CARE HOME ADULTS 18-65
Trefusis 38 Trefusis Road Redruth Cornwall TR15 2JH Lead Inspector
Lowenna Harty Unannounced Inspection 22nd June 2006 10:00 Trefusis DS0000009120.V301478.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 Trefusis DS0000009120.V301478.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. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Trefusis Address 38 Trefusis Road Redruth Cornwall TR15 2JH 01209 219333 01326 371099 enquiries@dcact.eu.com 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) Spectrum Ms Janet Elizabeth Hurley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Trefusis is a care home providing accommodation and personal care for up to 3 adults with a learning disability. The home is run by Spectrum, an organisation that provides specialist care in small units to adults who have autistic spectrum conditions. The aim is to provide service users with a homely environment in a local community setting and to enable them to live as normal a life as is possible. Spectrum employs a manager and team of staff to provide care and support for the service users living in the home. Senior managers from outside of the home are available to provide additional specialist input as and when it is required. The house is a detached, two-storey building set in its own grounds. Access is suitable for the three service users living there. The home is situated within easy reach of the town of Redruth with good access to transport and all the facilities of the town. The home has transport and drivers. Service users are provided with individual furnished bedrooms and a shared bathroom. The home has a combined kitchen and dining room, separate office and two lounges, one of which doubles as a staff sleeping in facility. The home has a spacious garden that is well maintained. There is a lockable office on the first floor of the building. Fees range from £813.00 - £7083 per week. Additional charges are made to service users for hairdressing, certain activities outside of the home such as bowling and swimming and personal items. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an annual key inspection, which took place on 22 June 2006 and was unannounced. It lasted for approximately seven hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that service users’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with them and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of the service users and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s manager. The principle method used was case tracking. This involves examining the care notes and documents for a select number of service users and following this through with interviews with them and/or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, all three of the service users were case tracked. There was evidence of ongoing improvement in care standards at this inspection and work is continuing to improve it further to provide service users with a safe and comfortable home in which they can develop their skills and independence. What the service does well:
Admission to the home is based on a detailed assessment so that service users can be confident it will be suitable for them. They are provided with written information about the home, what it provides and what is expected of them, which is provided to them in suitable formats, including translated formats, if this is appropriate. It is also sent with their relatives and representatives. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 6 Service users have detailed written care plans, which set out how the home will meet their personal, health and social care needs, including needs relating to their individual backgrounds and culture, age, sex, religion, individual abilities and sexual orientation. They, their relatives and representatives are invited to regular reviews so that their care plans can be agreed with them and updated. They are encouraged to make important decisions about their lives, such as what activities to take part in during the week and how to spend their free time so that they develop their confidence and independence. Any risks are carefully managed, to minimise restrictions on service users and enable them to take part in activities that develop their skills and enhance the quality of their likes. Service users enjoy a good quality of life in the home. Staff support them to take part in a wide range of activities in the community, which vary according to their individual interests. One attends a local college on a regular basis, whilst another undertakes voluntary work in the community, which she values greatly. The other prefers to take part in a range of activities in and out of the home with staff, rather than attend a formal college or work setting. Activities are age and culturally appropriate for them. They attend a variety of social activities within Spectrum and visit pubs and cafes with staff, in the community. They are actively supported and encouraged to maintain contact with their families so that they maintain and develop valued relationships outside of the home. They take part in planning, shopping and preparing meals with staff support so that they enjoy their meals, eat healthily and develop their independent living skills. Service users are encouraged to independently attend to their personal care so that they look smart and fashionably dressed, and take pride in their appearance. Staff provide low-key support and prompts, where necessary. They are helped to access a range of NHS healthcare providers, such as doctors, opticians and community nurses so that they maintain good general health and receive any specialist services they need. Their medicines are safely stored in the home and staff have clear written guidance so that they are protected from medication errors. Service users are able to make their views known and are taken seriously, especially if they wish to complain about any aspect of their care. They and their representatives said that they are safe and well cared for in the home and there is a real commitment among the staff team to ensure their welfare and protection from abuse. There are very sound formal systems in place to protect them, including written guidance for staff, and training. The home provides service users with ordinary, domestic accommodation in the community so that they can develop their skills and independence in a non-institutionalised setting. It is well situated so that they can access local community facilities easily and essential maintenance tasks are carried out promptly to ensure it is kept safe for them. It was clean and tidy throughout at the time of the unannounced inspection. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 7 There are sufficient numbers of staff with formal qualifications in care so that service users can have confidence that they are competent and they are employed in sufficient numbers to be able to work effectively with service users individually. The staff team is selected fairly and on the basis that people employed to work in the home are fit and suitable to work with vulnerable adults in a care setting so that service users and their representatives can have confidence in the people caring for them. All staff undergo induction training before they start to work in the home and have good ongoing access to training so that service users can have faith in their skills. The home is competently and well managed for the benefit of service users. The manager is registered with the Commission as a fit and suitable person to be in charge of a care home. Service users and their representatives confirmed that they are given opportunities to contribute their views about the management of the home, particularly during reviews and said that they are satisfied with the care and services the home provides. The home provides service users and staff with a safe environment to live and work in and they said that they feel safe in the home. What has improved since the last inspection?
