Inspection on 03/08/07 for Tamarisk House

This inspection was carried out on 3rd August 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tamarisk House 07/08/06

Tamarisk House 04/01/06

Tamarisk House 14/07/05

Tamarisk House 09/03/05

Tamarisk House 14/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Tamarisk House 26 Holt Road Horsford Norwich Norfolk NR10 3DD Lead Inspector Mrs Judith Last Unannounced Inspection 3rd August 2007 03:45 Tamarisk House DS0000027586.V347949.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 Tamarisk House DS0000027586.V347949.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. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tamarisk House Address 26 Holt Road Horsford Norwich Norfolk NR10 3DD 01603 890737 01603 890840 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Mr Martin Edward Rendle Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: Tamarisk is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. Care Management Group Limited, whose registered office is located in London, owns Tamarisk and other homes in the Norwich area. This home is located in the village of Horsford on the outskirts of Norwich. Local amenities, shops and pubs are close by. The home consists of an adapted bungalow. All bedrooms offer single occupation. One of the bedrooms has en-suite facilities. There is ample communal space and there is a large rear garden with patio, lawns and furniture. This is easily accessible to all service users. Limited off-road parking is available at the front of the home. The manager was unable to provide us with information about the range of fees at our visit, indicating these are perhaps not given the prominence they should be in the Service User Guide. This follows guidance from the Office of Fair Trading about openness and transparency in fees. Fees were later confirmed as ranging from £800 to £1343.82 according to dependency. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was unannounced. We spent a total of just over four hours in the home. We got information from the questionnaire the manager filled in, from records, from listening and talking to staff and from looking at what was going on. We had two letters from staff and two from relatives of people living at the home telling us what they think about the home. We spoke to all of the people living in the home, but it was difficult for some of them to tell us what they thought about it. We used this information and looked at our rules to see how well the service was doing. People are having an adequate service at the moment with staff working hard to do some things very well. What the service does well: Staff work hard to find opportunities for people to pursue their interests and to have busy and fulfilling lives. This includes opportunities for activities inside and out of the home (like horse riding or swimming) and for educational experiences. People say they have lots of things to do. Staff also support people to maintain contact with their families. Staff support people well to make sure they get the health advice and input that they need and also help meet people’s personal care needs. They make sure people have regular check ups as well as specialist appointments when these are needed. Staff say that they have access to training that helps them to understand and meet people’s needs. People living at the home or their representatives know that their concerns would be taken seriously and there are measures in place to help make sure people are protected from abuse. People live in a pleasant and homely house that fits in with those around it, and suits people’s needs. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are five things the manager needs to sort out by law. Where a person is known to be at risk in certain circumstances, staff must follow the instructions they have to minimise this risk. If they do not, accidents are more likely to happen. Sometimes people need medication that is only to be used occasionally and in variable amounts. Staff need to have clear guidelines about when they need to consider its use, the minimum gap between doses and how much of the variable dose to give. This is so people can have the treatment they need to avoid difficulties and distress, but also so that treatment is not used in a way that could harm or badly affect someone’s lifestyle. The way people are recruited needs to be more robust so that the manager can show any gaps in employment or between education and employment have been fully explained. Any information in references that is unclear or concerning needs to be explored. This is so the manager can be sure that staff taken on have been properly checked and are suitable to work with the people living at the home. Staff need to have adequate supervision from their line managers. This needs at least to match the National Minimum Standards in what is discussed and how often. Some of the issues may be because people are offering supervision who have not been trained to do so properly. Staff need the supervision so they can talk about their role in supporting people and the aims of the service. The wiring needs testing in this, (and any other of the older homes in the group), to make sure it is in good condition and is not likely to present a risk of fire. There are some other things that the manager could think about doing that would help to improve the service even more for people living at the home. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 7 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. Tamarisk House DS0000027586.V347949.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 Tamarisk House DS0000027586.V347949.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who were thinking of moving into the home would have their needs and goals looked at, so that staff would understand how to support them. EVIDENCE: No one has moved into the home since 2004. There is a procedure for admitting new people that involves getting information from others and the manager or team leader visiting to get more, before the person moves in. Previous inspections show the key standard as met. We did not look at any evidence this time as nothing had changed. Tamarisk House DS0000027586.V347949.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans set out needs and goals, although progress towards these is not clear and organisation and application of risk assessments needs to be improved. Additional methods of communication could be explored to improve the options available to people in attempting to make decisions and involving them in planning their care. EVIDENCE: The manager completed information about this outcome group before we visited. This did not reflect the individual standards or regulations governing this area, but related to outcomes in the lifestyle section. We were not therefore able to “audit” the evidence he provided in this group. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 11 The files for all three people were checked. These show that people’s needs and personal goals are set out. Goals are also given a priority for work and concentrate on improving people skills, for example to promote communication, skills in personal hygiene or domestic tasks. This is good practice. One person was not sure they had a care plan or that people talked to them about the help they need. The use of photographs, symbols or simple language is not shown. People and their keyworkers as representatives, are not always involved in their own formal reviews with social workers, although relatives do attend. A recommendation has been made. In some cases documentation is not signed or dated. This makes it impossible to tell who is accountable for its accurate completion and whether it is the most up to date information and does not represent good practice. A recommendation has been made. However, care plan goals are set out and in most cases progress sheets show regular review. In all of those sampled these persistently showed “no change” indicating that perhaps goals need to be broken down into smaller steps so that progress is more easily recognised. Records of care in daily notes need to show that this matches what has been set down as necessary in care plans, to meet people’s needs and in some cases goals (for example to provide “encouragement” and “choice”, makes this difficult to do). A recommendation has been made. Daily records and care plans reflect choice as being important, and there are underpinning risk assessments for when these may not be safe, for example, accessing bank accounts and managing medication. Records associated with people’s finances have been improved in line with the recommendation made at the last inspection. Three people completing comment cards say that they are involved in making decisions in their home. We were not able to verify this with people. This is because people had either communication difficulties or were focussed on other issues or otherwise occupied. Two relatives comment cards say they feel that they are given enough information to support decision-making and that the service usually meets the persons needs. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 12 There are risk assessments relating to people’s behaviour and activities. In some cases these are duplicated and would benefit from reorganisation. In two cases there are known risks when the person is out of the home. This is documented, but not related to other activities, for example, using public transport or shopping where members of the public could potentially be at risk. A recommendation has been made. Risk assessments could be refined and files organised better to avoid repetitiveness. One person had two copies of a risk assessment for evacuation in the event of fire, both of which were being routinely reviewed apparently without noticing the duplication. One person’s risk assessment was not being followed, specifically a known risk of scalding from hot drinks. A requirement has been made. However, the staff member spoken to had a good understanding of the needs and behaviours of people living at the home. Tamarisk House DS0000027586.V347949.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are occasional difficulties with staffing or transport, staff work hard to support people with activities they want to do, inside and outside the home. They maintain good contact with relatives. EVIDENCE: Daily records and weekly programmes confirm the range of activities open to service users in line with information provided by the manager. This includes swimming, horse riding, activities centre, sailing trips with the Nancy Oldfield Trust and holidays. Photographs of holiday trips showed what the group of people had done while they were away, and could usefully be used to present information for individuals rather than the group. One person told us they sometimes go to the pub, and a trip to an “Abba” tribute show has been arranged. The manager says the duty roster will be revised to allow for this. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 14 There had been a recent shopping trip to Anglia Square. Records did not show which staff on duty had supported all three people with this trip. This is needed in order to show that identified risks and the need for 1:1 support are addressed, together with concerns about additional risk assessment needed. See previous section and recommendation. The manager has aims to encourage and promote evening activities. The duty roster is not routinely staffed to allow for this, but the manager says this is flexible and arrangements would be made. However, on the day of the visit, the person covering this shift had called in sick. People had not been able to go out. In comment cards one person says that people’s social needs are “mostly” met and one says that they are met well. There are some difficulties arising from the lack of transport , a car being shared with another nearby house. See recommendations. One relative commented specifically that they did not feel a person was made to do something if they did not want to, and that they could spend time on their own in their room if they wished. One person can no longer attend Easton College, though efforts have been made to identify an alternative more suited to the person’s needs and abilities. Relatives say they feel people are supported to keep in contact and that they are kept informed about what is going on. Care plans contain sections on sexuality. We saw one person helping with the washing up and who came to fetch the ironing board for the staff member and then went to put their clothes away. Another brought laundry through at the end of their day and put this in the washing machine. Care plans reflect people being involved in some domestic routines although participation is not clearly reflected in daily notes. People say in their comment cards that they like the food. One person told us what was for tea, that food was good and they were looking forward to their meal. There is a table people can eat at in the kitchen and another in the lounge/diner, which one person told us was where they ate their meals. Records show that people’s weights are monitored and support given to manage this where need be. The mealtime routine as heard, was relaxed and quiet. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their personal and health care needs met in a manner that encourages independence and supports dignity. Some additional written guidance is needed at present in relation to one medicine prescription. EVIDENCE: People say in their comment cards that they feel well cared for. During our visit, one person was supported with a bath and respect for privacy was shown in the staff knocking on the bathroom door. People’s appearances showed they were dressed appropriately. A care plan showed one person took an interest in their personal appearance and responded well to compliments on this, as well as the goal to encourage more independence with personal hygiene. Records show people’s times for getting up and going to bed vary according to their routines. Each person has a keyworker allocated, although we were told that if the person wanted to change they could. One person told us who their keyworker was. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 16 Care plans show people have routine appointments, such as for foot care, and the frequency with which appointments are required, for example with the dentist. There are specific recording sheets in use, which show the outcomes of appointments. Files also contain correspondence from health care professionals. Staff consider they have appropriate training to meet people’s health care needs and managing medication. Medication is stored in a locked cupboard outside the sleep in room. The staff member responsible had the keys securely on their person. The cupboard was maintained in an organised manner, and most of the medication is dispensed in a monitored dosage system. There are reminders in the folder for medication that is not “blistered”. There were no omissions from records seen and packs were being used in order as set out in medication administration records. The practice of routinely both coding AND signing medication records for occasional or “when necessary” (PRN) medication when this is not needed, makes it less clear whether the medication has been given or not. Guidance from our professional pharmacist inspector is that no signature needs to be made routinely into PRN prescribed records unless the medication is given. A recommendation has been made. One person has been prescribed occasional medication to help with behaviour, in variable amounts since 19th July. This has not yet had to be given but there is no written guidance governing its use, for example stating exactly under which circumstances it is to be given and the interval expected between maximum doses. A requirement has been made. However, staff spoken to understand the behavioural difficulties sometimes presented and alternative means are generally used to manage this, (the person being encouraged to spend time in their room, no confrontation etc). They would seek guidance from the on call person who has access to the manager if they were not sure of anything, including how to use medication. Staff records show training in handling medication is given by Boots Chemist. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People or their representatives could be sure their concerns would be taken seriously. There are measures in place to try to protect people from abuse. EVIDENCE: Relatives completing comment cards say they know what the complaints procedure is. There is a record of complaints and compliments kept and no recent complaints are recorded. People supported to complete comment cards say they know who to talk to if they are concerned about their care. One person told us they were happy with things. Staff completing comment cards and spoken to say that they have training in safeguarding people, and this is supported by records. None of them has had concerns about safety or welfare of service users, or about the conduct of other staff. One person spoken to says they would report any concerns to the manager who was described as approachable. Financial records were checked for two people and evidence seen in relation to monies withdrawn from bank accounts for people’s use for personal spending and holidays. Receipts are kept and the balance of cash held was checked for one person and found accurate. The manager checks these “in house”, and staff sign for money held in the house at each handover. The Regional Operations Manager checks finances on monthly visits. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a homely environment that suits their needs and where efforts are made to protect them from avoidable infection. EVIDENCE: The risk from hot radiators has been assessed as required at the last inspection. These assessments are recorded on individual files and action taken as appropriate. The manager says all radiators have now been covered to address the risk. We did not check this. We did not look at all areas of the home, but did check that things in communal areas. The living room is in good order having been recently decorated. There are plans to do the kitchen/diner in the near future. There are homely and domestic furnishings and there were no odours. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 19 There is policy guidance for staff on infection control. They have had training in food safety and hot food and refrigerator/freezer temperatures are monitored and recorded. Staff have access to protective clothing (aprons and gloves) where this is needed. There are arrangements for disposal of clinical waste (certificates seen). The washing machine is located where linen does not need to be taken though food preparation areas. Environmental health officers, who are responsible for enforcement in this area, have expressed no concerns to us. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of their roles and of how to support people to meet their needs. There is room for improvement in the robustness of recruitment procedures and in the frequency and nature of supervision to support staff work with individuals. EVIDENCE: Staff training records show that they have access to training to support them in their roles. Training records show that courses considered as mandatory, for example fire safety, health and safety, medication, protection of vulnerable adults and first aid, are offered regularly. Comments from three staff show that they feel they have opportunities for training that is relevant to their role. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 21 Two of the three permanent staff have achieved National Vocational Qualifications (NVQ). Two others from another of the small homes in the group provide regular shift cover once a week. These people are known from inspection at that home not to have NVQ qualifications. The manager says he believes that two of the regular agency staff have NVQ qualifications but has not seen certificates. A recommendation has been made. The recruitment file for the most recent appointment was checked. The current manager says he did not have responsibility for completing the process. However, the file does not show reasons for a gap in employment history. Additionally one concern expressed on a reference was not followed up either by telephone or at interview. A requirement has been made. There is evidence of checks with the Criminal Records Bureau before people start work. The manager confirms that there is a probation period and any concerns about staff performance would be addressed during this time. There are records showing staff complete a full induction programme, but the manager says that there have been difficulties in obtaining certificates of satisfactory completion from the providing organisation. A recommendation has been made. The team leader supervises support workers and the manager provides the team leader with supervision. The manager says he had training some years ago, but the team leader has not had any training in delivering supervision and a recent training date was cancelled. There is a separate record of dates when supervision took place, but these dates are not supported by supervision records. For example, one person had five dates in the record of appointments for supervision but only two sets of notes. The notes do not support that supervision provided matches the minimum standard for either frequency or content. This is perhaps a result of the lack of training in this area. A requirement has been made. Staff say that the management team is supportive and that they can raise issues. Staff meetings have not been held at regular intervals but one is due this month. