CARE HOME ADULTS 18-65
Wallfield 29 Castlemain Avenue Southbourne Bournemouth Dorset BH6 5ES Lead Inspector
Heidi Banks Unannounced Inspection 1st March 2006 12:25 DS0000032029.V287895.R01.S.doc Version 5.1 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 DS0000032029.V287895.R01.S.doc Version 5.1 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. DS0000032029.V287895.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Wallfield Address 29 Castlemain Avenue Southbourne Bournemouth Dorset BH6 5ES 01202 428048 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) Bournemouth Borough Council Zuhal Halet Septekin Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (3) of places DS0000032029.V287895.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to be admitted to the first floor must be ambulant and able to manage stairs. Two service users (names to the CSCI) in the category PD may be accommodated to receive care. Service users in the category of LD(E) can be accommodated in the home up to a maximum of three places at any one time. 31st October 2005 Date of last inspection Brief Description of the Service: Wallfield is a Local Authority retained home with accommodation for fourteen residents. The home predominantly provides care and support for adults with learning disabilities although it has additional facilities to care for two service users with physical disabilities. Wallfield is managed on behalf of Bournemouth Borough Council by Mrs Zuhal Septekin. Wallfield is a detached building located in the Southbourne area of Bournemouth. It is within easy reach of local shops and community facilities. Some on-street parking is available outside the home and bus routes to Bournemouth and Christchurch are easily accessed. Accommodation is provided in single bedrooms, two being on the ground floor and the rest on the first floor. The communal facilities include two welldecorated and furnished lounges, a dining room and a training / activity room. There is also a large garden at the rear of the home that can be used for recreational purposes. DS0000032029.V287895.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of 7.5 hours on a weekday. The purpose of the inspection was to assess the home’s progress in meeting one requirement and three recommendations made at the last inspection and to assess outcomes for service users against some of the National Minimum Standards. Three further recommendations made at the last inspection were not assessed on this occasion and therefore will be carried forward to the next inspection of the service. The inspector was assisted by the Registered Manager, Zuhal Septekin, throughout the visit. There are twelve residents living at the home at the present time. All residents are currently under 65 years of age although the manager reported that two are approaching 65. At the start of the inspection the majority of residents were attending day services although four residents who do not currently attend day services were present in the home. However, during the afternoon, the inspector had the opportunity to meet the remaining residents on their return to Wallfield. The majority of residents at the home use non-verbal means of communication. Therefore during this inspection, information was obtained mainly from the registered manager, an assistant manager, one member of the care staff, observation of staff interaction with service users, a guided tour of the premises and inspection of a sample of records including service user records, staff files and some records relating to medication, complaints, training and health and safety. Comment cards were received from eleven residents, many of whom had the support of their key worker to complete their responses, six relatives of residents, one general medical practitioner, one health care professional and one Care Manager. Their responses have been used to inform this inspection. Nineteen standards out of the twenty-two key standards were assessed at this inspection. What the service does well:
Residents are involved in making choices and decisions about aspects of their daily lives and regular residents’ meetings ensure that there are opportunities for residents to communicate with staff about issues that affect them. Risk assessments are in place to ensure that residents’ safety in their home and community is protected and that their independence is promoted. Residents are encouraged to engage in a range of activities, access their community on a regular basis and maintain contact with their families which
DS0000032029.V287895.R01.S.doc Version 5.1 Page 6 supports their right to lead ordinary lives. Residents are offered a good range of nutritious meals and are given choices as to what they would like to eat on a daily basis. Individual support plans are in place to identify the assistance residents require from staff with personal care tasks and to ensure that this is carried out in a way that they prefer. Residents are supported to access health care appointments as appropriate to meet their needs. Systems are in place to ensure that the views of residents and their relatives are listened to and responded to appropriately. The home follows the Borough’s adult protection policy and staff are able to access training in relation to abuse awareness and the procedures to ensure that they know how to protect residents. There was evidence that refurbishment and redecoration is being carried out in the home as part of an ongoing plan to ensure that the home remains comfortable and safe for residents. The home is clean and systems are in place to ensure that good hygiene is maintained so that residents have a pleasant environment in which to live and are protected from infection. Recruitment procedures are robust to promote the safety of residents and a structured induction process means that staff are given the basic knowledge and skills to work in a residential care environment with the resident group. A range of accredited training opportunities are available to staff throughout their employment which enables them to develop the knowledge and skills to work effectively with residents. The home has a comprehensive quality assurance process which seeks to obtain the views of residents and their relatives / carers. This ensures that the service provided continues to meet the needs of residents and their views contribute to the development of the home. What has improved since the last inspection?