The home’s manager said that she has increased the range of activities that service users are able to take part in so that they have more choice in this respect and improved quality to their lives. She also provided examples of how she has actively encouraged and supported service users to maintain valued contact with their relatives. Written procedures to guide staff on how to manage service users’ medicines have been revised and up-dated. The manager has signed and dated them so that staff have clearer instructions and are less likely to make errors with regard to medication in the home. The home’s manager has undertaken training in the safe handling of medicines and most of the staff team have completed internal training with Spectrum so that they can safely and effectively assist service users with their medicines. Written information for staff on what they should do if they suspect a service user has been abused has been updated and improved so that they have very clear guidance. Spectrum’s internal policies have been reviewed and updated and are available in the home and the registered manager has written guidance from each of the service users’ placing authorities, as well as Cornwall County Council’s guidance so that staff can readily access the external agencies they need to contact if they suspect abuse. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 8 There have been some improvements to the home’s environment since the previous inspection and this time there was no odour of damp in any part of the house. All the service users have been provided with new beds and the registered manager was awaiting delivery of a new fridge and dishwasher for the kitchen. Most of the care staff have now undertaken training in infection control so that they are better trained to ensure that service users are protected from cross-infection. The manager has altered the deployment of staff so that there are more opportunities for service users to receive individual input from them. This means that their care plans can be more individually tailored to their needs and preferences. Induction training for new staff has improved so that all new staff receive training that is essential to enable them to work safely with service users prior to their commencing work in the home. What they could do better:
Service users and/or their representatives should be provided with improved information on the cost of their placements in the home, including clear, up-todate and accurate information on how the contributions they make are calculated so that they are made fully aware of their financial rights and obligations. Service users would benefit from being provided with more detailed and specific goals in their care plans so that they and their representatives are better informed of their progress and achievements in the home over time. Written records of medicines administered to service users, whilst mainly accurate and complete, should be clearly counter-signed where they are hand written, so that it is clear who has authorised any changes, where these occur. Less urgent, but nevertheless necessary maintenance tasks need to be attended to more promptly so that service users have a well-maintained and attractive environment at least most of the time. At the time of the inspection one service user had been waiting for a carpet for her bedroom and the paint was pealing off a large section of the wall in another bedroom. Parts of the communal areas also appeared worn and shabby and were in need of redecoration. Staff should be provided with formal supervision with records kept on a more regular basis so that service users can have confidence that the people working with them are well supervised. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 9 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. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 10 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 Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 11 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&5 Quality in this outcome area is adequate. Service users’ needs are assessed prior to their admission to the home to ensure that it will be suitable for them and they are provided with written statements of the terms and conditions of their placement in the home so that they are informed of their rights and obligations, but this does not include clear, or in every case, accurate information about the cost of their placements or how their individual contributions towards it are calculated. EVIDENCE: There have been no changes to the service user group for several years and all confirmed that they are familiar with the services that the home provides when interviewed. There is detailed assessment information relating to all the service users available on the home’s secure electronic information system, which was reviewed during the inspection. Service users have written statements of the terms and conditions of their placement, in suitable formats to make the information accessible to them, which they have signed and which were reviewed during the inspection. The information given to them does not include the total cost of their placement or a detailed breakdown of how their personal contributions towards the total cost is calculated to provide them with clear information about their welfare rights and in one case, the information did not accurately reflect the actual amount of their personal allowance although the correct amount was being paid to the service user. Representatives of service users who were interviewed confirmed