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 22 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of service users and acts to promote their safety. The acting manager needs to complete the relevant training, but these matters are in hand. When these are completed outcomes in this area will be good. EVIDENCE: The manager has recently been recommended for registration as a fit person. However, he has yet to achieve NVQ level 4 or equivalent in both management and care. He confirms that he has been recommended for a place on training for this and has documentary evidence in the form of a letter from the training department to support this. He showed, in discussion, a good understanding of the needs of the service users together with policies and procedures underpinning practice. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 23 Quality is surveyed by the organisation as a whole, and the manager says that questionnaires for stakeholders have recently been sent out. The frequency of meetings with service users to discuss issues could be improved, as could evidence that their suggestions are acted upon. There is a robust system for monitoring service quality on behalf of the providers, which takes into account discussion with people both living and working at the home. These reports, compiled in accordance with regulation 26, are submitted to the commission regularly. Given the progress made and that questionnaires have now been sent out ready for analysis and report, the requirement made at the last inspection is considered met. We sampled a selection of health and safety related records. There is information about cleaning products in use and any hazard they may present. Most cleaning materials are stored in a cupboard under the sink that is fitted with a padlock. However, this was noted as unlocked and open towards the end of the visit. The staff member on duty promptly rectified the situation. There are regular checks on fire safety equipment. However, the fire risk assessment refers to electrical safety and prompts for attention to both fixed and portable systems. Information sent to us shows that the fixed wiring has not been checked. A requirement has been made. There are regular audits and checks of other issues, such as monitoring of the content of first aid boxes and staff have relevant training. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 24 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 3 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 YA9 Regulation 13.6 Requirement Where there are known risks to people, the recorded ways of dealing with these and so protecting people must be followed. This is so they are protected from avoidable accidents. Where people have medication prescribed for occasional use, there must be clear written guidance about the purpose of it, and the minimum time limit between doses, especially if the maximum amount has been given. This is so people are protected from errors or improper use. The manager must follow recruitment practices that result in obtaining information set out in regulations as amended. This is to show all possible care has been taken to recruit good staff who can help support people safely. Arrangements must be made, by training, monitoring or other measures, to see that staff have adequate supervision in line with National Minimum Standards. DS0000027586.V347949.R01.S.doc Timescale for action 31/08/07 2. YA20 13.2 31/08/07 3. YA34 19, Schedule 2 31/08/07 4. YA36 18.2 30/09/07 Tamarisk House Version 5.2 Page 26 5. YA42 13.4 This is so the manager and provider can be satisfied staff receive the support they need to develop and improve practice in meeting people’s needs. Measures must be taken to ensure the health and safety of service users is promoted in terms of servicing to detect faults and minimise the risk of fire. 30/08/07 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. Refer to Standard YA6 YA7 YA6 Good Practice Recommendations People using the service should be able to understand some of the information in their care plans and this should be presented in different forms to help them with it. All records, care plans and assessments that staff complete should be dated and signed so that it is possible to see who is accountable for having completed them accurately and when. Known risks with people’s behaviour or from their histories, need to be incorporated into risk assessments for other activities, for example going out shopping. This is so they and others are protected from risk so far as possible. There should be records to show which staff accompany people on outings or for other activities, so that there is a check that risk assessments for levels of support are followed and people’s safety is promoted in line with these. Arrangements should be made for formalising access to transport so people have more opportunities to go for longer trips into the community for outings. Staff should initial MAR charts only when PRN medication is given (as well as continuing their current practice of recording circumstances on the reverse of the chart). This will make it easier to read the information and so monitor use and accuracy of records. 3. YA9 4. YA13 5. 6. YA13 YA14 YA20 Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 27 7. YA32 8. YA35 The manager should satisfy himself that agency staff he is using have appropriate qualifications so he can show at least half of the staff group have reached this level. This is so he can be sure that there is a core of staff with the underpinning knowledge to meet people’s needs. The providers should arrange to issue certificates of completion of satisfactory induction promptly. This is so they can clearly show the appropriate standard has been reached and they consider staff to have understood and be able to apply the skills they need to provide good support to people. Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Tamarisk House DS0000027586.V347949.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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