Inspection on 03/08/06 for Tree Tops

This inspection was carried out on 3rd August 2006.

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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tree Tops 23/01/09

Tree Tops 05/11/07

Tree Tops 22/12/05

Tree Tops 11/07/05

Tree Tops 24/01/05

Tree Tops 09/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Tweezle Twigg 3 Campden Road South Croydon Surrey CR2 7EQ Lead Inspector Claire Taylor Key Unannounced Inspection 3rd August 2006 11:00 Tweezle Twigg DS0000025863.V306412.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 Tweezle Twigg DS0000025863.V306412.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. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tweezle Twigg Address 3 Campden Road South Croydon Surrey CR2 7EQ 020 8680 1219 020 8667 1232 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) Tamarind Care Limited Miss Jocelyn Gillam Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 22nd December 2005 Date of last inspection Brief Description of the Service: Tweezle Twigg is a large family house situated in 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 homes 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 for which a variation has been granted. More detailed information about the services provided at Tweezle Twigg can be found in the home’s Statement of Purpose and Service User Guide – copies of these documents can be obtained directly from the home. Fees charged range from £700.00 and were accurate at the time of this inspection. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began at 11.00am and lasted for five hours. In accordance with the Commission’s “Inspecting for Better Lives” programme, the standards considered to be key to the inspection process were assessed at this inspection. Some information was taken from the questionnaire the manager filled in prior to the inspection and from written comment cards returned by some of the service users and seven relatives. Some service users living in the home do not have the capacity to share their views regarding their care. In order to make judgements about the care that these service users received, observations of care practices and interactions with staff took place. The home manager, Jocelyn Gillam facilitated most of the inspection and discussions were held with some of the service users and staff members on duty. Various records, policies and care plans were examined. The premises were viewed, as were several of the residents’ bedrooms. The Commission had received notification that the ownership of Tweezle Twigg was due to change in August of this year. This includes appointment of a new responsible individual for the home and development with the transition will be monitored through the course of future inspections. What the service does well: Tweezle Twigg accommodates service users who have both physical and learning disabilities, some of whom have highly dependent needs and limited communication abilities. The home demonstrates that it continues to meet the needs of the current service user group through a well-established manager and stable staff team. Records showed that family, friends and guests are welcome at the home and that the manager maintains very good communication links with the service users’ respective families. Compliments about friendly and welcoming staff were noted on comment cards received from relatives. “I am very satisfied with the level of care my ‘…….’ is getting..” Likewise, positive responses were noted on cards from two GP practices and one visiting professional to the home who wrote, “I have a good working relationship with the team”. Service users who were able to share their views commented “ I like it here, I’m happy” and “I like the staff”. The premises are homely and comfortable and service users bedrooms are nicely decorated and furnished with their chosen possessions and specialist furniture to meet their needs. Although improvements are needed with record keeping, the manager and staff continue to demonstrate valuable knowledge regarding service users’ needs, likes and dislikes. They were seen to be caring and sensitive in their approach and support individual service users with dignity and respect. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: One area of concern was that the home has repeatedly failed to address an outstanding requirement regarding a health and safety issue from September 2004. Risk assessments of the premises and safe working practices must be completed to ensure protection for the service users and people who work in the home. As a consequence, an enforcement notice was issued following this inspection. Since the December 2005 inspection, there has been an increase in areas where the home needs to improve. Some requirements are now outstanding and must be prioritised. In accordance with the recently amended regulation, the provider must therefore submit an improvement plan to identify how the home intends to address them as well as the new requirements outlined in this report. Ongoing failure to meet with outstanding requirements may result in the Commission taking further enforcement action. Written contracts must be provided to each service user so that they have information about the facilities and services they can expect to receive and likewise, the home’s duty of care to them. The home is still failing to provide service users with opportunities to access the local community which may have a detrimental affect on their quality of life. The registered provider must therefore ensure that their are enough drivers to meet the transport needs of the service users. New areas identified for improvement are outlined as follows. Care plans and risk assessments require expansion, updating and review or this has the potential to affect the quality of care if staff do not have accurate information to support service users needs. Each service user must have an up to date moving and handling risk assessment to ensure that staff have clear guidance on what action to take to support their mobility needs. Additionally, risk plans must be put in place for the newest service user. The home needs to provide a wider range of social and leisure activities that meet the needs and preferences of the service users. To maximise safe medication practices, a new medicine cabinet is needed and service users must have up to date profiles that correspond