Inspection on 14/03/07 for The Nak Centre

This inspection was carried out on 14th March 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 6 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 13/09/06

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 Lynda Kirtland Key Unannounced Inspection 14th March 2007 09:15 The Nak Centre DS0000009157.V331278.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.V331278.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.V331278.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.V331278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 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 £618.00-£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.V331278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission met with the Registered Provider on the 14 March 2007. A previous unannounced visit to the home on the 21 February 2007 occurred when the commission met with service users and staff. Overall the key inspection lasted for approximately seven 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 meeting with service users and opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Staff were interviewed, as was the Registered provider. 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. One service user was 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. The inspector would like to thank Service users, staff and the registered provider for their time and assistance during this inspection process. What the service does well: Service users are familiar with what the home sets out to provide as they have lived there for many years, the most recent admission was in 1997. There is 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. They are encouraged to maintain contact with their families, and family members are invited to attend their annual care planning review. 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 trips and horse riding. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 6 Meals are home prepared using fresh, locally sourced ingredients so that service users enjoy a healthy diet and stay well. Service users were observed to enjoy breakfasts on both visits to the home, with choices given. Staff were observed assisting service users attend to their personal care needs with respect and due regard for their rights to privacy and dignity. 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. Service users did not express any concerns regarding the care and services the home provides. The Commission saw letters from relatives complimenting the care and skills that staff provide to Service users. 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? At the previous inspection requirements and recommendations were identified for the registered provider to address. She has made efforts to ensure that these are complied with and therefore there has been an overall improvement in the service. The registered provider showed the Commission that she has amended the Service users Guide which now includes a clear statement of terms and conditions of what The Nak will provide for service users. This was handwritten as the registered provider wished to discuss the amendments before finalising the document. Some advise was given to amend the document further and the registered provider stated this would be completed within the timescale set. The registered provider has consulted with health professionals to review certain service users care needs in particular the management of behaviour. Consultations with relevant professionals have been arranged to ensure that any sanctions in respect of behavioural management are in line with up to date practice and are for the service users best interest. Personal information relating to service users is now stored confidentiality as the registered provider has purchased a lockable filing cabinet. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 7 The registered provider has arranged with Boots Pharmacist for medication training to be undertaken after Easter. In addition training in the administration of rectal diazepam has also been arranged. As this has not yet occurred the requirement will remain in place. New staff have been appointed and induction training was in place during the inspection. Staff are commencing NVQ training in the near future. In respect of the recommendations identified at the previous inspection the registered provider has ensured that service users care plans are reviewed six monthly. One is held ‘in house’ and the second is the ‘annual review’ to which service users and their representatives are invited to attend. A service user confirmed to the Commission that he and his family were attending his review. The registered provider has undertaken a Quality assurance survey and will send a copy of her findings to the Commission. What they could do better: The registered provider will complete the service users guide with amendments as discussed at the inspection to be incorporated. Care plans have been amended further and take into consideration individual’s faith and other specialist/ diverse needs and how these will be met. The care plans need to inform, direct and guide staff in their interventions with service users so that consistent care can be provided. Some written risk assessments in respect of activities have been undertaken but these could be improved further. This was discussed with the registered provider, as the risk assessments need to also cross reference with the service users care plan. The registered provider is considering the presentation of these documents so that service users will be able to access them more easily. The registered provider has attempted to attend and gain staff places on the Multi Agency Adult Protection training. This remains in progress. The registered provider is reviewing the Nak’s protection procedures plus agreed to gain a copy of the Multi Agency Adult Protection Procedures for the home so that staff were aware of what action to take if there was a suspicion of abuse in the home. The registered provider has recently recruited staff and is aiming for at least 50 of her staff team to achieve a NVQ qualification. Training in respect of medication is in progress. The registered provider is in the process of recruiting staff, they no longer have volunteers at the home. From inspection of staffing records this demonstrated that staff had commenced working at the home before relevant POVA and CRB clearance had been approved. Staff must have the minimum of POVA clearance before they can commence work at the home. Whilst the The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 8 registered provider was ensuring the staff members were being ‘shadowed’ this is difficult to achieve in such a small staff group at all times. Training in respect of medication is in hand. 