Inspection on 25/09/07 for The Nak Centre

This inspection was carried out on 25th September 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Nak Centre 14/03/07

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 Unannounced Inspection 25th September 2007 9:15am The Nak Centre DS0000009157.V350920.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.V350920.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.V350920.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 Position Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 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-£694.27 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.V350920.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the home occurred on the 25 September 2007 when the commission met with service users and the registered provider. As the registered provider was the only staff member on duty it was agreed that the inspection would take place on another day, this was arranged for the 18 October 2007. Overall the key inspection lasted for approximately eight and a half 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. 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. The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 6 Service users are able to make some decisions about things that are important to them, depending on their levels of ability 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. 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 provides 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. The registered provider has undertaken a Quality assurance survey and will send a copy of her findings to the Commission. 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 has amended the Service users Guide that now includes a clear statement of terms and conditions of what The Nak will provide for service users. 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 now inform, direct and guide staff in their interventions with service users so that consistent care can be provided. These are currently in written format and the registered provider stated they are shared with the individual. The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 7 They are reviewed every six month, which representative and relevant professionals attend. the service user, their Individual risk assessments in respect of activities have been implemented. The format was discussed and with a slight amendment to it, which the registered provider agreed to do, these will be satisfactory. The risk assessments have incorporated professional advise in the management of behaviours/ risks and are cross-referenced with the service users care plan. The registered provider is considering the presentation of all of these documents so that service users will be able to access them more easily. 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 relevant checks required by legislation are completed before a person commences work at the home. The deputy manager and carer have enrolled on NVQ level 2 training. What they could do better: 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 adult protection procedures. A copy of the Multi Agency Adult Protection Procedures for the home has been obtained so that staff are aware of what action to take if there was a suspicion of abuse in the home. The Nak has a satisfactory policy in respect of the storage, administration and disposal of medications. They use the Monitored Dose System (MDS) and paperwork in relation to the administration of this was accurate. The Commission advised that a record of what medication and when was received should be recorded on the MAR sheets. In addition when using PRN or ‘loose’ medications that there is a clear audit trail of these medicines, as currently this is not possible to do. Advise was given how to rectify this, which the registered provider agreed to action. The registered provider continues to attempt to arrange with Boots Pharmacist medication training plus training in the administration of rectal diazepam. As this has not yet occurred the requirement will remain in place. The registered provider employs a cook and maintenance person. The registered provider is in the process of recruiting care staff. The level of staffing at the home is insufficient as currently the registered provider and deputy plus one carer are employed to cover care work. This means that one person at times staffs the home, the registered provider stated that ideally she would like to employ two members of staff on shift plus one sleeping in member of staff. At times two members of staff on duty have not been The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 8 achievable despite attempting to recruit to these posts plus using agency staff. This remains a concern to the registered provider and the Commission. It is acknowledged that due to the commitment of the registered provider and deputy manager that they have managed to keep the service going without adverse effects to the service users. However it remains a concern as to how long this level of commitment can continue. Due to the staffing levels this has meant that relevant refresher training in the areas of medication, first aid and other courses such as adult protection have not been able to occur as staffing of the home has needed to be the priority. The registered provider hopes that when staffing levels increase this will allow time for training. The cook has agreed to contact the Infection Control department to ensure that the Nak is adhering to current guidelines and legislation in this area. It is recommended that paper towels are purchased for the kitchen and staff areas to promote infection control, plus it is recommended that the carpet in the bathroom be replaced with washable flooring to again prevent cross infections: the registered provider said she is planning to do this. Fly screens should be purchased in the kitchen areas. The registered provider is aware that the homes policies and procedures need to be reviewed and amended. This then needs to be cross-referenced to the staff handbook as this is used for induction of new staff. 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.V350920.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.V350920.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 good. 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 has been updated and 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 has updated the service users guide and it now reflects the services that the home provides. 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.V350920.