with their prescribed medications. Overall the home is decorated and furnished to a good standard although the upstairs bathroom is now in need of attention. The adapted chair has been Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 7 broken for some time meaning that service users are unable to use the bath facilities. Although the recruitment procedures are generally robust some gaps in record keeping for staff could affect the protection of service users. The manager must ensure that all documentation pertaining to all persons who work in the home is in place. Staff supervision must be carried out more frequently so that work performance is more closely monitored and any training needs can be identified and actioned. In addition, each staff needs a personal training and development profile. Service user and relatives questionnaires/surveys have been used at the home in the past, but not since March 2005. These are an important part of effective quality assurance and must be completed annually. Some other areas concerning health and safety need attention. The overall gas safety of the home now needs to be checked and weekly hot water temperature checks must be recorded for the protection of service users from potential harm. Five good practice areas are outlined as follows. Two of these are outstanding and should now be given serious consideration. Further training should be organised that is specific to the needs of the service users. I.e. on communication methods for people with profound learning disabilities. Service users care plans should be formatted in a way that is accessible and more meaningful to them. In conjunction with this, the home should now implement person centred planning. It would be better if agency staff sign confirmation when they have completed their induction to show that they have received an appropriate orientation to the home and the service users. The home’s annual training programme for staff should be documented so that any individual development needs can be promptly acted upon. 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 DS0000025863.V306412.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 Tweezle Twigg DS0000025863.V306412.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home provides introduction opportunities for prospective service users and their families to make an informed choice about whether to live there. Service users’ needs are assessed prior to admission to ensure that the home can meet their needs and that staff are aware of how to support them. Written contracts still need to be provided to each service user so that they have information about the facilities and services they can expect to receive. EVIDENCE: Since the last inspection, one new service user moved to the home in April. Records showed that the new service user was given opportunity to visit the home prior to moving in. The staff had completed a needs assessment on admission to identify what levels of support the service user required. Areas covered include hobbies, social/ cultural needs, dietary preferences, medical history and personal care. There was also a recent needs assessment completed by the placing Croydon social services in January of this year. As previously required, a review meeting had been held appropriately after the newest service user’s admission to discuss how they had settled in. It has been required at two previous inspections that a copy of the home’s terms and conditions is made available to each service user. This has yet to be done and the requirement is therefore repeated. The registered provider is reminded that failure to meet outstanding requirements may result in the Commission taking enforcement action. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 10 Tweezle Twigg DS0000025863.V306412.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The care planning process is in need of improvement. Care plans and risk assessments require expansion, updating and review or this has the potential to affect the quality of care if staff do not have accurate information to support service users needs. Mobility risk assessments are also needed to fully safeguard individual residents from potential harm. EVIDENCE: Including the newest service user’s, four files were sampled in relation to the planning of care. Although the home had carried out a review of needs within the last six months, the information was not reflected within the individual care plans. Some service users care plans dated back to 2004 and had not been updated to include any changed needs. Records showed that one person’s psychological needs had deteriorated and although the home was monitoring mood changes and was in consultation with other relevant professionals, the service user’s care plan had not been amended. As highlighted at previous inspections, the home should review the care planning process and consider a move towards a more person centred approach. Service users have highly Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 12 dependent needs and the lack of a person centred planning process means that service users are not fully offered opportunities to make their wishes and aspirations known regarding their care and lives. The manager reported that three staff have undertaken training in this area. 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. Daily records and observation of staff working with individuals reflected this. The manager explained that there are plans to arrange meetings for the service users so that they are given opportunities to contribute to the running of the home. Relevant risk assessments, matched to individual needs were in place for most service users. Examples seen included personal hygiene, eating, safety in the home and accessing the local community. A risk assessment tells the staff how to make sure that each of the service users is kept safe from anything that might harm them. The majority of service users have some degree of difficulties with mobility; some are wheelchair users and one individual is bed bound. Each service user must have an up to date moving and handling risk assessment to ensure that staff have clear guidance on what action to take to support their mobility needs. Additionally, risk plans must be put in place for the newest service user given that they have been in the home for over three months. Although improvements are needed with care plan record keeping, the manager and staff continue to demonstrate valuable knowledge regarding service users’ needs, likes and dislikes. They were seen to be caring and sensitive in their approach and support individual service users with dignity and respect. Tweezle Twigg DS0000025863.V306412.