In response to a requirement made at the last inspection, the registered manager acted promptly to ensure that a multi-agency review took place for one service user whose needs were not being fully met by the service. This resulted in the service user’s needs being reassessed and an alternative placement being found. Both the manager and assistant manager acknowledged that this was a positive outcome for the service user and has resulted in changes to the home environment at Wallfield that are positive for residents. The manager reports that as a result of this, a protocol is being drawn up by the service to ensure that in future assessments are carried out with involvement of staff at Wallfield and that effective liaison takes place with the multi-disciplinary team to ensure that the home only admits service users who DS0000032029.V287895.R01.S.doc Version 5.1 Page 7 they can adequately support and whose presence does not result in restrictions of freedom for other residents in the home. A sample of risk assessments were seen and showed that risks for individual residents are identified and an action plan is put in place to ensure that risks are minimised. Service users are now able to access their bedrooms as they wish without the need for staff to unlock their bedroom doors. This promotes their rights and independence within their home. 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. DS0000032029.V287895.R01.S.doc Version 5.1 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 DS0000032029.V287895.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: DS0000032029.V287895.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Service users are given opportunities to make choices and decisions that give them control over aspects of their everyday life. Risk assessments are in place to ensure that any risks associated with residents’ activities of daily living are identified and the action to be taken to minimise risks is clearly documented. EVIDENCE: Residents’ meetings take place approximately every two months. Minutes of meetings are converted into simple text and / or symbols to aid the understanding of residents. A sample of minutes showed that residents had been able to give feedback about their holidays, be involved in discussion about items to be purchased for the home, discuss preferences in relation to outings and activities, contribute ideas for holidays in the coming year and be given information about a new member of staff joining the home. A member of care staff discussed how she enables residents to make choices about the content of their packed lunch and talked of taking one resident shopping to choose a pair of shoes. As most of the residents at Wallfield communicate by non-verbal means, the member of staff stated that she uses objects of reference, pictures and photographs to support residents in making choices.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 11 A sample of risk assessments were inspected. There was evidence that a risk assessment had been completed for one resident where initial assessment had indicated a potential risk of choking. This gave instructions to staff regarding the presentation of food and need for supervision at meal times. There was evidence that the risk assessment had been reviewed. Another risk assessment was seen regarding a resident accessing the community. This detailed action that should be taken by staff to support her in busy areas and open areas in order to promote her safety. DS0000032029.V287895.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Residents are encouraged to engage in a range of activities and pursue personal interests which contribute towards their personal development. Residents are encouraged to access their local community on a regular basis which supports their right to lead ordinary lives. Residents are supported to build and maintain relationships with their peers and family which gives them a sense of belonging. Residents’ rights are respected so that they are supported to make choices and now have freedom of movement in their home. Service users are offered a range of nutritious meals and are enabled to make choices about what they eat on a daily basis. EVIDENCE: The majority of residents at Wallfield attend local day services which enable them to spend time with peers and take part in a range of activities that interest them and meet their need for positive occupation. Timetables showed that activities offered to them include music, pottery, arts and crafts and
DS0000032029.V287895.R01.S.doc Version 5.1 Page 13 swimming. There are no residents at Wallfield who are currently in paid employment or engaged in voluntary work. Entries in the home’s Activities Book showed that some residents choose to attend the local Gateway Club on a regular basis where they have the opportunity to socialise with their peer group and take part in various activities. The manager stated that residents are supported to access their local community. The home is close to the centre of Southbourne where there are shops and other facilities. The home is also on a bus route to local centres including Bournemouth and Christchurch and has a vehicle for visiting areas that are further afield. The vehicle is adapted to provide transport for residents who use wheelchairs. Records of residents’ participation in activities are listed in an Activities Book. For one service user being case-tracked these were seen to include a trip to a local owl sanctuary, two walks in the New Forest, a trip to Christchurch Priory, a picnic at Marwell Zoo, a lunch outing, a visit to a local shopping centre and a trip to Swanage over the course of two months. Residents are registered with local GP surgeries and attend appointments as required. The manager reported that, depending on their personal circumstances, most residents have good links with their families. Families are welcomed into the home and some service users go to their parents’ homes for short visits. The manager confirmed that the home maintains regular contact with families. Feedback received via comment cards from relatives indicated that they feel welcomed in the home, are able to visit their relative in private and are consulted about their relative’s care where appropriate. The manager reported that some residents have formed friendships with their peers at day services and one resident has a boyfriend at the day centre although he does not visit the home. Following a recommendation made at the last inspection the home has reviewed the practice of locking bedroom doors of residents so that they now access their rooms as they wish and there are no unnecessary restrictions to their freedom around their home. Observation of residents’ movements during the inspection showed that they were able to wander around the home freely and use any of the home’s facilities. The menu plan for the week was seen and showed a variety of home-cooked nutritious options on offer to residents. There are two part-time cooks at the home who prepare main meals for residents. Residents are assisted in making choices about the meals they want to eat through the use of colourful pictures. The cook on duty reported that most residents will indicate their choice by pointing to the relevant picture but staff also check the reactions of residents at meal times to ensure that the meal they chose is one they like and to see how much they have eaten. One care worker stated that residents are also involved in choosing the content of their lunch boxes with support from staff. As, during the inspection, the home’s kitchen was in the process of being refurbished, alternative facilities for catering had been set up in a nearby room to ensure that residents’ needs would be met while the work was taking place.