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 good. This judgement has been made using available evidence including a visit to this service. Service users personal care plans have been developed further and now cover the Service users physical, social, emotional and diverse care needs in greater detail. They are reviewed twice a year: annually with Service users and their representatives and internally. Service users are helped to make some decisions about aspects of their lives that are important to them. Risk assessments now 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 have been expanded since the previous inspection and now cover all physical, emotional and social care needs and take into account the persons diverse needs. Specialist needs are now included in the care plans The care plans now inform, direct and guide staff in their interventions with service users, to ensure a consistent approach in managing service users care needs. Minutes of a service users annual review were inspected and demonstrated that the Service users and their family plus other relevant professionals The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 12 involved in the care of the individual participated in this meeting. Care plans are provided in hand written formats only. Service users are provided with some choices, depending on their levels of ability and staff and a service user cited examples of being able to choose what clothes to wear and how to spend their personal finances. This is also reflected in the individuals care plan as it cites the individuals’ abilities and promotes their level of choice. The risk assessments have been developed further and clearly link with their care plans. These were discussed further and the registered provider agreed to make a minor amendment to them to ensure that all staff knew what action to take if there was a risk to an activity they engage in / or management of challenging behaviour in the community, for example. Information held about service users is stored securely and therefore kept confidential and safe. The Nak Centre DS0000009157.V350920.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 good. 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. Service users rights were respected during the inspection. Individual risk assessments guide staff as to what activity is a risk and what action to take, the format needs a minor alteration. 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.V350920.R01.S.doc Version 5.2 Page 14 At the time of the unannounced inspection, service users accessed the local community. On the second visit to the home service users were observed to go for a walk, shopping, and involved in craft activities in the lounge with staff. The registered provider is aware that some of the activities that service users are involved in can be viewed as ‘age inappropriate’ but from observations it was evident that service users were choosing and enjoying participating in these activities. 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 developed the risk assessment process for service users, they are now more specific to the activity and highlight what risks are attached to the individual participating in it. The registered provider agreed to rearrange the format slightly so that the risks highlighted and the action she would like staff to take is easier to follow. These risk assessments are now tailored to the individual. Service users care plans consider their dietary needs and they are provided with healthy, home-prepared meals according to the home’s menu. The cook said that she sources fresh local ingredients. The cook prepares all main meals and prepares items for tea from Monday to Friday. At weekends care staff prepare the meals. 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.V350920.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. There is a system to ensure that medication is stored and administered safely. Further improvements to ensure that loose mediations are accounted for need to be implemented. Training in the administration, storage and disposal of medication for all staff is being 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 The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 16 resources. 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 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. The Nak uses the Monitored Dose System (MDS) to receive, administer and dispose of medication. Documentation demonstrated that medication is administered and disposed of appropriately. There are no controlled drugs on the premises. When medication is received by the home this should be recorded on the MAR sheets. The Nak has minimal loose medications, however it was difficult to undertake an audit of them as the MAR sheets did not record the number of tablets it had received and therefore a tablet count of tablets, which were not in blister packs, was difficult to do. Advice was given in this respect that the registered provider agreed to act on immediately. Therefore a recommendation to this effect has been identified. The registered provider has been attempting to arrange medication training with Boots pharmacy that remains in hand. In addition all staff will attend a refresher course on the administration of rectal diazepam. The Nak Centre DS0000009157.V350920.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 sought form Service users and their representatives on the quality of the services the home provide. Training in the area of adult protection has occurred 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. The adult protection policy needs to be expanded further and in line with the local multi agency adult protection guidelines so that staff are aware of how to respond to allegations/ suspicions of abuse. EVIDENCE: Service users said plus observations evidenced that they are satisfied with the care and services provided to them and relative’s letters confirmed this. 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, further amendments to this is needed. The registered provider has gained 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 has attended adult protection training and it is recommended that she attend the multi agency adult protection ‘investigators course’. The deputy attended an adult protection-training course, which is also being covered in the NVQ training. It is evident that staff are properly checked prior to working at the home so that service users can be confident that they are suitable to work with vulnerable adults in a care setting. The Nak Centre DS0000009157.V350920.