CARE HOME ADULTS 18-65
Tweezle Twigg 3 Campden Road South Croydon Surrey CR2 7EQ Lead Inspector
Claire Taylor Announced 11 July 2005, 09:30 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 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 Stationary 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. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tweezle Twigg Address 3 Campden Road, South Croydon, Surrey, CR2 7EQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8680 1219 020 8667 1232 tweezle_twig@btopenworld.com Tamarind Care Limited Miss Jocelyn Gillam Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A variation has been granted to allow three specified service users over the age of 65 to be accommodated on condition that any of them will have to be moved to alternative accommodation if they become too physically or mentally frail and /or require nursing care. Date of last inspection 24 January 2005 Brief Description of the Service: Tweezle Twig is a large family house situated in the Croham district of South Croydon, not far from a bus route and about ten minutes walk from South Croydon rail station. There is parking space to the front of the house (enough to accommodate the home’s minibus) while visitors can park in the street directly outside. The house provides accommodation for up to ten adults with learning disabilities. All bedrooms are single occupancy, and are spread over three floors (including the ground). A passenger lift serves all floors. Toilet facilities are available on all floors, with bathing facilities on the ground and first floors. There is a pleasant lounge, a separate dining room, and a well laid out kitchen. There is a large well-maintained garden to the rear of the home. Three of the current eight occupants are aged over 65 (and a variation has been granted), while the remainder are in their 50’s. The General Manager described how they would hope to provide service users with a ‘home for life’ – as existing residents moved into the older person category then further variations would be sought, while any new residents would not be under the age of 40. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours and time was spent examining records, talking to service users and staff, touring the building, and meeting with the home manager. One of the organisation’s general managers also met with the inspector. Prior to the inspection, all service users, supported by their key staff, completed a questionnaire about their life in the home and several relatives used the Commission ‘s comment cards to express their views as well as one other relevant professional. The home had two vacancies on this occasion and had admitted one new service user since the last inspection. Comment/ feedback cards from service users, relatives, care managers and other professionals are welcomed by the Commission for Social Care Inspection and all those who contributed are thanked for their time and assistance. What the service does well: What has improved since the last inspection?
Following the last inspection (January 2005) and an additional visit to discuss outstanding requirements, the proprietors and registered manager have worked hard to address the majority. Essential repairs to the roof have been completed and maintenance work inside the house can now progress such as replastering and painting in some of the bedrooms. A detailed maintenance schedule for planned refurbishments has been put in place. Quality assurance monitoring has begun and the manager’s efforts to improve the quality of care are progressing well. E.g. Satisfaction questionnaires were
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 6 recently offered to all the service users and staff and the manager has started a self-assessment tool for the home on quality assurance. Another care staff has completed their NVQ level 2 qualification and the manager is due to finish her NVQ level 4 in management. Record keeping has improved in some areas. What they could do better:
Two requirements are now outstanding from 2003 and must be addressed within the newly allocated timescales. One being that staff need to receive disability and anti racism training and the other concerning the path in the rear garden. It was previously required that the garden path be extended so that it travels around the whole of the garden to allow easier access for the service users who use wheelchairs. At previous inspections, the home’s proprietors have indicated that a building extension is planned but no further developments have begun. The service users are rarely accessing the garden and given that two years have passed, the registered provider must now address this issue. The home has been set twelve new requirements and four recommendations. Requirements are centred round service users activities, environmental issues, some health and safety concerns, record keeping and decoration of the premises. Good practice recommendations are centred round improving administration, staff training and for the home to purchase a larger tumble drier. The number of staff who are able to drive the homes vehicle is limited and service users therefore lack opportunity to participate in social activities in the wider community. This should be addressed. Some areas of the home still require redecoration or repair and this should be addressed. The paintwork needs redecorating in the dining room together with a need to replace the dining table and chairs. The carpet in one bedroom must be replaced with a more suitable flooring that meets the service user’s needs. Several broken furniture items and two old mattresses were in the rear garden and need to be disposed of. Ventilation is still not adequate in the laundry area and therefore the requirement is repeated form the last inspection. Staff were not fully up to date in areas of health and safety training although there are plans for staff to receive appropriate training through self-learning development packs. Progress will be checked during the course of future inspections. Staff need to receive training in adult protection and would benefit from further training that is more specific to the service users individual needs i.e. communication methods for people with severe learning disabilities. To maximise safety within the home, environmental risk assessments need to be completed and a fire safety inspection must be carried out to ensure that the premises complies with appropriate regulations. Staff have been locking the front door for safety reasons following a recent admission. The front door is also a fire exit and locking it could compromise the safety of the service users The home is therefore required to complete a risk assessment and locked door policy. The provider is also reminded that fire doors must not be kept locked with a key as this does not comply with current fire regulations. Should the home continue or need to keep the front door locked, alternative security measures must be put in place such as an electronic key-pad access system.