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. The Nak Centre DS0000009157.V331278.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.V331278.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have some written information about the home and are familiar with what it provides, this is being amended currently to ensure that it reflects accurately the services the home provides. There is assessment information relating to service users so that their changing needs can be monitored over time. EVIDENCE: Records indicate that all of the service users have been placed in the home for some time. The most recent admission was in 1997 thus all of the service users are aware of what the home provides through their ongoing experience of living there. The registered provider is in the process of updating the service users guide and this was discussed during the inspection. The relevant amendments will be made by the 1/4/07. The registered provider is considering the presentation of these documents so that they are in a format that service users can access more easily. There is a copy of the home’s statement of purpose available, but in type written format only. 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.V331278.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have written care plans which are currently being developed. They are reviewed at six monthly intervals with Service users and their representatives. There is some consideration of service users’ diverse needs. Service users are helped to make some decisions about aspects of their lives that are important to them. Risk assessments need to link with care plans. Personal information relating to service users is securely stored to protect their confidentiality. EVIDENCE: Copies of service users’ care plans are held on their personal files. The care plans are currently being reviewed by the registered provider to ensure that all care needs including specialist needs are now included in them. The care plans need to inform, direct and guide staff in their interventions with service users, to ensure a consistent approach in managing service users care needs. A service user confirmed that his annual review had been arranged, to which he and family members had been invited to attend. Care plans are provided in hand or type written formats only. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 12 Service users are provided with some choices, depending on their levels of disability and staff and a service user cited examples of their being able to choose what clothes to wear and how to spend their personal finances. 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 or management of challenging behaviour in the community, for example. Information held about service users is stored in a new lockable filing cabinet and therefore kept confidential and safe. The Nak Centre DS0000009157.V331278.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 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 discussions with service users and staff members. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 14 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. A Service user confirmed that they maintain close contact with their relatives via telephone, letter contact or by visiting them during the holidays. This was also cross-referenced in daily records and in their care plans. 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. The registered provider has undertaken some risk assessments for service users, these need to be developed further as they are generalised and need to be separated onto the relevant individuals file to promote confidentiality. This was discussed with the registered provider in particular regarding managing challenging behaviour and how this needs to be assessed in further detail following consultants with relevant health professionals. 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 where observed to be given chooses at breakfast time and the mealtime appeared to be an unrushed and social occasion. The Nak Centre DS0000009157.V331278.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 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 and referral to health professionals regarding specialist needs and appropriate behavioural management is occurring. Training in the administration, storage and disposal of medication for all staff has been arranged. 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. Since the previous inspection the registered provider has contacted relevant health professionals to ensure that specialist input is provided via psychologists in the management of challenging behaviour. The advice they The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 16 receive must then be incorporated into the individuals care plans and risk assessment. There is appropriate storage of medicines and staffs have written procedures to guide them. Documentation demonstrated that medication is administered appropriately. Medication was disposed of appropriately. There are no controlled drugs on the premises. The registered provider has arranged for medication training for all staff after Easter. In addition all staff will attend a refresher course on the administration of rectal diazepam. The Nak Centre DS0000009157.V331278.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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a standard written complaints procedure, and views are now being sought form Service users and their representatives on the quality of the services the home provide. Training in the area of adult protection must occur so that staff are aware of and recognise signs and symptoms of abuse including institutional abuse and what action to take if they suspect abuse is present. EVIDENCE: Service users said that they are satisfied with the care and services provided to them and relative’s letters confirmed this. The registered provider has recently undertaken a quality assurance survey plus gains views from Service users and their representatives at the individuals annual review in respect of the services the home provides. 