Inspection on 16/09/08 for Tramways

This inspection was carried out on 16th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tramways 12/10/07

Tramways 19/04/06

Tramways 17/01/06

Tramways 03/08/05

Tramways 19/01/05

Tramways 26/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Tramways Tramway Road Brislington Bristol BS4 3DS Lead Inspector Sandra Jones Key Unannounced Inspection 16 & 17 September 2008 09:30 th Tramways DS0000026641.V369983.R02.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 Tramways DS0000026641.V369983.R02.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. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tramways Address Tramway Road Brislington Bristol BS4 3DS 0117 3009637 0117 9709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Julie Elizabeth Oliver Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 14. 12th October 2007 Date of last inspection Brief Description of the Service: Tramways is registered to accommodate up to fourteen adults with mental health nursing needs and operated by Aspects and Milestones Trust. The property was purpose built and arranged on one level, designed into two separate units accommodating seven people, linked by a passage, with a shared kitchen. It is situated in an industrial estate close to the Bath Road and within walking distance of shops, amenities and bus routes. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection was conducted unannounced over two days in September 2008 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection including the Annual Quality Assurance Assessment (AQAA). This information was used to plan the inspection visit. “Have your say” surveys were sent to the people living at the home and health care professionals and seven surveys were received from people living at the home. There are fourteen individuals living at the home and four were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the people living at the home and staff were gathered through face-to-face discussions. Five people refused and one person agreed to give feedback about the standards of care at the home. What the service does well: Through the AQAA the manager has reported that the move from Acramans Rd to Tramways and the admission of five individuals was successful. There was a smooth transition and these individuals have settled well. An individual giving feedback about the home said they had moved from Acramans Rd, this was successful and they had settled well. This person said the staff were ‘ok’, they had assistance from staff to meet their assessed Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 6 needs. This person said they felt safe at the home and would approach the manager with complaints. What has improved since the last inspection? What they could do better: There are nine requirements arising from this inspection and relate to information, care planning including risk assessments and systems that must be introduced to improve the outcome for people at the home. The Statement of Purpose and Service User Guide must be reviewed to include the information required by legislation. This will ensure that people wishing to live at the home, their relatives and placing agencies have sufficient information to make decisions about moving into the home. Care planning systems and associated risk assessment must be further developed to provide a person centred approach. This will ensure that people are at the centre of their care. Individuals assessed needs must form part of their care plan and must incorporate their likes, dislikes and preferred routines. Where individuals have ‘when required’ medications protocols must be devised that guide the staff to administer medication consistently. Risk assessments must be completed for medications that are crushed and for people that may overdose. Criminal Records Bureau (CRB) must be obtained for staff working at the home, ensuring that staff employed are suitable to work with vulnerable people. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 7 Fire Risk assessments must be completed to assess the potential of fire at the home to then develop an action plan to lower the potential of an outbreak of fire. A Quality Assurance system must be introduced. It is evident from the documentation that staff adopt their preferred system and there is no specific care planning approach in place. Comments made by the staff for example, everybody is treated the same and the assessed need included in the care plan is at the discretion of the staff, show that the people at the home are not at the centre of their care. Whilst staff continue to use their own, individual, preferred systems, consistency of care cannot be provided and current good practice followed. For example, person centred care. 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. Tramways DS0000026641.V369983.R02.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 Tramways DS0000026641.V369983.R02.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): (1) & (2) Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. The admission process that allows individuals to make decisions about moving into the home is not consistently followed. The Statement of Purpose and Service User Guide must be updated to ensure that people wishing to live at the home have accurate information to base decisions about moving into the home. EVIDENCE: There is a Statement of Purpose in place and it says that the aims and objectives of the home is to provide an effective service for adults of both sexes experiencing the effects of enduring mental health needs. Additional information must be added to the Statement of Purpose to make clear the age range of the people that can be accommodated particularly as there is a wide age group currently living at the home. The range of needs that can be met at the home must be specified and while it is acknowledged that in the Statement of Purpose there is a reference to the Complaints procedure, the procedure must be included. Also missing is the Privacy and Dignity policy and it must Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 10 be included. The Statement of Purpose must be reviewed to ensure that