Inspection on 13/09/06 for The Nak Centre

This inspection was carried out on 13th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Nak Centre 25/09/07

The Nak Centre 14/03/07

The Nak Centre 26/01/06

The Nak Centre 28/07/05

The Nak Centre 24/02/05

The Nak Centre 07/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Nak Centre Sundial House Coosebean Truro Cornwall TR4 9EA Lead Inspector Lowenna Harty Unannounced Inspection 13th September 2006 09:30 The Nak Centre DS0000009157.V309752.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 The Nak Centre DS0000009157.V309752.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. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Nak Centre Address Sundial House Coosebean Truro Cornwall TR4 9EA 01872 241878 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) Mrs Anne Elizabeth Barrows Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: The Nak is a home providing accommodation and personal care for up to six adults with learning disabilities. It is owned and managed by the registered provider, who is in active daily charge of the home. A small team of care staff and a cook assist her. Residents live in a large, detached property with extensive grounds, in a semirural situation. The house is located on the outskirts of Truro, the centre of which is a few minutes drive away. The house has two floors, the upper floor being reached via stairs. There is one bedroom on the ground floor with en suite facilities and four on the upper floor. One of the bedrooms is currently a shared room. There is an additional bedroom for staff to sleep in at night. There are two bathrooms on the first floor. There are two lounges on the ground floor, with a very large entrance hall with additional seating. The home has a spacious kitchen, separate laundry facilities and an office on the ground floor. Fees range from £619.00-£634.00 per week, according to information supplied at the inspection. The registered provider said that additional, variable charges are made to service users for their personal toiletries and they are charged £10.00 per week to attend specific activities in the local Community. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place on 13 September 2006 and lasted for approximately eight hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the service users living there. The inspection included interviews with two service users and telephone contact with relatives and social workers representing them. A member of staff was interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered provider, who also manages the home. Four service users were case tracked. This involved a more in-depth review of how the home meets their needs, with particular reference to their individual and diverse needs relating to their age, culture and ethnicity, religion, gender, sexual orientation and disabilities. Whilst the quality of outcomes for service users is adequate in some areas, there are areas that need to be improved upon, which were identified at this inspection. What the service does well: The service users are familiar with what the home sets out to provide as they have lived there for many years. Three have lived with the registered provider since 1977 and the most recent admission was in 1997. There is plenty of background information held in the home so that the registered provider and staff are familiar with how their needs have changed over time. Service users have individual written care plans that set out how their personal, health and social care needs will be met. Two of the service users who were interviewed at the time of the inspection said that they are aware of them and attend reviews. Service users are able to make some decisions about things that are important to them, depending on their levels of disability and staff assist them to make appropriate choices for example, about what to wear each day and how to spend their own money. Service users are assisted to participate in a range of activities in and out of the home, including attendance at art workshops, a working farm, shopping The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 6 trips and horse riding. There is evidence of their artwork throughout the home and celebration of their individual achievements with certificates framed on the walls in the hallway. They have a large video library and access to puzzles and games in the main lounge. They are able to maintain contact with their families, and are supported to maintain positive relationships with each other so that they enjoy a good quality of life in the home. Meals are home prepared using fresh, locally sourced ingredients so that service users enjoy a healthy diet and stay well. They are able to make drinks and snacks for each other, depending on their individual skills and abilities, with staff assistance. Staff were observed assisting service users attend to their personal care needs with respect and due regard for their rights to privacy and dignity. There are sufficient bathrooms in the home and service users look smart and appropriately dressed when they go out into the local community. Service users’ general healthcare needs are considered as part of the care planning process and they are assisted to access a range of local NHS healthcare services for routine checks when they need them so that they maintain good physical health. The home has a written complaints procedure and service users and their relatives who were interviewed said that they are satisfied with the care and services the home provides. Service users said that they are well treated and staff are kind to them. The home’s environment is homely and comfortable so that service users benefit from living in a non-institutionalised, “family home” setting. It is well furnished and tastefully decorated throughout and kept clean and tidy so that service users are adequately protected from illnesses caused by poor hygiene. Care staff working with service users are provided with formal induction and good ongoing access to training so that they can have some confidence in the staff team. What has improved since the last inspection? Service users’ care plans