Inspection on 20/04/06 for The Tynings

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Tynings 26/11/08

The Tynings 23/10/07

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 Tynings The Tynings Walmore Hill Minsterworth Gloucestershire GL2 8LA Lead Inspector Mr Richard Leech Key Inspection 20 & 21 April 2006 09:30 th st The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 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 Tynings DS0000065788.V290729.R01.S.doc Version 5.1 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 Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Tynings Address The Tynings Walmore Hill Minsterworth Gloucestershire GL2 8LA 01452 751037 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) grapevinecareadmin@gmail.com Grapevine Care Ltd Mrs Paula Braham Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation for up to 5 service users with a learning disability, but may also accommodate service users with minor associated physical disabilities provided that their primary needs relate to learning disability. The policies and procedures must be fully reviewed by 31/07/06 such that each one provides full, up to date guidance based on current law and best practice. 09/03/06 2. Date of last inspection Brief Description of the Service: The Tynings opened in 2005, and is registered to provide care for up to five people with a learning disability. It is located in a rural area near the village of Minsterworth and is about 10 miles from Gloucester. The home is set in seven acres of land and various animals are kept including sheep, horses, chickens and pigs. Residents have single rooms. Four bedrooms have en-suite facilities and the fifth has access to a nearby bathroom. There is a large dining and living area on the ground floor, as well as a conservatory with views over the countryside. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Thursday morning, lasting until mid afternoon. All of the service users were met along with most of the staff team. The inspection continued on the following Friday morning until around lunchtime. The manager was present through the inspection. Records checked included care plans, risk assessments, medication records, healthcare notes and staffing files. Records for two service users were looked at in more detail as part of ‘case tracking’. Information about the range of fees charged was not obtained on this occasion. Service users completed comment cards. The manager also distributed survey cards to others involved with service users’ care (for return direct to CSCI). The manager and staff refer to people living in the home as residents. This term is therefore used in the report. What the service does well: Good systems are already in place for care planning and for assessing and managing risks. Residents are offered choices, and their rights and individuality are respected. They are supported to be as independent as possible. Routines in the home are flexible and relaxed. Residents feel listened to and valued by staff who are skilled and caring. The team is encouraging residents to take part in activities which suit their needs and interests, and to become a part of the local community. Residents are also supported to stay in close contact with friends and family. Residents receive the help that they need with personal care and to stay well. People are given a healthy balanced diet and have choice about what they eat. The home is well run. Systems are in place or are being developed to check the quality of the service and to make improvements. This includes asking residents what they think. The home is spacious, clean, comfortable and well decorated. It is set in large, attractive grounds and residents have the chance to look after the animals if they want to. Comment cards received about the service provided positive feedback. This included evidence that residents’ needs were being met, care plans were being followed and that there was good communication within the team and with others involved in residents’ care. Given how new the home is this represents a significant achievement. Whilst some areas are still being developed, this is a very good start for the service. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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 Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 7 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 Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 8 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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admissions procedure is thorough and individualised, helping to ensure that only people whose needs can be met are admitted, although one part of the process needs attention. EVIDENCE: The home has an admissions procedure, a summary of which appears in the Statement of Purpose. At the time of the inspection the home had three residents (and two vacancies). The manager said that the team would carefully consider referrals in terms of compatibility with existing residents. A referral would be followed by an assessment and the gathering of further material such as a community care assessment. The person would be visited in their current home and would be offered visits to the Tynings. The manager said that assessments would form the basis of care planning. Comment cards provided evidence that residents had chosen to move to the home and had been involved in the process. The admissions of two residents were considered in more detail. Appropriate assessment and background information had been obtained, and introductory visits had been offered. In one case the person was still in a very gradual transition to fully moving into the home. Regulation 14 (1) d was considered. There was no evidence on residents’ files that confirmation in writing had been sent to the person (or their representatives) that the home was suitable for meeting their needs. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems are in place for care planning and for assessing and managing risks, helping to promote residents’ independence, choice and individuality. EVIDENCE: Two residents’ care plans were checked. They were wide ranging and provided clear, appropriate guidance for staff. There was evidence of regular review. The manager and staff described how residents were involved in shaping the care plans. Notes from review meetings were checked and seen to be detailed. Staff confirmed that they had read the care plans. Some people felt that it would be useful to have more background information about residents, for example to increase their knowledge of what approaches and ideas had been tried before and whether these had worked or been unsuccessful. Although it was agreed that the existing plans could be described as personcentred it was suggested that the team look at different person-centred tools The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 10 and care planning formats to consider whether these may be helpful and appropriate for some residents. Daily notes were satisfactory, although it was agreed that improvements could be made to the consistency of recording in some areas. The manager had already identified this and was beginning to trial some new recording formats. Care plans identified and justified certain limitations and restrictions. The need to ensure that all significant restrictions are fully assessed, documented and reviewed (in consultation with residents and their representatives as far as possible) was discussed with the manager, who will continue to put these principles into practice as the service develops. Staff described how they offered residents choices in different areas of their lives, and gave examples of how each person communicated their choices/preferences. Care plans placed an emphasis on identifying and respecting these choices. A resident described how they were offered choices in day to day life, and comment cards provided further evidence of this being the case. Individual risk assessments seen were clear and covered appropriate areas. The format asked the author to consider the potential benefits of an activity, promoting an empowering rather than limiting approach. The service has a missing person’s procedure. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided for residents to take part in activities which reflect their needs and interests, helping them to lead full lives. Contact with family and friends is promoted, helping residents to maintain and develop important relationships. Residents benefit from flexible routines and an approach which respects their needs, choice and individuality. A balanced, healthy diet is provided, reflecting people’s preferences and specialist needs. EVIDENCE: Residents have activity care plans. The manager had just introduced a new recording format for activities in order to provide a clearer picture of how people were spending their time. Whilst there were clearly challenges in engaging some residents in activities, it was clear from records and from discussion with the manager and staff that there was a strong commitment to building up people’s activity programmes based on their interests and needs. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 12 Comment cards, discussion with residents and observation during the day provided further evidence of this commitment. The manager and staff described future plans for activities, such as therapeutic trampolining for one person. A referral had been made for this activity. Activities include helping to look after the animals on site, going to pubs and cafes, shopping, social clubs and accessing day centres. Residents were seen tending to animals and relaxing in the home watching TV, having an aromatherapy massage and doing jigsaws. One person had a job and clearly valued the team’s support in this area and the opportunities that employment offered. Another service user needed to have a clear, planned structure and there was evidence on file of staff responding to this and recognising the importance of routine and clarity to the person. Discussion with the manager and viewing of records provided evidence of family being very involved in the admissions process where appropriate. One family member had written, “thanks…for…taking the trouble to get things right for [service user]”. Notes provided evidence of contact with family being supported, including through visits and by telephone. Staff described residents’ friends visiting the home and opportunities to meet up at social events. Staff described routines in the home, indicating that they were flexible and individual. This was observed during the inspection, with people pursuing different activities and choosing where and with whom they spent time. Daily notes provided further evidence of flexibility of routines. One person is prompted to go to bed around a particular time. Staff explained the reason, although the ‘sleeping’ care plan did not reflect this practice. This should be added. Staff said that residents were given their post and were offered support to deal with correspondence if necessary. One care plan described the importance of one person being referred to only by their name rather than by other terms such as ‘dear’. Staff spoken with were fully aware of this and recognised its significance for the person. The home operates four-weekly menus. These appeared to offer variety and balance. Staff also said that they are flexible, and that alternatives are offered if a person requests this, giving examples. One person’s meals are planned with them individually for the forthcoming week. Records of this were seen. One resident described the food as ‘lovely’ and confirmed that they had choice over what they ate. Two mealtimes were observed and were seen to be very relaxed, with the food attractively presented. Some staff commented that a bigger freezer will be needed once more people move into the home. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided with personal and healthcare needs, promoting residents’ dignity and wellbeing. Reasonable systems are in place for handling medication in the home, although further work is needed to minimise the risk of errors being made. EVIDENCE: Care plans described the support people needed with personal care and how this was to be offered. Reference was made to respecting people’s preferences, and to their privacy and dignity. Staff described how they provided this support. Where monitors and alarms were in use this was documented and protocols around their operation were in place. Healthcare records provided evidence that residents were supported to access routine and specialist services according to their needs. The manager was arranging for one person to have a full review from a consultant including a medication review. Referrals had also resulted in an Occupational Therapist beginning some in-depth assessments with two people. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 14 Up to date health action plans were not in place. These should be developed for each person. One person’s healthcare notes for chiropody appointments had not been kept up to date, although evidence was available from other sources confirming that they regularly saw the chiropodist. These records should be maintained to provide a full and readily accessible summary of healthcare appointments (this may be superseded by health action plans once in operation). The pharmacist inspector visited the home on March 9th 2006, making five requirements and 2 recommendations. The manager described the significant progress made in many areas. Medication storage appeared to be in order, although it was agreed that an alternative location should be found for some cigarettes. New medication policies and procedures have been produced, which the manager felt accorded with national and local guidance for care homes. These will be passed to the pharmacist inspector for comment. However, it was noted during the inspection that the document made only brief reference to homely remedies. A homely remedies policy should be drawn up which fully meets the RPS and PCT guidance. Alternatively this could be incorporated into the new medications policy. Regarding training, the manager described the system of in-house instruction and monitoring. Staff also complete a workbook from the supplying pharmacy. To fully meet the requirement, the manager had made contact with a local college with a view to all staff receiving in-depth training in the safe handling of medication. The requirement is repeated since it is not yet met, although the agreed timescale had in any case not yet expired. The manager had signed a handwritten entry on the MAR sheets, in line with advice from the pharmacist inspector, although it was agreed that, ideally, a second person should check the entry for accuracy and also sign. Some protocols for ‘as required’ medication had been written in accordance with a requirement, but some remained to be done. Files included residents’ consent to having medication administered. There was also information about each person’s current medications. A discussion in a staff meeting was observed about creating an audit trail for medications released when a person went home. It was suggested that the manager contact the pharmacist inspector for further advice if necessary. The manager said that staff were awaiting training about the administration of an emergency nasal medication, and that until this was provided the protocol stated that an ambulance should be called if necessary. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Clear complaints procedures and an open culture help residents to feel listened to and to say if they are unhappy with something. Frameworks are in place which help to protect residents from harm and abuse, although more input in this area would provide further safeguards. EVIDENCE: The home’s complaints policies were seen. There is a text and a symbol version. The manager and staff described how residents communicated that they were unhappy with something, giving examples of how issues had been handled informally or in a more formal way depending on their nature. Some notes were seen relating to an issue that one person had raised. Comment cards and discussion with residents provided evidence that they felt listened to and able to raise concerns and complaints. One resident has been known to make statements about staff, and there is a care plan which describes the team’s approach to this. Care plans and guidelines were in place around the management of challenging behaviour, including the use of red/amber/green descriptions. There was an emphasis on prevention, de-escalation and diversion. The manager and staff reported that restrictive physical intervention is not used in the home. Staff described a consistent approach towards particular behaviours. This accorded with records on ABC charts. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 16 There were records of incidents of physical aggression towards staff. The manager had already identified that staff would benefit from attending a course about the origin and management of challenging behaviour. Representatives from each of the organisation’s homes were due to attend a course on this for further information and to assess the suitability of the training for the wider staff teams. The manager was not sure if this was BILD accredited. All staff should receive suitable training in the management of challenging behaviour which should be from a provider accredited by BILD. Records of residents’ finances were briefly checked. These appeared to be in order apart from evidence that staff had used their own store loyalty cards for a transaction involving a service user’s money. At a staff meeting on the second day of the inspection the manager informed staff that this must not occur. One person was being supported to have a review of their finances. New policies are in place about whistle blowing, adult protection and the prevention of abuse. Staff spoken with were clear about their responsibilities in this area and said that they would report any concerns. The manager said that representatives from each of the organisation’s homes had been on training about adult protection, and that she may develop an in-house package to raise awareness about these issue. NVQ and LDAF training would also add to staff’s knowledge in this area (see standards about staffing). Some free local training on adult protection issues has been forwarded to the organisation and may be useful for staff to attend. It was agreed that, whatever the means, the most important factor was the outcome of staff being fully aware of issues around adult protection and their role in preventing abuse and reporting concerns. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. The environment is clean, comfortable and homely, enhancing residents’ wellbeing and quality of life. EVIDENCE: The home has been redecorated throughout. All areas checked were clean, comfortable and pleasantly decorated. There is a large dining/lounge area, and a separate conservatory. Residents’ rooms were spacious and attractive. Four of the bedrooms have en-suite facilities. The manager said that when the fifth bedroom is occupied the person will use a bathroom near their room and would probably have a key to the bathroom or to a cabinet within the room (it was being kept locked, related to one resident’s needs). This bathroom requires some redecoration. The manager said that this would be done by the time a fifth resident moved in. The home is set in large and pleasant grounds. The kitchen and laundry appeared to be clean and hygienic. Fridge/freezer temperature records were satisfactory. A cleaning schedule was in place. Comment cards provided evidence that the home was kept clean and fresh. Some hygiene measures have been adopted following visits by Environmental Health Officers to other homes in the group, though the manager plans to seek clarification about some issues, such as on residents’ access to the kitchen. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 18 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, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are skilled, caring and competent, and a training programme is in place. However, there is scope for further development in this area to better equip the team with the knowledge and skills needed for the role. Recruitment procedures are generally satisfactory, although one aspect needs attention to ensure that risks of employing unsuitable staff are minimised. EVIDENCE: Minutes from a staff meeting from January 2006 were seen. A meeting was observed during the inspection, providing evidence of good discussion of issues in the team. Comment cards and discussion with residents provided evidence of a positive relationship with staff. One person said that they ‘get on great’ with the staff and that it was like being part of a family. Some of the staff team have NVQ and GNVQ qualifications in care. However, no plan was yet in place for providing this for other team members, although the Statement of Purpose says that staff must attend training for NVQ 2. This should be addressed. There should also be opportunities for staff to access The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 19 LDAF accredited training (although it is acknowledged that the organisation has previously made efforts to address this, with unforeseen difficulties limiting the progress made). Recruitment procedures were discussed and some staffing files checked. Documentation appeared to be in order apart from a gap in one person’s employment being uncounted for. Staff have been taken on with a PoVA-first check in place pending return of their CRB. CSCI had been contacted and a risk assessment put in place. The manager is aware that recruitment on this basis must be only in exceptional circumstances rather than standard practice. The organisation has a training coordinator. Training records provided evidence that staff had received some training in mandatory areas and were booked onto other appropriate courses in the near future. A requirement about training is not made on the understanding that all staff will receive training in core areas in the near future. Care planning files provided information about specialist conditions experienced by residents. The manager and staff reported that they had received some training about a particular condition experienced by one resident. There was a general consensus that this was adequate for the time being but that more training may be needed in the future. Some awareness training about epilepsy was booked for later in April. Some staff felt that more training/input should be provided about a progressive condition affecting the mobility of one resident. As noted, training should be provided about the management and challenging behaviour and about adult protection. A staff member talked through their induction to the home and described it as ‘really good’. Another person expressed the same opinion. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home is well run, promoting positive outcomes for residents and resulting in an effective staff team. Systems are in place for monitoring and improving the quality of the service. Residents are involved in this process, helping them to feel valued and listened to. Health and safety is generally well managed, although there is scope for further promoting people’s safety and wellbeing. EVIDENCE: The manager is a qualified nurse who has completed the Registered Manager’s Award. Staff spoken with consistently said that the home was well run. Other comments included that the manager was approachable and effective, and cared about the residents and the staff. There was a suggestion that communication from management could be better as sometimes the manager The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 21 and deputy gave quite different advice about handling a particular situation/behaviour. Regulation 26 reports are being forwarded to CSCI by the organisation’s quality control coordinator. These include reference to discussions with residents. The coordinator also has a role in issues like complaints as a more independent party. The manager said that residents’ meetings would be trailed, and that if this did not work then feedback would be sought on a more one to one basis. The manager said that feedback also comes during care plan and placement reviews, both from residents and their representatives. Comment cards provided evidence that residents felt listened to. A condition is in place whereby policies and procedures must be fully reviewed. The manager reported that this is taking place. New policies on medication and adult protection have been generated. The manager said that feedback is regularly sought from staff on a day-to-day basis and in meetings. This was observed during a staff meeting. Various other forms of quality assurance were discussed which the manager will consider. These could operate at the level of the home or the organisation. Staff spoken with felt that the home was a safe place to live and work. The manager said that health and safety issues form part of induction and that all staff would in due course attend formal training in this area. Accident records were looked at. When the home opened evidence was seen of routine safety checks being carried out such as on wiring and heating. The fire log provided evidence of alarms and emergency lighting being tested at suitable intervals. However, no drills had yet taken place. It was agreed that these need to be started as soon as possible. There was also a discussion about the fire risk assessment being updated to discuss issues with individual residents, perhaps following a drill when a clearer picture emerges of how different people respond. Records are kept of hot water temperatures. At the time of the inspection a ground floor toilet was locked as the hot water tap was generating water at a high temperature. A requirement is not made about this, on the basis of the manager saying that arrangements were already being made to address this and to restore residents’ access to the room. There was a discussion with the manager about whether further environmental risk assessments should be conducted, such as in respect of the grounds and outbuildings (which contain tools and other hazards), particularly with warmer weather coming and people more likely to be going out. The team should The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 22 consider this and take any necessary action to assess and manage identified risks. During the staff meeting there was a discussion about obtaining data sheets for the chemicals in use in the home. The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 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 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 2 x The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 (1) d Requirement As part of the admissions process, confirm in writing to service users that the home is suitable for meeting their needs. Ensure that all staff involved with medication undertake formal training in the safe handling of medicines with ongoing assessment of their competence in this work. Ensure that written protocols describing the use of any medicines prescribed on an ‘as required’ basis are in place. Timescale of 15/04/06 not fully met) Ensure that satisfactory written explanation of any gaps in employment is available for all staff. Conduct fire drills at suitable intervals in order that staff and, as far as possible, service users are aware of the fire procedure. Timescale for action 15/05/06 2 YA20 18 01/07/06 3 YA20 13 (2) 17 01/07/06 4 YA34 Sch.2 (7) 01/06/06 5 YA42 23 (4) e 30/06/06 The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 25 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 Research different person-centred tools and care planning formats to consider whether any of these may be helpful and appropriate for some residents. • Consider whether staff have access to sufficient background information about service users, such as approaches that have been tried in the past. Expand one person’s care plan about sleeping to incorporate the practice of prompting them to go to bed, and the reasoning, as discussed during the inspection. • Develop health action plans for each resident. • Ensure that all healthcare notes provide a full record of appointments and outcomes. • Devise a policy on homely remedies which accords with local national guidance on the handling of medications in care homes. • A second designated and competent person should countersign handwritten entries on the MAR sheets, having checked the entry for accuracy. • All staff should receive suitable training in the management of challenging behaviour which should be from a provider accredited by BILD. • All staff should also receive suitable input/training around adult protection and abuse. Provide opportunities for staff to access NVQ training in health and social care, and LDAF accredited training. Consider whether staff require further training/input about specialist conditions experienced by service users such as the progressive condition affecting one person’s mobility or about autistic spectrum conditions. • Update the fire risk assessment to include issues with individual service users. This could be done following a drill, when a clearer picture emerges of how different people respond. • Consider whether further environmental risk assessments should be conducted, such as in respect of the grounds and outbuildings. Take any necessary action to assess and manage identified risks. • 2 3 4 YA16 YA19 YA20 5 YA23 6 7 YA32 YA35 8 YA42 The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI The Tynings DS0000065788.V290729.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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