Inspection on 15/01/07 for Talbot Court

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 23 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 10/05/06

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 15th January 2007 09:00 Talbot Court DS0000004780.V326359.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 Talbot Court DS0000004780.V326359.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. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 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 *** Post Vacant *** Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 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 10th May 2006 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.V326359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second key inspection for this inspection period 2006 – 2007. As it was a key inspection this means that all core National Minimum Standards were assessed. This inspection was unannounced meaning that no one received prior notification. The inspection took place over two days with the inspector arriving at 9.00 a.m. and leaving at 6.00 p.m. on the first day. On the second day the inspection started at 9.00 a.m. and was finished by 3.00 p.m. A pharmacist inspector also visited to assess the safety of medication practice. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the manager and 5 members of staff. A member from the community learning disability was also contacted. A number of records and documents were read, a tour of the building was undertaken and three residents’ care was case tracked through interviews with staff and examination of records. Two meal times were observed. There are currently ten residents living at Talbot Court and all were seen during the inspection. Formal interviews were not appropriate therefore the inspector relied upon brief chats with 2 residents, observations of body language and gestures, and interaction between staff and the remaining 8 residents. Since the last inspection the previous manager has left and a new manager started at the home on 1 August 2006. What the service does well: Staff attempt to meet the individual needs of residents and they are aware of their likes and dislikes. Daily routines are flexible with residents able to get up and go to bed when they wish. They can decide whether they wish to spend time alone in their bedrooms or can sit in the communal lounges. Residents looked relaxed in their surroundings and were dressed in clothing and accessories that reflected their individual personalities. Staff support residents to maintain important links with their families and friends. Visitors are warmly welcomed by staff. There is a clear complaints procedure for service users and relatives, thereby ensuring peoples’ views and concerns would be listened to and acted upon. The health needs of residents are closely monitored by staff and any concerns are dealt with by seeking prompt medical attention. The premises was warm and brightly lit with no offensive odours. Communal areas are generally comfortably furnished. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are many areas which the service needs to improve upon. Fundamental to this is the continued stability of the management and staff team, the lack of which in the past has had a significant role in the deterioration of the service. Record keeping remains poor and a number of improvements seen, for example in activities and outings, could not be fully corroborated by examination of residents’ records. This is also vital in order to continually monitor and assess that services meet residents’ needs and preferences. Neither is the level of support provided by staff reflected in the current care planning systems. Although there is a more balanced and varied menu, staff are failing to complete records to demonstrate that residents are being offered these meals and in particular that specialist dietary needs are being met. The standard of the décor and furnishings particularly within residents’ bedrooms is continuing to deteriorate and is very poor. Carpets were heavily stained through out the premises and some infection control procedures need to be improved. A ground floor shower room is badly in need of Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 7 refurbishment. Residents require more aids and adaptations in order to maximize their independence and dignity and there are currently some residents who are unable to have a choice of a shower. Formal support systems for staff must improve to ensure they can carry out their responsibilities effectively. 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. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an assessment tool for ensuring that prospective service users’ needs are fully assessed prior to admission. However existing residents’ individual aspirations and needs require to be kept under more regular review. EVIDENCE: Talbot Court is fully occupied. The last service user was admitted in August 2005. On examination residents’ case files contained an ‘activities of daily living’ assessment tool which includes the topics identified in the National Minimum Standards (NMS) 2.3. However, at least 2 residents’ assessments had not been reviewed since July 2005. It is essential that assessments are reviewed and revised if service users’ needs change in order to ensure care plans are up to date and relevant, and to demonstrate that the home can continue to meet needs. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 10 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. The system for care planning needs improvement as it does not provide staff with easy access to all of the information necessary in providing the care required by service users. Risk assessments are in place but not for all of the risks which are posed in delivery of care; an improved system would offer more protection to service users. EVIDENCE: A random sample of care plans were examined. From interviews with staff and observations of practice it is evident that the level of care and support provided is not reflected in current care plans. For example, one resident receives nutritional supplements yet the care plan relating to dietary needs made no mention of this fact. The care plan was established in September 2005 and stated that the key worker was to devise a list of likes and dislikes; this had not taken place. There was no care plan in place for one resident as to how they are supported to manage their epilepsy. Another resident has blended foods and nutritional supplements yet there was no care plan in place Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 11 regarding dietary needs. There was no care plan regarding the resident’s mobility and the support required from staff in mobilizing as identified following a recent physiotherapy assessment. Some care plans were vague and insufficiently explicit. For example, a care plan regarding incontinence management stated that staff