Inspection on 14/09/05 for Tullyboy Homes

This inspection was carried out on 14th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tullyboy Homes 05/09/06

Tullyboy Homes 01/02/06

Tullyboy Homes 11/01/05

Tullyboy Homes 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tullyboy Homes 2 Inlands Close Pewsey Wiltshire SN9 5HD Lead Inspector Tim Goadby Unannounced 14 September 2005 th 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. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tullyboy Homes Address 2 Inlands Close Pewsey Wiltshire SN9 5HD 01672 562124 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) Tullyboy Homes Mrs Catherine Howie Care Home 5 Category(ies) of LD Learning Disability (5) registration, with number of places Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 January 2005 Brief Description of the Service: 2 Inlands Close provides personal care and accommodation for five adults who have a learning disability. The home is owned by Tullyboy Homes, a private sector organisation. They run another similar establishment in Wiltshire. Both owners have close involvement in all aspects of service delivery. One of them is also the registered manager for Inlands Close. The house is in a residential area, close to the various amenities available in the large village of Pewsey. The service has been open for over ten years. All five current residents have lived there since it opened. All service users have single bedrooms. Most of these are on the ground floor. There is one user’s bedroom upstairs. This has an en-suite shower. There is a bathroom for general use downstairs. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in September 2005. It was a short notice announced inspection, arranged two days beforehand. The two homes operated by Tullyboy were both inspected on the same day. Findings have been applied to both services, where appropriate. The following inspection methods have been used in the production of this report: indirect observation; sampling of records, with case tracking; discussions with service users and management. What the service does well: What has improved since the last inspection? Care plans and accompanying guidance had been updated and clarified, for people with significant changes in needs. Systems were working to keep key issues under regular review, with the involvement of appropriate specialist advice. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 6 The organisation’s risk assessment format includes a scoring system. Previously, this had not always been applied correctly. But the examples seen during this inspection were completed accurately. What they could do better: 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. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 7 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 Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 8 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 & 5 Prospective service users have the necessary information to make a choice about the home. Standards relating to admissions to the home were not applicable at this inspection. Service users have their needs and aspirations met by the home. Service users have individual terms and conditions of residence in the home. EVIDENCE: The home has produced all required documentation about its services and facilities in thorough detail. It has also made some available in adapted formats that residents might understand. All the necessary criteria are addressed. Information is presented in a clear and easily understandable form. There have been no new admissions to the home since 1993. It is therefore not possible to rate practice under the relevant standards. The organisation has relevant procedures, which have been applied in its other home. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 9 Inlands Close has regular input from a range of professionals. They assist the home in meeting the various needs of its residents. A range of support is offered to the user group. There is ongoing assessment and planning in place, to adapt to the developing needs of particular individuals. Reference is made to steps that would be taken if the service ever felt unable to meet someone’s needs. The home’s staff have undertaken various training courses in techniques and principles that are of direct relevance to their daily work with residents. Service users’ contracts reflect that their places are funded by the local authority. Updated information is available to show fee levels for the current year. The home has produced its own information on key terms and conditions of residence. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 10 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, 7 & 9 Service users have their abilities, needs and goals reflected in their individual plans. Service users can make choices and decisions in their daily lives. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: The home has a comprehensive care plan format. This provides a range of relevant information for each user. Needs are identified. The actions to be taken in response are clearly described. There is also a focus on people’s strengths and preferences. The home’s practice under a range of standards can be seen by reference to these plans. Care plans include a section on goals for each individual. These set out the actions being taken towards these targets. They provide a framework for review. This takes place at regular intervals. Where changes have been Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 11 made, the previous information is also left visible. This shows how things have developed. The home promotes people’s rights to make their own choices and decisions, wherever possible. A Users’ Charter sets out their entitlements. Experimentation and exploration are encouraged. The input of the home’s staff team, and other relevant parties, is to ensure that responsible decisions are reached by a process of assessment. Guidelines for the approach taken to particular needs are drawn up with help from other professionals. Systems for the management of service users’ money appear to be efficient. The registered manager is appointee for all five, although some people have the involvement of family or other representatives in respect of certain sums. Appropriate recording is in place to demonstrate the home’s accounting systems. These are open for inspection, if relatives wish it. They are also checked annually by an external accountant. Arrangements for direct payment of service users’ benefits income are in line with guidance set out by the CSCI. The account used for this purpose is kept separate from the main business account of the home, not forming part of its assets. Also, the account records are itemised, to show separately deposits and withdrawals for each individual service user for whom monies are received. A range of risk assessments are in place. They are kept under review. They include topics specific to individual residents. Guidelines for particular areas are drawn up with input from relevant professionals. This is shown clearly on the record. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 12 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, 15 & 16 Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. EVIDENCE: Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 13 Residents of Inlands Close attend a variety of educational and occupational facilities. There is also some outreach support. There are continuing efforts to increase the number of sessions people can attend, and to develop the appropriateness of those already obtained. The home’s own staff escort service users to daytime opportunities, if that is necessary for the place to be taken up. There is a need to have drivers on duty, to get people to various locations. This has to be borne in mind when compiling rotas. When people are not receiving other support, the home ensures that they get 1 to 1 input. This enables them to undertake activities. Weekly plans are drawn up. These ensure that all service users get equal access to opportunities, and allocate the staff members who will support them. Residents at Inlands Close make full use of the range of amenities on offer in Pewsey itself. They also travel further afield to participate in leisure opportunities that reflect their particular interests. The home has its own vehicle. At home, users have access to entertainment equipment in their own rooms. There are also a range of games, puzzles, and books available. Outside the home, users attend some local clubs specifically intended for people with learning disability. They also access a full range of integrated activities. People participate in physical exercise, including swimming, and trampolining. All users receive the opportunity of an annual holiday, escorted by staff. These are done in small groups. Some people may only go for short breaks, if they find it difficult to cope with longer periods of absence from familiar surroundings. Holiday destinations have included trips overseas. Family contact has become limited for the majority of the current resident group. This is chiefly due to the age of relatives, or the fact that they do not live nearby. However, for some individuals there has also been success in initiating contact after many years without any. The home aims to support family links as much as possible, where this is wished for. Some users have specific friendships, and they are helped to maintain these. Visitors to Inlands Close are welcome at any reasonable time. People are generally encouraged to notify the home of an intended visit in advance. This means the home can ensure that the relevant resident will be present, and can be made ready to welcome guests. The importance of allowing users privacy with their visitors is stressed in guidance to staff. The home also has an appropriate policy statement about residents’ relationships. This balances their rights with staff’s duty of care. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 14 There is generally unrestricted freedom of movement for residents. They are expected to respect the privacy of each person’s own bedroom. A limited number of areas are kept locked, for particular health and safety reasons. External access is also made secure overnight. Care plans show the reasons for such steps. There are guidelines on the morning routine for each day of the week. These vary, depending on which service users have to go out. The times that people need to get up are specified, where necessary. Inlands Close has always been found to have a pleasant, homely atmosphere. Positive interactions amongst residents and staff are the norm. There is no sense of barriers between the two groups. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.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 Service users are supported to address their personal and health care needs effectively. Service users are placed at risk by deficits in the home’s practices for the administration and recording of medicines. EVIDENCE: All service users need a high degree of support with personal care. People are encouraged to do whatever they can for themselves. Attention is given to ensuring that they maintain a positive image at all times. Any specific issues related to individuals are known about. These are reflected in their care plans and guidelines. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 16 The home has been proactive in ensuring that the health needs of users are identified and addressed. Staff have worked hard to challenge and overcome negative images that may have been associated with people with learning disability in the past. They promote people’s rights to receive necessary treatment. There have been successes in the resolution of some long-term difficulties. A range of professional advice is sought in relation to all the needs of the user group. Some innovative approaches have also been tried. Health needs continue to develop for the group. These may be linked to natural ageing processes, or to the particular conditions that people have. There is ongoing monitoring and review of care. As well as responding to situations as they arise, the home plans ahead for likely future changes. This includes ensuring that staff receive training on any relevant topics. At the time of this inspection, a lot of preparatory work was being carried out in advance of an operation that one service user would require. Various steps were being taken to reduce the individual’s anxiety, and increase the chances of this important treatment proving successful. None of the present service user group are self-medicating. So staff are involved in storage, administration and recording of any prescribed drugs. They receive training after they have been in post for six months. As at the previous inspection, medication practices showed some serious failings. These were related to one service user, whose medication was under frequent review. ‘As required’ medication was also being used regularly, as one intervention to manage behavioural issues. Problems stemmed from both of these elements. Areas remaining in need of attention were: • Clear documented proof of the actual prescribing instructions from the relevant doctor Some medicines recorded as given