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 7 The home keeps accurate records for accidents and incidents, however, events that affect the well being of a service user must be notified to the Commission under regulation 37 of the Care Standards Act. Although quality assurance systems have been implemented, an annual development plan for the home should also be put in place to demonstrate how the home regularly appraises its care practices through the views of service users, relatives and other relevant parties. 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. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 & 5 Accessible information is in place that describes the services provided and enables service users to make an informed decision about moving in to the home. The home has its own assessment plan to ensure that any new service user’s needs are fully assessed prior to their admission and that staff are aware of how to support them. Written contracts are in place, however every service user has a copy to ensure that they are aware of their rights and responsibilities to living in the home and also the home’s duty of care (its terms and conditions). EVIDENCE: The home caters for service users with learning disabilities who also have physical disabilities. Staff have had training sessions specific to some of the service users needs such as epilepsy and diabetes. The manager demonstrated a valuable understanding of each service user’s needs and what support was required. Staff who spoke with the inspector were knowledgeable of the service users needs and how to support them. The home has revised its service users guide and statement of purpose as required at the last inspection. Both these documents now contain all the necessary information. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. Detailed and informative needs assessments were available for the home’s two most recent service users.
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 10 Daily notes and other records seen also evidenced that the new service users were well supported to familiarise themselves with the home and that their respective families were involved throughout the process. A review meeting had not been held for one service user following their admission and this must be addressed as the service user has been living in the home for over six months. The home’s contract has been revised and clearly outlines the terms and conditions of occupancy but each service user needs to be provided with a completed copy. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,8 & 9 Service users’ plans of care clearly identify their needs and how they are supported to achieve their planned goals. Individual plans are frequently reviewed and reflect any changing needs. Generally service users are provided with the necessary support to take risks so that independence is maximised as far as possible. EVIDENCE: Files sampled each contained comprehensive documentation relating to each service user. Informative action plans outline what service users can do independently and when they require support from staff. Overall, plans were being reviewed on a six monthly basis and involved relatives and other professionals such as care managers. Daily records of care directly relate to the assessed needs and goal plans identified in the service user plan. Some service users cannot use verbal communication and the home should therefore consider ways to improve its communication methods for these particular individuals. I.e. service user plans written in a format that they can understand. E.g. Visual, audio or graphic. The manager explained that the home intends to implement person centred planning. Whilst the ability of most of the service users to make informed choices is limited, staff nevertheless try to consult them on everyday decisions that affect them. Discussion with two staff members identified that they were clear about their roles in regards to assisting service users to make the right decisions.
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 12 Records showed that service users are supported to take ‘responsible’ risks as appropriate. Relevant risk assessments, matched to individual needs are in place for all the service users. e.g. personal hygiene, eating, mobility and accessing the local community. The newest service user has left the premises without informing staff on several occasions and as a consequence, staff have been locking the front door for safety reasons. The front door is also a fire exit and was also being bolted. This could compromise the safety of the service users and the home is therefore required to complete a risk assessment and locked door policy. The provider is also reminded that fire doors must not be kept locked with a key as this does not comply with current fire regulations. Should the home continue or need to keep the front door locked, alternative security measures must be put in place such as an electronic key-pad access system. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 17 Arrangements to ensure that the social, leisure and recreational interests of the service users are identified and met need to be improved to enable the service users to have more opportunities to engage in activities in the wider/local community. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food. EVIDENCE: Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 14 The service users at Tweezle Twigg have highly dependent needs including physical disabilities and limited communication abilities. Staff therefore tend to organise activities based upon each individual’s assessed needs and knowledge of service users preferences. Five of the current service users attend two local day centres for two to three days a week. The remaining service users spend their time in the home and activities provided include art and craft, music, television/ videos and beauty treatments. An aromatherapist visits the home on a regular basis. Two service users were supported with their colouring hobby and other residents took part in a music session during the afternoon. Although the home has its own minibus, which can carry up to three wheelchair-bound service users at any one time, access to the local community is somewhat limited as the home does not have enough drivers to meet the transport needs of the residents. The general manager commented that the home was trying to recruit another driver. A number of care plans detailed that service users enjoy outings and they should be provided with the resources to achieve these identified goals/needs. Allocation of staff needs to be improved upon in order that the current drivers in the staff team have more opportunities to take service users out on community outings. I.e. Extra staff allocated on shift to support the service users who are not going out. Meals are regular and menus appeared nutritiously balanced. Service users are able to take meals at flexible times and alternatives are offered where necessary. Nutritional monitoring and dietician support occur where required. Three service users require full support to eat and information about their needs was clearly documented i.e. guidelines and risk plans for those at risk of choking. The kitchen cupboards appeared well stocked with a variety of nutritional foods available. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Personal care is carried out in a way that service users prefer so that dignity and choice are maintained. Service users’ health care needs are met well by this home. Suitable arrangements are in place to ensure that their physical and emotional needs are identified, planned for and met. Medication is well managed to maintain maximised good health. EVIDENCE: The service users require varying degrees of assistance with their personal care. Detailed information is available concerning each individual’s needs and what level of support is required. Consistency and continuity is achieved for service users through designated key workers. Service users have access to relevant professional support to maximise independence, including physiotherapy and speech therapy. Service users are supported to attend regular health checks, outpatient appointments and other medical appointments as required. The continence advisor has links with the home and access to other NHS facilities is available. Care plans include details of GP involvement as well as Consultant, dental, chiropodist, optician and district nurses. Evidence was seen of regular monitoring of healthcare needs including regular medication reviews and weight checks. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 16 There are hoists and handrails in place to assist with meeting the needs of service users who have physical disabilities. The staff team have all attended a moving and handling course. Although none of the service users are able to self medicate, they are supported to take their medication. Medication is stored in a locked cupboard in the dining area and records for administration were found to be well maintained and accurate to service users’ prescribed and current medication. Records and medication relating to one service user’s diabetic condition were being well managed. Adequate staff have undertaken training to administer medication with the registered manager and three senior staff are also trained to administer insulin for one service user. The manager reported that refresher training in medication is planned for all staff later in the year. The home has a contract with a local pharmacist who visits the home to check the medication storage and administration systems quarterly. Guidelines for one service user’s “as required” medication have been put in place although these could be expanded upon to provide clearer instructions on their use i.e. specify a timescale and what action staff should take before medication can be given. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The process for dealing with complaints needs to be improved to ensure that service users and their relatives can be confident that their views will be listened to and acted upon. There are procedures and systems in place regarding the protection of vulnerable adults and prevention of abuse although some further staff training is needed to maximise protection for the service users. EVIDENCE: The home has a complaints procedure that meets all the elements of this Standard that is also available in an accessible format for service users. Prior to this inspection, feedback from relatives indicated that they were not fully aware of the complaints process. The manager is therefore required to ensure that all relatives know how to make a complaint and provide them with a copy of the home’s procedure. In addition, a suitable record for logging complaints needs to be put in place which will serve as a better means for recording concerns and defining how the home takes action to address them. There are systems in place regarding the protection of vulnerable adults. I.e. legislative checks, such as CRB disclosures completed on new and current staff and numerous policies to safeguard the service users welfare. e.g. management of their finances, dealing with aggression and conflict and a whistle blowing policy to state what action to take should staff suspect anything untoward. As previously required, the home’s adult protection policy has been amended so that the stages for staff to follow in the event of a referral are in line with the Croydon local authority’s procedures. The general manager and home manager attended a formal training course on adult protection over two years ago. A requirement is therefore set that all staff receive training on abuse awareness and adult protection. The manager is appointee for the majority of service users and has access to their accounts.
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 18 Appropriate documentation was in place with regard to income/expenditure on behalf of the service users. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26 & 30 To enable service users to live in a safe environment, the home is overall kept clean, hygienic and in a generally good state of repair. However some redecoration is needed in the home and the premises are due a fire safety inspection. In addition, there are still environmental issues that need to be addressed to ensure that home provides the service users with comfortable surroundings that are free from harm. EVIDENCE: The lounge is comfortable and spacious with a range of entertainment facilities including television, video and music stereo system. A selection of board games and art and craft activities are available for the service users. Most of the furniture and fittings are well maintained and of good quality although the dining table and chairs need replacing. In addition, the dining area needs repainting. The bedrooms were found to be decorated to a good standard, comfortable and reflect the personalities and the individuality of each service user. E.g. Items such as family photographs, toys, ornaments, music centres, televisions and videos. Since the last inspection in January 2005, essential repairs to the roof have recently been completed and damp areas attended to in two of the bedrooms. A written maintenance plan has been developed for the home that specifies any redecoration issues/ repairs needed for the premises. This includes a schedule for repainting the plasterwork in two service users bedrooms.