needed to ensure that the correct aids were used but failed to identify what these were. Another care plan regarding mobility stated “X will received ‘supervision’ from staff at all times” but did not stipulate the type of ‘supervision’ required. One resident has autistic spectrum disorder but there was no specific care plan in relation to this condition or how this impacts upon the resident’s daily life. There was limited information regarding how staff support residents with their oral hygiene. There was no evidence to demonstrate that care plans are actively reviewed at least six monthly with the service user and significant others. One resident’s care plans had not been reviewed since they were established in September 2005. Another resident’s ‘falls care plan’ established in February 2006 stipulated that this would be reviewed in seven days. There was no record that this had taken place. In some residents’ case files staff had written ‘reviewed 30.10.06’ on the care plan but there was no signature to denote who had reviewed the plan or the outcome of the review (and no details as to whether the resident had been included in the review process). In the past there have been some attempts at introducing person centred planning but no further progress has been seen since the last inspection and there is no evidence that these have been reviewed. Not all residents had a person centred plan and as discussed with the manager, different person centred planning styles need to be explored in order to determine the most appropriate (for example PATH, personal futures planning, life story books and essential life style planning). Case files contained details as to how residents communicate. However, 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, clothing). 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 of risk management need much improvement. For example, one resident had a risk assessment with regard to choking. This stated that all foods are to be liquidized but according to staff this is not the case. There were no risk assessment for one resident who requires lifting equipment to access the minibus. Another resident requires blended foods but there was no risk assessment with regard to choking. Moving and handling risk assessments were not always sufficiently detailed for example, there were no details regarding the resident’s weight, communication, cognitive behaviour, visual or hearing impairments. There were risk assessments in place for wheelchair users but although these stated that posture belts must be fitted correctly, Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 12 they did not include all of the risks associated with posture belts and other seating accessories as identified in medical device alert notices. Some risk assessments had not been reviewed since April 2005. In most cases residents’ files contained two risk assessments for the same subject written by different staff at varying times and sometimes with conflicting information. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There appears to be increased opportunities for service users to participate in stimulating activities and social inclusion in order to support and enrich their lives, although this could not be corroborated through record keeping or care planning systems. Staff support residents to maintain important links with their families. The home has made some progress in providing a more balanced and varied diet. However further improvements are needed to demonstrate that residents’ specialist nutritional needs are met and that they are enabled to exercise control and choice over their diet. EVIDENCE: During interviews staff stated that they felt improvements had been made in providing more stimulating activities and outings. Residents were observed Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 14 participating in a number of interesting activities including one to one sessions with staff, story reading, hand and foot massages and various outings to the local shops. There is a pictorial activity board which is updated on a daily basis and corresponds with residents’ individual based activity programmes (contained within their case files). There is now also a television in the dining room as well as the lounge area. During interviews one resident indicated that she liked the activities on her programme and confirmed that they did take place regularly and according to her preferences, for instance a weekly swimming session. The manager stated that two residents are now attending a college course on a weekly basis. More staff are now qualified to drive the mini-bus and staff confirmed that they also utilize public transport. Unfortunately, the progress made could not be assessed further or validated due to poor record keeping. The activity record sheets are not consistently completed. For example, during one week there were 6 blank periods which had not been completed by staff on behalf of one resident. The resident did not participate in any community outings during this week according to the records maintained. Most the of week was spent ‘relaxing’. Another resident’s activity records were examined which revealed the same poor record keeping with a large number of blank sessions (8), and no recorded outings. There is no active evaluation or monitoring systems in place to assess whether activities provided are enjoyed by residents and meet their needs. There are now pictorial information sheets in service users’ case files explaining how they are enabled to be politically active as required at the last inspection. Interviews with staff confirmed that family and friends are made welcome. The home has a visiting policy. There are no restrictions on visiting times, at any reasonable time of day. There is a visitor’s book in the front porch. Daily reports and activity record sheets contained evidence of family visits. Daily routines are flexible as observed during the inspection. For example residents were seen to have breakfast at times of their own choosing. Service users’ privacy and dignity, was observed to be largely respected with regards to personal care, entering toilets and bathrooms. A couple of issues were identified and discussed with management, for example residents’ ‘aprons’ were seen to be frayed and one resident’s trousers were too long compromising dignity and also posed as a trip hazard. One bedroom had been left untidy by a member of staff after assisting a resident with personal care. Meals and mealtimes have improved in some areas. Staff were frequently seen asking residents what they would like to eat and drink and giving them a number of options in order for them to select their choice. Staff were seen to react promptly when one resident indicated that she did not like her lunch and an alternative suggested. On examination the menu plan provides a more balanced and nutritious diet with more emphasis on home cooked foods rather Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 