Inspection on 16/03/07 for Touchwood

This inspection was carried out on 16th 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Touchwood 29/08/07

Touchwood 19/01/06

Touchwood 18/11/05

Touchwood 10/01/05

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 Touchwood 13 Somerset Road Christchurch Dorset BH23 2ED Lead Inspector Heidi Banks Key Announced Inspection 16th March 2007 09:35 Touchwood DS0000059217.V333626.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 Touchwood DS0000059217.V333626.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. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Touchwood Address 13 Somerset Road Christchurch Dorset BH23 2ED 01202 487575 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) touchwoodcare@aol.com Principle Care Ltd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user (as known to the Commission for Social Care Inspection) under the age of 18 may be accommodated. 19th January 2006 Date of last inspection Brief Description of the Service: Touchwood is a care home situated in a residential area close to the centre of Christchurch. The home was first registered in April 2004 and provides support, accommodation and personal care to a maximum of five people with learning disabilities. The registered provider is Principle Care Ltd who also own two other care homes in the area. The house is domestic in size and is in-keeping with neighbouring properties. There is a large garden at the rear and some parking on the front driveway. The home provides five bedrooms, all with en-suite bathrooms. One bedroom is situated on the ground floor and the remaining four bedrooms are on the first floor. There is a lounge with dining area and a kitchen. There is also a fully equipped laundry/utility room, a staff sleep-in room and a small office. The home has its own vehicle to support people with accessing their community. The home is also close to a bus stop which offers routes into Christchurch town centre, Boscombe and Bournemouth. The home is staffed on a 24-hour basis with one waking night member of staff and one sleep-in duty each night. At the time of the inspection, the current weekly residential fees at Touchwood ranged from £1250 - £1733 per week inclusive of day care. Also included in the fee are basic toiletries and medical requisites, provision of transport by the home and holidays. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the service undertaken with one day’s notice to ensure that the provider was available to attend. The inspection took place over approximately 7.5 hours on 16th March 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards and assess the provider’s progress in meeting the requirement and recommendations made at the last inspection of the service. At the time of the inspection there were five people living at Touchwood aged between 18 and 37. During the inspection we were able to take a guided tour of the home, talk to two people who use the service and observe some interaction between them and staff. Discussion took place with the provider, the deputy manager and two members of the staff team. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. A pre-inspection questionnaire was completed by the provider before the inspection. Two comment cards were received from relatives of service users prior to the inspection, views from which are reflected in this report. A total of twenty-three standards were assessed at this inspection. What the service does well: The home ensures that people are only admitted to the service after assessment of their needs has been carried out by an appropriate person. This helps ensure that they only offer placements to people whose requirements and wishes can be adequately met. Support plans for people who use the service contain sufficient detail to inform care workers of their personal care needs and preferences. It was clear from reading them that their rights to make choices about the care they receive are promoted. General risk assessments are in place to ensure care workers know what action they must take to minimise risks while encouraging service users’ independence in their home and community. The home achieves good outcomes for service users in terms of their lifestyle. Plans in place for daily activities are individualised and it was clear that they have been designed to meet the specific needs and interests of each person. People are supported to lead normal lives in their community, access ordinary Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 6 resources and have contact with their families as they wish. They are encouraged to contribute to the running of their home and make choices about their activities and meals. Personal care is delivered with a focus on promoting the self-care skills of the individual, their privacy and dignity. The home is spacious and comfortably furnished. Service users have their own bedrooms with en-suite facilities which meets their needs for independence and personal space. What has improved since the last inspection? What they could do better: As a result of this inspection, seven requirements and fifteen recommendations have been made. One of the seven requirements one is repeated from the inspection of the service in November 2005 where the regulation has not been met. Although appropriate checks are generally carried out on staff before they start in post, there is a need for the home to ensure that references they obtain are robust. This ensures that people who may be unsuitable to work with vulnerable adults are not employed. Although the Commission was informed that the former Registered Manager of Touchwood had resigned, there is no evidence that the new manager has submitted an application to register. The home must clarify this issue with the Commission and ensure that an appropriate application for registration is submitted without further delay. This will help make clear lines of accountability within the home. A requirement made for the service