Inspection on 18/06/07 for Unicorn House (16)

This inspection was carried out on 18th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Unicorn House (16) 30/05/08

Unicorn House (16) 10/12/07

Unicorn House (16) 05/03/07

Unicorn House (16) 27/06/06

Unicorn House (16) 08/11/05

Unicorn House (16) 18/04/05

Unicorn House (16) 06/10/04

Unicorn House (16) 01/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Unicorn House (16) 16 Campden Road South Croydon Surrey CR2 7EN Lead Inspector James O`Hara Key Unannounced Inspection 18th June 2007 9:30am Unicorn House (16) DS0000025864.V342871.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 Unicorn House (16) DS0000025864.V342871.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. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Unicorn House (16) Address 16 Campden Road South Croydon Surrey CR2 7EN 020 8688 1907 020 8686 0135 unicornprojects@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Maharajah Madhewoo Post Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow two specified service users over the age of 65 to be accommodated until such time as the needs of the service users can no longer be met or until such time as the placements cease. No new service user with a mental health condition may be admitted to the home. A variation has been granted to allow two specified service users with physical disabilities to be accommodated at Unicorn House until such time as the service users can no longer be met or until such time as the placements cease. 5th March 2007 2. 3. Date of last inspection Brief Description of the Service: Unicorn House is a twelve bedded home that is registered to provide care for residents who have a learning disability. The location of the home is within easy reach of good public transport links and the centre of Croydon. This results in the residents being within easy reach of local amenities and services. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out between 9am and 4.30pm on a Monday morning/afternoon. Two inspectors Mr James O’Hara and Mr Lee Willis carried out the inspection. The last key inspection was carried at the home on the 5th of March 2007. The Commission has taken in to consideration that the home was sent a draft copy of the inspection report on the 10th of May 2007 and the final report on the 6th of June 2007. It was agreed that the acting home manager, Jay Venkaya, would need more time to address some of the recommendations from that report. These recommendations will be examined at the next inspection. Records examined at this inspection included the homes Statement of Purpose, care plans, person centred plans, peoples support guidelines, risk assessments, activities, medication, staff recruitment, staff training, quality monitoring and health and safety and fire safety. Comment cards were returned as feedback about the home to the Commission from residents and their relatives. Methods of inspection included previous inspection experience of the home, observation of contact between staff and people who use the service, discussion with people living at the home, the acting home manager, the deputy manager and staff on shift. Inspectors also met with the newly recruited home manager on her first day of induction. The new home manager however she is no longer employed by the project. Requirements and recommendations from previous inspections were discussed with the acting home manager and deputy manager. What the service does well: Residents are involved in the recruitment process and recently took part in the recent interview and decision to recruit the new home manager. Resident’s dietary needs and preferences are well catered for, the home is providing them with daily variation, choice, and interest. A number of comment cards/questionnaires were returned to the Commission as feedback from residents and their relatives. One relative commented “I have always had complete confidence in the way the home is run. I have always been confident that I will be informed about my relative”. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 6 Another relative commented, “Some of the staff are very young but seem to manage the day to day needs of the people there. They seem very caring young people doing a good job”. One resident commented, “I am happy very happy in Unicorn House”. Another resident commented, “I feel happy in Unicorn House and have made lot friends with other residents and with the carers”. What has improved since the last inspection? What they could do better: There was one requirement and seven recommendations set at the last key inspection. The home has not met the requirement and only three of the recommendations have been addressed. As a result of this inspection there are now twenty-two requirements and twelve recommendations. People who may wish to use the service cannot be confident that their needs can be met as the Statement of Purpose continues not to be an accurate reflection of the services provided at Unicorn House. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 7 During previous inspections numerous requirements and recommendations have been set in relation to various parts of the home’s Statement of Purpose however the home has continually failed to develop a Statement of Purpose that accurately reflects what the home offers. The home needs to develop a Statement of Purpose that includes accurate information and takes into account the registration category of the home. Continued failure to comply with this requirement may lead to enforcement action being against the home. The service needs to develop an appropriate procedure for admitting people to the home. This needs to take into account the registration category of the home. Residents receive personal support in the way they prefer although physical health practices are inadequate. This could result in poor or inconsistent care being received by people with mobility needs. Arrangements for handling medication in the home are insufficient. Lack of adequate recording, staff awareness of the homes medication procedures, and failure to respond to unsafe medication practices has placed people who use the service at risk of harm. The physical environment does not meet the specialist needs of some the residents. It is not possible for wheelchair users to access the home without first seeking assistance from staff. Ramps need to be fitted to the homes backdoors to ensure wheelchair users can gain access the rear garden. The homes arrangements for controlling the spread of infection could be improved by installing a wash hand basin in or near the laundry room. The homes fire safety arrangements are not sufficiently robust to ensure the health and welfare of the residents, their guests, and staff are, so far as reasonably practicable, promoted and protected. The inspector’s would like to thank the residents, their relatives, the staff, the acting home manager and the deputy manager for their support in the inspection process. 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. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service cannot be confident that their needs can be met as the Statement of Purpose continues not to be an accurate reflection of the services provided at Unicorn House. The home does not have an appropriate procedure for admitting people to the home. The home has failed to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. EVIDENCE: It was recommended at previous key inspections on the 20th of September 2006 and the 5th of March 2007 that the homes Statement of Purpose be reviewed and include only information that was accurate and appropriate. This was so that those who wish to seek placements in this service have a clear understanding of what client groups the home’s staff are qualified and experienced to support and provide services to. The aim of the Statement of Purpose and inspection reports is to assist them to make informed decisions. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 10 The last key inspection report also stated that in order that there is no further misunderstandings, those staff who assess prospective residents should be mindful of the registration category of the home and the Statement of Purpose when dealing with care managers who are seeking placements. In this context the Statement of Purpose needs to be revised to remove the reference to ‘associated mental health problems as there is a condition placed on the home that no one in this category should be admitted. The acting home manager stated that since the last inspection he had revised the Statement of Purpose however the Statement of Purpose still stated that the home provides specialist care primarily for people with learning disabilities and challenging behaviour with associated mental illness. The acting home manager was reminded that during previous inspections numerous requirements and recommendations have been set in relation to various parts of the homes Statement of Purpose but the home has continually failed to develop a Statement of Purpose that accurately reflects what the home offers. The registered provider must make sure that the home develops a Statement of Purpose that includes accurate and appropriate information and takes into account the registration category of the home. Continued failure to comply with this requirement may lead to enforcement action being against the home. A new resident was admitted to the home on the 6th of April 2007. He was admitted from 104 Coldharbour Road another care home owned by the registered provider. The resident was admitted to Unicorn House despite the placing authority, Greenwich Social Services, advising the acting home manager to wait for a formal review before taking any further action. A statutory requirement notice was served on the registered provider on the 23rd of May 2007 for failing to ensure that the needs of the new resident were assessed by a suitably qualified or suitably trained person prior to admitting him to the home, failing to ensure that there was appropriate consultation regarding the assessment with the resident or a representative of the resident and failing to confirm in writing to the resident that having regard to the assessment the care home was suitable for the purpose of meeting his needs in respect of his health and welfare. It was stated in the last key inspection report that there continues to uncertainty in this area which may have led to another resident being admitted to Unicorn House at short notice from the previous placement. The care managers and NHS professionals then had to reassess the person in order to confirm that the placement was satisfactory. Staff in the home then Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 11 needed specific training in order to properly understand the person’s current and future needs. It is the case again that a resident has moved into the home where staff are not qualified and experienced to support and provide services to meet his diagnosed condition and assessed needs. The acting home manager stated that the registered provider and a registered manager from 104 Coldharbour Road had carried out the initial assessment before admitting the resident to 104 Coldharbour Road. The resident was then moved to 16 Campden Road. At the time of the inspection the acting home manager stated that for any new admissions the new home manager would carry out the assessments. The homes admission procedure is included in the Statement of Purpose. This refers to admission based on the assessment of the individual residents needs for care and services, visits and overnight stays and states that within three months a meeting will be held with all relevant professionals such as care managers, home managers, relatives and carers to discuss care plans, settlement and future needs. The procedure does not indicate that an assessment by the placing authority should be completed prior to admitting new residents. The registered provider must make sure that the home develops an appropriate admissions procedure that takes into account the registration category of the home and the Statement of Purpose. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 12 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress has been made on reviewing residents Person Centred Plans and care plans however residents cannot be sure that they will be supported in decisions to take risks unless they are fully involved with their Person Centred Planning and risk assessments. EVIDENCE: Two residents were case tracked and their files examined. At the inspection of 27th of June 2006 a requirement was set that the registered provider contact the care manager of one of these residents in order to verify that they were suitably placed in the home. At the key inspection on the 5th of March 2007 the deputy manager confirmed that the care manager had reviewed the placement but had yet to send the report to the home. The home has yet to obtain a copy of this review. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 13 It was recommended at the key inspection on the 5th of March 2007 that the acting home manager contacts all residents care managers and request copies of their most recent care plan/needs assessments/placement reviews so that they can be kept on the residents file. The acting home manager stated that a number of care managers had visited the home and carried out care plan/needs assessments/placement reviews, some where on file and some had not yet been obtained. The other resident case tracked moved into the home since the last inspection. As previously stated in this report the home had failed to ensure that the appropriate assessments had been carried out prior to admitting him into the service. This person has been diagnosed with Autism however at the time of admission none of the staff team had been trained on this condition. The acting home manager stated that a Community Learning Disability Nurse from Croydon Social Services had visited the home and facilitated an autism awareness session and planned to return to the home to train staff on autism. A great deal of information was on file from the resident’s previous placement with the National Autistic Society including risk assessments, behaviour management strategies and a TEACCH schedule. The TEACCH approach focus’s on the person with autism and the development of a program around this persons skills, interests, and needs. The major priorities include centering on the individual, understanding autism, adopting appropriate adaptations, and a broadly based intervention strategy building on existing skills and interests. It is recommended that the acting home manager/new home manager contact the National Autistic Society for further advice on TEACCH Training and autism. This resident did not have a service user plan/care plan however the acting home manager produced a temporary management plan. The acting home manager explained that he was waiting for the placing authorities needs assessment before developing a plan. The new resident had his needs assessed by the placing authority in April 2007 and a copy of the assessment report has recently been obtained by the home. It is required that a service user plan/care plan is developed in partnership with the new resident, based on his assessment. The plan should clearly set out how specialist requirements will be met through positive and planned interventions. The plan should focus on current needs, development of skills, and his future aspirations. Full risk assessments were in place for both residents. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 14 At the last key inspection it was noted that two residents Person Centred Plans had last been reviewed in April 2006 but had not been reviewed at the set date for October 2006. The deputy manager was of the view that care managers needed to be present in order for the reviews to be undertaken. The deputy manager has reviewed the majority of residents Person Centred Plans since that visit. Croydon Councils Person Centred Planning co-ordinator visited the home on the 8th of March 2007 to offer support with Person Centred Planning. The deputy manager stated that the home had applied for staff to attend Person Centred Planning training but this was not possible as the course was fully booked. The deputy manager stated that she had contacted the co-ordinator and hopes to get staff on this training in October 2007. At the last key inspection it was noted that all residents files included a full risk assessment. These risk assessments had last been reviewed on the 20/04/06. It was recommended that all residents risk assessments be reviewed and updated on a regular basis. These risk assessments have yet to be reviewed. The acting home manager/home manager must make sure that all residents risk assessments be reviewed and updated on a regular basis. It was observed at the last key inspection that the risk assessment format included the statement “this is to certify that I have been involved while discussing the risk I pose to myself, the environment and other people under different circumstances, the contents have been explained to me and I understand” It was noted that the risk assessments had been signed and agreed by the registered provider and the residents key worker but not the residents. It was recommended that if appropriate residents agree and sign their risk assessments. These risk assessments have yet to be agreed and signed by the residents. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being involved in the broader community and participating in a wider range of social activities. However as stated at the last key inspection this needs to be sustained before they can be confident that this can be is a regular expectation. The dietary needs and preferences of residents are well catered for providing them with daily variation, choice, and interest. Opportunities are also available for residents to be involved in planning the weekly menus, although these arrangements could be improved to enable individuals to have far greater say in this process. Care plans should contain more detailed information about individual food preferences and religious practices to enable staff to meet resident’s unique dietary wishes and needs. EVIDENCE: Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 16 A number of residents went on a holiday to Mauritius last year. Concerns were raised by care managers in respect of the residents having opportunities to select other holiday venues and different types of holiday closer to home. They were also concerned that they were not involved in any discussions about these holidays until after all the arrangements had been made. It was recommended at the last key inspection that key people in the resident’s lives (including care managers) are notified as soon as practicable when decisions are being made about residents travelling abroad. The acting home manager stated that residents have planned to go on holiday on the UK this year. A number of residents plan to go to Blackpool. He stated that residents had discussed their preference for holidays at a residents meeting. He also stated that he has written to individual residents care managers with holiday proposals including the cost of the holiday and individual risk assessments. Two residents were case tracked and their files and activities examined. The home employs the Keeping Track Participation format for recording resident’s activities in the home and in the community. Activities are recorded on a weekly basis then archived. It was stated at the last key inspection that this format appears to work well for some of the more active residents but for those residents who choose not partake in activities most of the record is blank. The deputy manager stated that she is currently developing a more appropriate activities record for individual residents. It was noted at previous inspections/visits to the home that one resident spent much of his time in his bedroom. His weekly timetable now indicates that he attends the Unicorn Workshop during the week, Church on Sunday’s, goes out to the local pub, goes to the betting shop, personal shopping with his key worker and visits his parents on Wednesdays. He is also offered in house activities such as watching movies, playing darts and karaoke. The other resident moved into the home in April 2007. The deputy manager produced a weekly timetable for activities. Monday –walk in the park, cleaning, a short drive. Tuesday – personal shopping, puzzles, walks and gardening. Wednesday – tidy room, activity of own choice. Thursday, personal shopping, puzzle, indoor activity, pub in the evening. Friday – out for walk or drive, gardening. Saturday prepare lunch, out for walk or drive, pub in the evening. Sunday clean room, walk in the park. The home has a people carrier vehicle. His needs assessment states that his social needs are currently under review, it is important to enable him the time and pace to adjust to his new placement Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 17 and therefore his care plan will be modified in accordance with his needs. A requirement has been set that the home develops a service user plan/care plan for this resident. The home still relies on the day service provided by the Unicorn Workshop. However the deputy manager stated that residents are offered other activities. The deputy manager stated that residents are now offered the opportunity to go shopping in Croydon, Saint Mary’s club on a Monday evening, a club run by Mencap on a Saturday but stated that these clubs are not popular with residents. Some residents have attended shows at Fairfield Hall and Fairfield Hall regularly sends the deputy manager a programme of events that she discusses with residents. Residents generally go to a local café and hairdressers near the Unicorn Workshop as they have become familiar with that area over time. Some residents also go to a local pub on a weekly basis. With the developing Person Centred Planning focus it is hoped that residents can be more involved and supported in the community to increase their leisure and recreational activities. The acting home manager stated that residents meetings are held monthly. It was requested that he advise the inspector of the date of the next meeting and enquire if residents would mind if the inspector attended. The homes administrator contacted the inspector on two occasions but he was not able to attend at these times however he would like to attend a residents meeting schedule permitting. A number of comment cards/questionnaires were returned to the Commission as feedback from residents and their relatives. One relative commented “I have always had complete confidence in the way the home is run. I have always been confident that I will be informed about my relative”. Another relative commented, “Some of the staff are very young but seem to manage the day to day needs of the people there. They seem very caring young people doing a good job”. One resident commented, “I am happy very happy in Unicorn House”. Another resident commented, “I feel happy in Unicorn House and have made lot friends with other residents and with the carers”. All other comment cards/questionnaires returned by residents had been ticked positive. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 18 The published menu for the week was conspicuously displayed on a notice board in the dinning room. The deputy manager stated that the home currently has four published menus that are rotated on a weekly basis. The choice of meals advertised on June’s menus looked quite varied and nutritionally well balanced. Two residents spoken to confirmed that they were happy with the quality of the food they received at the home and were always offered a choice of what to eat at meal times. Staff maintain an up to date record of all the food provided which matched the meal choices advertised on the previous weeks published menu. The record also revealed that alternative meals are frequently offered to anyone who does not like what’s advertised on the menu on any given day, which showed residents who live at the home have a choice. During a tour of the premises it was noted that a number different condiments were laid out on all the tables in the dinning area for the residents to use if they wished. The kitchen was well stocked with a wide variety of healthy foodstuffs that were correctly stored in accordance with basic food hygiene standards. The two care plans being case tracked and one selected at random revealed information contained in these documents varied. E.g. While details about two residents specific dietary needs and food preferences were found in their care plans, another did not contain any information about the individuals food likes and dislikes. Furthermore, it was evident from comments made by the homes manager and the deputy manager that there was a degree of confusion about what the specific dietary needs were in terms of the individuals faith. This matter needs to be reviewed with the individual and their representatives, and their care plan updated to reflect the outcome of any meeting. Documentary evidence was made available on request to show that advice had been sought from a speech therapist and a risk management strategy established to ensure staff had the necessary knowledge to provide appropriate assistance at mealtimes. Two members of staff informally interviewed demonstrated a good understanding of this residents dietary needs and more specifically what support they required at mealtimes to minimise the identified risk. Three members of staff spoken with about menu planning, food shopping, and preparing meals stated that residents were actively encouraged and supported to join in these tasks. The deputy manager stated that residents have the opportunity to help staff plan the menus at residents meetings. The minutes of the three residents meetings held in 2007 were made available on request and revealed menu planning had been discussed at each of them. As only three residents meetings have been held in the past six months the acting home manager agreed that more suitable arrangement should be introduced to Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 19 enable residents more opportunities to be involved in planning the weekly menu. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. In the main residents receive personal support in the way they prefer and require, although physical health practices are inadequate, which may result in poor or inconsistent care being received by residents with mobility needs. Arrangements for handling medication in the home are insufficient. Lack of adequate recording, staff awareness of the homes medication procedures, and failure to respond to unsafe medication practices has placed residents at risk of harm. EVIDENCE: The three members of staff spoken with about residents physical disabilities were aware of the actual support these individuals required to ensure their mobility needs were met. The two care plans specifically chosen for the purpose of evaluating the homes performance in this outcome group contained information about residents general health care and the outcome of appointments with various health care professionals, including GP’s, speech therapists and opticians. However, these Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 21 plans did not contain any manual handling assessments or guidance for staff to ensure these residents received all the personal support they preferred and required. Furthermore, these plans showed that residents with mobility needs had not received any input from suitably qualified occupational therapist for well over three years. The deputy manager was able to provide written evidence to show she had referred this individual to an occupational therapist in April 2004, which the OT department declined to take any further action. The deputy manager stated that no further attempts to seek advice or input from a qualified Occupational Therapist had been made in the intervening years, despite the aforementioned resident receiving a new wheelchair in this period. During the course of this site visit a community based optician arrived to carry out prearranged eye check ups on a number of residents. The optician stated that they were regularly invited to the home to carry out eye tests. Staff maintain detailed records of all the accidents involving residents. This record showed that two accidents had occurred in the home since it was last inspected. The deputy manager stated that staff on duty had appropriately dealt with both accidents at the time and that none of the residents were admitted to hospital or sustained any ‘serious’ injuries. One of the accidents involved a resident falling in the home. As previously mentioned in this report these residents care plans did not contain a manual handling assessment or management strategies to help staff minimise the risk of this resident falling in the home. Medication administration records sampled at random reflected medication stocks currently held by the home on residents behalf. These stocks are appropriately stored in a locked cabinet. Medicines that need to be kept in the fridge were also correctly stored in a locked metal box. It was noted as recommended at the last key inspection that the pharmacist now stamp the returns of medication book on the date when medication is returned. A number of recording errors were noted on two medication administration (MAR) sheets sampled at random where staff had failed to sign for medicines given. The home uses a monitored dosage system and the deputy manager was able to confirm that all residents prescribed medication had been correctly administered in the past two weeks. This suggests that sometimes medication records are not signed when medication is given. Furthermore, records are not being kept of all the medicines received into the home. The deputy manager stated that