Inspection on 26/09/06 for Twyford House

This inspection was carried out on 26th September 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Twyford House 29/05/07

Twyford House 19/12/05

Twyford House 25/07/05

Twyford House 17/02/05

Twyford House 10/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Twyford House Whitfield Avenue Dover Kent CT16 2AG Lead Inspector Kim Rogers Unannounced Inspection 26th September 2006 08:50 Twyford House DS0000023595.V311435.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 Twyford House DS0000023595.V311435.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. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twyford House Address Whitfield Avenue Dover Kent CT16 2AG 01304 241804 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) The Robinia Care Group Ltd Mrs Jayne Anne May Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Twyford House is part of the larger Company of Robinia Care, and is registered to provide accommodation and personal care for 13 younger adults with a learning disability who at times may present challenging behaviour. The premises are a purpose built detached property. All service users have their own bedroom. Two of the service users also have a small private kitchenette area. It is situated on the outskirts of Dover in a residential area near to local shops with easy access to the main bus route to the town. The local church and pub are within walking distance from the home. The home also has its own transport. The fee for living at this home is £ 83,115 to £106,280 per year For more information about this home and what he fee covers please contact the provider on twyford.house@robinia.co.uk Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and carried out by two inspectors over about eight hours. The visit forms part of the key inspection. Other pre visit fieldwork was carried out. This included speaking to four care managers and one family about the service. The home completed a pre inspection questionnaire. Some service users completed and returned a questionnaire about the service. During this visit the inspectors spoke to service users, staff, deputy manager and the manager. Staff were observed and interviewed, as was the deputy and manager. Service users were able to give their views as a group and in private by speaking to the inspectors and by their behaviours. One inspector observed activities and lunchtime and had a look around the home. Various records were sampled. Medication administration was observed. What the service does well: What has improved since the last inspection? Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 6 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. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 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 the following standard(s): 1,2 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. The home must make its aims clear in the statement of purpose and to service users. Pre admission assessments need improvement, as service users cannot be sure their needs and aspirations will be assessed. EVIDENCE: The home has a statement of purpose, which the manager is currently reviewing. This should outline what services the home intends to provide and should outline the home’s aims. However, information about the purpose of the home is fuzzy. The statement of purpose states the homes philosophy is based on five accomplishments. Neither the manager nor deputy could say what these accomplishments were. The manager sees the home as a treatment and assessment centre, but 7 service users have resided at the home for over 2 years; four for over 8 years. Some service users have lived at the home for a short term and wish to move onto more independent living. Care managers also understand that the home is for ‘treatment and assessment’ It was evident that the views of the manager, care managers, service users and the statement of purpose on the aim of the home are conflicting. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 9 The home is trying to meet two distinctly different purposes, and is at conflict trying to meet service user needs. The inspectors discussed the need to make the purpose and aims of the home clear to current a prospective service users and stakeholders. The type of assessments and interventions are not in line with supporting people to move on. Pre admissions assessments are not kept in the home. They had not been used to inform the basic care plan and as such, important information about how individual service users communicate was missing. Several service users commented that they did not like the mix of people in the home and compatibility was poor. Individuals with known disruptive behaviours had been admitted, but no functional assessment had taken place. The staff were guessing what certain behaviour meant, and without some constructive strategy, the individual remained poorly supported and staff may inadvertently reinforce some challenging behaviours. The manager said that prospective service users are able to make visits to the home before moving in. She said that this is planed around individual needs. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 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 the following standard(s): 6,7,9 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users cannot be sure their aspirations and personal goals will be supported in a person centred way. Choice making needs improvement through staff understanding and opportunity. Attitude to risk assessing needs improvement to enable, rather than restrict, service user opportunity. EVIDENCE: Service user plans (care plans) were sampled in detail and two individuals were ‘case tracked’ Care plans focus mainly on medical and health support needs, and these are generally well supported. There is a lack of focus on the positive aspects of the person. No attention has been paid to personal aspirations or lifestyle goals. Although some person centred planning (PCP) training has been given, no individual had a PCP that they had been engaged in. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 11 There were no communication plans, portfolios or assessments – non-verbal communication is poorly understood. No assessments had taken place to work out the function of particular behaviour. The social needs of the person have largely been overlooked, which may be because the home think of itself as an ‘assessment and treatment’ centre. Particular restrictions on personal freedom had been challenged, and were under review, but day-to-day stuff, like taking a sandwich from a trolley without permission, was frowned upon. All service users had to go through a senior staff member to access their finances; although several had emphasis on moving out to live more independently they had little or no control over this area. Some staff actively supported choice making thorough structured activity. However, senior staff had a poor understanding of choice, seeing it more as menu’s being planned ‘around’ residents, the choice of room decoration and college courses – rather than everyday stuff that makes us feel valuable as individuals. The ethos of decision-making needs to be revisited. Risk assessments were in place, but the reviewing process did not note when the ‘risk’ had last occurred. As such, service users continued to live with restrictions. Staff and management were able to say what they felt were trigger factors to risky situations, but had done nothing to plan ahead to enable particular development opportunities. Poor assessment processes were a factor to imposed restrictions. It was evident that one service user was taking a risk which affects his health. This had not been assessed and appropriately supported. The ethos of decision-making and risk taking needs to be revisited. Formal review meetings are held six monthly or yearly. Care managers said they usually attend. If they do not attend care managers said the home sends them review notes. The manager said the home uses the services of a private psychologist and psychiatrist rather then access the local community team. She said this was because most of the service users are from out of the local area. The manager should review this thinking, as it is evident that some service users need more support. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 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 the following standard(s): 12,13,15,16,17 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Access to external education and occupation needs review and improvement. Opportunity to be involved in the community could be improved. Family relationships are well supported, but those between service user peers and staff need improvement. Daily routines are restrictive and have an institutional style. Food is of a high quality, but mealtimes and service user involvement in this area need improvement. EVIDENCE: Some people use local college facilities, but for others, their placement has failed. Due to challenging behaviour, exclusion from college had occurred, and opportunities had then been restricted. The inspector was concerned to find that in house activities for one person have been reduced due to an increase in challenging behaviours. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 13 No active engagement within the kitchen or laundry was witnessed during this visit, although staff say that this does take place. People who had greater support needs had less opportunity to access external occupation or educational resources. A great deal of ‘in house’ occupation takes place, and much of this is enjoyed. But limiting so much to the home itself means people spend a huge amount of time in a noisy environment and only get a minimal opportunity for a change of scene. Access into the community is quite limited for people who have additional support needs. Several service users said that they were supported to see their family and friends. Two expressed the wish to move back to the local area from where they came, to be closer to family. For one, some action was now taking place. Relationships within the home between staff and service users and between peers need reviewing. One staff had a bossy attitude, and some did not empower people to do chores with their support. Other staff were keen to engage people, but only the more able and willing. Staff tolerated horseplay between residents, but when the recipient directed similar attention to staff, this was reprimanded. A house rule exists that service users ‘are encouraged’ to be in the main part of the house and join in activity between 9am and 4pm. Some hand in their keys to staff, but more dependant people rely on staff to open their doors at all times. There is no quiet or private area for people to go to other than their room and the relaxation room –both need staff support to get access to it. Garden access is restricted; the doors are locked and staff accompany people outside. The kitchen is always locked. Access and choice of drink depends on individual staff attitude. The home does not promote independence and needs to review how it can improve. Service users said that the meals and tasty and enjoyable, but are cooked mainly by staff. Some individuals have cooking care plans, but rarely get involved in general cooking with the dedicated cook. Staff said that people would work in the kitchen with the cook sometimes, but the new cook is waiting for their police check to be returned – so this has limited an activity. People with greater support needs are not supported with cooking care plans. Choice of menu is discussed at weekly