15 than convenience meals. There is only one choice identified on the menu for lunch and dinner however examination of residents’ individual food records confirmed that alternatives are regularly provided. During interviews staff gave instances where they had changed a meal because they knew the resident did not like the option listed on the menu. There are some areas however which do still require further consideration. The majority of residents are not able to easily communicate their choices. The menu board in the dining room is currently not pictorial and strategies for enabling choice such as photographs, taster sessions etc. are not provided. During interviews staff demonstrated a good awareness of individual residents’ likes and dislikes and their specialist needs however these preferences are not recorded in residents’ care plans. There are a number of residents who are on specialist diets including gluten free, diabetic, weight reducing, pureed and blended foods. There are no separate menus or suitable alternatives identified on the current menu plan regarding these specialist diets. This is important as new staff and bank staff may not necessarily be aware of every residents’ needs (which also compounded by the lack of effective care planning). Residents’ daily individual food intake records are not consistently completed by staff. Staff are also failing to consistently complete food portions and meal size as indicated on the food charts. Whilst staff stated that they aim to provide more cultural foods for one resident, this was not apparent on examination of her food records. In addition the resident is not supposed to be given beef yet on one occasion her food record stated that she had a roast beef dinner. This was refuted by staff who stated it had been a recording error. Another resident has a care plan which confirms that they have a propensity for putting on ‘lots’ of weight and an assessment which scores them as ‘obese’. However, food records indicate that staff are not adhering to the care plan and they are having a high fat diet. For example, on one day lunch consisted of beans and cheese on toast followed by a dinner of sausage bean and chips. Another resident is on nutritional supplements but according to records these are not consistently offered. Nutritional screening tools are in place but it was unclear as to whether assessments had incorporated the resident’s actual body mass index (BMI) and one assessment tool had not been dated so it was not possible to deduce when this had been carried out. For any other items discussed during inspection of these standards please see the Requirement and Recommendation section of this report. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. 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. Improvements are needed in order to ensure that residents receive personal support according to their preferences and needs. There are good systems being operated to ensure residents’ health care needs are recognised and treated, only slight improvements are necessary with regard to screening and monitoring. The service must ensure that the control and handling of medication continues to develop in order to maintain the safety and welfare of service users’. EVIDENCE: During interviews one service user indicated that she was happy at the home and said “I like them” (the staff). She confirmed that she could get up when she wished and stated “I go to bed when I want, don’t need staff to help me”. Residents were observed to choose their own times for getting up in the morning and bathing. Care plans do not always identify service users’ preferences for how they are supported and in particular with regard to opposite or same gender personal care delivered by staff. The majority of service users receive two hourly checks during the night time (although care Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 17 plans don’t always specific the exact number of checks to be undertaken). As discussed with the manager, the frequency of checks during the night must be based on the individual residents’ preferences and, whether there is a justified medical or behavioural reason for this level of monitoring. This must be discussed and agreed with the service user and/or within a multi-disciplinary team (and recorded in the care plan and risk assessment). More equipment and adaptations are needed to aid residents’ maximum independence and dignity (see standard 24). Interviews with staff and examination of records confirms that there are generally good systems in place for meeting the health care needs of residents. Nurses deliver all of the nursing care within the home, and other specialists are utilised as needed. For example, one service user was recently assessed by physiotherapists due to frequent falls. Staff were concerned that another resident may have a recurrence of a health problem and as a result she was referred for a scan. The support and advice of the Macmillan nurses has since been accessed. Various healthcare services are utilised and there are regular dental, ophthalmic and hearing tests. There are only a couple of items which still require attention. Not all service users have care plans (or fully completed health action plans) in place particularly with regard to testicular, cervical, breast or menopausal screening. Any issues of capacity to consent must be discussed within a multi-disciplinary team and records maintained. One resident’s Waterlow score had not been reviewed since 6 November 2005. Another service user’s nutritional assessment stipulated that weekly weight checks are carried out although this is not always being undertaken by staff. A full audit was undertaken of all systems in place for the safe handling of medication. All nursing staff had undertaken additional training on the safe handling of medicines provided by Care Associated Training. Three senior support staff had also completed the training in order to witness the administration of medication when necessary. This means that service users’ are given their medication by trained staff. The service had a comprehensive medicine policy (Milbury Policy), dated September 2005 and reviewed September 2006 that reflected good practice, however there was no indication that staff had read and agreed to adhere to the policy. This means that staff may not be aware of the safe handling of medication within Talbot House and this may potentially put service users at risk of a medication error. Medication was securely locked in a dedicated treatment room. There were locked cupboards, a locked medicine trolley, locked refrigerator for safe storage of medication requiring refrigeration, a sink and a large work surface. Daily records were kept for the temperature of the refrigerator, which were within the required temperature range of 2-8°C. A boiler was sited in the treatment room, which initially gave some cause for concern for medication Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 