment for residents and visitors. EVIDENCE: There were two serious concerns identified at this visit which require immediate action: the carpet in the main corridor had become frayed and dislodged from one of the carpet grippers posing a trip hazard. Two of the Kirten chairs had torn covers with the inner foam exposed posing a fire safety and infection control hazard (as well as not promoting residents’ dignity). It was pleasing to see that service users’ bedrooms are decorated and furnished to a good standard and individualised with different colour schemes, personal possessions and photographs. However some bedroom carpets remain badly stained as do carpets in communal areas. Communal areas require redecoration as paintwork and plasterwork is damaged. Progress towards addressing items identified at the last inspection is slow. For example Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 24 the kitchen is still awaiting refurbishment (however the manager now has a date for the work to commence in May 2006). The treatment room has now been relocated however flooring needs either replacing or repaired as it is stained and seals are broken. The walls must also be made impermeable. The garden area is very disappointing and uninviting being untidy and austere. It mainly consists of a large slabbed area (uneven in places), and some borders filled with overgrown shrubs and bushes. There are also some small patches of lawn (which are overgrown). Despite being very hot and sunny on both days of the visit there were no service users able to enjoy the garden as there was no garden furniture or shade (this was said to have been ordered by the previous manager). The manager discussed how she would like to make this into a sensory area which is commendable but needs investment and commitment from the provider. The home still needs to improve infection control practice. There were areas in the home which were dirty and unhygienic. For example, walls and skirting boards in the dining area were stained where drinks had been splashed and not wiped clean. Radiators are not being cleaned properly with accumulated dust and dirt clearly visible beneath the guards. A clinical waste bin had been left in the corridor outside a communal bathroom. The sensory bathroom had stained flooring and in areas the seal was broken. It was pleasing to see that a supply of disposable gloves and aprons are now available in the laundry area. However, mops stored in this area were not dried inverted and staff gave different versions of how they thought these were cleaned by night staff. During interviews staff also gave different accounts of how dirty and soiled laundry is transported through the premises. A senior support worker confirmed that sealed laundry bags were available but support staff were using plastic uncovered laundry baskets. There was no information relating to the control of substances hazardous to health (COSHH) contained within the laundry area. It was disappointing to see that an item of dirty clothing had been left lying in the corridor outside the laundry door whilst staff were attending to a resident’s personal care. Only four staff have completed infection control training. See comments in standard 42 regarding food hygiene practice. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 33, 35 and 36 The overall outcome for this group of standards is judged to be poor. Standards with regard to the number of staff who are NVQ qualified and who have received the required induction and foundation training remain poor. The turnover of staff, use of agency staff and vacancy levels remain high with a lack of structured supervision resulting in a lack of consistency of care for service users culminating in poor practices. Service users are not protected by the home’s recruitment and selection procedures. EVIDENCE: The home currently employs eighteen support staff. Five of whom are qualified to NVQ 11 or above. There is little specialist training for support staff. During interviews staff reported that they found it hard to cope with residents’ challenging behaviour as they have received no training which is compounded by poor management behavioural guidelines in care plans and changes in staff. A new member of staff acknowledged that they may have inadvertently mismanaged an episode of challenging behaviour because they were new to the service. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 26 Since the last inspection the deputy and manager have left the home. There remains five vacancies for support workers, and one full time and one part time vacancy for a qualified nurse. During the last eight weeks a total of 390 hours were provided by agency staff. During interviews staff expressed dissatisfaction with high number of agency staff. A visiting professional commented that some staff were excellent but others were less committed. Staff gave an example whereby a service user would only respond to permanent staff whom they knew. At present the home provides a minimum of six support staff and one qualified nurse per shift per day time shift. As already stated, this requires review to ensure that staffing levels meet the needs of the service user group with particular emphasis on providing more structured and stimulating activities within the home and in the community which are person centred. According to the statement of purpose, staff meetings are to occur on a monthly basis. The last recorded minutes are dated September 2005, although there was an agenda for a meeting dated January 2006. It was reassuring to see that the new manager had however already planned a meeting to take place on 11 May 2006. As already stated there are serious concerns regarding the recruitment of staff. Agency staff have been employed without a POVA check and some staff have not received a CRB or POVA check within the last twelve months. It was also concerning to find that staff have been recruited who have previous criminal convictions but there is no documented evidence that this was considered during their recruitment and selection process neither was their a risk assessment in place. Staff had also received no formal supervision. There was no copy of a CRB and