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. Updated information on infection control to ensure that the home is meeting current guidance is recommended EVIDENCE: Visual inspection of the home provided evidence that it is well maintained, spacious, attractively decorated, well furnished and homely. Service users 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 The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 19 home. This includes separate laundry facilities and suitable facilities for effective hand washing, for example. Service users currently eat in the kitchen area, environmental health inspection were made aware of this and did not comment on it. The cook and registered provider are aware that they need to be vigilant regarding infection control, especially as food is eaten in the kitchen area. The cook agreed to contact the Infection Control Department to gain updated information to ensure that they are adhering to recent guidance and legislation in this area. It was noted that supplying paper towels/ aprons to staff would promote infection control, as would the installation of fly screens on windows. It is also recommended that a bathroom carpet be removed to again promote infection control. The Nak Centre DS0000009157.V350920.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): 32,33,34,35 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 of recruiting new staff. There are insufficient staff employed at the home and the registered provider is in the process of attempting to recruit new staff. All relevant CRB/POVA checks and references are gained before a person commences employment. Formal training is available for staff. The home’s recruitment policies are being 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. The staff handbook needs to be updated. EVIDENCE: On the first day of this inspection the registered provider was the only person on duty. She explained that one staff member was on sick leave and the other on special leave. On the second arranged day of inspection the deputy plus an agency worker was on duty with the registered provider present for the inspection. The registered provider is actively recruiting and has needed to use agency staff. The registered provider agreed that staffing levels are not sufficient and is trying to address this. It is acknowledged that due to the dedication and commitment of the registered provider and deputy manager the service has been able to continue to no detriment to service users. However it The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 21 is of concern as to how long the registered provider and the deputy can maintain this level of work. Due to staffing levels this has meant that there is one staff member on duty at times as the registered provider and deputy are working ‘back to back’. The registered provider stated that ideally she would like to employ two full time staff, as this would then allow sufficient staffing during the day plus a sleeping in staff member at night. The registered provider employs a cook plus a maintenance person. The deputy manager and carer are enrolled for NVQ level 2. The registered provider has gained the Registered Managers Award The home has written procedures that state that staff are recruited on the basis of equal opportunities. The registered provider has implemented an interview checklist to demonstrate that staff recruitment is fair and effective. In checking staff records it was evident that relevant checks on staff have been completed before they have staff have commenced work. References had been sought. Staff records showed completed formal induction training and undertaken training in fire safety, basic food hygiene, infection control and health and safety. The registered provider is aware that first aid training refresher course is needed. The staff handbook needs to be reviewed and updated to ensure that it accurately reflects The Naks philosophy, policies and procedures. The Nak Centre DS0000009157.V350920.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): 37,39,41,42 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 and their individual risk assessments have improved. Policies and procedures in the home need to be reviewed amended where appropriate and updated. EVIDENCE: The registered provider has completed training towards achieving NVQ 4 in management and recent adult protection and fire training. 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.V350920.R01.S.doc Version 5.2 Page 23 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. Written risk assessments relating to individual service users have been developed further and with a minor amendment to the form these will be satisfactory. The registered provider agreed that The Naks’ policies and procedures need to be reviewed and updated. It is understandable that this has not been done due to staffing levels in the home. Policies that need urgent attention are expanding the adult protection policy, the policy on physical intervention and management of resident’s monies. The Nak Centre DS0000009157.V350920.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 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 2 2 X The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 25 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 YA20 Regulation 13(2) Requirement The registered provider must ensure that training for staff in the administration, storage and disposal of medication occurs to protect service users from medication errors. 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. Timescale for action 01/03/08 2 YA37 YA33 18(1)(a) 01/12/07 3 YA42 13 The homes policies and 01/03/08 procedures must be reviewed to ensure they are accurate and up to date with legislation. They must then be cross-referenced to the staff handbook. The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 26 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 YA20 YA23 Good Practice Recommendations The registered provider should ensure that an audit trail of PRN/ loose medication is implemented so that they are aware of all medication that the home holds. It is recommended that the registered provider should attend the local multi agency adult protection-training course. The adult protection policy should be expanded further and written in line with the local multi agency adult protection guidelines. 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. Staff should attend relevant training: adult protection, medication and first aid. 3 YA23 4 YA39 5 YA32 6 YA35 The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 The Nak Centre DS0000009157.V350920.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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