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 12 that information on service users’ terms and conditions is shared with them, is clear and fair. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. Service users are aware of their care plans, which address their health, social and personal care needs in full, including needs relating to their age, sex, sexual orientation, disability, cultural and ethnic backgrounds and religion. They would benefit from more detailed and specific goals to work towards so that they can monitor their own progress and achievements. They are encouraged to develop their skills in making decisions for themselves to develop their confidence and independence and to take managed risks in this respect. EVIDENCE: Service users confirmed that they are aware of and understand their care plans in interviews with them during the inspection. They said that they are invited to attend their reviews and to contribute to the process. Their relatives and representatives confirmed this. Copies of service users’ care plans were available for inspection. They are detailed and address service users health, social and personal care needs in full, although the goals set for service users were not very detailed or specific. The home’s manager, staff and service users themselves provided examples of how they are enabled and encouraged to make decisions for themselves and their abilities in this respect are considered as part of the care planning
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 14 process. There are formal consultation exercises held with service users each month and records are maintained of this, as well as informal discussions on a day-to-day basis. Service users are able to choose what to wear, the types of activities they would like to take part in during the day and how to spend their leisure time, for example. There are detailed, written risk assessments in place for each service user, with clear risk management plans so that service users can undertake a range of activities to develop their skills and independence in ways that are safe. These also detail any restrictions that are necessary to protect the service users and/ or other people. Service users have signed them to indicate their agreement and relatives and representatives interviewed as part of the inspection stated that they are sent to them as well. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. Service users access a wide range of activities, in accordance with their individual needs and preferences, so that they develop their skills and independence. They access the local community and are supported to maintain valued relationships with their friends and relatives so that they are not isolated and they enjoy a good quality of life. Their rights and responsibilities are recognised and promoted as far as is practicable and they are well fed so that they stay physically healthy and enjoy their meals. EVIDENCE: During the inspection, service users took part in a range of different individual activities and there were sufficient staff to support them to do this. Their individual needs and preferences are considered as part of the ongoing care planning and review process so that they can be provided with activities that are appropriate for them. This includes attendance at a local college for one and voluntary work for another. Service users’ daily care records confirm that they make use of a wide range of community resources, including colleges, cafes, pubs and shops and staff
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 16 confirmed that they support them to go out of the home regularly, so that they can develop confidence in dealing with community situations. Service users talked about their families and their contact with them during the inspection. There are records of this, including visits home, which their relatives confirmed. Their care plans and risk assessments consider issues and surrounding their developing personal relationships and senior managers from Spectrum are able to provide support where necessary, so that care staff are informed of how to support service users appropriately in this respect. Service users rights and responsibilities are clearly set out in their individual service users’ guides, in written and translated formats, so that they are informed of what is expected of them. These are shared with their relatives and representatives, who confirmed that the information is clear and fair. Service users said that they like the food provided to them and they are encouraged to plan, prepare and make meals for themselves, with staff to assist them, where necessary. There are clear records of food provided to service users so that staff can monitor their nutritional intake and encourage them to eat healthily. Trefusis DS0000009120.V301478.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. Service users are helped to maintain and develop their independence with regard to their personal care. They are assisted to access the healthcare services they need so that they can stay well and enjoy their lives. Arrangements for managing medicines are mainly safe but some improvements are needed to ensure that service users are protected from medication errors. EVIDENCE: Service users were observed to make use of the bathrooms and facilities for maintaining their personal care independently, whilst staff were available at all times to prompt and assist them in low key ways, where necessary. They appeared smart and fashionably dressed and obviously take a pride in their personal appearances. There are clear records of their regular attendance for health checks with a range of NHS healthcare providers, including doctors and dentists and specialist services, where necessary. Relatives and representatives interviewed stated that they are satisfied that service users’ health care needs are managed appropriately. There are secure storage facilities for service users’ medications and staff have clear written guidance for the safe management of medicines in the home. There are clear written records although some hand written instructions should