to review the quality of care provided to people who use the service remains outstanding and is repeated at this inspection. This must be addressed for the provider to ensure that the home is being proactive in monitoring its own progress and development and is being run in the best interests of those who use the service. Four requirements have been made in relation to health and safety practices in the home. Although the home meets the regulations in some areas of fire safety, the training programme must be reviewed to ensure that staff access regular formal training updates from a competent person. This will help ensure Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 7 they have the knowledge and skills to be able to keep people safe in an emergency. The programme of fire drills must also be reviewed to enable all staff and service users to participate on a regular basis. The home’s training programme must be more comprehensive to ensure that all staff access suitable training in relation to health and safety when they commence employment and by timely updates. This will ensure that they are equipped with the skills to be able to support service users with, for example, their moving and handling needs, physical intervention and requirements in relation to first aid. The provider should look at making support plans fully accessible to service users so that they are fully engaged in the care planning process and know how their personal goals will be met. Where people exhibit behaviours that need a consistent approach from staff there should be more information about this on file so that care workers know how they are to respond to situations. This helps promote continuity of care for the service user and ensures they are being supported in an effective way. Recommendations have been made in relation to medication practices including the need for all staff with responsibility for administering medication to undertake accredited training to ensure their competence with this task. The provider should ensure that concerns expressed by service users’ relatives are recorded with clear evidence of the action taken in response to the concerns. This helps ensure that people know their concerns are taken seriously, and responded to appropriately, even if they are not wishing to make a formal complaint. Training offered to staff by the home should be more comprehensive ensuring that staff have the qualifications, knowledge and skills to be able to support service users effectively and keep them safe. Managers undertaking training should also ensure that the qualifications they are working towards are recognised as equivalent to NVQ 4 / Registered Managers’ Award to ensure that they are equipping themselves appropriately for their role. Policies and procedures in the home should be reviewed and updated on a regular basis to ensure that they contain up-to-date information and continue to reflect the home’s care practices. Record-keeping in relation to fire training and drills should also be reviewed to ensure that appropriate information is held on file to evidence what the home is doing to promote the safety and welfare of people who use the service. 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. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home considers its ability to meet prospective service users’ needs based on assessment. Appropriate introductory procedures are in place so that the person can make his own decision whether the home will meet his needs. EVIDENCE: Two service users have been admitted to Touchwood since the last inspection of the service. The records for one service user were inspected for evidence that the home had obtained sufficient information about the service user’s needs prior to his admission. A Care Management plan was seen on file which offers some information about the service user’s needs. The home’s own assessment document had also been completed prior to the service user’s admission by the funding authority. Some information about the service user’s personal care needs, family contact and emotional and behavioural issues had also been obtained from the person’s previous residential care placement. There was evidence that representatives from Principle Care Ltd had visited the person at his education Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 10 placement and that he had been able to visit the home for lunch and tea visits prior to the actual move. A review of his progress had been conducted in March 2007, attended by the service user, his advocate, representatives from the local authority, his teacher and management representatives from the home. The review documentation had been signed by the service user and his views about the home had been included. Touchwood DS0000059217.V333626.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support plans contain valuable information about the service users’ needs which helps ensure that they receive the help they require. However, they are not in a format that is accessible to them which prevents their full ownership of the plan. Service users are encouraged to make a range of decisions in their everyday lives giving them a real sense of choice and control over what they do. Risk assessments are in place for everyday activities which promote service users’ welfare and independence in their home and community. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 12 EVIDENCE: Two support plans for service users were seen. These contained some useful information about service users’ personal needs and the level of assistance required from staff in their daily routines; ‘X needs a bath and hair wash every day. He has a dry scalp therefore he needs to use Oilatum Monday and Friday. This is a shampoo for dry scalp. On the other days of the week ‘Head and Shoulders’ should be used’. The person’s individual communication needs had also been considered in his plan in that, about fifteen minutes before his usual bedtime, it is recommended that he is informed that it will soon be time for him to go to his bedroom to give him time to process this information and minimise his stress. Individual plans in the home are stored in the office and are not currently in a format that is accessible to the service users themselves. Service users at the home are encouraged to participate in their formal reviews and to contribute to house meetings. House meetings are held on a weekly basis, minutes of which indicated that people are enabled to make decisions about activities and menu choices. Observation of interactions between staff and service users during the inspection indicated that they are given choices about what they want to do within a framework of activities which is designed to meet their individual needs. The risk assessment documentation for two service users was seen. These covered risks of abuse, use of kitchen equipment and risks posed by various activities. For a service user who has recently been admitted to the service, a preliminary risk assessment was in place which indicated that the service user had been reported to use electrical kitchen equipment before coming to the home but these would need to be reassessed at Touchwood. Until these are completed the assessment indicated that the service user would need supervision in the kitchen. Risk assessments also extend to community activities, for example, for one service user who cannot swim but enjoys being in the water, the risk assessment identifies this as a high risk and states that the person ‘needs staff supervision in the shallow end with qualified pool staff available. Has life jacket which he needs to take with him.’ Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encourages service users’ individuality and provides social, leisure and educational opportunities that enrich service users’ lives. Their rights to have contact with family and friends are supported and routines in the home respond to the needs and preferences of the individual so that people lead ordinary lives. Service users’ choices are incorporated into the menu plan and a good range of meals are provided which meets their dietary needs. EVIDENCE: Each person living at Touchwood has their own individualised programme of activities. For some service users this comprises attendance at local colleges and education centres. Others engage in structured home-based activities on an individual basis with staff according to their needs. A recent review for one person indicated that memberships of clubs and associations were to be Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 14 considered to promote his leisure interests and discussion demonstrated that service users had been supported to continue with interests they had enjoyed prior to moving to the home. People are also supported to contribute to the running of their is a rota which sets out who will take responsibility for various each day, for example, loading the dishwasher, taking out the setting the table and assisting with preparation of the evening home and there domestic tasks waste bins, meal. Service users’ individual programmes promote their access to their local community, for example use of local shops, leisure centres, pubs, parks and places of interest. Evidence of this was also seen in people’s daily records. A holiday for three service users in Devon has been arranged for May, the remaining two service users having elected to remain at Touchwood and go out on day trips instead. Service users have contact with their families as is their choice, this also being considered in their support plans; ‘We will allow X to dictate the level of contact he requires with his family and assist and facilitate as required.’ During the inspection, a parent made contact with the manager to arrange to collect her relative for a visit to the family home for the weekend. Two comment cards from relatives were received, both indicating that they felt welcomed in the home at any time, could visit their relative in private and had been kept informed of important matters affecting them. Observation of service users in their home showed that they have access to all communal areas. Restrictions are agreed with the service user and are clearly documented in their individual plans, for example, the level of supervision they need in the community, restricted access to the rooms of other service users and the requirement for staff intervention if their behaviour is seen as posing a risk to either themselves or others. Touchwood employs a part-time cook who is responsible for preparing a variety of home-cooked main meals for service users at lunch-times and also prepares meals in advance of the weekend which are then frozen. A copy of the weekly menu is on display in the kitchen and showed that service users’ choices, as expressed in house meetings, have been incorporated. Two service users spoken with during the inspection commented that they enjoy the meals provided by the home. People generally eat together although this is flexible according to service users’ preferences. For example, it was noted in one person’s support plan that he may find eating with others intimidating and therefore he should be enabled to have his meal at an alternative time if he so chooses. Service users’ food and drink preferences had also been recorded in their plans although conversation with the cook indicated that there are no service users requiring special diets at the home at the present time. The main grocery shop is delivered to the home by a local supermarket. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a sound understanding of people’s personal care needs and support is offered in a way that promotes their independence, privacy and dignity. People are supported to access appropriate services to meet their individual health care needs but some written documentation would benefit from further development. This will help ensure that staff have all the guidance they need to offer consistency and continuity of care to service users. The implementation of recommendations with regards to medication practices and increased access to accredited training will help ensure that practices in the home are more robust and fully protect service users. EVIDENCE: Service user plans and observations of their interactions with staff indicated that the personal support they receive is individualised and based on their respective needs and abilities. Discussion with a member of staff Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 16 demonstrated that where service users have the ability to be independent in aspects of their care this is encouraged. The need for service users’ dignity to be respected in the delivery of personal care has also been noted in their plans. For example, where service users may need a reminder about an aspect of their personal care it was noted that ‘this should be done discreetly respecting his privacy.’ Also, where a person has a tendency to spill his drink it had been documented that staff should only half-fill the cup to minimise the risk of this happening and any distress this might cause. Both relatives who completed comment cards indicated that they were satisfied with the overall care provided by the home; ‘Very pleased with Touchwood. My son has thrived there and is doing very well’. Records showed that a service user who came to live in the home in the previous two months had registered with the local health centre and was due to have a dental check-up in the next week. Medical log sheets are maintained for each service user in their personal files listing details about health care appointments. There was evidence that where a service user had become agitated, prompt advice had been sought from a medical practitioner and there had been liaison between the home and the service user’s college placement. Information on file indicated that the service user needs regular reassurance from staff to allay his anxieties. A member of staff spoken with recognised that this was one of the service user’s fundamental emotional needs. It was noted that the service user’s records could be expanded to include more guidance to staff about this to ensure they are consistent in their approach towards him. There was evidence that certain health care issues are being monitored by the home and log sheets are in place to record these. The challenges presented by one service user were discussed with the provider. The service user’s behaviour was described as ‘unpredictable’ and the provider showed awareness of the effect it may have on other people in the home. It was reported that a review had recently been held with the individual’s Care Manager and his needs had been assessed by a Physiotherapist. A referral is being made to an Occupational Therapist for possible sensory integration work. Although the home is clearly taking steps to seek appropriate advice, it was evident that there was no comprehensive, written plan in place giving specific information to staff about how they should respond to the service user’s behaviour incorporating the advice of health care professionals. The manager indicated that they would be putting this in place. A policy and procedures in relation to medication administration are in place in the home. However, information from the pre-inspection questionnaire supplied by the Registered Manager indicates that this was last reviewed in April 2004. Therefore, there is no evidence to suggest that the policy has been updated to include procedures for taking verbal messages regarding Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 17 medication and obtaining written confirmation as recommended at the last inspection of the service in January 2006. The home continues to re-dispense medication from their original boxes into a weekly dosette box from which they are administered by staff. Guidance from the Royal Pharmaceutical Society states that re-dispensing is not considered to be good practice. This was raised with the home at the last inspection of the service. The home also continues to produce their own Medication Administration Record (MAR) charts. These have photographs of the service users on them to aid identification and allergies are clearly noted. The provider has confirmed that all printed MAR charts are checked by at least two staff members to ensure that information on them is accurate. A sample of medication was checked against medication administration record charts. Charts had been signed appropriately which suggests that medication had been given as prescribed. All staff working in the home participate in an in-house induction programme at the commencement of their employment. This covers procedures in place to support service users with their medication needs. The home’s ‘core training checklist’ was reviewed. This provides some information about medication training for staff in the home. Out of a total of eighteen staff who were working at Touchwood during the week of the inspection, seven are recorded as having undertaken some form of accredited medication training between 2003 – 2005. Four are recorded as being booked onto accredited training with a pharmacy for completion by August 2008. Seven staff had no record of accredited training. A sample of the home’s weekly rota was supplied with the pre-inspection questionnaire and review of this showed that one third of shifts in that week had been covered by staff who, although would have undertaken the home’s induction training in medication, had not undertaken accredited training. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home promotes an open atmosphere in which service users are encouraged to express their views. However, development of systems for recording concerns will enable the home to demonstrate how they respond to issues that are raised. Promoting access to external training for all staff, and any service users who are interested, will help ensure that people are fully protected. EVIDENCE: Each service user has an allocated key worker who is a point of contact for them if they have any issues they want to discuss. In addition, people’s views are sought in weekly house meeting where they are encouraged to express their views and voice any complaints. Information supplied by the provider in the pre-inspection questionnaire states that there have been no complaints received by the service since the last inspection. The home’s complaints record was seen. This included documentation of an incident dated December 2006 but this was not a complaint or concern. Discussion with the provider indicated that a relative has expressed a series of concerns which have been responded to directly but have not been recorded. Information supplied by the provider in the pre-inspection questionnaire indicates that there have been no adult protection concerns requiring referral Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 19 to statutory agencies since the last inspection. The home has a policy on adult protection and the prevention of abuse, which according to the pre-inspection questionnaire, was last reviewed in April 2004. The home’s whistle blowing was also last reviewed in April 2004. Review of the induction programme indicated that new staff are introduced to adult protection procedures at the start of their employment. Four staff are reported to be undertaking the Learning Disability Award Framework (LDAF) induction units, one of which is ‘Understanding Abuse’. Of eighteen staff scheduled to work at Touchwood during the week of the inspection, five had undertaken adult protection training with the local authority in May 2005. The home should ensure that written references obtained for prospective employees of the service are sufficiently robust to fully protect people in their care (see Standard 34). Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Touchwood offers a comfortable and homely environment that meets service users’ needs. A review of policies and procedures in relation to infection control and hygiene is needed to ensure that the most recent guidance from the Department of Health is included and implemented in the home. EVIDENCE: Touchwood is an ordinary family-style home in an ordinary road. It provides accommodation in single bedrooms with en-suite bathroom facilities for five service users. A guided tour of the home showed that service users have been able to personalise their rooms as they wish. The provider confirmed that some improvements to the home were being planned including redecoration of the lounge, re-organisation of the laundry room and an extension to the rear of Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 21 the building to provide a games room. It was suggested that the home enables people who use the service to select pictures for the walls of the lounge so that they are in-keeping with their age and preferences. The home presents as clean and liquid soap and paper towels are available at hand basins to promote good hygiene. There is a separate laundry room in the home, accessible to service users, equipped with a washing machine and tumble dryer. The home has policies and procedures on communicable diseases, disposal of clinical waste and hygiene and food safety. The preinspection questionnaire indicates that these were last reviewed in April 2004. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the provision of NVQ and specialist training mean that the staff group do not currently have adequate qualifications to demonstrate how they can fully meet the specific needs of service users. Shortfalls in the quality of references obtained for prospective care workers must be addressed in order for the home to be confident that service users are fully protected by their recruitment practices. EVIDENCE: The majority of staff at Touchwood also work in the two other care homes in the Principle Care group. The home has a training plan for 2006 / 2007 which was supplied by the provider as part of the pre-inspection questionnaire. There is a designated person in the organisation who co-ordinates training across the staff group. An objective of the organisation’s plan is that training in National Vocational Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 23 Qualifications (NVQs) are available for all staff at all levels. Of the eighteen staff working at Touchwood during the week of the inspection, the core training checklist indicates that one is qualified to NVQ Level 2 standard and one is qualified to NVQ Level 3. The Deputy Manager is currently working towards her NVQ Level 4. Two staff files were inspected for evidence of recruitment documentation. These showed evidence of completed application forms and a structured interview process. Appropriate checks with the Criminal Records’ Bureau had been undertaken prior to the care workers starting in post and suitable proof of identity was seen on file. However, the references obtained for one care worker were not sufficiently robust to meet the standards as neither was provided by the care worker’s last official employer. For the second care worker the relationship of one referee to the applicant was unclear. The provider was directed to the most recent guidance on recruitment procedures; ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’, available on the Commission’s website. All staff employed at the home undertake an in-house induction programme which covers basic health and safety practices, personal care, record-keeping, medication and adult protection procedures. The provider reported that the organisation is looking to develop a new induction programme that meets the revised Common Induction Standards. Shortfalls continue to exist in the provision of specialist training for care workers that reflects the needs of service users, for example, mental health, sexuality and personal relationships, aspects of learning disability and diversity training. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 24 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, 40 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements for the home must be formalised with the Commission so that lines of accountability are clear. The home has not fully implemented its quality assurance process which means that it is not setting objectives for its future development based on service users’ needs and aspirations. Regular review of policies and procedures will help ensure they continue to reflect practice in the home and are based on the most recent guidance. Gaps in training and record-keeping must be addressed for the service to demonstrate that staff are fully aware of health and safety procedures and ensure that service users are fully protected in the home. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 25 EVIDENCE: The management arrangements for Touchwood have changed since the last inspection. However, the new manager has not submitted an application for registration in respect of the home to the Commission. The proposed manager does not have an NVQ Level 4 in Care / Registered Managers’ Award but is planning to undertake an Open University course in managing health and social care. The manager is supported by a deputy manager and within the organisation there are people who have specific responsibilities for recruitment, medication, finance and training across all the Principle Care homes. A requirement was made at the inspection of the service in November 2005 that the home must fully implement a quality assurance process as a way of measuring their success in meeting the needs of service users and the objectives set in their Statement of Purpose. To date, the home has produced questionnaires to be sent out to service users, their family, staff and Care Managers to obtain feedback on the service. Work has been done to produce service user questionnaires in a format that is accessible to them. The manager reported that staff surveys had been sent out at the end of 2006 but other surveys had yet to be distributed. The home does not have a plan in place setting specific objectives for its development. Therefore this requirement is repeated for the second time. The home has a range of policies in place which were implemented in April 2004. These are kept in the office of the home where they are readily accessible to staff. Information provided in the pre-inspection questionnaire indicates that policies have not been reviewed since this time to ensure the information they contain continues to reflect the practices of the home and that they incorporate the most up-to-date guidance. A sample of health and safety records was inspected. A fire risk assessment was undertaken in June 2006. The provider must ensure that the risks for specific individuals are covered within the assessment documentation. For example, for a service user who needs some supervision when using the stairs, an individual risk assessment must be carried out to ensure that, in the event of a fire, appropriate support is provided to promote his safe evacuation. Weekly checks of the fire alarm system and fire extinguishers were up-to-date. Quarterly servicing of the fire alarms and emergency lighting had been carried out by an external agency. Fire drills had been recorded as taking place every two months. Three of the four most recent drills had taken place during the afternoon but the time of one drill had not been recorded. One of the five people living at the home had been present at all four fire drills taking place since June 2006. Another service user had been present for two of the four drills. There was no record that the remaining three service users had participated in any drills in the previous nine months. It was not clear from Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 26 the records that all staff working at Touchwood had been able to participate in fire drills to ensure their understanding of evacuation procedures in the home. Records indicated that new staff to the home are provided with fire training as soon as they start in post. Information supplied in the pre-inspection questionnaire indicated that ‘after completion of the induction process staff are expected to take part in compulsory, externally administered training in fire safety’. However, the core training checklist shows a number of gaps in formal fire training and there was no evidence to show that this training is updated on a regular basis. Records showed that procedures are reviewed with staff at bimonthly staff meetings and the provider confirmed that scenarios are used as a basis for this ‘informal’ training. However, information about the scenarios used was not on file and there was no evidence to indicate that the person who facilitates this ‘informal’ training has some competence in fire safety practices to ensure that they are communicating the right information to staff. Following the inspection the provider forwarded an updated training checklist to the Commission to show that he had made arrangements for more staff to undertake formal fire training in May 2007. Information in the pre-inspection questionnaire stated that the home last had an inspection from environmental health authority in July 2005 at which time a policy on legionella had been required. Following the inspection the provider reported that a policy and risk assessment document on legionella had been completed by the service in December 2006. A copy of this document has been supplied to the Commission. One service user in the home is documented as needing some support with getting in and out of the bath. This was initially provided by two members of staff but the manager indicated that this has since been reduced to one. The home’s core training checklist for staff shows gaps in moving and handling training. Gaps were also identified in relation to emergency first aid training even though this is considered by the provider to be ‘core training’. Following the inspection an updated training record was forwarded to the Commission to show that the provider had made arrangements for a further four members of staff to undertake first aid training in May 2007. Non-Violent Crisis Intervention (CPI) training is provided for all staff by two of the Directors of Principle Care Ltd who have obtained an instructor’s qualification in this area. Staff are expected to undertake this training at the start of their employment and then by annual updates. It was not clear from the core training checklist that all staff are attending this training as soon as they come into post. It was also evident that three care workers are documented as receiving their last update in May 2005 which means that their certification has expired. Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X 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 2 2 X 2 X 2 2 X 1 X Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 28 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 YA34 Regulation 19(1) Requirement The registered person must ensure that a written reference is taken up from the care worker’s last employer. Timescale for action 01/06/07 2. YA37 CSA 11 The proposed manager of the 01/06/07 home must submit an application for registration to the Commission for Social Care Inspection. The home’s quality assurance system must be fully implemented. This requirement is repeated from the last inspection of the service as the timescale of 31/03/06 has not been met. 01/07/07 3. YA39 24(1) 4. YA42 23(4A) Fire safety risk assessments must include evacuation plans for individual service users who have specific mobility needs. The provider must review existing arrangements for fire training to ensure that all staff access regular formal training from a competent person. 01/06/07 Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 29 The provider must ensure that all staff and service users have the opportunity to take part in fire drills in the home on a regular basis. 5. YA42 13(4)(c) Staff must access training in first aid at induction and be provided with refresher training at appropriate intervals. Staff must be provided with suitable training in moving and handling at induction and by refresher training at appropriate intervals. All staff must have training in safe physical intervention as soon as they commence employment. All staff must be provided with suitable update training before the expiry of their previous certificate. 01/07/07 6. YA42 18(1)(c) 01/07/07 7. YA42 13(6) 01/06/07 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 YA19 Good Practice Recommendations Service user plans should be in a format that the service user can understand and be held by the service user. Where service users’ behaviour presents challenges, a clear plan should be put in place detailing the strategies in place to respond to the behaviour. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, DS0000059217.V333626.R01.S.doc Version 5.2 Page 30 3. YA20 Touchwood handling, administration and disposal of medicines. It is recommended that the home’s procedure for redispensing medicines be reviewed. Medicines should be given directly from the container in which the pharmacy supplied them labelled with the doctor’s prescription directions. Procedures for taking verbal messages regarding medication and obtaining written confirmation should be added to the medicines policy. These recommendations are repeated from the last inspection of the service. 4. 5. YA20 YA22 Accredited training in medication administration should be provided for all staff who undertake this role. Procedures should be put in place to record concerns received by the service. This should include information on how these were responded to by the provider and the outcome for the person raising the concern. All staff, and service users if they so wish, should be able to access appropriate external training in abuse awareness. The home’s policy on adult protection and preventing abuse should be updated to ensure it contains the most recent guidance. 7. YA30 The home’s policies on infection control and hygiene should be reviewed to ensure they remain up-to-date and contain recent guidance from the Department of Health. 50 of all care staff in the home should obtain a Care NVQ Level 2 or above. This recommendation is repeated from the inspection of the service in November 2005. 9. YA35 The home’s training and development programme should be reviewed to ensure that all staff receive training in equal opportunities, including disability equality and race equality training. All staff should be able to access training that is linked to the home’s service aims, service users’ needs and Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 31 6. YA23 8. YA32 individual Plans. This recommendation is repeated from the last inspection of the service. 10. YA37 The proposed manager of the home should ensure that qualifications he undertakes in managing health and social care are recognised as equivalent to the NVQ Level 4 in Care / Registered Managers’ Award. The home should have an annual development plan based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. Policies and procedures should be reviewed and updated, as appropriate, on a regular basis. Times of fire drills should be recorded and the provider should ensure that drills are carried out at varied times of the day, in particular at times when staffing levels are reduced. The content of ‘informal’ fire training, for example, as delivered in staff meetings, should be clearly documented. The individual responsible for facilitating ‘informal’ fire training in the home should have some competency in this area. 15. YA42 All staff with responsibility for handling food should undertake suitable accredited training in basic food hygiene. 11. YA39 12. 13. YA40 YA42 14. YA42 Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Touchwood DS0000059217.V333626.R01.S.doc Version 5.2 Page 33 - 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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