to the individual were not in line with the written instructions available. Issues related to the time of administration, and, in a couple of cases, the strength of dose given. These discrepancies were stated by the home to be due to errors in a doctor’s letter; and to acting in line with verbal instructions. Records must make clear that any medication given to service users is in accordance with prescribing instructions. • Entering of all relevant details on medication administration record charts Up to date information about the service user’s ‘as required’ medication was available in records. But it had not been transcribed on to the administration record chart in current use. In addition, a change to one drug had been Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 17 entered on the chart in a confusing way, leaving the new instructions unclear. This issue was addressed during the inspection. • Detailed and objective guidelines on when to use ‘as required’ medication There is clear guidance for staff on steps to try before considering the use of additional medication. There is also a general policy on the requirement to take advice from senior staff before doing so. But clearer individual information is needed to support the use of medication as an intervention for the management of behaviour. This should include objective detail about the criteria for use. Present records, citing reasons for administration such as “agitation” or “negative attitude”, are not sufficient. For the individual concerned, the ‘as required’ medication prescribed included two different drugs, both in varying possible doses. Recorded information supporting the use of this intervention needs to make clear how different decisions are taken about the strength and type of drug to give. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users are safeguarded by the home’s policies and procedures for complaints and protection. EVIDENCE: A complaints procedure is in place. There is a version with symbols and photographs, intended to be more comprehensible for service users. No complaints had been received. Inlands Close operates in accordance with local multi-agency arrangements for adult protection. A copy of the relevant procedure is kept in the home. A whistle blowing policy is also in place. The home has appropriate staff conduct and disciplinary procedures. Service users at the home may present with episodes of disturbed behaviour on some occasions. This is usually infrequent. But guidelines are in place for any current issues. These have been developed with input from appropriate professionals, and are kept under review. The example seen set out clear information about possible triggers, and a consistent approach to take for each of these. There was a good insight into the individual’s own perspective. There was also guidance on how to react if difficult situations did develop. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.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 Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: The premises present as well maintained. There is evidence of regular and ongoing redecoration. The owner is able to carry out a number of jobs himself, having relevant professional qualifications. Other contractors are engaged as necessary. Records are in place regarding the upkeep of the building. These note problems identified, set timescales for action, and show when they have been resolved. The main desire of the service is to maintain a homely feel. This has been achieved. Periodic audits of the home are carried out. These identify any tasks to be addressed. Since the previous inspection the oil tank had been replaced. An electrical audit had identified the need for rewiring of the property. This was due to be done shortly, whilst service users were away on holiday. Some areas would also be redecorated at the same time. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by effective recruitment practices. Staff are supported and supervised effectively, enabling them to deliver a service that meets its users’ needs. EVIDENCE: Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 21 Inlands Close was registered under previous legislation. So it must not regress from the staffing levels in place as of 31st March 2002. The home aims to run on three staff per shift. But this is not always possible. A minimum of two people is always maintained during daytime cover. Additional staff are provided when this is required, to facilitate particular activities. Overnight cover consists of one person, who sleeps in. They have access to senior staff, via an on-call rota. There is a mixture of full and part-time staff. Some people work set shift patterns. These vary depending on individual’s circumstances. There is also a pool of relief staff, and agency cover may be used when necessary. There were no vacancies at the time of this inspection. The home employs one person aged under 18, for some cleaning duties. This person also assists with taking service users out. They are always supervised by other staff, and do not deliver any personal care. There is a checklist for all stages of recruitment, selection, and joining the organisation. This is closely linked to the home’s quality assurance system. Sampled records showed that all required checks are carried out, at the appropriate times. New starters do not commence working until satisfactory clearances have been obtained. Service users have informal involvement in the recruitment and selection of staff, as candidates visit the home. All new starters are subject to an initial probationary period of 6 months. This may be extended, if it is felt that an employee has not yet demonstrated the necessary competence or conduct. Additional supervision arrangements are then put in place. On initial induction, staff will be overseen by a manager for the first fortnight. They will then be supervised by a senior carer. The home’s training programme looks to access any courses which may be relevant to the needs of the user group. Some learning also takes place in-house. Talks are occasionally given by some of the professionals with whom the home has contact. Individual training records are maintained for all employees. These include information about any qualifications people may have gained in previous employment. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 22 Induction of new employees is carried out in line with national standards for people working in learning disability services. One of the organisation’s managers acts as an assessor of employees working in other homes. This helps Tullyboy to earn credits towards putting its own candidates through the training. The organisation also has a strong commitment to NVQ training. At Inlands Close, three staff have achieved this award at Level 3, and another has done so at Level 2. All staff receive supervision and appraisal, including those who only work a few hours a week. Both of the organisation’s registered managers act as supervisors for a group of staff. Ways were being considered in which to record more of the informal supervision that takes place as they work alongside people. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.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) 37, 39, 41, 42 & 43 Service users benefit from a well run home, with clear leadership and involvement from senior figures. Quality assurance measures underpin service developments. Effective record keeping is maintained, but service users would benefit from improvements in records relating to their care and welfare. Service users’ health and safety are protected by the systems in place. EVIDENCE: Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 24 Tullyboy Homes has two registered managers. Both work in both of the homes operated by the organisation. They are each qualified to the required levels in both care and management. In addition, one has a professional background in learning disability nursing. Although not practising in this setting, she has maintained her registration through regularly updating her knowledge. The managers attend a range of courses and conferences. Tullyboy Homes is also a member of organisations concerned with developments in the social care field. Usually these two senior staff will alternate the weeks when they focus on Inlands Close. The other week will be spent in the organisation’s other care home. However, they are available for advice and support when required. The access to two well qualified managerial staff is of advantage to the service. One carer at this home is now studying towards the NVQ Level 4 award, and taking on additional responsibilities. The intention is that this person will also be able to offer managerial support to both services. An extensive quality assurance system has been devised and implemented by the organisation. It is built around the home’s Statement of Purpose, and tailored specifically to the service. The system enables a comprehensive audit of all areas of performance. Frequencies of review are set at varying intervals: monthly, quarterly, or annually. Staff are allocated different areas to check. Annual review is tied in with the service’s end of financial year. This enables findings to be incorporated into the next year’s business plan. It is also shown who is responsible for checking on various areas. Views of service users have been accessed via a questionnaire exercise. Records showed that this had been repeated a couple of times during 2005. Inlands Close maintains all required areas of recording. The home’s record keeping policy reflects the requirements of the Data Protection Act. It makes clear the rights of access of users to the records held about them. Records about service users are generally of a good standard. Entries reflect positive aspects, and include general comment on somebody’s mood, behaviour and state of health, as well as any necessary details about significant incidents. However, some issues would benefit from clearer recording. Monitoring of behavioural needs is more effective when events are described objectively. Also, there should be proper cross-referencing between different records, where appropriate. For instance, some use of medication was shown on administration record charts, but not reflected in the daily records for the same date. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 25 There is evidence of regular checks and maintenance on key equipment and systems. Policies and procedures are in place for a range of relevant issues. Risk assessments have been carried out, and are kept under review. Staff receive regular training on health and safety topics. This is updated as necessary. The fire log book showed that the prescribed checks, practices and staff instruction are recorded as being carried out and up to date. The property’s fire risk assessment was reviewed in June 2005. Business and financial planning arrangements for the service were viewed and discussed during this inspection visit. All appear to be appropriate. Accounts are certified annually. Relevant insurance covers are in place as required. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 26 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 N/A 3 N/A 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tullyboy Homes Score 3 4 1 x Standard No 37 38 39 40 41 42 43 Score 4 x 3 x 3 3 3 Version 1.30 D51_S28632_TULLYBOY_V28632_140905Stage4.doc Page 27 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 YA20 Regulation 13(2); 17(1)(a), Schedule 3(3)(m) Requirement For all medicines administered to service users, there must be clear documented proof of the prescribing instructions from the relevant doctor. (Timescale from 11/01/05 not met) COMMENT: Some reported prescribing instructions were not supported by available records. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. Medication administration record charts must contain all relevant details, to ensure that medicines are administered in accordance with prescribed instructions. (Timescale from 11/01/05 not met) COMMENT: Current administration record charts were not clearly updated, presenting the risk of errors occurring. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. There must be clear guidance on Timescale for action From 14/09/05. 2. YA20 13(2) From 14/09/05. 3. YA20 12(1); Guidance Page 28 Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 13(2); 17(1)(a), Schedule 3(3)(m) the criteria for administration of medicine prescribed on an ‘as required’ basis. (Timescale from 11/01/05 not met) COMMENT: Guidance had not been developed in line with the criteria set out in the previous inspection report. Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. on current as required prescriptions to be in place not later than 30/09/05. 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 YA41 Good Practice Recommendations Records should contain objective descriptions of behaviours, and ensure clear cross-referencing when details about significant events are held in more than one place. Tullyboy Homes D51_S28632_TULLYBOY_V28632_140905Stage4.doc Version 1.30 Page 29 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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. 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