Inspection on 21/05/08 for Twynhams

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Twynhams 16/05/07

Twynhams 19/01/07

Twynhams 08/12/05

Twynhams 04/07/05

Twynhams 12/01/05

Twynhams 06/07/04

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Hillview Farm

Dalewood Respite Care

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REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Twynhams Old Christchurch Road New Milton Hampshire BH25 6QB Lead Inspector Sue Kinch Unannounced Inspection 21st May 2008 11:00 Twynhams DS0000055837.V363756.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 Twynhams DS0000055837.V363756.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. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twynhams Address Old Christchurch Road New Milton Hampshire BH25 6QB 01425 618950 01425 618950 twynham@truecare.co.uk 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) Truecare Group Ltd Mr Matthew Thomas Care Home 7 Category(ies) of Learning disability (0) registration, with number of places Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 7. Date of last inspection 16th May 2007 Brief Description of the Service: Twynhams is owned and managed by Truecare and is registered to provide personal care and accommodation for up to 7 residents who have a learning disability. The home is located close to local amenities in New Milton. The house is a two storey detached property with car parking for several vehicles and a garden to the rear. Residents are provided with single bedroom accommodation with five rooms having en-suite facilities. The manager reported during the visit that the weekly fees for living at Twynhams range from £1096.76 to £3013.08 Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection included consideration of the Information held about the home and received since the last inspection in May 2007. We considered the content of the Annual Quality Assurance Assessment submitted by the manager before the visit and surveys from five staff. We spoke with several staff and people living in the home, the manager and operations manager who also provided additional information after the inspection visit. During the visit aspects of the physical environment were seen and some of the records viewed. We issued an immediate requirement notice in respect of aspects of medication and this has been responded to. We also notified the responsible individual that statutory powers under sections 31 and 32 of the Care standards Act 2000 were in use and a notice was left identifying issues which were subject to requirements in the last inspection report. The commission is considering the action to be taken as a result of this non-compliance and following a management review of the situation the organisation will be informed of the action to be taken. What the service does well: It is recognised that the people living in the home have individual needs and that staff need to vary their approaches to encourage involvement in activities. The manager is keen to promote more activity and stimulation and has newly recruited a co-ordinator to assist with this. Independence is promoted and risk assessments are carried out to support this. People are supported to access health services they needs and personal care is provided with the support that they prefer. Regular improvements to the environment and furnishings take place including redecoration and maintenance is planned. Health and safety is monitored. Staff levels are kept under review. Staff are recruited by a thorough process. Staff training needs are assessed with consideration given to the needs of new people coming into the home and existing residents. Plans are place for further staff training in a range of issues relevant to people living in the home. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Twynhams DS0000055837.V363756.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 Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission work is taking place but needs to be robustly applied to ensure that people moving in and those already living in the home are fully supported. EVIDENCE: In the AQAA the manager gave detailed information about the admissions process that is in place using the company’s procedure involving pre-admission assessments, information from others, visits, involvement of the people moving in and assessment of the compatibility with the existing group of people living in the home. He also said that risk assessments and care-plans are in place and training needs of staff to meet those needs are met. We noted from the information in the AQAA that three people had moved into the home since the last inspection. One person had left after the home’s decision that they could not meet the needs of that person. Records of pre admission and assessment were checked for two people and records were found, including a care management assessment for one person but not the other although some information had been obtained from the previous home. Care plans and risk assessments were in the home for these people but more work is needed as identified in the individual needs and choice section below. In one file it was noticed that there was no terms and Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 9 conditions of residence for Twynhams but an old one from the home that the person previously lived in. The manager said that work was done to check the compatibility of the people moving into the home and identified some factors taken into account. He also gave examples of the training provided in relation to the new people moving and which he said staff received either before the person moved in or just after. He gave details of the planning and visiting process for one person. A member of staff and the resident confirmed visits had taken place before that