18 storage, however a ventilation system was operating and the daily recorded temperature of the room was within the correct temperature requirements for medication storage (below 25°C). This ensured that service users’ medication was being kept safely and securely. An unlabelled 1L plastic container was stored in an unlocked cupboard under the sink in the treatment room. The container contained an unknown clear liquid that smelt like ‘turps’. This unsafe storage does not meet the required COSHH or Health and Safety Regulations. It is a potential high risk of causing harm to staff and service users’. The refrigerator was placed on top of the medicine trolley, which meant that the trolley could not be moved around the home. The medicine trolley was used to store extra supplies of medicine for service users’ and was used as a ‘top up’. The pharmacist inspector asked the manager how medication was transported around the home if the medicine trolley was not used for this purpose. She explained that staff would administer one service user’s medication at a time from the treatment room. The treatment room would be locked and then the member of staff would return and continue with the next service user’s medication. The manager assured the pharmacist inspector that only one service user’s medication would be done at a time. No service users’ within the home were self-medicating their own medication. Nursing staff can call in a General Practitioner (GP) to review service users medicine on a regular basis. This had recently been completed for all service users’ within the home. This ensures that service users’ healthcare needs were being met. Since the previous inspection daily audits of service users’ medicines were being undertaken, which was good practice and helped to ensure that service users’ medicines were being given as prescribed by a GP. However it was not available for all of the medicines stored in the home. Audits were only available for medicines in the Monitored Dosage System used by the home and also for some medicines stored separately in boxes. There were no audits for medication prescribed on a when required basis or for medication kept as ‘top up’ in the medicine trolley. The date of opening on the original container (box or bottle) was not always recorded. For example, one service user was prescribed a nasal spray to control hay fever symptoms. The bottle had been dispensed and labelled by the pharmacy in July 2006 and had been opened, however there was no date of opening recorded. The nasal spray had a two- month expiry date on opening. This means that staff had failed to ensure the safe storage and administration of medication. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 19 No balances of medicines were carried over on to new medicine charts. This means a full medicine audit could not be done to ensure that medication had been given to service users as prescribed by the GP. The medicine records were pre-printed by the supplying pharmacy. Residents’ allergy status was not recorded on the medicine charts. It is important to ensure that all relevant medical information relating to a resident is immediately available and to help protect the resident from harm. Photographs of service users were kept next to their medicine charts for identification purposes, however some of the photographs did not name the service user. This was highlighted to the manager who was aware of this and explained it would be corrected. An ‘Administration of Medicines Plan’ was available for each service user. It detailed ‘How I Take My Medication’ and provided service user specific information from the service user’s point of view. This was good practice. Guidelines for the administration of when required medication was available for each service user, which had been agreed and signed by the service users’ GP. They were dated 18/5/06. This was good practice. Specific information for service users’ prescribed ‘when required’ sedatives or antipsychotic medication for behaviour management was available. For example, one service user was prescribed the anxiolytic lorazepam 1mg when required. Guidance to staff was very clear and stated that lorazepam 1mg should only be given ‘If I start to hit out at others, or if I start hitting my head with my hands and become really restless and become very vocal…’ This statement described to staff under what circumstances they should administer this medication. This was very good practice and was commended at the inspection. Some medication prescribed and labelled for service users’ was not recorded or documented on the current medicine charts. For example, there were five diazepam 10mg rectal tubes in a box labelled for one service user to be used in the event of an epileptic seizure. This was not documented on the medicine chart. There was no audit or record of an audit to ensure that the medication was still required for the service user. This means that the health and welfare of the service user was at risk because the medicine chart was not up to date or an accurate reflection of the service user’s health needs. A drug profile for each service user was available next to the medicine chart, which listed the drug name, dose, indications and side effects of the medication. This was useful information for staff to refer to. However the medicine reference source available in the home was an out of date British National Formulary (BNF) dated March 2004. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 20 Many service users had records indicating that their tablets were given with ‘my meal, or yoghurt or cream. This allows me to swallow them easier’ and some stated ‘ always inform me that you are giving me my medication’. This indicated that medication had to be given in service users’ food in order for them to take their medication. Many of the service users’ did have swallowing difficulties and due to their physical and mental disabilities this form of administration would be beneficial and advantageous to the service users’. It is therefore essential that the home involve the full multidisciplinary co-operation of other healthcare professionals, for example speech therapist, pharmacist. This should be documented in the relevant service users’ care plans. The Controlled Drug Register (CDR) was checked in order to ensure controlled drugs were being stored and recorded according to legislation. The running stock balances were accurate when counted. There was no record of the strength of one of the medicines documented in the CDR, which means that there was a risk of a possible medication error and also the records do not follow the required legislation. Medication for return was placed in dedicated waste disposal containers, which were locked and secure. This ensures that service users are protected from harm. The home had a contract with a private waste disposal company to remove all unwanted medicines. There was a record available for medicine that was to be disposed of, however it was not complete or accurate. There was a large quantity of medication to be returned but the records did not indicate this quantity. The pharmacist inspector was able to identify at least two medicines that had not been documented in the returns book. This means that there was incomplete audit trail of service users’ medication. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 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. 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 complaints procedure which ensures that users’ views are listened to and acted upon. There are improved arrangements for protecting residents from abuse although further progress is needed in order to make all areas sufficiently robust. EVIDENCE: There is a clear complaints procedure for service users and their relatives to access if necessary. There have been no complaints received by CSCI about the home during the last twelve months. During interviews staff gave examples as to how they have supported residents to make their concerns known in the past when they wished to raise issues. The complaints procedure has been produced in a format suitable for service users. A copy of the Local Authority vulnerable adult procedures are available in the manager’s office for staff to reference if necessary. Since the last inspection there have been three allegations of abuse which have been investigated by the Local Authority and not upheld. Management followed the correct multiagency reporting procedures and reacted promptly to the allegations made. During interviews staff gave appropriate responses as to how they would deal with any potential incidents of abuse and understood the principles of Whistle Blowing. According to the central training matrix there are at least 9 staff who have yet to receive training in vulnerable adult abuse awareness. Staff also require training in managing challenging behaviour. There are improved recruitment and selection procedures (see comments in standard 32 and 34). Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 22 Since the last inspection improvements have been made towards practices regarding service users’ money. During interviews the manager stated that service users are no longer being charged for meals when out in the community. In addition they also do not pay any contributions towards the minibus (this was a previous concern as it was thought that service users were contributing towards the vehicle but were not using it). On examination of residents’ finances there is improved record keeping and monitoring in place. For example there are two staff signatures for all financial transactions and twice daily auditing checks carried out by staff. A sample of records and monies balanced accurately. There were a couple of anomalies identified in practice. One resident was seen to have recently paid for her own bed linen. The manager stated that this was purchased as the resident had only one set. This should normally be included as part of the basic contract fee and not funded by the resident. A discussion was also held regarding the potential cost towards redecorating and refurbishing service users’ bedrooms. A requirement has been made for liaison with the commissioning authority and residents must be reimbursed for any items for which they have been inadvertently charged; during a period to be determined by the Local Authority. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 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. 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. Although communal areas are comfortably furnished and decorated, the standard of service users’ bedrooms continue to deteriorate with little evidence of improvement through maintenance or future planning. The building and environmental adaptations do not meet all of the needs of persons with physical disabilities and thereby limits residents’ independence and compromises dignity. Infection control measures require improvement in order to offer residents safer systems for controlling the spread of infection. EVIDENCE: A tour of the premises was undertaken including viewing residents’ bedrooms (with one exception where the service user indicated that she was not happy for the inspector to enter her room). Serious concerns raised at the last inspection have received appropriate action with worn Kirton chairs replaced and unsafe carpet repaired. In addition the kitchen has now been refurbished Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 24 and residents have been provided with a sensory garden. As required following the last inspection a programme of redecoration and refurbishment was forwarded to CSCI however timescales for completion have not been met. For example bedrooms were supposed to have been redecorated by October 2006 which has not been carried out. All number of bedrooms viewed were seen to require redecoration because of badly damaged paintwork, plasterwork and torn wall paper. Progress is extremely slow. For example, bedroom no. 3 had wall paper stripped ready for redecorating in 2003 according to staff. Bedroom no. 1 had stripped wallpaper with attempts at repairing damaged plasterwork although any further work had ceased, allegedly due to budget constraints and the lack of a dedicated handyperson. Staff stated that another resident’s bedroom had not been redecorated since she had moved into the home in 2001 and the décor reflected the tastes of the previous male occupant. Although bedrooms contained residents’ personal possessions and effects including televisions and music centres there was limited sensory or tactile equipment. There is a communal specialist bath and a communal shower room. However not all residents have the option of either shower or bathing facility. At least one resident cannot access her ensuite shower facility as there is no overhead tracking and insufficient room for a portable hoist to be utilized. The ensuite is therefore used as a store room. Neither can she access the communal shower due to lack of suitable space and equipment. There is no drying table in the communal bathroom. It is recommended that an assessment is obtained from a professional competent person such as an Occupational Therapist (O.T.) to determine whether the current aids and adaptations are sufficient to meet all of the needs of the service user group. There were no offensive odours through out the premises although the carpets in bedrooms and communal areas remain heavily stained. Staff reported that these were professionally cleaned following the last inspection in July 2006. However no other deep cleaning has been undertaken other than regular vacuuming. Due to heavy usage a more proactive cleaning schedule must be established. The communal shower room was seen to have badly stained grouting and flooring. The light pull cord was dirty requiring replacement and transfer decorations on the tiles were peeling off. The communal bathroom flooring has tears in places and is therefore not impermeable. Generally staff were seen to follow good infection control practice wearing appropriate protective clothing when carrying out domestic or personal care tasks however, there are some practices which require improvement. For example, dirty (and soiled clothing in an unsecured laundry sack) was found on the laundry floor. There was no clinical waste receptacle in the laundry area and staff had therefore disposed of clinical waste in a black bin liner. On examination cleaning schedules are not always consistently completed by staff. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 25 Since the last inspection there has been improvements in training for staff with regard to infection control; the majority of staff have received this training. The new housekeeper has yet to undertake this training however. Any other items discussed during inspection of these standards is contained within the requirements and recommendations section of this report. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. There is now progress towards providing staff with the specialist and vocational training in order to equip them to meet residents’ needs. Staffing levels are being increased in order to offer more support and consistency of care to service users. Recruitment and selection procedures are more robust and offer sufficient safeguards and protection for residents. Formal support systems for staff must improve to ensure they can carry out their responsibilities effectively. EVIDENCE: Since the last inspection staff have received copies of the code of conduct set by the General Social Care Council. There was evidence on personnel files that new staff had received a copy of this code. There is a central staff training matrix and a sample of training certificates were examined which corroborated that training had taken place as depicted on the matrix. The manager acknowledged that parts of the matrix required Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 27 up dating as this did not incorporate some of the more recent training which had taken place. The home employs four nurses and twenty support staff. The manager states that eight support staff have now completed their NVQ II or above, and that the majority of the staff team are now enrolled on a vocational qualification. All of the four support workers who were interviewed were undertaking an NVQ qualification; two staff commented that they felt training was much improved. There is a number of specialist training which still needs to be accessed although during interviews the manager demonstrated a commitment to sourcing further training for staff. For example, four staff are to receive specialist training from the Macmillan nurses. Three staff have completed induction and foundation training by an accredited learning disability awards framework (LDAF) provider. Five staff are currently undergoing this training. On examination of the duty rota the service continues to provide a minimum of six support staff and one qualified nurse per shift per day time shift. There is no longer a dependency upon agency staff because of a high number of vacancies or sickness. For example, no agency staff were seen to be employed during the last two weeks. Extra bank staff have been employed to improve upon consistency of care to residents. Until recently, the manager reports that the home had a full complement of staff although there are now two vacancies. Staffing levels have increased with two new posts of a housekeeper and a dedicated cook; there are a further 20 hours awaiting allocation. Following the last inspection there was a requirement to improve the frequency of staff meetings. Unfortunately there were no minutes available for two of the three meetings which were said to have taken place. Serious concerns were identified previously with regard to the lack of clearance checks for agency staff. This has received appropriate action. In addition all bank staff had appropriate clearance checks. Risk assessments have now been carried out with regard to any staff who may have had a previous conviction. There were also checks in place for the visiting aromatherapist. Examination of a personnel file for a newly recruited member of staff confirmed that appropriate recruitment procedures had been followed. There was only one shortfall whereby dates of previous employment given by the applicant did not correlate with those given by the former employer. The frequency of formal staff supervision still needs improvement. For example, one member of night staff who commenced employment in 2003 has only received one formal supervision session according to records maintained. Another member of staff was seen to have only two supervision sessions in a thirteen month period. There is no annual appraisal system in operation. The manager is attempting to introduce a formal supervision programme for all staff and she has accordingly devised is a written timetable. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 28 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 adequate. This judgement has been made using available evidence including a visit to this service. The many changes in management have resulted in inconsistent leadership, guidance and direction to staff which the new manager is starting to reverse. The service is beginning to regularly review aspects of its performance through a programme of quality assurance although residents and their relatives must be allowed opportunities to participate in this process. Overall there is some good health and safety practice although some elements need improvement in order to offer residents more safeguards. EVIDENCE: Since the last inspection the previous manager has left employment. In the last two years there have been at least five different managers at Talbot Court. The current manager has been in post for five months and has in the past Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 29 managed the home during former managers’ absences; she is therefore known to both residents and staff. Ms. Bailey was formerly registered manager of another service and is in the process of pursuing an application to register as manager of Talbot Court with CSCI. She is a qualified and experienced manager who demonstrates a commitment to her role and was observed to have a good rapport with residents. The majority of staff were very positive and felt that a number of improvements had taken place that were of benefit to both service users and themselves. One member of staff commented “she’s made a lot of changes, staff are getting along and are working together better”. Feedback was also sought from a member of the community learning disability team. They stated that they felt the manager had made improvements and that relatives were also more happy with the service. The service provider needs to continue to support Ms. Bailey in her application as registered