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. Service users are supported in undertaking activities that they enjoy although these could be increased to provide more interest and stimulation for them. The home is still failing to provide service users with opportunities to access the local community which may have a detrimental affect on their quality of life. Service users are assisted to maintain contact with family and friends and visitors are welcomed to the home. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. EVIDENCE: 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. Activities provided in the home include art and craft, music, television/ videos and beauty treatments. An aromatherapist visits the home on a regular basis. One service user enjoys colouring and word Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 14 search puzzle books. A garden party was held in the summer for service users and their relatives. Good records are maintained to show what activities service users take part in although there is a somewhat limited range. In response to the last inspection, little progress has been made with service users being able to access the community. The manager explained that there was still a lack of drivers to facilitate outings. One of the regular staff had been removed from driving duties due a recent phased return from sick leave. Another driver has been appointed but only on a part time basis. Records showed that some service users had not attended their respective day care placements since May of this year. In addition, some individuals enjoy outings and they should therefore be provided with the resources to meet their identified needs and achieve their personal preferences. As highlighted at previous inspections, the registered provider must therefore ensure that their are enough drivers to meet the transport needs of the service users. Records showed that family, friends and guests are welcome at the home and that the manager maintains very good communication links with the service users’ respective families. Compliments about friendly and welcoming staff were noted on comment cards received from relatives. One service user met said they go and stay with their family every weekend and another talked about her relative regularly visiting the home. The menus appeared nutritiously balanced with alternatives offered where necessary and service users are able to take meals at flexible times. Nutritional monitoring and dietician support occur where required. Records are kept of the service users’ food choices and also fluid intake charts for one service user. Three service users require full support to eat and information about their needs was clearly documented i.e. guidelines for those at risk of choking. Tweezle Twigg DS0000025863.V306412.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 at least once during a 12 month period. 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 all the available evidence including a site visit to this service. Personal care is carried out in a way that service users prefer so that dignity and choice are maintained. Promotion of health is well observed and suitable arrangements are in place to ensure that the service users’ physical, healthcare and emotional needs are met. Overall, the arrangements for the management of medicines are appropriate but some improvements are needed to further maximise safe practice and ensure that service users are not put at risk. EVIDENCE: Records concerning service users healthcare needs were in good order and involvement with specialist services highlighted where necessary. They showed that potential complications and problems are identified and dealt with through prompt referrals to the appropriate health professional. Service users are in regular contact with General Practitioners, consultants and other health care services as required. I.e. hospital clinics, dentist and optician. Medication records are overall well organised and no errors were noted on the sampled administration sheets. Records were accurate for the receipt and disposal of medication although each service user needs a current medication profile with photo, as several were out of date. An appropriate healthcare Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 16 professional reviews each service user’s condition regularly to ensure that they receive the correct medication regime or treatment where necessary. Medicines are stored in a lockable wall filing cabinet although this is not ideal as the facility is also used to store non-medical items such as service users’ daily records and other day-to-day documentation. The home must therefore obtain a more suitable cabinet that meets the requirements of pharmacy legislation and that can be used purely for the safe storage of medication. The supplying pharmacist visits the home to check the medication storage and administration systems quarterly; the last visit was carried out in February of this year. Some areas of advice were given and the manager acknowledged that these were yet to be actioned. Most of the staff have received in house training on administering medication and the manager advised that staff were due to complete distance learning training on medication. These issues will be checked for progress at the next inspection. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Arrangements for complaints and protection from abuse are well managed and ensure that service users feel listened to and safe. EVIDENCE: The home has a complaints policy and feedback from relatives showed confidence that the home would deal with any complaints appropriately and that staff are approachable and receptive to any concerns raised. The current group of service users living at the home would need support to make a complaint and would rely on a relative, staff or other people to raise a complaint on their behalf. There is a complaints book and records showed that no complaints have been made since the last inspection or indeed within the last twelve months. 