have been reviewed since the previous inspection, so information has been updated. Staff have some written guidance on the steps they should take to protect service users from abuse but further improvement is needed. The registered provider said that she has obtained two places on a local training course on the protection of vulnerable adults from abuse, neglect and self-harm so that she can update her knowledge and skills. The registered provider pointed out improvements she has made to the home’s environment since the previous inspection, including painting and varnishing of The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 7 the house and bedroom carpets for two service users, which they helped to choose. The registered provider has now completed training to achieve a formal qualification in management so that service users can be more confident of her skills and competence to run the home well. What they could do better: Service users do not have enough information about the terms and conditions or costs of their placements in the home so they lack awareness of their rights and obligations as residents of the care home. Some are not consulted or involved in the care planning process and there is a lack of consultation with external professionals or trained advocates who could oversee their best interests. The registered provider said that reviews only take place once a year rather than in response to service users’ changing needs. Care plans consider service users’ specialist and diverse needs, including faith and cultural needs but lack detail and do not set out how they will be met. Daily care records show instances of when service users may have been deprived of important choices and subjected to inappropriate sanctions, not set out or agreed in their care plans, in order to address specific behavioural difficulties. Improvements are needed to ensure that they are fully protected with regard to their dignity, treatment and welfare. Written risk assessments are cursory and do not fully consider specific risks involved in activities that service users take part in, such as horse riding or their rights, especially regarding sanctions used to control their behaviour. They are not reviewed frequently enough so there is no apparent ongoing consideration of how risks change over time. Specialist advice and input should be sought with regard to managing service users’ challenging behaviour appropriately and effectively and in accordance with best care practices. The registered provider said that she has sought advice from a clinical psychologist in the past, but not recently or in relation to service users’ current situations. There has been no recent formal consultation with service users and/or their relatives or external representatives with regard to the quality of the services the home provides and this is important, particularly for some service users whose relatives have not seen them recently so that their views are actively taken into account in the ongoing development and improvement of the service. Formal systems to protect service users from abuse need to be strengthened, with particular regard to providing staff with improved written guidance and ensuring that they are properly checked so that service users can have The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 8 confidence that they are suitable to work with vulnerable adults in a care setting. The registered provider said that she had been short of a full-time staff member since May, which has severely impacted on her ability to effectively manage the home, as the pre-existing team was small. There are currently only three staff members to care for six service users and the registered provider is having to undertake shifts to cover for the vacant post. None of the care staff have completed training to achieve formal qualifications in care to the standards required and there is a lack of evidence that they are fairly or safely recruited on the basis of their suitability to work with vulnerable adults in a care setting. The registered provider said that she has lacked time to make improvements necessary for the welfare and protection of service users that she was notified of at the previous inspection, because of staffing shortages. Further improvements have been identified in this report as necessary to ensure that the home is well run in the future, for the benefit of the service users living there. 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 Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. Service users have some written information about the home and are familiar with what it provides, but lack information on the fees and their terms and conditions. There is assessment information relating to service users so that their changing needs can be monitored over time. EVIDENCE: The registered provider said that there had been no changes in the service user group and none are currently planned, which was confirmed through observation of the service users living in the home. Records indicate that all of the service users have been placed in the home for some time. The most recent admission was in 1997 and three service users have lived with the registered provider since 1977. Thus all of the service users are aware of what the home provides through their ongoing experience of living there. There is a copy of the home’s statement of purpose available, but in type written format only. Copies of service users’ individual contracts were not available for inspection and the registered provider said she has not updated them to include information on the fees and terms and conditions. Records of service users’ initial assessments are held on their personal files, so they can be referred to, when reviewing their current needs. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. Service users have written care plans but they are not always person centred or reviewed regularly. There is some consideration of service users’ diverse needs, but this should be improved so that their faith needs are met appropriately. Service users are helped to make some decisions about aspects of their lives that are important to them, but there are examples of their being denied choice. Risk assessments are poorly developed, do not link with care plans and fail to address specific activities, such as horse riding and management of challenging behaviour in the community. Personal information relating to service users is not properly or securely stored so as to protect their confidentiality. EVIDENCE: Copies of service users’ care plans are held on their personal files. Two of the service users who were interviewed said that they are aware of them and attend their reviews. Reviews have been held recently, but the registered provider said that there are only resources for this to happen once a year. Relatives of one service user said that they are informed of care plan reviews but others said they were not involved in this. Care plans are provided in hand or type written formats only and there is little evidence of service user involvement in the process in most cases and limited recognition of the The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 12 specialist care needs of some. Whilst there is service users’ faith needs are acknowledged, there is a lack of consideration of how they will be met. Service users are provided with some choices, depending on their levels of disability and the staff member who was interviewed cited examples of their being able to choose what clothes to wear and how to spend their personal finances. Daily care records for two service users, however, provided examples of how they may have been inappropriately deprived of important choices. There is little evidence of service user involvement in the care planning process in every case or input by external professionals or advocates where they lack capacity to contribute to the decision making process. There are written risk assessments on service users’ individual files, but these are not well developed, do not clearly link with their care plans and do not address obvious risks attached to activities they engage in, such as horse riding, which happened on the day of the inspection or management of challenging behaviour in the community, for example. Information held about service users was found stored in one of the home’s lounges and not securely locked away in the lockable filing cabinets in the office, so service users could not be confident that highly personal information about them would be kept confidential and safe. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. Service users are assisted to access a range of activities in and out of the home, individually and together so that they enjoy a good quality of life and are not isolated in the home. Some maintain relationships with their families and friendships with other service users in the home. Improvements are needed so that service users’ rights are respected. They are provided with home-cooked, healthy meals so that they enjoy their food and stay well. EVIDENCE: Service users’ care plans and daily care records indicate that they take part in a range of activities in the home and in the local community, in accordance with their individual needs and preferences, so that they develop their skills and independence and enjoy a good quality of life. This was observed during the inspection and confirmed during interviews with service users and staff members. At the time of the inspection, service users accessed the local community, firstly in the morning, to go horse riding at a local centre and then in the afternoon, when they went on a local walk together. Daily care records indicate The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 14 that they access resources in the local community regularly with staff assistance and two of the service users who were interviewed confirmed this. Relatives of one service user said that they maintain close contact and the service user regularly visits them at home. Others said that they maintain contact with the home by telephone or letter. Service users have close friendships with each other, according to the registered provider and staff, as they have lived together, almost as a family for many years. There are written policies and procedures to guide staff with regard to supporting service users’ needs around sexuality and relationships. Service users do not have clear written contracts that set out their rights as residents of the home and risk assessments do not consider their rights with regard to the application of what appear to be sanctions with regard to management of challenging behaviours, as recorded in daily care records on at least two recent occasions. Service users ‘ care plans consider their dietary needs and they are provided with healthy, home-prepared meals according to the home’s menu. The registered provider said that she sources fresh local ingredients for the home’s cook to prepare. Some service users can access the kitchen independently, depending on their individual abilities and this was observed during the inspection. Service users who were interviewed said that they enjoy their meals and the food set out for the day was attractively presented and appetising. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. Service users are supported with their personal care needs so that they appear to be well cared for, smart and appropriately dressed. There is consideration of their healthcare needs but further input with regard to specialist needs and appropriate behavioural management is needed. Improvements are needed to ensure that service users are better protected from medication errors. EVIDENCE: The home has sufficient toilets and bathrooms, including facilities, which they may use in private, so that they can attend to their personal care needs, with staff support and assistance if necessary. Their care plans consider their needs and abilities with regard to personal care issues such as dressing and maintaining their personal hygiene. Service users appeared smartly and appropriately dressed at the time of the inspection and staff were observed assisting those that required help, appropriately and respectfully. Service users’ care plans consider their healthcare needs and there are records of their attendance for regular, routine