manager. The home has recently been successful in retaining the Investors in People achievement award. The senior staff at the home continue to undertake ‘quality checks’ and senior managers from the organisation also visit to undertake monitoring and quality audits. Feedback needs to be actively sought from service users, their relatives, advocates and stakeholders and incorporated into the quality assurance process. A random sample of maintenance and service records were examined. Some were found to be up to date but others were not. For example, although there is an annual inspection of the fire alarm system and fire extinguishers, the weekly checking and recording of the fire alarm needs to be more vigilantly carried out (there was no check recorded between 29 December 2006 and 12 January 2007). The manager stated that the majority of staff had participated in a bi-annual fire evacuation drill although there were insufficient records to substantiate this. There is a Legionella risk assessment and regular checking and recording of water temperatures. However, whilst the regular cleaning of shower heads was included on the cleaning schedule (as per the Legionella risk assessment), staff were not always signing to confirm that they had carried out this task. There are regular recorded health and safety checks with regard to equipment such as bedrails and wheelchairs. Staff need to be more careful in ensuring that substances hazardous to health (COSHH) are held secure at all times as a number of products were found unsecured through out the premises. In addition, on one occasion the laundry was left unlocked despite the warning sign for staff to ensure that this is secured at all times, (this also contained unsecured COSHH). The manager was able to demonstrate on-going progress towards mandatory training for staff with courses booked in the near future. Almost all staff have undertaken training in moving and handling, infection control and food hygiene Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 30 awareness. According to records sixteen of the twenty four staff have received up to date training in fire safety. Fire safety training is booked to take place every month so that the remaining staff can participate. The majority of night staff have received this training, but as this is more than twelve months old, they should be given priority. Continuing efforts must also be made to ensure that all staff receive training in first aid awareness and health and safety. Since the last inspection improvements have also been made in food hygiene practice. For example, all high risk foods were seen to be labelled and stored correctly and there is regular checking and recording of food, fridge and freezer temperatures. The home has recently achieved a Food Safety award from the Local Authority environmental services agency. Any other items discussed during inspection of these standards are contained within the requirements or recommendations section of this report. Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement A system of reviewing the service users’ needs assessments must be implemented. (Previous timescale of 31/10/05 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 (with service users and their representatives). 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 service users/their representatives have been involved in the production (Previous timescale of 30/11/05 is not met). Timescale for action 01/05/07 2. YA6 15 01/05/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 33 3. YA7 12,14 4. YA9 13(4)(c) 5. YA12 16 6. YA13 16,17 7. YA16 12 The home must demonstrate how individual choices are made by service users and instances when others make decisions (including care plans identifying how service users are supported to manage their finances). (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. (Previous timescale of 1/9/06 is not fully met). To improve record keeping, evaluation and monitoring systems in order to demonstrate that service users’ independent living skills, therapeutic and social activity programmes are being fully implemented. To ensure that service users are 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 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 DS0000004780.V326359.R01.S.doc 01/05/07 01/05/07 01/05/07 01/05/07 01/05/07 Talbot Court Version 5.2 Page 34 8. YA17 16 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 ensuring there are no gaps in the recording of foods provided for those on special diets. (Previous timescale of 31/03/06 is not fully met). To ensure more consistent recording of service users’ food intake (including refusals). (Previous timescale of 1/8/06 is not met). 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. (Previous timescale of 1/8/06 is not fully met). 01/05/07 9. YA18 12,14 The home must demonstrate how personal support is provided flexibly and are service users are enabled/encouraged to exercise control over lives. For example gender preferences with regard to personal care, frequency of night time checks. (Previous timescale of 30/06/06 is not fully met). 01/05/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 35 10. YA19 12,13 To introduce a formal procedure 01/05/07 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). (Previous timescale of 1/9/06 is not fully met). To ensure that there is regular reviewing (at least annually) of tissue viability risk assessments. Staff must fully adhere to the frequency of weight checks identified in the nutritional screening assessment tool. 11. YA20 13(2) To undertake the following improvements to the control and administration of medication: 1) The date of opening of all medicine containers should be recorded and any balances of medicines carried over onto a new medicine chart in order to undertake a medicine audit and also to ensure medication no longer in date is disposed of. 2) All substances that are not labelled or identified under COSHH regulations must be removed and destroyed to protect service users’ and staff from harm. 3) The medicine charts must document service users’ allergies or state ‘none known’ to ensure all relevant medical details are accessible. 01/04/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 36 4) The medicine record must contain an up to date record of all current medications prescribed for a service user to ensure accuracy and protect the healthcare needs of the service user. 5) Medication review must involve a multidisciplinary team to ensure medication is being given to service users safely. 6) The Controlled Drug Register must be recorded accurately and document the strength of any medication prescribed. This must meet The Misuse of Drugs Act 1971. 