POVA check on the premises for a visiting therapist and this could not be located at the organisation’s head office. During interviews the therapist did confirm that they had undertaken a CRB check. A copy must be located and held on the premises. There has been limited progress in introducing induction or foundation training by an accredited Learning Disability Awards Framework (LDAF) provider. Only three staff have currently received induction training to the required standard. There is a lack of structured supervision for staff. For example, one member of the night support workers has only received one recorded supervision session since their employment commenced in 2003. Another member of staff who started employment in November 2005 had received no formal supervision. Agency staff do not receive any formal structured supervision. Any other items discussed during evaluation of these standards are contained within the Requirements section of this report. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The overall outcome for this group of standards is judged to be poor. The many changes in management have resulted in inconsistent leadership, guidance and direction to staff. There has been limited action to ensure continuity of care, this has resulted in poor practices which do not always safeguard the health, safety and well being of persons using the service. EVIDENCE: Since the last inspection on 30 December 2005 the Registered Manager and deputy have ceased employed. During interviews staff expressed disillusionment with the constant changes claiming that there have been around eight different managers at varying periods during the last few years. Inadequate leadership and supervision within the home are contributing to an overall weakness in performance which is having a negative impact on service delivery as identified through out this report. A new manager has now been appointed who had only commenced employment on the previous week before this visit. Despite this positive changes are already starting to occur and it was reassuring to hear some of the plans for improving the service. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 28 Milbury Care Services need to consider reinforcing the quality assurance policy and procedure for Talbot Court. The former Registered Manager had produced an annual development plan but as stated at the last visit, this required expansion in order to provide an efficient system of planning, action and review and incorporate various monitoring documents. No further progress has been made. At present quality assurance systems based upon service user and other third party feedback are not in place. Statutory training for staff needs improvement. The majority of staff have received training in moving and handling however according to the central staff training matrix (a copy of which still needs to be forwarded to CSCI), only 50 of staff have completed training in health and safety and food hygiene. Only ten staff have training in first aid awareness and four staff have received training in infection control. Fire safety training was the subject of an immediate requirement in August 2005 yet despite this, only sixteen of the current twenty two staff team have received training. It was reassuring that fire safety training is booked for later in the current month. A sample of training certificates corresponded with the information contained on the Central staff training matrix at the time of this visit. A small sample of maintenance and service records were checked and found to be up to date. There is a good system for accident reporting it was pleasing to see that management had recently reintroduced a thorough monitoring system. However there are some concerns regarding other aspects of health and safety practice. COSHH was found unsecured in the communal bathroom cabinet. The laundry door had been left unlocked which not only compromises safety, but in addition the COSHH cupboard within the laundry area was also unlocked. Food hygiene practice still requires improvement. For example, staff are still failing to consistently check and record the temperature readings of cooked food. The food probe is not being calibrated. Frozen foods need to be labelled with the date of freezing and all dried foods must be stored in pest proof containers. Any other items discussed during this visit are contained within the requirements section of this report. Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 29 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 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 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 2 X X 1 X Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 30 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 YA2 Regulation 14 Requirement A system of reviewing the service users needs assessments must be implemented. (Previous timescale of 31/10/05 partly met) The registered person must demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. (Previous timescale of 30/11/05 partly met) Ensure that Service User plans cover all areas of identified need through a process of assessment, and are reviewed at last six monthly. The home should continue to implement a system of Person Centred Planning, or similar, such as Essential Lifestyle Planning. Attempts should be made to produce care plans in different formats suitable for service users, and evidence that DS0000004780.V291126.R01.S.doc Timescale for action 01/08/06 2. YA3 14 01/08/06 3. YA6 15 01/09/06 Talbot Court Version 5.1 Page 31 service users/their representatives have been involved in the production (Previous timescale of 30/11/05 is not met). 4. YA7 12,14 The home must demonstrate how individual choices are made by service users and instances when others make decisions. (There is on-going progress towards meeting the previous timescale of 30/06/06). To review current risk assessments to ensure that all areas of risk associated with individual service users are clearly documented, and expanded where necessary, such as all challenging behaviours, refusal of medication, independent living tasks, travelling on the minibus and use of public transport. The home must ensure that structured activity/plans are in place for the service user group, and demonstrate that opportunities for day care and education have been explored (Previous timescale of 30/11/05 is partly met). To undertake a review of the current ‘in-house’ day care provision in consultation with service users and advocates (through person centred planning). To ensure that individual activity programmes reflect service users’ preferences and incorporate independent living skills, social and leisure activities. 