the information is comprehensive and up to date, which ensures that people wishing to live at the home, their relatives and placing agencies can make decisions about moving to the home. The Service User Guide is in large print providing accessible formats for people that have visual impairments. However, gaps in the information were also found. The Service User Guide must be reviewed and the information required by legislation must be added. Seven people made comments through surveys about information received about the home. Three people said that they received enough information about the home before moving in, so they could decide about living there. Three people said that they had not received information about the home and one person said ‘they received bits and pieces of information’ Through the Annual Quality Assurance Assessment (AQAA) the manager has describe the home’s admission process. It states that people are admitted only following an admission assessment, introductory visits and trial periods to ensure the person needs can be met at the home. The case records of three people that have recently moved into the home were examined. The Integrated Care Programme Approach (ICPA) devised by the Care Coordinator was available at the home indicating that an assessment of need was undertaken before admission. For one individual pre-admission assessment’s, ICPA and signed contracts were found and daily report support that introductory visits including overnight stays took place. This demonstrates that steps are taken to ensure the staff have the skills and resources to meet the person’s needs. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6), (7) & (9) Quality in this outcome area is (poor) This judgement has been made using available evidence including a visit to this service. For individuals to achieve independent lifestyles, the care planning process must be more effective for people to also benefit from consistent and indivudualised care. People at the home are involved in decision-making. EVIDENCE: The case files of six people living at the home were examined and there is a wide range of information formats that focus on background history, personal profiles and ‘All About Me’ summaries. Summaries include information about the person’s likes, dislikes, hopes, aspirations and goals. It is evident that the information being used relates to previous accommodation and the home continues to use documentation from other homes. The language used in some of this documentation is written in the first person, but its very Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 12 subjective and must be addressed by the manager. For one person it was difficult to determine whether this individual said the information included in their profile. Care plans are written in headed paper for Acramans Road and not for Tramways, they are not always consistent with the Integrated Care Planning Approach (ICPA) and while the care plans for one person was person centred, the others were not. Mental health care needs of the people at the home are not always included in the care plans, early warning signs of deteriorating mental health with signs and symptoms must be included in the action plan. In addition there are people who are subject to restriction under section of the Mental Health Act. However, the restrictions and the actions to be taken by the staff for breeches of the restrictions are not included in the care plans. Staff make entries in the daily reports and are mainly about physical care, it was therefore difficult to establish the progress made with the care plan in place. Feedback about staff’s responsibility with care planning was sought from qualified nurses and support workers on duty. The qualified nurse on duty said that they acted as keyworker to specific individuals at the home and with the person develop care plans, reviewing care plans and liaising with other staff and professional are also part of the role. Two support workers on duty said that they their role extends into the development of the care plans, reading the care plans and writing daily notes. In terms of keyworking, support workers said it involved having specific knowledge of a group of individuals and having and time spent with each person. Risk assessments are in place for activities that may involve an element of risk. It is evident from the dates of the risk assessments and letterheads from a Trust no longer in operation, that the risk assessments are not current. For example, there was a risk assessment for using public transport, which is reviewed at Tramways but relates to another home. One person has cigarettes controlled by the staff and although, there are references to a risk assessment, it was not available. The deputy manager said that three people could become physically and verbally aggressive. Risk assessments that include behaviour plans are in place and for some people their risk assessments were dated 2006. Risk assessments must be reviewed to ensure that risk assessments conducted two years prior, remain within good practice guidelines. Daily reports about the outcome of the incidents and the actions taken by the staff are vague and do not give a clear account of the incident. Input from Health Care professionals was sought for people that need ‘best interest’ decisions and an IMCA was appointed for two people. The deputy manager said that the people at the home could verbally express their wishes Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 13 and feelings. It was explained that people at the home make choices about food, décor and activities. Also after discussion with the person, they sign their care plans if they agree or can negotiate about what has been written. The staff on duty were consulted about the way people at the home are empowered to make decisions. Support workers and the qualified nurse on duty said that giving people choices, offering support, encouraging and their negotiating skills ensure that people at the home are given opportunities to make decisions. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12), (13), (15), (16) & (17). Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. There are support systems in place for people to maintain their lifestyles. The staff currently lack insight about the rights of the people living at the home. EVIDENCE: There is an activity rota on display in the office and it shows that people at the home attend education and occupation. With the exception of three, the people at the home attend structured activities and those people not participating in activities pursue hobbies and undertake household chores. The people that have structured activities attend the Drop-in Centre operated by the organisation, college courses, Dance Voice, day trips and voluntary employment. The deputy manager said that where possible, people at the home use the community and it is the role of the keyworker to discuss with Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 15 the person their wishes with education and occupation. However, education and occupation is not currently part of the care planning process. Comments made by six people through surveys indicate that they usually make decisions about what to do each day and one said this was always so. A support worker on duty said that individuals are supported with independent living skills, there are ad-hoc trips to cafes and post offices and in-house groups, which include gardening. The deputy said that six people can leave the home without staff support and can use public transport the staff support the others. Regular outings are organised to the seaside, garden centres and boat trips. The majority of people at the home maintain links with family and friends. There is open visiting at the home, acknowledging that maintaining relationships with friends and family is important. It is also stated in the policy that visiting is at the discretion of the nurse in charge and the people at the home. The manager must make clear the visiting policy so that people are clear about the arrangements. IT is evident that there are rules at the home, for example, designated smoking areas, no access into the kitchen and participation into the running of the home. These rules must be specified in the Statement of Purpose and Service User Guide so that people at the home are aware about the expectations, before they move in. There is a Respect section in the Statement of Purpose and it is made clear that people are treated as individuals and not as a group. This section needs to be more specific about the way this is achieved through staffing, environment and care planning processes. For example, the means used by the staff to ensure that people are treated with respect, how the environment provides it and the way the care approach used ensures people are respected. One person agreed to give feedback about the way staff respect people as individuals. It was stated that staff are respectful some of the time. Accommodation is arranged in single bedrooms and is lockable which ensures individuals have private space. The feedback about the way people are respected as individuals was sought from support workers and the qualified nurse on duty. The qualified nurse on duty said that consulting the person before undertaking tasks and knocking on doors were the means used to respect people. Support workers said that by treating people the ‘same’ they were respected as individuals. While there is little evidence that staff practices are not respectful, the manager must ensure that staff have insight into the rights of the people at the home including individuality, dignity and privacy and promote their wellbeing and independence. The activity worker devises menus at the home with the people who live there. There is also an alternative menu for special diets catered. However, a record Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 16 of food provided is not kept at the home. A part-time cook is employed and on the cooks days off staff prepare the meals. A good range of fresh, tinned and frozen food were found supporting that the people at the home have a varied diet. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. There is a strong emphasis on personal care and people receive appropriate health care. Medication systems do not always follow good practice or safe practice guidelines. EVIDENCE: Personal care is the main focus of care at this home and evidenced through daily reports, which are based on hygiene tasks completed by the staff or the person. For one person, personal care is not listed as a need in their Integrated Care Programme Approach (ICPA), but is identified as a need by the previous service provider, the home lifted this information from the previous care plan and is now included in the home’s care plan. The qualified nurse and a support worker said that they assist people with personal care. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 18 Documentation in place supports that people have input from the GP’s specialist, psychologists and psychiatrists. Individuals that have background history forms in their case files have physical and medical diagnosis included. Others have a detailed discharge summary from the Avon Wiltshire Partnership (AWP) and one has a healthy lifestyle checklist, which could be from the previous home. For some people Doctor’s notes are used to report the outcome of visits and the advice to be followed. It is difficult to establish from the documentation in place whether people access NHS facilities. The deputy manager said that people at the home visit the chiropodist, dentist and optician. Support workers giving feedback about meeting individuals health care needs said that people at the home are accompanied on health care appointments. Staff also said that medical advice is passed on through handovers and daily reports, ensuring that advice given is followed. It is a common theme that the home continues to use documentation transferred with the person from other care providers. Three types of medication administration sheets were found in place and staff sign medication sheets after administering medications. It was noted that people at the home have ‘when required’ medications administered at the home. However, protocols to guide staff on consistently administering the medication are not in place. For another person staff are instructed to crush medication, however, a risk assessment that considers other alternatives, consent and effects of crushing the medication is not in place. For another person it is stated that the person is at risk of overdosing, but a risk assessment is not in place to ensure that where possible the level of risk is reduced. A record of medications no longer required is maintained and the signature of the pharmacists indicates their receipt of the medication for disposal. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22) & (23) Quality in this outcome area is (adequate This judgement has been made using available evidence including a visit to this service. The home fails to inform people about the complaints procedure, they don’t all know the procedure for making complaints. There are systems in place that show a commitment towards safeguarding people from abuse. EVIDENCE: There is a detailed Trust Complaints procedure, which confirms that feedback on the quality of the service is essential. The steps to be taken to resolve complaints are detailed within the procedure. While the procedure is detailed, it is not in formats that are accessible to the people for whom it’s intended. Also the procedure is not included in the home’s Statement of Purpose and Service User Guide. The records of complaints received at the home were examined and it is evident that one person will physically abuse other people at the home. In this instance the manager reported the allegation of physical abuse to the care coordinators who made the decision about the best way to manage the situation. Care coordinators have a duty to report allegations of abuse to their managers. If an investigation is indicated they will convene a strategy discussion to agree the best way to investigate the allegation. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 20 One individual agreed to give feedback about the complaints procedure. It was stated that the manager would be approached with complaints. Members of staff giving feedback said that the complaints procedure would be followed for complaints received from people at the home. Seven people made comments through surveys about the complaint procedure in place. Six people said that they know who to speak to if they are not happy and three said that they know how to make a complaint. One person did not know who to approach with complaints and did not know how to make a complaint. Policies that show a commitment towards safeguarding adults are in place and include ‘Do the right thing,’ Equal Opportunities and Safeguarding Adults. The person giving feedback about the standards of care at the home said that they felt safe living at the home. Members of staff confirmed that Safeguarding Adults training was provided and knew the factors of abuse and the actions to be taken for allegations of abuse. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24) & (30) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. The home is adequately maintained and people benefit from living in a comfortable and clean environment. EVIDENCE: Tramways was originally purpose built for fourteen people with learning disabilities, the purpose was recently changed and now accommodates fourteen nursing patients with mental health care needs. The property is sited within an industrial estate with close access to residential community. Shops, restaurants, bus routes and amenities are within a short walking distance. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 22 The accommodation is arranged on the same level with two units of bedrooms separated by a corridor. There are seven single bedrooms, bathrooms, toilets and lounge at each end of the property, with a smoking room in the corridor that links the home together. The kitchen is in the centre of the home with a dining room and breakfast/activity room at each end. The home is currently experiencing difficulties with the showers, the manager explained that the system is not coping with the demands and there is reduced pressure. The bath panel in the corner bath is in need of attention. The laundry is sited adjacent from the dining room, it has painted walls and vinyl flooring for easy cleaning. There are three washing machines; two are industrial washing machines with sluicing facilities and a tumble dryer. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 23 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): (34) & (35) Quality in this outcome area is (Adequate) This judgement has been made using available evidence including a visit to this service. The manager has failed to check that the qualified nurses are registered to practice and must ensure that staff employed are suitable to work with vulnerable adults. EVIDENCE: Since the last inspection, one member of staff was transferred within the organisation, and the documentation included application forms, references and Criminal Records Bureau (CRB) checks. However, no CRB was obtained when the person moved to Tramways. CRB are not portable and the manager must obtain a CRB disclosure for this person. Personnel files for the staff on duty were checked and POVA first checks and CRB checks obtained are kept on file. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 24 Qualified nurses employed at the home have a mental health qualification. The records show that the pins of the nurses has not been checked with the NMC since 2005. For qualified nurses to practice, they must register annually and providers must check the register annually. This means that the manager may not be aware that nurses are practicing without a current pin. Training was discussed with the manager and it was understood that statutory and specific training is provided and vocational qualifications are encouraged. Members of staff at the home attend statutory training in fire, Manual Handling, Food Hygiene and First Aid. Team days are also used to provide training to all staff and the manager said that Mental Capacity Act training was provided at the last team day. The manager reported that members of staff going through induction attend mental health awareness training to ensure they have an insight into the needs of the people at the home. Feedback about the provision of training was sought from the staff at the home. Members of staff confirmed that they must attend statutory training and since the last inspection staff attended refresher training in Fire and Manual Handling. The qualified nurse said that PREP is undertaken to maintain their nurse registration and both support workers said that they had NVQ level2. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42). Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. The environment for people at the home must be safer and they must be reassured that standards will be the subject of ongoing monitoring. EVIDENCE: The manager’s feedback was sought about the style of leadership and systems that ensure consistency of care. The manager said that an approachable style of management is used at the home. It was also said that up-coming changes that include the appointment of an activity coordinator and training would provide better outcomes for the people at the home. It is expected that the Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 26 activity coordinator will be developing profiles with the person and training sessions will be organised for staff to cascade information from training attended. One person giving feedback about the home said that the staff were ‘ok’. Members of staff on duty were consulted about the leadership style used and the systems used to maintain consistency at the home. The staff said that the manager was approachable and had a respectful manner towards the people at the home. Handovers when shift changes occur, staff meetings and individual supervisions are the systems used to maintain consistency at the home. Comments from seven people were received about staffing through surveys. Three people said they were always well treated by the staff and four said this was usual. Six people also said that carers usually listened and acted on what they said and one person said this was always so. It is evident from the documentation that staff adopt their preferred system and there is no specific care planning approach in place. Comments made by the staff for example, everybody is treated the same and the assessed need included in the care plan is at the discretion of the staff, show that the people at the home are not at the centre of their care. Whilst staff continue to choose their preferred systems, consistency of care cannot be provided and current good practice followed. For example, person centred care. The external manager visits the home monthly and through Reg.26 reports on the conduct of the home. The report for July 2008 was the most recent report and a summary of issues, with sample of records examined were included. The duty rota was examined and a qualified nurse is on duty throughout the day with support workers. Generally there are four staff rostered in the morning and in the afternoons the staffing levels are reduced to three. At night there is a qualified nurse and a support worker. There is an accident book kept at the home and twenty-five accidents and incidents were recorded since the last inspection. It is evident that for repeated accidents there are further investigations, for example, GP’s and OT input is sought. There are facilities for safekeeping at the home and the individual’s records corresponded with the cash held for the person. Quality Assurance was discussed with the manager and it was understood that peer auditing would be taken place. This is where another manager with similar care homes within the same organisation visit each other and evaluates the standards of care. However, a Quality Assurance system is not in place. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 27 Fire risk assessments in place were devised in June 2008 by the previous manager and relates to another group of people, which give raise to a separate potential for fire. For example, the people previously accommodated at Tramways did not smoke where the current people living at the home smoke. Also the home has undergone structural changes and the risk assessments do not relate to the current building. The Environment Agency officer visited and the home was awarded 4 star for Food Safety. Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 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 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The Statement of Purpose must a) be reviewed to make clear the range of needs that can or cannot be met at the home. b) The age range of the people that can live at the home, c) the complaints procedure must be included and d) the privacy and dignity policy must be appended. The Service User Guide must be reviewed and information must meet the requirements of legislation. a) Care plans must include the areas of need identified through assessments conducted before admission. b) Individuals mental health care needs must form part of the care plan A person centred approach must be used to develop care action plans. Individuals likes, dislikes and preferred routines be incorporated Risk assessments in place must be reviewed and must follow current good practice. Risk assessments must be completed for individuals that DS0000026641.V369983.R02.S.doc Timescale for action 30/01/09 2. YA1 6 30/01/09 3. YA7 15 30/12/08 4. YA7 12 (3) 30/12/08 5. 6. YA9 YA20 13 (4) (b) 13 (2) 30/12/08 30/12/08 Tramways Version 5.2 Page 30 7. 8. YA34 YA42 7,9, &19 Sch. 2.2 23 (4) 9. YA39 24 have medication crushed and for those that may overdose. Protocols must also be completed for individuals that have ‘when required’ medications Criminal Records Bureau Checks must be undertaking for staff working at the home. Fire Risk assessments must be completed to assess the potential of fire at the home to then develop an action plan to lower the potential of an outbreak of fire. A Quality Assurance system must be introduced. The legal people have said we cannot enforce this so make it a recommendation. 30/10/08 30/11/08 30/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Tramways DS0000026641.V369983.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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