7) All medication that is to be disposed of must be recorded and documented To provide all staff with training in vulnerable adult abuse awareness. (Previous timescale of 1/10/06 is not fully met). To undertake a documented liaison with Local Authority Commissioning Departments to establish the exact nature of what the basic contract fee covers in terms of service users expenditure. To fully reimburse service users for any items for which they have been inadvertently charged within a timescale agreed by the Local Authority, for example worn or replacement bedding, redecoration and furnishings etc. Records must be held on individual service user files. 12. YA23 13(6) 01/05/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 37 13. YA24 13, 23 To undertake the following improvements to the premises: 1) To clean stained armchair in dining room and repair torn fabric. 2) To clean or replace all stained carpets through out the home and which include communal areas, individual service users’ bedrooms and storerooms. 3) To carry out repairs and redecoration of all service users’ bedrooms and any communal areas where paintwork/plaster and wall paper has been damaged and/or is worn. 4) To ensure that wardrobes are secured to bedroom walls where there is a safety risk identified. 5) To ensure that any worn or broken furniture in service users’ bedrooms is replaced or repaired. To undertake the following improvements to infection control procedures: 1) To repair and reseal all torn impermeable flooring in bathrooms, toilets and treatment room. 2) To clean stained ceiling in bedroom no. 7. 3) 3) To carry out redecoration and refurbishment of the communal shower room. 6) To cease leaving dirty or 01/05/07 14. YA30 13(3) 01/05/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 38 soiled clothing on the laundry floor. 7) To install appropriate clinical waste receptacle in the laundry in order for the safe disposal of clinical waste such as personal protective clothing. To provide all staff with training 01/05/07 in understanding and managing challenging behaviour. (Previous timescale of 1/9/06 is not met). All staff must receive all mandatory training and specific training to support their existing skills and knowledge of service users individual needs including: 1) Epilepsy awareness. (Previous timescale of 1/9/06 is not met). 2) Autism awareness. (Previous timescale of 1/9/06 is not met). 3) Disability equality. (Previous timescale of 1/9/06 is not met). 4) Diabetes awareness. 16. YA33 18 To improve the frequency of staff meetings (at least a minimum of six per annum). (Previous timescale of 1/9/06 is not met). To improve recruitment and selection procedures by ensuring a written explanation is obtained for any discrepancies in dates of previous employment given by DS0000004780.V326359.R01.S.doc 15. YA32 18(1)(c) 01/05/07 17. YA34 19 01/04/07 Talbot Court Version 5.2 Page 39 18. YA35 18,19 the applicant and those given by the referee. 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 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 fully met). To improve the frequency of staff supervision and support (a minimum of six per annum). (Previous timescale of 1/9/06 is not met). To introduce an annual appraisal system for all staff. 01/05/07 19. YA36 18(2) 01/05/07 20. YA37 9 21. YA39 24 The provider must ensure that 01/04/07 upon completion of a CRB check that the manager applies for registration with CSCI. The company must evidence an 01/05/07 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 demonstrating the quality of service is appropriate, and include other stakeholders. DS0000004780.V326359.R01.S.doc Version 5.2 Page 40 Talbot Court (Previous timescale of 30/11/05 is not fully met). 22. YA42 12,13,17,23 To undertake the following improvements to fire safety and health and safety: 1) To ensure that all substances hazardous to health (COSHH) are held secure at all times. (Previous timescale of 30/6/06 is not met). 2) To ensure that staff follow the key holding policy for keeping the laundry locked at all times. 3) To ensure that there is more consistent weekly checking and recording of the fire alarm system. 4) To ensure that there are records maintained to demonstrate that all staff participate in a bi-annual fire drill. To provide all staff with up to date manadatory training in: 1) First aid awareness. 2) Health and safety. 3) Fire safety. 01/05/07 23. YA42 18(1)(c) 01/05/07 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 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. Refer to Standard YA17 Good Practice Recommendations To consider introducing more meals which meet the cultural needs of service users. It is recommended that a more comprehensive nutritional screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’) is introduced in order to identify issues relating to malnutrition and obesity and which utilizes a Body Mass Index scoring system. To obtain piping bags and moulds for improving the presentation of pureed foods. To consider producing a separate menu or sample menu plans for service users who are on specialist diets (such as diabetic, gluten free and weight reducing). To provide staff with guidance regarding exploring different strategies for enabling residents to make choices from the daily menu and in menu planning, for example using objects of reference, taster sessions. 2. YA20 It is strongly recommended that all staff who administer or witness the administration of medication read and sign to agree to adhere to the medicine policy. It is strongly recommended that the home obtains an up to date medicine reference source for example a new edition of the BNF. It is recommended that an assessment from a suitably recognised professional such as an O.T. is obtained with regard to providing more equipment and adaptations to meet service users’ needs for example: the provision of overhead tracking in bedrooms, a drying table for the communal bathroom and a portable cradle shower chair to enable easy access for communal showers or ensuite bathing facilities. 3. YA24 Talbot Court DS0000004780.V326359.R01.S.doc Version 5.2 Page 42 4. YA30 To consider purchasing a range of sensory/tactile equipment and furniture for residents’ bedrooms. To ensure that regular washing/deep cleaning of carpets is included on the cleaning schedule. To consider purchasing suitable equipment for the regular deep cleaning of carpets. To ensure 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. To maintain records and/or training certificates to demonstrate that bank staff have received suitable training. 5. YA32 6. 7. YA33 YA37 To cease using correctional fluid on documents for example duty rotas. 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. To ensure that staff more consistently maintain records to demonstrate regular cleaning of shower heads is carried out as per the Legionella assessment and recommendations. To undertake take regular calibrating of the temperature probe with written records maintained. food 8. YA42 Talbot Court DS0000004780.V326359.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 Talbot Court DS0000004780.V326359.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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