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 18 be clearly countersigned and referenced back to the original prescriptions so that there is a clear audit trail in respect of medicines administered to service users. The registered manager has undertaken a course in the safe handling of medicines and most of the staff team have completed internal training with Spectrum in this respect, so that the manager is confident of their ability to safely assist service users with their medicines. Trefusis DS0000009120.V301478.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. There are formal and informal systems in place so that service users’ views can be taken into account in the day-to-day running of the home. Service users’ welfare and best interests are well protected so that they feel safe and well cared for in the home. EVIDENCE: Service users confirmed that their opinions are listened to and said that they are satisfied with the care and services provided to them at the home. The home’s manager said that there are formal systems by which service users can make their views known. These are through care plan reviews, monthly meetings to elicit their views about the home and the home’s complaints procedure, which is given to all of them. Records held in the home backed this up, including full and detailed records of formal complaints, which had been satisfactorily resolved and copies of questionnaires completed by service users. Informally, service users constantly interact with staff, which was confirmed through interviews with them and observation during the insp0ection. Service users said that they feel safe and are well cared for in the home. Their representatives confirmed that they have confidence in the home’s ability to protect service users from abuse. There are full and detailed written procedures to guide staff on the action they should take if they suspect a service user has been abused. They have received training within Spectrum and the home’s manager has attended multi-agency training on the protection of vulnerable adults from abuse, so she is familiar with the way in which different agencies should work together to protect vulnerable people. The home’s records showed that staff are recruited on the basis that they are suitable to work with vulnerable people in a care setting. Most importantly, service users are not isolated in the home. They are encouraged to participate in community activities and maintain contact with relatives and representatives
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 20 from outside of the home. They all have good communication skills and are able to tell people if they have any concerns about the ways in which they are being looked after. Trefusis DS0000009120.V301478.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. Whilst the home provides mainly suitable accommodation for service users, improvements are needed to make it more comfortable and attractive for them. The home is kept clean and tidy and good hygiene is maintained so that service users and staff are protected from infection risks. EVIDENCE: The home is well situated so that service users can readily access local community facilities, but set in its own grounds so that they have a degree of privacy. It is an ordinary, domestic house, suitable to encourage service users to develop their skills in independent living. Service users have their own rooms, which they have keys to so that they can lock them for privacy. Maintenance records show that emergency repairs are quickly attended to, so that the home is kept safe for service users and staff confirmed this. There has been less prompt action in respect of routine, ongoing maintenance of the property, however, and at the time of the inspection, parts of the home were in need of re-decoration. A carpet in one bedroom needed replacement and the paint was pealing off the wall in another, so that service user’s rooms were less comfortable and attractive for them than they should have been. There have been some improvements, service users confirmed that they have new beds in their rooms and the registered manager said that new white goods are due to be delivered to improve the kitchen, including a new fridge and dishwasher.
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 22 The home appeared clean and tidy throughout at the time of the inspection, with equipment in place to ensure good hygiene. The registered manager stated that new staff undergo training in basic food hygiene and infection control as part of their induction training and existing staff have good access to ongoing training to ensure they update their knowledge and skills on a regular basis. Records and staff who were interviewed confirmed this. The registered manager said that service users have undertaken basic food hygiene training because they assist in the preparation of food and she is arranging for them to update this. Most of the care staff have undertaken training in infection control and all have been trained in basic food hygiene. Trefusis DS0000009120.V301478.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. At least half of the staff team are qualified to the level recommended in the National Minimum Standards so that service users can have confidence that people working with them are competent to do so. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. They have good access to ongoing training, so that service users can be confident that they have the training they need to be able to work safely in the home. Staff are well supported but should be provided with more regular, formal supervision so that service users can be assured that they are properly supervised. EVIDENCE: The home’s manager said that at least half of the staff team are qualified to NVQ level 2 or above and the remainder are in the process of completing their training to achieve this. Records reviewed at the time of the inspection confirmed this. Service users’ representatives said that they find staff knowledgeable and helpful. Staff who were interviewed and service users confirmed that staff are employed in sufficient numbers to be able to work effectively with service users. The manager said that she has re-organised duty rotas to ensure that there are sufficient staff to undertake individual work with service users. At the time of the unannounced inspection there were sufficient staff on duty and they were observed to work closely and appropriately with service users.