01/09/06 5. YA9 13(4)(c) 01/09/06 6. YA12 12,15,16 01/09/06 Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 32 7. YA13 16,17 To ensure that service users are 01/09/06 provided with opportunities for social inclusion, participate in the community, and documented evidence is available. Daily notes should evidence the social activities provided. (Previous timescale of 30/11/05 is partly met). The manager must ensure that service users are enabled to be politically active. 8. YA14 15,16 The range and availability of leisure activities provided, should through effective care planning and consultation with service users, be increased and records kept of the same. The Manager needs to ensure that all service users activities are monitored and fully evaluated. (Previous timescale of 30/11/05 is not met). The home must evidence and demonstrate that service users rights are respected and routines are flexible to suit the needs of individual service users. (There is on-going progress towards meeting the previous timescale of 30/6/06). With regard to Meals and menus at the home: A choice of meal should be offered/recorded for the teatime meal. A pictorial menu should be implemented and utilised to assist service users to make an informed choice. Portion sizes must be consistently documented and DS0000004780.V291126.R01.S.doc 01/09/06 9. YA16 12,14 01/09/06 10. YA17 16 01/08/06 Talbot Court Version 5.1 Page 33 ensuring there are no gaps in the recording of foods provided for those on special diets. (Previous timescale of 31/03/06 is not met). To review the current menu plan in consultation with service users and to introduce a more varied and well balanced diet. To ensure more consistent recording of service users’ food intake (including refusals). To undertake a review of individual service users’ nutritional screening tools to ensure that they more accurately identify risk and level of monitoring based on healthcare needs. The home must demonstrate 01/09/06 how personal support is provided flexibly and are service users are enabled/encouraged to exercise control over lives. (There is on-going progress towards meeting the previous timescale of 30/06/06). To improve daily reporting systems to ensure that these adequately reflect goals identified within care plans with regard to health and personal care. For example recording of the number of checks undertaken by night staff and to include change of position records. 12. YA19 12,13 The Registered Manager must evidence an audit trail for the provision of healthcare, including recording service DS0000004780.V291126.R01.S.doc 11. YA18 12,14 01/09/06 Talbot Court Version 5.1 Page 34 users weight, and the provision of pressure sore and nutritional risk management. (Previous timescale of 30/12/05 partly met). To introduce a formal procedure for the monitoring of service users’ health with regard to potential complications such as breast, testicular and cervical cancer screening in individual care plans (or health action plans). 13. YA20 13(2) To clarify the correct dosage of 15/05/06 Lorazepam for the identified service user at this inspection, with the Consultant Psychiatrist and to amend the MAR sheet accordingly– within one day of the inspection. To forward a copy of the amended MAR sheet to the Commission for Social Care Inspection by 15 May 2006. (Immediate Requirements 15/05/06). To undertake a thorough review 01/07/06 of all practices and procedures relating to the administration and control of medication. A detailed plan of action to improve existing practice must be forwarded to the Commission for Social Care Inspection. To provide all staff with training 01/10/06 in vulnerable adult abuse awareness. To review the practice of service users funding the cost of their own meals whilst out in the community and which are in place of meals provided by the Home, (for which the service user is already funded by the Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 35 14. YA20 13(2) 15. YA23 13(6) Local Authority). If this practice is to continue, it must be negotiated with funding authorities and service users. A formal procedure must be agreed which is contained in individual service users’ plans. To review the practice of routinely charging service users for use the minibus when access has restricted. Records must be maintained and service users reimbursed if they have not used this vehicle. Two staff must sign to authorise and account for financial activity in respect of service users money as per the home’s corporate policy. 16. YA24 13, 23 All of the environmental and 01/08/06 premises issues identified in the sections of the inspection report (dated: 30/12/05) as needing attention must be addressed, (i.e. general maintenance, décor, food safety/kitchen and infection control/laundry room. A detailed plan of action for each issue with dates for completion should be submitted to the Commission for Social Care Inspection by 7/2/06. (There is some progress towards meeting the previous timescale of 30/06/06 – although a detailed plan of action has not been submitted). To carry out an audit of all worn furniture (including the two Kirten chairs) and complete a written programme of replacement with timescales – within one week of the Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 36 inspection and to forward to the Commission for Social Care Inspection. (Immediate Requirement – 15/5/06). To repair and make safe the worn and frayed carpet in the corridor – within 24 hours of the inspection. (Immediate Requirement – 15/5/06). To carry out a written programme of refurbishment and redecoration including all issues identified in this report, and previous inspection report (dated 30/12/05). To include timescales for completion and to forward to the Commission for Social Care Inspection by 01/08/06. 