meetings, but only a limited number of people can have a say. No communication assessment had been conducted for people with limited or non verbal expression so no work to find out what people with communication difficulties would prefer has taken place. The mealtime observed was not a relaxed, enjoyable time. While staff and some service users were permitted to take extra sandwiches from the trolley, other, non-verbal people were reprimanded for doing so. Staff handed sandwiches around, but did not sit to eat theirs until several rounds had been made to service users. This was a disjointed experience, staff were clearing away (without supporting service users to do it), while people were still eating. Drinks were restricted to water jugs, mainly kept on the trolley. Drinks are not freely available, as the kitchen is locked. People cannot get a drink unless they knock on the kitchen door and ask. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 14 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 for service users is adequate. This judgement has been made using available evidence including a visit to the service. Support plans need to aim to maximise service user independence in personal care. Physical healthcare needs reasonably supported, but a serious shortfall was found and mental health needs through improved communication need addressing. Medication practice is adequate. EVIDENCE: Personal care support requirements are reasonably documented, but there is no plan in place to improve independence. Staff say how they support people to be more independent, but is inconsistent between staff members. Service users are able to say who they wish to support them with personal care. Healthcare is a central focus for the home, and reasonably supported. Monitoring of physical wellbeing takes place regularly, and this is documented. A person’s particular need had been identified, but the strategy for supporting this was unclear and had inconsistencies. An immediate requirement to address this potentially life-threatening situation was issued during the inspection. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 15 There is a serious lack of communication assessments. Accurate understanding of how a person feels is largely subjective guesswork. Communication is one function of challenging behaviour; therefore service users should have detailed communication assessments to establish if the function of their behaviour is communication. Medication administration was observed. Medication is generally administered from the staff office to service users by two staff. No service user controls their own medication. Service users came in one at a time for their medication. Staff checked the medication administration record before administering the medication then signed the medication administration record. Staff encouraged some service users to do as much for themselves as possible. Records were well recorded and the stock was tidy and secure. Keys are secure. One staff member was observed administering a spoiled medication. This was discussed with the staff member and later with the manager. Both felt on reflection this should not have happened. Some service users challenging behaviour is controlled by psychotropic medication. When questioned staff had an awareness of what the medication was for but were not sure about side effects of some of the drugs they administer to service users. Although staff attend a training session before they can administer medication there are no competency appraisals carried out to check staff are still competent. The deputy produced an assessment that has been developed to check staff competency through observation and questioning. The inspector welcomed the plan to implement this. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 16 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 for service users is adequate. This judgement has been made using available evidence including a visit to the service. A service user complaint system is in place, but is the domain of those who have vocal communication. Adult protection awareness has not been a priority for staff education. Service users are not supported to recognise what is abuse. EVIDENCE: For more able service users, the complaints system has some value. Recorded complaints have had some action taken, but seem to be about dynamics in the home, which has not been sufficiently addressed. Two service users said that they objected to being hit on the head by another service user. When asked if they had complained about this, the reply was ‘There’s no point, management will just say it’s their behaviour’. Work needs to take place to make this system more meaningful. The home has received a number of complaints since the last inspection mainly from neighbours complaining about the noise level from the home. Most have complained about a shouting noise coming from the home during the day and night. In reaction to the complaints the home bought an air-conditioning unit so windows could be shut in the summer and the person kept inside. This person has now been given notice by the home to leave, which is a real shame as the person has a history of failed placements. There was no pre admission assessment at the home for this person or an assessment of why they present the behaviours. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 17 Most service users present some form of challenging behaviour including shouting, self-harm and self-injury and injury to others. As mentioned no functional analysis has been carried out to establish why the person presents these behaviours. Staff may inadvertently reinforce some behaviours. This has lead to the use of aversive measures to control behaviour including medication, exclusion and restraint. The manager and deputy demonstrated the use of the physical intervention used on service users. Stage 4 of this technique requires the use of pain to be applied. The manager said this is rarely used, however any such method must be properly assessed, monitored and reviewed regularly with the consent and agreement of the service user and their stakeholders. Physical intervention is a reactive strategy and must only be used as a last resort. There is a reward system in place where service users are awarded 10p for ‘good behaviour’ This is a generalised strategy rather than individualised. The deputy manager said that money does not mean a thing to some service users however money continues to be used as an ineffective reinforcer. The pre-inspection questionnaire submitted by the manager records 253 incidents of restraint since the last inspection (19/12/05). The inspector required that all physical intervention and procedures for dealing with incidents be reviewed. The manager is a registered learning disability nurse(since 1982). The manager and staff attend training in de-escalation and physical intervention. The manager must ensure that training is in accordance with the department of health guidance as required by the National Minimum Standards. Protection of vulnerable adult training is scheduled to take place in the next month. Some staff have worked in the home for years and not had any awareness coaching or training in this area. The manager must ensure staff are aware of discriminatory practice and improve on communication between staff and service users. Twyford House DS0000023595.V311435.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): 24,25,30 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. The stated purpose of the home is fuzzy. The environment is not a comfortable, homely residence that people can call ‘home’. Some bedrooms are stark, but improvement is planned. Toilets and bathrooms are stark and do not have basic provisions. Generally, the home was clean, but toilets and bathrooms need attention. EVIDENCE: The home is trying to be a residence for some and a treatment and assessment centre for others. As a consequence of trying to meet diverse needs, the communal living area is open plan, plain, somewhat sterile and not homely. The lounge, dining area and conservatory run into each other, this is where the majority of people spend most of the day. Twenty or more people (13 service users and 7 staff) can be in this one space at any given time. Curtains and ornaments have been removed. With no alternative provided access to the garden is limited, as the doors remain locked. The noise level within the home is high. There is a classroom for 1:1 work off the main area and a relaxation (snoozelem) room that can be used with staff support. Many service users Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 19 cannot get privacy in their own rooms between 9am and 4pm without asking staff to let them in. Some rooms are very well decorated, but others are really stark. A person said that they didn’t think they could put their pictures up. A staff member told them this was OK. Service users should be supported through the key worker system to make their rooms homely. The manager said some redecoration program was planned although the home has no development plan. The ground floor service user toilet was out of action during the visit. Other toilets and bathrooms were stark and unpleasant. Some had wet floors and either no toilet roll or industrial size rolls not on holders. Efforts to maintain dignity and a high level of hygiene in this area are needed. The home was otherwise clean and free from odour. Staff have lockers in a separate toilet. Twyford House DS0000023595.V311435.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): 32,34,35 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Some staff demonstrated inclusive attitudes with service users, while others had a rather ‘them and us’ approach. Opportunities to attend statutory training are good but this should be consolidated with competency appraisals. Recruitment checks are carried out but could be more robust. EVIDENCE: A mix of staff with varying skills and abilities are on shift during the day. A dedicated day programme team work in the week to make sure activities take place. Some staff were clearly engaging and supportive with all service users, but the more able the service user, the greater amount of staff time was given in social contact. Other staff seemed rather bossy and disinterested. Senior staff on duty said they spent considerable time in the team office, not working with service users as much. Staff need to be supported by the designated senior staff, who have NVQ 3 qualifications. Many staff have large bunches of keys attached to their belt loops, which is dangerous and gives an antisocial appearance. The company employs a training manager who organises regular courses. Most staff have attended statutory training including first aid, moving and handling, Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 21 food hygiene and fire awareness. However, little of the training budget is dedicated to values training and specific training like challenging behaviour. As mentioned, at most staff attend training in de-escalation and physical intervention. The manager must ensure this is in accordance with the National Minimum Standards and DoH guidance. A recommendation was made for all staff to have some training in Positive Behaviour Support techniques. Although staff attend training sessions, no competency appraisals are carried out. This means staff have completed the learning part but not the assessment part. The manager agreed to introduce a system of competency appraisal to check staff competency in practice. This should include an element of observation. The manager said that the home uses the Certificate in