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 20 Progress with the home’s refurbishment plans will be checked during the course of future inspections. Scaffolding was still set up around the building and the general manager advised that various window frames were due to be replaced. Several broken furniture items and two old mattresses were in the rear garden and need to be disposed of. An outstanding requirement remains that the garden path be extended to enable wheelchair users better access. This work has still not been completed due to recent roof repairs and ongoing development of the premises as mentioned above. The home has not been inspected by the local fire service since 2001. A requirement is therefore set that the provider arranges for a visit from the LFEPA (London fire and emergency planning authority) to ensure that the premises comply with current fire regulations. Good hygiene practices are in place and systems to control the spread of infection. The home has various policies and procedures on hygiene and infection control and staff have received mandatory training in key areas. With the exception of the carpet in bedroom 8, the home was clean and odourfree. The provider must replace the carpet with more suitable flooring to meet the needs of the service user. The laundry facilities are in the basement. Washing machines have appropriate programmes to control the risk of infection. Considering that large amounts of laundry are generated, the home would benefit from a more suitable tumble drier as the current one is of a small domestic size and has failed on several occasions. Although an extractor fan has been fitted the ventilation is still not adequate in the laundry areas. Action must be taken to improve matters and therefore the requirement is repeated form the last inspection. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34, 35 & 36 Recruitment practices have been consistently followed and securely managed to maximise protection for the service users. On the whole, appropriately trained staff are meeting the service users’ needs although this could be improved upon. Service users are benefiting from having a well-supported staff team who are receiving supervisions with their manager at regular intervals. EVIDENCE: Since the last inspection, there has been little change to the staff team resulting in ongoing stability and beneficial continuity of care for the service users. The home has one part time vacancy for a carer and one for a driver at present. All new staff who commence work in the home undergo a thorough vetting procedure. Records confirmed that all staff have undergone appropriate checks such as a CRB disclosure and a check against the Protection of Vulnerable Adults register. Staff files were well organised and contained all the required documentation to evidence their fitness to work with this service user group as well as training certificates. Induction processes ensure that staff are fully inducted in all aspects of the home’s care practices along with some training relevant to service users needs e.g. Epilepsy. The home keeps records which show what training courses staff have done, and when they did them. Further training is recommended that is specific to the needs of the service users. i.e. for staff to develop a better understanding and refresh their
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 22 knowledge on communicating with people who have severe learning disabilities. Outstanding from the last inspection is that staff are provided with disability and anti-racism training. This must also be addressed. The home’s supervision programme was found to good and all staff receive formal supervision on a monthly basis. Annual job appraisals need to be completed however for all staff to show that job performance is monitored and staff development needs can be addressed. Minutes of staff meetings were sampled and included in depth consultations about the home’s care practices and service users needs. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,41 & 42 The quality assurance system which the home has established needs to be further developed to ensure that quality of care provided to service users is regularly appraised to see that it is in their best interest and that the home is meeting its objectives. Improvements have been noted in the homes administration procedures which helps to safeguard service users. Overall, health and safety practices ensure that service users live in a safe environment, however record keeping regarding some health and safety issues could be improved upon. EVIDENCE: The last inspection required for the home to implement a quality assurance system and an annual development plan, with both involving the service users. Some quality monitoring tools are in place to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, service users meetings and monthly visits from the registered provider. In addition, satisfaction questionnaires are provided for service users, relatives, care managers and the home’s general
Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 24 practitioner. Recent ones from March 2005 all gave complimentary feedback. To improve quality monitoring, the home should now develop an annual plan of objectives that reflects upon aims and outcomes for the service users. Accidents and incidents are recorded appropriately although the home must ensure that the Commission is notified of any events that affect the service users well being e.g. concerning falls and/ or admissions to hospital. Two such events had been appropriately documented in the home but not reported to the Commission. Regulation 37 of the Care Standards Act was discussed with the manager. Records of regular fire drills, fire equipment checks, water, electrical and gas safety certificates were up to date. Cleaning products that may be hazardous are stored securely in the home. Staff were not fully up to date in areas of health and safety training i.e. moving and handling, food hygiene and infection control. The manager has started to plan for staff to receive appropriate training however through self-learning development packs. Progress will be checked during the course of future inspections. An outstanding requirement is that the manager must ensure that environmental hazards around the home are risk assessed to safeguard the welfare of the service users and minimise the risk of injury. A timescale was agreed with the manager for this to be completed within one month, as the requirement remains outstanding from September 2004. Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 2 2 Standard No 22 23
ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 x x x 2 Standard No 11 12 13 14 15 16 17 x 3 2 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tweezle Twigg Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 3 2 x G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 26 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 28 Regulation 23(2)(a)( n)(o) Requirement The pathway around the rear garden must be continuous and of a sufficient width to provide for a safe passage of service users walking or wheeling around the garden.(Now outstanding from November 2003) All staff must be provided with disability and anti-racism training (Now outstanding from November 2003) The proprietor and those responsible for the home’s management must ensure that residents are enabled to participate in activities outside of the home.(Timescale of 30.9.04 not met) Allocation of staff (drivers) needs to be organised in better fashion to enable service users to participate in community outings. The ventilation in the laundry must be improved.(Timescale of 10.12.04 not met) Each service user must be provided with a copy of the homes contract The manager must ensure that risk assessments of the premises Timescale for action 31.10.05 2. 35 18(1)(c i) 30.9.05 3. 13 12(3) 16(2)(m) 30.9.05 4. 5. 6. 30 5 42 23 5(1)(b)(c) 13(4) 30.9.05 30.9.05 30.9.05
Page 27 Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 7. 4 14(1)(d) (2)(a) 8. 9 13(4) 9. 22 22(5) 10. 23 13(6) 18(1 a & c)19(5 b) 13(4)(a) 23(2)(o) 11. 24 12. 24 23(4) 13. 14. 15. 16. 17. 24 24 26 39 42 23(2)(c & g) 23(2)(c & d)_ 16(2)(c & k) 21(2)24(1 )(a)(b) 37 are carried out, recorded and regularly reviewed.(Timescale of 10.12.04 not met) The home must ensure that an appropriate review meeting is held following the admission of a new service user.Minutes of the meeting need to be documented and provided for the service user and any other relevant parties. The registered provider must write a risk assessment and develop a policy for locking the front door The manager must ensure that all relatives know how to make a complaint and provide them with a copy of the home’s procedure. All staff must receive training on the Protection of Vulnerable Adults, with records to evidence this kept in the home. The registered provider must make arrangements to dispose of the broken furniture items and two old mattresses that are in the rear garden. The home arranges for a visit from the local fire brigade (LFEPA) to ensure that the premises comply with current fire regulations. The dining tables and chairs need to be replaced due to their general poor condition. The dining area needs to be redecorated. The flooring in bedroom 8 needs to be replaced due to the unpleasant odour. The home must produce a written record of an annual quality development plan. The registered manager must ensure that all accidents are recorded and reported in accordance with regulation 37 of the Care Standards Act. 30.9.05 30.9.05 30.9.05 30.11.05 30.9.05 31.10.05 31.10.05 31.10.05 30.9.05 31.10.05 11.7.05 and henceforth Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 28 18. 36 18(1c)(2) 19(5) The registered manager must ensure that all staff receive an annual appraisal and keep records to evidence this. 31.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 20 Good Practice Recommendations Guidelines for one service user’s “as required” medication should be expanded upon to provide clearer instructions on their use i.e. specify a timescale and what action staff should take before medication can be given. Considering that large amounts of laundry are generated, the home should purchase a more suitable tumble drier as the current one is of a small domestic size and has failed on several occasions. Further training should be organised that is specific to the needs of the service users. i.e. communication methods for people with severe learning disabilities. A suitable record for logging complaints needs to be put in place which will serve as a better means for recording concerns and defining how the home takes action to address them. Some service users cannot use verbal communication and the home should therefore consider ways to improve its communication methods for these particular individuals. I.e. service user plans written in a format that they can understand. E.g. Visual, audio or graphic. 2. 30 3. 4. 35 22 5. 6 Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tweezle Twigg G53-G53 S25863 tweezletwig V198509 110705 stage 4.doc Version 1.30 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