the home does not have any procedures regarding the receipt of medicines. The acting home manager will need to establish such a procedure that makes it clear to staff they should always check the full details of the medicines being received and keep an accurate record of the process as part of an effective medication monitoring Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 22 system. The deputy manager was reminded that spaces already exists on residents medication administration sheets for staff to sign for any medicines received. Documentary evidence was produced on request to show that staff authorised to handle medication in the home had initially received accredited training in these area of practice in 2003 and attended an in-house refresher course in 2006. A drug that could only be administered through an invasive medical procedure was found in the medication cabinet. A mediation administration sheet revealed the residents General Practitioner had prescribed the drug. However, the deputy manager conceded that none of the homes staff team had received any training from a suitably qualified General Practitioner or District Nurse regarding the drugs safe administration, and nor had any risk assessments been carried out regarding its use. The deputy manager also stated the aforementioned drug had never been administered in the home. The drug must be returned to the dispensing pharmacist as a matter of urgency and advice sought from the relevant health care professionals regarding its future use. The deputy manager confirmed that some residents receive as and when required (PRN) medication and was very clear when and how to administer thus type of medication. However, no written protocols regarding the appropriate use of PRN medication could be produced on request. It is essential PRN protocols are established to ensure all staff authorised to handle medication in the home are clear when and how to give this type of medication and ultimately who is authorised to use it. A requirement was set at the last inspection that all staff must be made aware of the home’s policies and procedures for handling medicines so as to ensure that residents are so far as reasonably practicable protected from harm. The large number of shortfalls identified during the course of this inspection suggests the registered provider and his staff team have failed to address all the homes unsafe medication practices. Consequently staff will still need to refresh their knowledge about how medicines are used in the home and the basic principles behind the homes medication policies and procedures. Repeated failure to address this on going matter will result in the Commission considering taking enforcement action to ensure future compliance. The home does not have a copy of the Royal Pharmaceutical Society of Great Britain’s guidelines on handling medicines in care homes. It is recommended the home obtain a copy of the guide for reference purposes. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. The homes arrangements for dealing with concerns and/or complaints are sufficiently robust to ensure residents feel their views are listened to and acted upon. However a more accessible complaints procedure still needs to be introduced to ensure residents know how and to whom to make their complaints The homes safeguarding adult’s procedures are sufficiently robust to protect the people who use the service from harm. EVIDENCE: The deputy manager stated that no formal complaints about the homes operation had been made since the last inspection. No new entries were recorded in the homes complaints log since it was last inspected. The acting home manager stated people could use a wooden box located in the entrance hall to make complaints about the homes operation. It was not clear what the purpose of the box was as no sign to indicate its use was present, and the acting home manager acknowledged that he was not aware of it ever being used. The acting home manager also acknowledged that the homes complaints procedure was not available in a suitable format that could easily be understood by the residents. The procedure needs to be made far more Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 24 resident ‘friendly’ to ensure that the residents know how their complaints will be dealt with. Two residents said staff are very approachable and listened to their point of views, especially if they are not satisfied with any aspect of life at the home. The home has copies of the Local Authorities safeguarding adult’s procedures and its own whistle blowing protocols for staff to follow, although a copy of the Department of Health’s ‘No Secrets’ guidance could not be produced on request. It is recommended a version of the guidance be obtained for references purposes. The acting home manager stated that there had been no allegations of abuse made within the home since it was last inspected or staff referred for possible inclusion on the protection of vulnerable adults register. Documentary evidence was produced on request to show that sufficient numbers of the homes current staff team had attended the local authorities recognising, preventing and reporting abuse training in the past six months. The acting home manager stated that physical intervention techniques are never used in the home as this contravenes the homes philosophy of care. The acting home manager stated all the money belonging to residents that was mismanaged last year (2006) has now been refunded and more robust financial monitoring systems established to prevent a similar incident reoccurring. The acting home manager stated that the process of transferring control of resident’s monies away from the home to resident’s relatives and care managers was well underway and was almost complete. Progress on this matter will be assessed at the homes next inspection. The balances recorded on the financial sheets kept for the two residents being case tracked matched the amounts being held by the home on their behalves. The money was individually stored in a secure place in the homes safe. Receipts are kept for all goods and services purchased by staff on residents behalves. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 25 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, 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment does not always meet the specialist needs of the residents and ramps will need to be fitted to all the homes backdoors to ensure wheelchair users can also gain access the rear garden. The homes arrangements for controlling the spread of infection need to be improved by installing a wash hand basin in or near the laundry room. EVIDENCE: During an inspection at the home on the 27th June 2006 there was a strong smell of urine emanating from one residents bedroom. It was recommended that the registered provider seek professional advice before, (in conjunction with the resident) devising a programme to support the resident with his enuresis. At a subsequent visit it was observed that the deputy manager had set in place a programme to support the resident to the toilet. This had eliminated the Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 26 smell of urine. During this visit it was noted that the smell had returned. The acting home manager stated that he would re emphasise the toileting programme to the staff team and that he had plans to replace the carpet with appropriate non-slip washable flooring. It was also noted that some of the radiator covers in the home