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 24 A staff member who was interviewed said that they were treated fairly when they were recruited. Staff recruitment records show that recruitment is fair and effective in that job applicants are tested against pre-set criteria, having submitted an application form and safe in that checks are made that they are suitable to work with vulnerable adults in a care setting. A staff member who was interviewed said that they received formal induction training on taking up their post and that they have good access to ongoing training so that they can develop their knowledge and skills. The manager has drawn up a team training plan for the home, which was reviewed at the time of the inspection and there are records of training undertaken by individual staff, which were also reviewed. Staff rotas indicate that there is a good skills mix among staff on duty so that service users can be safely cared for. The manager said that induction training for new staff has improved so that when they come to work at the home they have already received “core” training covering first aid, basic food hygiene and other training essential to work safely in the home. The home’s manager works alongside staff and the staff member who was interviewed said that they feel well supported. Records of formal supervision indicated that staff do not receive formal 1:1 supervision on a regular basis and this needs to improve. Trefusis DS0000009120.V301478.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome group is good. The manager is competent to be in charge of the home so that service users can be confident that the home is well managed for their benefit. Service users are able to contribute their views and opinions, which are taken into account in the day-to-day management of the home. There are suitable arrangements to protect their health, safety and welfare. EVIDENCE: The manager is registered with the Commission as fit to manage a care service. Service users, their representatives and staff who were interviewed confirmed that the home is well managed for their benefit. Service users said that they are satisfied with the care and services provided to them at the home and their representatives agreed with this. They confirmed that they are able to contribute their views during formal care planning reviews. There are records of complaints to show that service users who have grievances are taken seriously and action is taken to ensure issues they raise are resolved to their satisfaction. Where appropriate, senior managers and
Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 26 external professionals are involved in their resolution. Records indicate that Spectrum’s senior managers regularly visit and inspect care and safety standards in the home. Service users are formally consulted each month on the quality of the care and services provided to them so that standards in this respect are constantly monitored. The registered manager is in the process of drawing up an annual development plan for the home for this year, based on the outcome of ongoing consultation with service users and reviews of their care needs. The home looked safe for service users and they all confirmed that they feel safe there. The staff member who was interviewed also said that they feel safe in the home. She said that emergency repairs are attended to promptly so that service users and staff are not placed at risk. Records indicate that the manager has undertaken fire safety and environmental risk assessments and regularly reviewed them to ensure a safe environment for service users, staff and visitors. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 28 NO 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 YA24 Regulation 23(2)(b) & (d) 16(2)(c) Requirement There must be prompt action to ensure that identified maintenance tasks are carried out. This includes ensuring that all parts of the home are kept reasonably well decorated and that service users’ bedrooms are provided with suitable floor covering. Timescale for action 01/07/06 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 YA5 Good Practice Recommendations Service users should be provided with clear information about the costs of their placements, including more detailed and accurate information on how their personal contributions are calculated Service users’ individual care plans should contain more specific and detailed goals to assist them to develop their skills and independence in practical activities of daily living. Hand written instructions on MAR charts should be
DS0000009120.V301478.R01.S.doc Version 5.2 Page 29 2. YA6 3.
Trefusis YA20 4. YA36 counter-signed and referenced back to the original prescription. Care staff should be provided with more regular individual/ formal supervision, with records maintained. Trefusis DS0000009120.V301478.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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