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, adult protection procedures and a whistle blowing policy to state what action to take should staff suspect anything untoward. The majority of staff have received training on the protection of vulnerable adults with plans for the newest employees to attend a suitable course. The manager is appointee for the majority of service users and has access to their accounts. Appropriate documentation was in place with regard to income/expenditure made on behalf of the service users. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29 and 30 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Overall the home is decorated and furnished to a good standard enabling service users to live in comfortable surroundings. The premises is kept clean, hygienic and in a generally good state of repair although the upstairs bathroom is now in need of attention. The adapted chair has been broken for some time meaning that service users are unable to use the bath facilities. EVIDENCE: The home remains well maintained and furnished to comfortable standards. The living accommodation is well decorated and homely. Since the last inspection, the hallway and staircase has been redecorated. Several bedrooms were viewed with permission of the service users. The staff have ensured that each service user’s bedroom reflects their interests, hobbies and personal identities. Three service users confirmed that they liked their rooms and had all the things they needed. As previously required, a more suitable flooring has been fitted in one service user’s room and the home was awaiting delivery of a new mattress for this individual who has some incontinence needs. The majority of service users have physical disabilities or difficulties with mobility. Staff members have access to specialist equipment and aids to assist them in Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 19 promoting and maintaining the independence of service users. E.g. hoists, rails and wheelchairs. In the upstairs bathroom however, the adapted chair for the bath was broken and therefore out of use for service users. Service users should have the option to take a bath if they prefer and records showed that one individual has indicated such a preference. The home must therefore arrange for the necessary repair or replacement of the adapted chair. In addition, the bath panel is also in need of mending. Aside from this issue, the premises presented as very clean and free from malodour with good standards of hygiene practice well observed. The regulatory records from the Fire authority and Environmental Health departments were checked and up to date. Following the visit in July 2006, the Environmental Health officer set two requirements that the home needs a policy on safe food management and that the kitchen needs redecorating. Progress will be checked at the next inspection. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The service users are supported by a team of staff who are committed to meeting their needs although some minor improvements are needed with staff training and supervision. Although the recruitment procedures are generally robust some gaps in record keeping could affect the protection of service users. EVIDENCE: Valuably, staff turnover remains low and most of the staff have worked in the home for many years. This means that service users benefit from a stability and consistency of care. Staff allocation allows for three carers to be on morning duty, three in the afternoon with two staff at night. The lack of drivers however has a direct bearing on the failure to provide external activities for service users as mentioned earlier in the Lifestyle Standards. Various staff files were sampled including documentation for the regular bank and agency staff that work in the home. Since the last inspection the home has employed two members of staff; both files were examined and contained the majority of required checks including a completed job application, the terms and conditions of their employment, two references and a CRB disclosure/POVA check. Some gaps were noted however in that files did not have any photographs or proof of identity. The manager must ensure that all documentation pertaining to all persons who work in the home is in place. The Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 21 manager should refer to those listed in Schedule 2 of the care homes regulations. New staff complete an induction process whereby an experienced staff supervises and supports the new worker. Learning topics include the particular needs of the service user group, the worker’s role in the home and general principles of care. The home uses regular agency staff on occasions and it would be good practice if these staff sign confirmation when they have completed their induction. Records confirmed that the home meets the required standard for numbers of trained NVQ staff. The manager oversees staff training and was in the process of planning a training programme for staff to refresh their knowledge as needed and attend mandatory courses such as moving and handling, first aid and infection control. This needs to be recorded and a training and development profile needs to be developed for each staff that includes identified training needs. As previously recommended at the last two inspections, training that is specific to the needs of the service users should be organised. I.e. for staff to develop a better understanding/ refresh their knowledge on communicating with people who have profound learning disabilities. Minutes of staff meetings were sampled; most recent held in April 2006, and included in depth consultations about the home’s care practices and service users needs. Staff supervision is undertaken by the manager to discuss concerns, monitor job performance and offer guidance. Records showed that yearly job appraisals for staff were up to date but some staff had not received supervision for several months including the two staff appointed in April of this year. Supervision must be completed more frequently so that work performance is more closely monitored and any training needs can be identified and actioned. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. Service users have the benefit of a home that is run by an experienced manager who has relevant qualifications and good leadership qualities. Overall, health and safety practices are well observed but the ongoing failure to complete risk assessments of the premises has the potential to put people living and working in the home at risk. Some routine maintenance and safety checks are also needed. EVIDENCE: Jocelyn Gillam, the registered manager has attained the NVQ level 4 management qualification and is continuing to study for the Registered Managers Award. She began employment as a support worker at Tweezle Twigg and has gained vast experience in working with people who have learning disabilities. Discussions and observation confirmed that she is openly familiar with the needs of the service users and continues to demonstrate good management practice. Staff spoke well of her leadership qualities and this is Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 23 reflected by the low turnover of staff. Records showed that service users, relatives and visitors to the home are consulted on the quality of care and facilities provided. Service user and relatives questionnaires/surveys have been used at the home in the past, but not since March 2005. These are an integral part of effective quality assurance and must be completed annually. Other systems are used to monitor quality of care including service users reviews, monthly environment checks and as previously required, the registered provider had undertaken monthly visits in accordance with Regulation 26 of the Care Standards Act. Records of these visits were seen for the months of March through to June 2006. One area of concern was identified in that the home has repeatedly failed to address an outstanding requirement regarding a health and safety issue from September 2004. Risk assessments of the premises and safe working practices must be completed to ensure protection for the service users and people who work in the home. As a consequence, an enforcement notice was issued following this inspection. The servicing and maintenance records of equipment in the home were generally up to date. Relevant and timely certificates were held on all things except the overall gas safety of the home which now needs to be checked. Records for weekly hot water temperature checks had not been completed and this is required for the protection of service users from potential harm. Fire drills are organised at regular intervals and fire alarms and equipment checks were up to date. Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 1 X Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 25 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 YA5 Regulation 5(1b&c) Requirement Each service user must be provided with a copy of the homes contract. (Timescale of 30.9.05 and 31/01/06 not met) Each service user must have an up to date care plan that is based upon their needs assessment review and/or as needs change. Service users care plans must be reviewed at least six monthly. Each service user must have an up to date moving and handling risk assessment to ensure that staff have clear guidance on what action to take to support their mobility needs. Risk assessments based upon assessed needs must be put in place for the newest service user. The home provides a wider range of social and leisure activities that meet the needs and preferences of the service users. Timescale for action 30/09/06 2. YA6 15(1,2) 31/10/06 3. 4. YA6 YA9 15(2)(b) 12(1 a) 13(4)(5) 31/10/06 31/10/06 5. YA9 13(4) 30/09/06 6. YA12 12(1 - 3) 16(2 m,n) 31/10/06 Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 26 7. YA13 12(3) 16(2m) The proprietor and those responsible for the homes management must ensure that service users are enabled to participate in activities outside of the home. Allocation of staff (drivers) needs to be organised in better fashion to enable service users to participate in community outings. (Now outstanding from September 2004) A more suitable storage facility must be provided for the safe storage of medication that is in line with Pharmacy legislation. Each service user must have an up to date medication profile with photograph. The adapted chair and the panelling for the upstairs bath must be repaired or replaced. The registered provider must ensure that all documentation required in Schedule 2 of the National Minimum Standards and regulations is obtained for all staff members and retained in the home. Each staff member must have a documented individual training and development profile. The registered manager must ensure that each member of staff has formal documented supervision at least six times per year. Quality assurance questionnaires need to be offered to service users; their family/ representatives and other interested parties to assess whether the home is meeting its aims, objectives and stated purpose. 31/10/06 8. YA20 13(2) 30/11/06 9. 10. 11. YA20 YA29 YA34 13(2) 17(1a) 23(2) 31/10/06 31/10/06 31/10/06 13 (4 c) 18(1) Sch. 2 & 4(6) 12. YA35 18(1)(c) 19(5d) 30/11/06 13. YA36 18(1a)(2) 31/10/06 14. YA39 24 30/11/06 Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 27 15. YA42 13(4) 16. YA42 13(4) 23(2 c, j) 17. YA42 12(1a) The manager must ensure that risk assessments concerning the premises and safe working practices are carried out, recorded and regularly reviewed. (Now outstanding from September 2004. Enforcement notice issued) Hot water temperature checks on all hand basins, baths and showers must be carried out on a regular basis with records maintained. The registered provider must ensure that the home’s overall gas safety is checked and certified. 12/09/06 30/09/06 31/10/06 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 YA35 Good Practice Recommendations Further training should be organised that is specific to the needs of the service users. i.e. on communication methods for people with profound learning disabilities. (Repeated from July and December 2005 inspection) The home should implement person centred planning to make the care plans more accessible and meaningful to individual service users. 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. pictorial, audio or graphic. (Repeated from July and December 2005 inspection) The homes agency staff sign confirmation when they have completed their induction. The home’s annual training and development programme for staff is documented. 2. 3. YA6 YA6 4. 5. YA33 YA35 Tweezle Twigg DS0000025863.V306412.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 DS0000025863.V306412.R01.S.doc Version 5.2 Page 29 - 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. 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