where made of flimsy plywood. One in the above mentioned resident’s bedroom had been badly broken probably by his wheelchair. It is recommended that radiator covers in resident’s bedrooms and communal areas throughout the home be replaced. It was observed during a tour of the premises that the bathroom and shower room on the ground floor were in a poor state and not a place where residents could relax in comfort. The bath has an overhead shower. A member of staff explained that a number of residents use this on a daily basis however there was no shower curtain. It is recommended that a shower curtain be fitted to the bath that has an overhead shower. The bath also had a bath seat at the end of the bath. The member of staff did not know who this belonged to or if indeed any of the residents used it. The deputy manager stated that one resident uses it to set her soap on. The bath had a non-slip mat; on examination this was found to be mouldy. This was removed from the bath. The acting home manager was asked to look at the bathroom when the inspector returned with the acting home manager the mouldy non-slip mat had been put back in the bath. The acting home manager removed the mat and the bath seat and asked a member of staff to take it away. The acting home manager also looked in the shower room. A toilet in the shower room has a raised toilet seat on legs and a movable arm rail that has been tied to these legs. The acting home manager was not sure of the reason for this arrangement. There is a bathroom on the first floor was is a much better standard; this had been refurbished about two years ago. The bathroom is close to a number of residents bedrooms and therefore more accessible than the downstairs bathroom. However it was noted that the taps had been removed. The acting home manager explained that this was because of a leak and that replacement taps had been ordered. When the taps are received the bath will become operational. It was noted that the hot water temperature in the downstairs bathroom was 34 degrees centigrade at 2.50 pm and the hot water temperature in one of the residents bedrooms was only 22 degrees centigrade. It was noted that a clinical waste bin is kept in the shower room an incontinence pad had not been Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 27 properly disposed off and left a strong smell. I was brought to the acting home manager’s attention that staff needs to wash their hands in hot water and that staff need to adhere to infection control guidance. The deputy manager stated that she had attended training on this topic and would discuss it with staff at the next meeting. The home manager must ensure that staff is appropriately trained on infection control. The deputy manager showed that the thermostat on boiler in the kitchen was used to regulate hot water temperatures throughout the home. The home manager must ensure that the hot water temperatures in the home are regulated based on assessment of the capabilities and needs of residents (i.e. temperature close to 43º C). The acting home manager stated that hot water temperatures used to be checked on a weekly basis but conceded that these had not been done since December 2006. He stated that Unicorn House has obtained the services of Peninsula Business Services Ltd as consultants on health and safety. The acting home manager stated that Peninsula Business Services Ltd had visited the home and carried out an assessment. A certificate to Unicorn House is hung in the office from Peninsula Business Services Ltd stating that health and safety at work legislation is complied with. The acting home manager stated that two boxes in the office contained information and policy and procedures from Peninsula Business Services Ltd on health and safety in the home and that these are to be employed in the home. A hot water boiler at the top of the house had water dripping into a bucket underneath. The acting home manager explained that this boiler was not in use for the home but for the top flat that is not in use at present. It is recommended that the boiler at the top of the home be serviced. It was noted that the light in one resident’s bedroom was not working. A member of staff explained that this was because of the resident’s behaviour of flicking the switch on and off. The acting home manager stated that the home is considering other options of lighting for his room. The home accommodates two residents who use wheelchairs. Access to the home is through two sets of saloon type doors at the front of the house; there is a small ramp to the first set of doors and a step at the second set of doors. It is not possible for wheelchair users to access the home without first seeking assistance from staff. The registered provider must ensure that suitable arrangements are made at the entrance to the home so that residents who use wheelchairs can gain access to the home without the need for physical assistance from staff. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 28 One resident spoken with said they were unable to access the rear garden without staff support because they could not get their wheelchair over the steps that formed part of their external bedroom door, as well as the communal back door (dinning room). The deputy manager confirmed that none of the homes wheelchair users could access the homes garden without first seeking assistance from staff. Suitable ramps will need to be installed in the aforementioned doorways to ensure wheelchair users can gain independently access to the home and the rear garden. The registered provider needs to consider how wheelchair users can access appropriate areas of their home. On arrival a member of staff was observed using a dinning room table to sort out residents clothes that had recently been washed and ironed. The dinning room was clearly still in use at midmorning as a number of residents were observed eating their breakfast in this area at this time. The acting home manager must remind staff that this practice is not only disrespectful but also unnecessary as the home has adequate facilities and space for residents clean clothes to be sorted out away from any areas where food is stored, prepared or eaten. During a tour of the premises it was noted that contrary to basic infection control standards no handing washing facilities were available in or near the homes laundry room. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 29 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 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally there is greater clarity in the staff roles and responsibilities and residents are beginning to benefit, as staff are more supported, supervised and trained. Recruitment practices have improved but residents cannot be confident that they can be supported and protected until good recruitment practice has been consolidated. EVIDENCE: One new member of staff has started work at the home since the last inspection. This member of staffs personnel file was examined. The file included a completed Criminal Records Bureau Check, passport, two written references, qualifications, and employment history. It was noted that this member of staff did not have experience of working with people with learning disabilities. The acting home manager stated that the member of staff had worked briefly at Unicorn House last year but left. The acting home manager stated that he employed him after a short interview Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 30 because of his