17. YA30 13, 23 All of the environmental and 01/08/06 premises issues identified in the sections of the inspection report (dated 30/12/05) as needing attention must be addressed, (i.e. general maintenance, décor, food safety/kitchen and infection control/laundry room. A detailed plan of action for each issue with dates for completion should be submitted to the Commission for Social Care Inspection by 7/2/06. (There is some progress towards meeting the previous timescale of 30/06/06 – although a detailed plan of action has not been submitted). To carry out a written programme of improvement, refurbishment and redecoration including all issues identified in this report, and previous inspection report (dated Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 37 30/12/05). To include timescales for completion and to forward to the Commission for Social Care Inspection by 01/08/06. To ensure that all parts of the home are kept thoroughly clean and hygienic at all times. 18. YA31 18 The Registered Manager must ensure that staff understand their own and other’s roles and responsibilities. Staff must be aware and support the aims and values of the home, and be familiar with the standards of conduct and practice set by the General Social Care Council `Code of Conduct`. (Previous timescale of 30/11/05 partly met). To provide all staff with training in understanding and managing challenging behaviour. All staff must receive all mandatory training and specific training to support their existing skills and knowledge of service users individual needs e.g. epilepsy, autism awareness and disability equality. 20. YA33 18 01/09/06 To ensure that vacant carers posts are actively recruited to and shortfalls in staffing provision are addressed as soon as practically possible. (Previous timescale of 30/11/05 is not met). The Manager must undertake an up to date review of staffing ratios and service users dependency levels. To forward Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 38 01/09/06 19. YA32 18(1)(c) 01/09/06 written proposals to the Commission for Social Care Inspection. Sufficient staff must be allocated on a daily basis to provide all service users with a range of stimulating activities and opportunities for personal development as well as meeting care needs. To improve the frequency of staff meetings (at least a minimum of six per annum). To cease the employment of 01/07/06 any agency staff who have not received a POVA check. (Immediate Requirement within one day of inspection). To cease the employment of any agency staff who have not received a CRB and POVA check within the last 12 months. (Immediate Requirement within one day of inspection). To obtain and hold on the premises a copy of the POVA and CRB check for the visiting aromatherapist. To undertake a written risk assessment for any staff who have a criminal conviction – to identify and adopt control measures to protect service users from abuse To ensure that induction provided at the home (within 6 weeks of commencement) and foundation training (within 6 months of commencement) is delivered, and is in accordance with guidance issued by `Skills for Care` and includes all safe DS0000004780.V291126.R01.S.doc 21. YA34 19 13(6) 22. YA35 18,19 30/06/06 Talbot Court Version 5.1 Page 39 working practice topics. To ensure that all new staff are registered on a `Learning Disability Award Framework` accredited training course. (Previous timescale of 30/11/05 is not met). The Registered Manager must submit an updated staff training and development plan to the Commission for Social Care Inspection, by7/2/06 for all mandatory and foundation training commensurate with staff duties. This must clearly identify programmed dates of training for completion. (Previous timescale of 7/2/06 has not been met). 23. 24. YA36 YA37 18(2) 18(1)(a) To improve the frequency of staff supervision and support (a minimum of six per annum). The provider must ensure that an application to register a manager in respect of Talbot Court is submitted to CSCI by the date given. To establish and forward an individual personal plan for the new manager of Talbot Court to CSCI by the date given. 25. YA39 24 The company must evidence an effective system for quality assurance is in place in which standards and indicators to be achieved are clearly defined and monitored on a continuous basis. The Registered Manager should involve the service users and staff at Talbot Court in the quality assurance process and explore ways and methods of DS0000004780.V291126.R01.S.doc 01/09/06 01/07/06 01/09/06 Talbot Court Version 5.1 Page 40 demonstrating the quality of service is appropriate, and include other stakeholders. (Previous timescale of 30/11/05 is not met). 26. YA42 12,13,17,23 The Registered Manager is required to ensure the health, safety and welfare of service users and staff in relation to safe working practices, (staff training (food hygiene, infection control etc), and associated routines in the home, in addition to deficiencies noted about the premises as detailed in the report (dated 30/12/05). (Previous timescale of 30/06/06 is not yet met). To ensure that all substances hazardous to health (COSHH) are held secure at all times. 30/06/06 Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 41 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA12 YA17 YA24 YA32 Good Practice Recommendations To provide suitable training for the activity co-ordinator. To consider introducing more meals which meet the cultural needs of service users. To consider providing a sensory garden for service users. That the home continues to work towards meeting Sector skills workforce targets of 50 of care staff having achieved an NVQ level 2 or above. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. The Registered Manager should review the annual development plan, as recommended in the report. 5. YA37 6. YA39 Talbot Court DS0000004780.V291126.R01.S.doc Version 5.1 Page 42 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: 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. 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