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 registered provider confirmed that she does not have a copy of the relevant multi-agency procedures, which set out how different agencies should work together to protect vulnerable adults from abuse, neglect and self-harm. The registered provider agreed to gain this and said that she has attempted to attend local multi-agency training. 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.V331278.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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides service users with a comfortable, homely and safe place to live in so that they benefit from a non-institutionalised 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. On both visits, one of which was unannounced 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.V331278.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered provider is in the process if recruiting new staff. All relevant checks must be made before a person commences employment, as it was evident that POVA and CRB checks had not been checked prior to commencing work at the home. It has been arranged for staff to attend formal training. The registered provider has covered staff vacancies so there has been 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. EVIDENCE: The registered provider confirmed by staff, stated that all staff would be achieving the NVQ. Currently one recently recruited staff member has a NVQ level 2; two other staff members will be commencing this. A prospective staff member who has not yet commenced work at the home has also gained the NVQ level 2. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 20 Since the last inspection the registered provider has attempted to increase the staff team. The registered provider, deputy manager, and three care staff are currently employed with a fourth care staff member joining them in the near future. When this occurs the staff team will have increased by one care staff member. Due to this the registered provider and deputy manager have to cover, which is having a negative impact on the management of the home At all times in the home there is a minimum of two staff members on duty and one sleeping in member of staff. 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. In checking staff records it was evident that staff have commenced work before their POVA and CRB checks have been approved. The registered provider stated that staff are not left on their own to work with Service users until this is clear. However it is difficult to achieve this as only 2 staff members are in the home at any one time and to completely shadow the care member of staff at all times is difficult. References had been sought. Staff records showed completed formal induction training and undertaken training in fire safety, first aid, basic food hygiene, infection control and health and safety. The Nak Centre DS0000009157.V331278.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider is qualified and experienced in running the home but currently lacks time to do so effectively because of staffing shortages. Formal consultation with service users and their representatives with regard to the quality of the services the home provides has improved. 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 has completed training towards achieving NVQ 4 in management. It is acknowledged that despite staff shortages and the amount of cover she has provided, that she has worked hard to achieve compliance in many of the statutory requirements set at the previous inspection. The registered provider is working towards achieving compliance in the remaining requirements. The Nak Centre DS0000009157.V331278.R01.S.doc Version 5.2 Page 22 The registered provider has undertaken a Quality assurance survey, which included gaining the views form Service users, their representatives, visitors and ex staff members. Comments received were positive regarding the quality of service provide. The registered provider agreed to collate the findings of the survey and to send an action plan to the commission. 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. The Nak Centre DS0000009157.V331278.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 2 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X The Nak Centre DS0000009157.V331278.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 Regulation 5(1)(b) Requirement 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 from inappropriate sanctions must be strengthened so that their behavioural needs are addressed in accordance with best care practices and their individual care plans. The registered provider must ensure that training for staff in the administration, storage and disposal of medication occurs to protect service DS0000009157.V331278.R01.S.doc Timescale for action 01/04/07 2 YA7 12(4)(a), 13(6) 01/05/07 3 YA20 13(2) 01/05/07 The Nak Centre Version 5.2 Page 25 users from medication errors. 4 YA23 17 & 19 The registered provider must 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. Staff must not commence work at the home until POVA checks have been completed. The registered provider must employ sufficient staff at all times to ensure that service users needs are met and that they benefit from a wellmanaged service. 01/05/07 5 YA34 17, 19 01/05/07 6 YA37 18(1)(a) 01/05/07 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 YA16 Good Practice Recommendations Care plans should be developed further to inform, direct and guide staff in their interventions with Service users to ensure a consistency of care practice. 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 DS0000009157.V331278.R01.S.doc Version 5.2 Page 26 The Nak Centre 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. 3 YA23 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. 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 and management of behaviours. 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. The registered provider should forward to the commission following the quality assurance survey, the home’s annual development plan. 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. 4. YA42 5. YA39 6. YA32 The Nak Centre DS0000009157.V331278.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: 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. 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