previous employment at the home. The member of staff had worked at the home before the acting home manager came to the home. The acting home manager stated that the home is due to shortlist for new staff and that it was his intention to shortlist and recruit only people with experience in working in a care setting. The acting home manager stated that it was important to build a team of staff with experience and skill. The acting home manager stated that another member of staff has been recruited and will start work once he has obtained a Criminal Records Bureau Check. This member of staff has been recruited as a team leader and he has experience of working in care. The new home manager stated that she had attended her interview at Unicorn House and was interviewed by the acting home manager and one of the residents. She was not surprised that a resident was on the panel as she says this is the way she is used to recruiting new staff. The new home manager is no longer employed at the home. The acting home manager stated that Unicorn House has obtained the services of Peninsula Business Services Ltd for employment law and personal consultancy. The acting home manager stated that staff contracts have been amended in line with legal requirements following consultation with Peninsula. A certificate to Unicorn House is hung in the office from Peninsula Business Services Ltd that Unicorn House is an “Employer of Excellence” an accredited standard. Staff supervision records were examined. It was noted that six staff had formal supervision in March 2007 and one member of staff had formal supervision in April 2007. The acting home manager stated that the deputy manager had carried out most of the supervisions as he only worked at the home on a part time arrangement. At the time of the inspection the acting home manager stated that now that the new home manager was in post that staff would have supervision on a much more frequent basis. It is recommended that all members of staff receive formal recorded supervision at least six times per year. The acting home manager stated that Peninsula have provided the home with an appraisal format, he is awaiting paper work before employing the system in the home. As previously stated the new resident admitted to the home has been diagnosed with Autism however at the time of admission none of the staff team had been trained on this condition. The acting home manager stated that a Community Learning Disability Nurse from Croydon Social Services had visited the home and facilitated an autism awareness session and planned to return to the home to train staff on autism. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 31 It has been recommended that the home manager contact the National Autistic Society for further advice on TEACCH Training and autism. Two other residents have physical disabilities and require the use of a wheelchair to get around. Staff has not had training on physical disabilities. The registered manager must ensure that all staff attends training on physical disabilities. It is recommended that the home manager develop a staff training programme that takes into consideration the diagnosed conditions and assessed needs of the residents. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 32 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At the time of the inspection the home had recruited a new home manager however she is no longer employed by the project. The homes fire safety arrangements are not sufficiently robust to ensure the health and welfare of the people who use the service, their guests, and staff are, so far as reasonably practicable, promoted and protected. EVIDENCE: The home has not had a manager registered with the Commission to run the home since the previous registered manager resigned his post in February 2006. At the time of the inspection the home had recruited a home manager however she is no longer employed by the project. The homes administrator Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 33 stated during a telephone conversation on the 6th of July 2007 that she had contacted an employment agency in order to recruit another home manager. The registered provider must recruit a home manager and have them registered with the Commission to run the home. As stated at the last inspection the appointment of the acting home manager had resulted in improvements in the way the home is being managed. However the acting home manager also has a full time job with the NHS and is only part time in the home. He and the management team have introduced a different style of management within the home that has encouraged the staff to develop. However the improvements need to be observably sustained and the benefits to the residents need to be clear and measurable before the Commission can confidently assess the service as improving. The challenge for the management team will be the introduction of robust and verifiable quality assurance system in order to improve and develop the service. The deputy manager has supported the acting home manager. The majority of the staff team have now been together for over two years. It was observed at the last key inspection that resident’s files included service user comment forms. These comment forms had last been completed for the period August 2005 to March 2006. It was recommended at the key inspection that the home manager offer residents the opportunity to complete a service user comment form so that the home could gain feedback about the quality of service provided in the home. The deputy manager stated that residents had not yet been offered the opportunity to complete a service user comment form. It was also recommended at the last key inspection that the home manager seek the views of resident’s families, advocates and care managers about the standard of care provided at the home and how these can be improved further. The deputy manager stated that this information has not been sought. The Commission has taken in to consideration that the home was sent a draft copy of the last key inspection report on the 10th of May 2007 and the final report on the 6th of June 2007 and the acting home manager may need more time to complete the service user comment forms and seek the views of resident’s families, advocates and care managers about the standard of care provided at the home. These recommendations will be examined at the next inspection. The registered provider has carried out regular independent monthly visits to the home (Regulation 26 visits) and sent copies of the reports to the Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 34 Commission. Copies of these reports were also available in the home for inspection. The acting home manager was able to produce a fire risk assessment of the premises that been reviewed in the past twelve months and up dated accordingly to reflect any changes to the homes physical environment. The deputy manager stated that a support worker had been assigned the weekly task of testing the homes fire alarm system and arranging monthly fire drills. The homes fire safety records showed that no log of weekly fire alarm tests and monthly fie drills had been kept since December 2006. The deputy manager stated that she was confident that these alarm checks and drills had continued to be undertaken in this period, but conceded that the homes record keeping regarding its fire arrangements had been poor. Up to date Certificates of worthiness were in place to show that suitably qualified engineers had carried out annual checks on the homes fire alarm system, fire extinguishers, portable electrical appliances, and electrical installations. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 35 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 2 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 1 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 3 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 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 1 X 2 X 2 X X 1 X Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1) Requirement The registered provider must make sure that the home develops a Statement of Purpose that includes accurate and appropriate information and takes into account the registration category of the home. Continued failure to comply with this requirement may lead to enforcement action being against the home. The registered provider must make sure that the home develops an appropriate admissions procedure that takes into account the registration category of the home and the Statement of Purpose. It is required that a service user plan/care plan is developed in partnership with the new resident, based on his assessment. The plan should clearly set out how specialist requirements will be met through positive and planned interventions. The plan should focus on current needs, development of skills, and his DS0000025864.V342871.R01.S.doc Timescale for action 30/09/07 2. YA1 4 (1) Sch 1.8 30/09/07 3. YA6 15 (1) 31/07/07 Unicorn House (16) Version 5.2 Page 37 future aspirations. 4. YA9 13 (4) b & c. 13(4) (5) & 17(1)(a), Sch 3.3(m) The home manager must make sure that all residents risk assessments be reviewed and updated on a regular basis. Manual handling assessments must be carried out in respect of all residents with physical needs and where risks are identified appropriate management strategies developed to enable staff to provide healthcare support in the way these individuals prefer and require. Suitably qualified occupational therapists must assess the physical needs of all these service users who require mobility aids/adaptations, and the physical environment. All staff must be made aware of the home’s policies and procedures for handling medicines and up date their training in medication to ensure service users are, so far as reasonably practicable, protected from harm. Previous timescale for action of 31st May 2007 not met. The registered manager and staff must comply with the homes policy and procedures for the recording of medicines administered in the home ensure service users are protected from harm. The registered manager must establish a procedure for receiving all medication into the home and ensure staff keep an accurate record of this process. The registered manager must establish protocols for the use of as required (PRN) medication to ensure staff are clear when and how to administer this type of medication, and who authorises DS0000025864.V342871.R01.S.doc 01/08/07 5. YA18 01/08/07 6. YA18 13(1)(b) 01/10/07 7. YA20 18 (1) c 01/08/07 8. YA20 17(1)(a), Sch 3.3(i) & 13(2) 18/06/07 9. YA20 13(2) 15/07/07 10 YA20 13(2) 15/07/07 Unicorn House (16) Version 5.2 Page 38 its use. 11. YA20 13(2) Drugs used for medically invasive procedures, which staff have not been suitably trained or authorised to administer, must be returned to the dispensing pharmacist and appropriate advise sought from the relevant health care professionals about who should be responsible for handling this type of medication. The home must establish a far more accessible complaints procedure that enables service users to know how and to whom they can make complaints to. Suitable ramps must be fitted to all the homes backdoors to ensure all the homes wheelchairs users have independent access to the rear garden. Laundry must not be sorted on tables where food is eaten, especially during mealtimes, as this practice contravenes environmental hygiene standards and is undignified for the people who live at the home. Hand washing facilities must be located in the laundry room to prevent the spread of infection The home manager must ensure that staff are appropriately trained on infection control. The registered provider must ensure that suitable arrangements are made at the entrance to the home so that residents who use wheelchairs can gain access to the home without the need for physical assistance from staff. The home manager must ensure that the hot water temperatures DS0000025864.V342871.R01.S.doc 01/07/07 12. YA22 22(2) 01/08/07 13. YA29 23(2)(n) & (o) 01/09/07 14. YA30 12(4)(a) & 16(2)(j) 18/06/07 15. 16. 17. YA30 13(3) & 23(2)(j) 13(3) 23 (2) a 01/09/07 01/08/07 01/09/07 YA30 YA29 18. YA30 23(2) j 01/09/07 Unicorn House (16) Version 5.2 Page 39 19. 20. YA32 YA37 21. YA42 22. YA42 in the home are regulated based on assessment of the capabilities and needs of residents (i.e. temperature close to 43º C). 18 (1) c The registered manager must ensure that all staff attends training on physical disabilities. 8 (1) & (2) The registered provider must recruit a home manager and have them registered with the Commission to run the home. 17(2), Sch The registered manager and 4.14 & staff must comply with the 23(4)(c)(ii) homes fire safety procedures and keep an up to date record of every (weekly) fire alarm equipment test conducted in the home. 17(2), Sch The registered manager and 4.14 & staff must comply with the 23(4) homes fire safety procedures and keep an up to date record of every fire drill practice conducted in the home. 01/09/07 01/09/07 01/07/07 01/07/07 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. Refer to Standard YA32 YA9 YA9 YA39 Good Practice Recommendations It is recommended that the home manager contact the National Autistic Society for further advice on TEACCH Training and autism. It is recommended that all service users risk assessments are reviewed and updated on a regular basis. It is recommended that if appropriate service users agree and sign their risk assessments. So that the home can gain feedback about the quality of service provided in the home it is recommended that the home manager offer service users the opportunity to complete a service user comment form. It is recommended that the home develop a more DS0000025864.V342871.R01.S.doc Version 5.2 Page 40 5. YA12 Unicorn House (16) 6. 7. YA24 YA39 8. 9. 10. 11. 12. YA24 YA30 YA36 YA32 YA29 appropriate activities record for individual residents. It is recommended that radiator covers in resident’s bedrooms and communal areas throughout the home be replaced. It is recommended that the home manager seek the views of the service users families, advocates and care managers about the standard of care provided at the home and how these can be improved further. It is recommended that a shower curtain be fitted to the bath that has an overhead shower. It is recommended that the boiler at the top of the home be serviced. It is recommended that all members of staff receive formal recorded supervision at least six times per year. It is recommended that the home manager develop a staff training programme that takes into consideration the diagnosed conditions and assessed needs of the residents. The registered provider needs to consider how wheelchair users can access appropriate areas of their home. Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Unicorn House (16) DS0000025864.V342871.R01.S.doc Version 5.2 Page 42 - 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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