Working with People with a Learning Disability for the staff induction training. Staff complete a workbook. There were no workbooks in the staff files sampled just a tick list induction. The manager said this might be that staff have taken their workbooks home. The manager said it has been recognised that the staff induction should be more effective and meaningful. Staff files were sampled and were well organised. The manager said that the human resources manager shortlists applicants and carries out interviews with the area manager. The manager meets prospective staff when they come to the home for an informal chat and a look around. The human resources department carries out recruitment checks. It was evident that not all checks are robust yet staff have started in post. One staff had been taken on with two references, one of which was not satisfactory. This staff was also subject to disciplinary proceedings at a previous job for abuse. No extra checks had been carried out or extra support and supervision put in place. Supervision (or one to one meetings) is hit and miss depending on the supervisor. Observation is not currently part of the supervision and appraisal system. Twyford House DS0000023595.V311435.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): 37,39,42 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. The management of the home is adequate There is no quality assurance system in place so service users views do not underpin any improvement. Service users health and safety is generally protected but more could be done to stop incidents of challenging behaviour. EVIDENCE: The manager is a registered learning disability nurse and has managed the home for about two years. The manager has several years experience in working with people with a learning disability. The manager spoke with understanding of service users needs. However, the manager has no formal qualification in challenging behaviour and most service users exhibit challenging behaviour. A recommendation was made to address this. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 23 A running total of challenging behaviour incidents is kept and is sent to head office. This included the type of behaviour and frequency. Details of duration and antecedents are recorded elsewhere. There are high levels of these incidents with evidence of no meaningful analysis, which would help to prevent further occurrence. For example environmental factors have not been thought about and changed if necessary. The home reports these incidents appropriately to care managers and CSCI but the ‘action taken’ box for most is blank or states ‘guidelines will be reviewed’ and ‘continue to monitor’ This means high numbers of incidents continue. The manager said that the home has no formal quality assurance system. She said that service users meetings are held as a large group This is clearly not suitable for all service users needs so the more able service users get to air their views while other service users go unheard. There is no yearly quality audit carried out with involvement of service users and stakeholders. Monthly audits should be carried out. Records at the home indicated this does not happen this frequently. The inspector was concerned by the lack of supervision and appraisal for the registered manager. There was no record of any supervision or appraisal for this year. The manager conformed that this was the case. A recommendation was made to address this. Twyford House DS0000023595.V311435.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 1 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 1 X X 2 X Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 25 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 YA2 Regulation 14 Requirement Assessments of service users needs and aspirations must be carried out. A copy of this assessment must be kept at the home. The use of aversive interventions to support challenging behaviours must be reviewed. Service users must be supported to reduce their challenging behaviours by way of referral to a specialist or other means. Clear guidelines must be in place for service users who have epilepsy or other health needs. This requires immediate action. Staff must have regular competency assessments relating to medication practice. Effective quality monitoring and quality assurance systems must be developed based on seeking the views of service users to measure the success of achieving the homes aims and objectives. Service users communication must be supported by way of referral to a specialist or other means. DS0000023595.V311435.R01.S.doc Timescale for action 30/11/06 2. 3. YA23 13 13 31/10/06 31/12/06 YA23 4. YA19 12 26/09/06 5. 6. YA20 YA39 13 24 30/11/06 31/01/07 7. YA7 12 31/12/06 Twyford House Version 5.2 Page 26 8. YA34 19 The manager must ensure that 30/11/06 all documents required are at the home in relation to all staff. Thorough recruitment checks must be carried out in line with the Minimum Standards. 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. 2. 3. 4. 5. Refer to Standard YA6 YA1 YA37 YA24 YA35 Good Practice Recommendations Individual service user plans must be developed from initial assessments using person centred approaches to support identified needs and personal goals. A statement of purpose should be developed after consultation with service users and stakeholders, which details the homes purpose and intentions. The manager and staff should have training in Positive Behaviour Support. The manager should produce a development plan for the home, which includes the update of bedrooms and bathrooms. The manager and staff should have ongoing training in person centred planning and support. Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Twyford House DS0000023595.V311435.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!