healthcare checks at local NHS resources. Specialist input with regard to developing appropriate responses to challenging behaviour exhibited by service users is needed, on the basis of recent entries in some daily care records. The registered manager said that she currently makes use of techniques advised by a clinical psychologist, but The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 16 this was several years ago and not in the context of service users’ current situations. There is appropriate storage of medicines and staff have written procedures to guide them. Some medicines are not given in accordance with instructions on a service users’ medication chart, which should be updated according to what the service user actually needs. There is no list of approved homely remedies or records of their administration, despite the fact that some non-medically prescribed preparations are given to service users. The senior staff member trains staff internally, but she does not have formal training in the safe handling of medicines. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. The home has a standard written complaints procedure, but little is done to formally seek the views of service users or their representatives on the quality of the services the home provides, particularly with regard to service users who do not have relatives or trained advocates actively involved in their welfare. Systems to protect service users need to be improved so that they are protected from institutional abuse. EVIDENCE: Service users said that they are satisfied with the care and services provided to them and relatives who were interviewed confirmed this, but some said they have little involvement in the home, apart from by telephone or letter. One said they had never actually visited the home. The registered provider said that there had not been any recent formal consultation with service users and/or their representatives about the quality of the services the home provides and that no formal complaints have been made since the previous inspection. There are written procedures to guide staff on what they should do if they suspect abuse of a service user, but these are internal only. The staff member who was interviewed confirmed that she has not seen the relevant multiagency procedures, which set out how different agencies should work together to protect vulnerable adults from abuse, neglect and self-harm. The registered provider said that she is booked to attend local multi-agency training in October of this year. Some daily care records contain entries suggestive of inappropriate techniques used to manage challenging behaviours of service users although service users who were interviewed said that they are well cared for and staff are kind to them. There is a lack of evidence that staff are properly checked so that service users can be confident that they are suitable to work with vulnerable adults in a care setting. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. The home provides service users with a comfortable, homely and safe place to live in so that they benefit from a noninstitutionalised environment. It is kept clean and hygienic so that they are protected from cross-infection EVIDENCE: Visual inspection of the home provided evidence that it is well maintained, spacious, attractively decorated, well furnished and homely. Service users who were interviewed said that they are satisfied with their private accommodation and service users looked comfortable and settled in the communal areas. The registered provider pointed out improvements she has made to the home’s environment, since the previous inspection and further improvements that are planned. The inspection was unannounced and the home appeared clean and tidy throughout, with adequate facilities and guidance for staff to maintain good hygiene without compromising on the family-style domestic setting of the home. This includes separate laundry facilities and suitable facilities for effective hand washing, for example. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is poor. There are only three care staff currently employed to work in the home and none of them is formally qualified so service users cannot be assured of the competency of the people working with them. There is currently one full-time vacancy and the registered manager is covering this, so there is a lack of time to undertake essential management tasks. The home’s recruitment policies are not demonstrably followed so service users cannot be sure that staff are recruited using fair, safe and effective practices and are suitable to work in a care setting. Staff have access to ongoing training so that they can work safely in the home. EVIDENCE: There was a lack of evidence that any of the staff working in the home has completed training to NVQ level 2 or above. The registered provider said that none of the care staff had achieved qualifications to this level although one has recently completed her induction training and will be working towards achieving it. The registered provider said that there is currently a full-time vacancy and the post has been open since May of this year. There are now only three care staff, so she and the senior carer have to cover, which is having a negative impact on the management of the home. The staff member who was interviewed said that she felt that there is sufficient staff cover to ensure that service users’ daily care needs are met and they are able to engage in their individual and group activities as usual. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 20 The home has written procedures that state that staff are recruited on the basis of equal opportunities but there is a lack of evidence to support this. The registered provider said that she does not keep interview records so she cannot effectively demonstrate that staff recruitment is fair and effective and records of essential checks to demonstrate that recruitment is safe were not available. The staff member who was interviewed said that she has completed formal induction training and has undertaken training in fire safety, first aid, basic food hygiene, infection control and health and safety. She said that she has good access to ongoing training for the benefit of service users. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. The registered provider is qualified and experienced in running the home but currently lacks time to do so effectively because of staffing shortages. There has been a lack of formal consultation with service users and their representatives with regard to the quality of the services the home provides. There are systems in place to protect the health, safety and welfare of service users, but their individual risk assessments need to be improved, reviewed and updated so that service users are kept safe from avoidable harm. EVIDENCE: The registered provider said that she has now completed training towards achieving NVQ 4 in management but that with staff shortages, she currently lacks time to effectively manage the home. This was evident with regard to the lack of action to achieve compliance with requirements that had previously been set, for the improvement of the home and protection of service users, including formal consultation with them and/or their representatives about the quality of the service the home provides. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 22 There are records of fire safety equipment tests and checks and staff training in fire safety. There are written procedures to guide staff on how to ensure that service users are kept safe in the home and the staff member who was interviewed said that she feels safe working there. Written risk assessments relating to individual service users, however, need to be improved, regularly reviewed and updated, with particular regard to there being only one member of staff on duty at night, service users’ engagement in specific activities outside of the home. Risk assessments relating to fire safety at night and nighttime supervision are dated 2002 and 2004 respectively, for example. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 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 2 33 1 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 1 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 X 1 X X 2 X The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 YA16 Regulation 5(1)(b) Requirement Timescale for action 30/11/06 2. YA7 YA16 YA19 12(4)(a), 13(6) 3. YA23 YA10 The homes service users guide must include a clearer statement of the terms and conditions in respect of accommodation to be provided for service users, including information on the range of fees and method of payment so that service users have clear information on what is expected of them. The timescale for action to achieve compliance with this requirement has been extended from 31/05/06. Systems to protect service users 30/11/06 from inappropriate sanctions must be strengthened so that their behavioural needs are addressed in accordance with best care practices and their individual care plans. Personal information relating to service users must be stored safely and securely so that their confidentiality is maintained. 30/11/06 12(1)(a) 12(4) The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 25 4. YA20 13(2) 5. YA23 YA34 17 & 19 6. YA33 YA37 18(1)(a) The registered provider must 30/11/06 ensure that systems for recording of medicines and training for staff administering them are safe so as to protect service users from medication errors. The registered provider must 30/11/06 obtain and retain evidence of records required by regulation in respect of staff and any volunteers employed in the home so that service users can be confident that people working with them have been fairly recruited, are fit and suitable to work in a care setting. The timescale for action to achieve compliance with this requirement has been extended from 31/05/06. The registered provider must 30/11/06 employ sufficient staff at all times to ensure that service users needs are met and that they benefit from a wellmanaged service. 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 YA6 Good Practice Recommendations Service users’ care plans should be reviewed at least every six months so that their individual and changing needs are fully accounted for. The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 26 2. YA6 YA16 3. YA9 YA16 YA42 4. YA19 YA23 5. YA22 YA39 Care planning should include full consideration of how service users’ faith and other specialist/diverse needs will be met. They should be provided in formats that enable service users to participate as fully as possible. Where they lack capacity there should be input by external representatives and/or independent, professional advocates so that service users benefit from a more person centred approach. Service users’ individual care plans should include assessments and management of risk, with particular regard for restrictions on them, and consideration of risks attached to specific activities such as horse riding and accessing the local community. Risk assessments should reflect respect for service users’ rights and concern to protect them from harm and injury. They should be regularly reviewed and updated so that service users’ changing needs are accounted for. Service users with behavioural difficulties should be referred to specialists for advice on how to manage them, so that their rights are respected and appropriate techniques are used to assist them. Service users’ and/ or their representatives’ views should be formally sought to contribute to the home’s annual development plan. Copies of the most recent multi-agency procedures for the protection of vulnerable adults from abuse should be obtained for the home from the local authority and service users’ placing authorities, where they are placed from outside of the local area, so that staff have clear guidance on the steps they need to take to protect service users from abuse. At least 50 of the staff team should be qualified to NVQ level 2 or above so that service users can have confidence in the competence of their ability to work with them effectively. 6. YA23 7. YA32 The Nak Centre DS0000009157.V309752.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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