admission and another person living in the home said they had an opportunity to say what they thought about the admission. Visits had not taken place for the other person and the manager said that an Independent Mental Capacity Advocate under the Mental Capacity Act, had been involved in the decision. In the records we noted that there had been some problems in the initial period in the home for that person and a risk assessment had not been written following a particular incident. A staff member said that a review had taken place a month later but minutes were not available in the file. A person living in the home said that they had known that the person was moving in but did not feel comfortable with them. The manager said that they have updated their service user guide and their statement of purpose but have plans to make them more user friendly. One person who had moved in said that they had been given some written information about the home that was helpful. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Attention is needed to care planning and risk assessments so that up to date staff guidance is in place to ensure that the needs of people living in the home are met consistently. EVIDENCE: A requirement was made following the last inspection to ensure that care plans include information about how all the identified needs of people living in the home should be met. This has not been fully met and prompt action was identified as needed to address this. The manager, in the AQAA said that matters raised at the last inspection regarding a person’s mobility have been addressed. Work on other care plans is needed. We looked at aspects of three care-plans during this visit. These were mostly recently written. We noted that these included a number of risk-assessments and sheets of guidance for staff. However, one of the issues raised at the last inspection was about more details being needed about how to keep a person Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 11 safe after an incident. We noted that an incident occurred 9/4/08 in which a person was kicked. Staff were not able to find a regulation 37 notification although the operations manager thought that social services and the commission had been informed. We were not notified and when looking at the care plans saw no details of the risk to that person or of the strategies in place to avoid further incidents. People living in the home spoken with said that they are aware of their care plans. One person said that the staff sit and read them with them. We saw that people living in the home had signed some of them. The manager said in the AQAA that a key-worker system is in place and that the needs of people are met based on their wishes, preferences, choices and beliefs and that the care provided is person centred. He plans to work on making the care plans and risk assessments user friendly. We noted that they are not currently in formats that are accessible to all people living in the home. We saw written evidence of key worker meetings with people living in the home. One person spoken with said that they were able to what they wanted to do and another that they were supported to do the things they liked doing and gave examples of external activities. It was also noted that the risk assessment for one person regarding the management of behaviour included two sets of guidance date 1/4/08 involving two types of intervention that could be used involving a physical intervention. One of these included a strategy that is not in line with the training now provided by the company and included prone restraint. This was brought the attention of the manager and operations manager who agreed that it should not be in the records. Staff said that the new strategy is used, and the record of incidents held at the home did not include a record that prone restraint had been used with that person. Guidance missing for a specific ‘ as required’ medication is referred to in the section health and personal care. In another person’s file we noted that de-escalation techniques were referred to. These were not in enough detail to show a person centred approach, such as what worked for that person. We looked for written evidence that the physical interventions used was based on a multidisciplinary decision but this was not available. We noted that staff and the management said that some people living in the home were difficult to motivate although there is evidence that people are trying out new things. Two people have recently started going to music sessions at a day service. However, care plans lack details of how to motivate specific people based on what has worked. In staff surveys they said that they usually or always had up to date information about the needs of people they support. 4 said usually and 1 always about systems of passing information between staff (including the manager). Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements are being made to increase the range of internal and external activities that people are supported with and this would be assisted by more relationship building. A variety of food is on the menu for people living in the home but records of the food provided need to be accurate to ensure that a healthy diet is offered. EVIDENCE: During the visit some people were engaged in a music session at a local day service. Another attended a day service five days a week. The others were at home mostly self-occupying but considering options open to them. One person was heard discussing the option of going to purchase an ice cream later in the day and another was discussing going to the pub in the evening. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 13 The manager has recruited an activities co-ordinator who started working at the home two days before our visit. The manager said that he recognised that some people living in the home were difficult to motivate and wanted more to be offered to increase the use of the community and plan activities and things to do in a way suitable for each individual. He recognised that some people respond better on a day-to-day basis and wanted to develop this. Verbal and written evidence showed that some people go out for some activities alone. This includes shopping and going to the post office by bike. Others are reported by the staff and manager to have varying levels of support depending on assessment. Activity plans are being developed and in the record viewed for one person there was evidence of them doing things out of the home including being supported to visit relatives during May 2008 and this corresponded with what the person said. However, although records for that person indicated involvement in household tasks and self-caring, the care plan about motivating the person lacked specific details of what works for them. When looking around the home and in people’s rooms there was evidence of personal belongings and of individual interests being persued. One person talked about doing drawing a lot and another had completed several puzzles. People also talked about their involvement in some aspects of food preparation, and daily living routines such as cleaning and laundry tasks and confirmed that they had free access to these areas. One person said that they liked living in the home because they didn’t like cooking and didn’t have to do it although they did do other tasks. Although mealtimes are on the kitchen door staff said that meal times are flexible and this was noted as people had lunch at different times depending on what they were doing. Comments from people about the food were positive with comments about liking the lunch provided and pleasure at the thought of the meal planned for the evening. One person said ’there’s lots of fruit’ and another said they ‘liked nice dinners’ and agreed that they got them. A staff member was asked for details of the food provided to show that the diet is monitored. This was not available. A menu is in place but changes and alternatives, which staff said could be given, are not recorded. It was noticed that the people at lunch table were not supported by staff at the table and although conversation was taking place between them, the staff remained seated in front of the television behind the people at the table. This was pointed out to the operations manager as an opportunity to work on social skills and relationships was missed. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work is taking place to ensure that the emotional and health needs of people living in the home are met but this would be enhanced further by ensuring that medication recording is accurate and ‘as required’ guidance in place. EVIDENCE: In the AQAA the manager said there are plans to develop strategies to help people to express their physical state and indicate health needs. He said that staff support people to go to appointments and to voice health care concerns to staff. A staff member and a person living in the home spoke of how health needs have been addressed. This included accessing a range of health professionals and provision of various aids for that person. The person said that they felt supported with health matters and could talk about it with staff. Records of how staff should help with aspects of personal care and health care were sampled and found to be in place. The latter included managing anxiety, Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 15 incontinence, epilepsy and communication. Records were also noted of monthly meetings between key worker and person living in the home. Medication procedures are held in a file and a separate file holds information about the various medications used at the home. A monitored dosage system is used and drugs are stored in a metal medication cupboard. At the last inspection a requirement was made about medication and this was to ensure that accurate records are maintained of medication held in the home. In the AQAA the manager said that the medication process now included a witnessing process. This was noted to be in use in the sample of records viewed. However, some gaps were noted. The administration of medication has mostly been recorded although had not been signed at 17:00 on the day before the inspection for three people. This however appeared to have been an error which a member of staff admitted had occurred and all of the medication, where checked had gone from the monitored dosage system. Records for another person, who had been prescribed two types of liquid medication, were unclear. Staff said that they thought one had been stopped although there was no record of this in the health records or of when it was prescribed. For another there were some gaps in the records although the medication was not ‘as required’. An immediate requirement was made to address this and we were informed that the error was in not recording the changes to the prescription by the doctor. A discussion was held about a controlled drug that is given ‘as required’. A general practitioner had written to the manager agreeing that he could authorize ‘as required drugs’ in line with protocols and guidance. Although there was evidence that staff had been trained to give that specific medication, the manager was not able to provide details of the procedure to follow for that person. An immediate requirement was made to address this and a copy of the guidance was written and sent to us. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People in the home are given opportunities to raise issues and plans are in place to provide staff with adult protection training but local adult protection procedures are not always followed to ensure that a protection plan is agreed. EVIDENCE: At our last visit it was noted that the complaints process was not accessible to people living in the home. The manager at the time had said that it was due for a review and that alternatives would be considered. At this visit a copy of the complaints procedure was displayed in the front hall but had not been adapted. In the AQAA provided before this inspection the manager said that they were in the process of simplifying the complaints procedure to ensure that people can access it. The manager said that he had an open door policy and people were able to raise issues with him and often did. In one file observed it was noted that there were records of a support session, for a person living in the home, with a member of staff. People said that they could talk to staff and the manager but one was not sure if, following an incident, action was taken. The complaints log contained a number of complaints, which the manager had referred to in the AQAA. There was some recording of action taken including some made by the people living in the home but not enough details of how the issues had been followed up or monitored. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 17 The home’s manager has reported to have received training, in training staff, in adult protection and we saw plans for this training in June 2008. Following our visit we were sent copies of certificates to evidence that six staff have had previous training in 2005 or 2006. Since the last inspection an adult protection issue has been raised by the manager and referred through the safeguarding procedures to the local social services and a safeguarding meeting was planned to take place after our inspection. However, verbal and written information was received about another incident 9/4/08, ( already referred to in the section on individual needs and choice) which had been reported in the home’s incident reporting sheets, but not referred by regulation 37 to CSCI. The operations manager thought that a regulation 37 had been completed but it could not be found. Following the inspection visit we have referred it to social services. We also checked a file to see if a risk assessment had been carried out in relation to this incident and were not provided with one. In the survey of staff all said that they knew they know what to do if concerns are raised about the home. This and whistle blowing was discussed with one of the staff who showed knowledge of the types of abuse that can occur and of action to take should an incident arise. The home does manage some finances for people living in the home and staff were dealing with this during the inspection. A record is held for each person indicating transactions and the running total and the money is held in individual folders. Where checked the money held was in line with the record. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have a comfortable clean and maintained environment to live in with regular improvements but this would be enhanced by a review of cleaning schedules for bathrooms and some renewed flooring. EVIDENCE: Since the last inspection manager said that there has been regular maintenance and some redecoration of shared areas. He also said that the system of maintenance has been improved to speed up completion of tasks. During the visit to the home some of the shared private areas of the home were viewed and the inspector was told of new furniture in the lounge and paving to the side of the house with more furniture on order. There is a maintenance reporting procedure and this is ticked when items are completed. People spoke with about their rooms were positive about them and spoke of involvement in routines for cleaning and washing. The home was generally Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 19 clean and systems are in place for cleaning but not fully effective. Two of the toilets had stained floors which needed to be replaced and cleaned to a higher standard as marks were on the floor and the walls and the odour was not fresh. The operations manager was aware of a redecoration plan and this was viewed but did not include a room that had marked walls and did not address flooring problems. The operations manager said that this would be checked out. She has subsequently provided plans including these issues. There is large dining room/ lounge for people to use and a conservatory. There is also a moderately sized garden with seats available but overall the area is bare with unused raised borders. Laundry facilties are provided and people in the home use them. Staff said that the clothes dryer had been fixed that morning. In the AQAA the manager says that all 13 staff have received infection control training. Some bathroom facilities were observed and most contained all item needed although one bathroom used by a person living in the home on this day had no toilet roll, towel or soap. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good level of staff, recruitment process and ongoing plan for staff training to meet the needs of the people living in the home. EVIDENCE: The manager reported that 10 of the 12 permanent staff and the two bank staff used are assessed to National Vocational Qualifications (NVQ) level 2. We found at the inspection that over 50 of staff are trained to NVQ level 2 or above and others are being assessed. The home has had changes to the staff team and currently uses an agency or bank worker on one or two shifts a day to maintain adequate staff number on shift. A member of staff said that there are 3-4 staff working in the mornings, three in the afternoon and two at night. This was noted to be in line with the rota viewed. An agency worker was being inducted to the home in the afternoon of the inspection. In the survey and at the inspection the staff thought that there were usually enough staff to meet needs. The manager said that staff levels are regularly reviewed. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 21 The manager reported in the AQAA before the inspection visit that all of the staff recruited since the last inspection had been employed following the required recruitment checks. In the staff surveys before the inspection visit 5 of the five staff surveyed said that the employer carried out checks such as CRB and references before they started work. At the inspection we found that record supported this although details of supervision arrangements for one person without a full CRB were not recorded. A system is in place for obtaining information about bank and agency staff. In the file we checked all the information needed was not in place. There is a training programme at the home and this includes essential and desirable training identified in the training plan. The manager said that induction and staff development is in line with national minimum standards. He said he has improved training and personal development but could develop induction. We noted from verbal and written information that staff are receiving training and this has recently included fire training, infection control, epilepsy, and management of behaviour, Makaton and aspects of medication. Further training is planned for June in the Mental Capacity Act and Adult protection. records of training are held for each person. In staff surveys four said that the induction covered what they needed to know and one said that is mostly did this. All said that the training is relevant to their role that it keeps them up to date with new ways of working and four said that it helped to understand the needs of people using the service. They all said that support was regular or often. They said that they usually felt that they had the right support experience and knowledge to meet the different needs people. At the inspection staff showed awareness of the systems and procedures and of the support that individual people living at the home needed. The manager has informed us of action taken to address aspects of care practices. Twynhams DS0000055837.V363756.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems in place for managing the home, although these have not identified all of the shortfalls in relation to meeting people’s individual needs. EVIDENCE: Since last inspection a new manager has been recruited and commenced employment on 1/9/07 and Matthew Thomas was registered in April 2008. It was noted in the training records that the manager is involved in regular training and plans are in place for him to have training effective management and supervision in May 2008. The manager said that staff are consulted in staff meetings but had plans to encourage staff more in the effective provision of the service provided. Staff Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 23 confirmed that there are staff meetings and the operations manager said that that they were addressing the attendance issues relating to staff. The manager said that he wants to improve user participation with regular meetings and support sessions for people living in the home. One person spoke of these support sessions and we noted records were held in the file viewed. There are records to evidence that the operations manager visits the home each month to assess the quality of the service provided and identifies areas for the manager to address. There is evidence of systems in place to monitor aspects of the service and a redecoration and maintenance plan was provided. At the last inspection it was noted in the report that the quality assurance systems have not identified the shortfalls described in that report in relation to care planning and medication practices. This was also noted at this inspection. In the AQAA the manager confirmed that servicing of equipment is regular with fire heating and gas services last checked in February-March 2008. The manager says that 100 staff trained in food hygiene and there is evidence of other training planned for health and safety matters. The regulation 26 reports include monitoring aspects of health and safety and indicated that that regular fire checks were completed and recorded in April 2008. Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 2 x x 3 x Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans include information about how all the identified needs of service users should be met. This is a repeated requirement from the inspection of 16/5/07. 2. YA09 12 Following incidents risk assessments must be reviewed or developed to ensure that safeguards are in place to protect people living in the home. An immediate requirement was made to ensure that all medication in the home is accurately recorded in records. This is to ensure that all doctors directions are fully recorded. This is an amendment to the requirement made at the inspection of 16/5/07. An immediate requirement was made to ensure that guidance for a specific ‘as required’ medication was available for staff. DS0000055837.V363756.R01.S.doc Timescale for action 30/07/08 30/07/08 3. YA9 13(2) 21/05/08 4. YA9 13(2) 21/05/08 Twynhams Version 5.2 Page 26 5 YA23 37 6 YA39 24 All incidents affecting the wellbeing of people living in the home should be reported under adult protection procedures to ensure that action is taken to safeguard people affected. Quality assurance systems must be reviewed to ensure that errors in medication, risk assessment, care planning and reporting incidents are picked up and acted on promptly. 21/05/08 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Twynhams DS0000055837.V363756.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Twynhams DS0000055837.V363756.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. 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