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users’ needs and preferences form the basis of their support plans. This ensures that staff know their individual requirements and are aware of their personal likes and dislikes. The home is developing a protocol to ensure that residents are not admitted whose needs cannot be met. The home ensures that liaison with generic and specialist health care services takes place to meet the needs of existing residents. Procedures are in place to promote safe systems for administering medication but some recommendations have been made in order for service users to be more fully protected. EVIDENCE: A sample of support plans were inspected. The level of personal support required by the resident was clearly documented in addition to the specific preferences of the individual. For example, one resident was noted to need full support with regards to her personal hygiene and was stated to enjoy having her hair brushed, her nails painted, make-up applied and a daily bath. A member of the care staff confirmed that this information is accurate. DS0000032029.V287895.R01.S.doc Version 5.1 Page 15 The manager reported that there is a file at the home which gives all essential information to staff with regards to the individual care needs of residents, for example, how they like to be woken up, their preferences with regards to bathing / showering and their likes and dislikes. Each service user has a Personal Health Record in which appointments with various healthcare professionals can be documented. Discussion with the manager demonstrated that, following the last inspection of the home where it was identified that improvements needed to be made to the support given to one resident to ensure her needs were met, an urgent review was called involving Social Services and an alternative placement was sought. The home maintains links with the Borough’s Social Work teams and health care professionals with regards to meeting the needs of residents. There was evidence on residents’ files that they had been supported to attend medical and dental appointments as necessary. Where residents have required specialist health care support from the Community Learning Disability Team there was evidence to indicate that this has been provided. One comment card from a general medical practitioner and one from a health care professional who has contact with the home were received. These indicated that they are satisfied with the care provided to residents within the home, that staff demonstrate a clear understanding of the needs of the residents and that specialist advice is incorporated into residents’ support plans. All relatives of residents who completed comment cards indicated that they too are satisfied with the care provided at Wallfield and that they are kept informed of important matters affecting their relative; ‘We are very happy how Wallfield staff look after X and know he is receiving the best treatment and attention.’ The home has a medicines policy. Medicines are stored securely in a lockable cabinet in the office of the home. Most medicines are administered from Monitored Dosage System (MDS) blister packs supplied by a local pharmacy. A sample of these were checked. It was noted that one resident is prescribed a certain medication four times a day. However, records indicated that on some days, one dose of the medication had not been administered to the resident. The manager stated that this was because the resident concerned does not always wake up until late morning and on these days he is given three doses during a day instead of four. Other medication is given from original packs or bottles but the date of opening them had not been recorded to provide an audit trail.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 16 Four senior staff at the home have been designated with responsibility for administering medication and have undertaken in-house training to be deemed competent. There is no accredited training around the administration of medication available to staff at the home. The staff who are currently responsible for administering medication to residents have been employed for some time and are familiar with residents. However, it is apparent that a new Deputy Manager has recently been appointed who will be responsible for giving medication following his induction period. Photographs of residents on medication administration records have therefore been recommended to ensure that residents are identified correctly and therefore are given the right medication. It was noted that the allergies of a service user who was on a short stay at the home had not been printed on the medication administration record chart. Although details of medications are generally printed on residents’ medication administration records by the supplying pharmacy, it was noted that some details of prescribed medication had been added in writing by one member of staff. There was evidence in the medication file that the home ensures that each resident’s medication is reviewed each year by the resident’s general practitioner. DS0000032029.V287895.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Procedures are in place to ensure that complaints can be raised with the home by service users and their relatives and responded to effectively. Systems and procedures are in place to ensure that service users are protected from abuse. EVIDENCE: The home has a complaints procedure that is comprehensive and which provides a framework for complaints to be raised and responded to within a given timescale. The complaints record was seen and indicated that no complaints had been received by the service since October 2004. The record also includes compliments received by the service and there was evidence of two relatives of service users writing to the staff in the past year to offer praise about the care provided to their relative. Completed comment cards from six relatives of service users indicated that they were aware of the home’s complaints procedure but that they had not needed to make a complaint. Discussion with the manager demonstrated that on occasions, relatives may raise issues about the care of their relative during conversation and that a system is in place for communicating any issues or concerns to all staff via the home’s office log book. All staff are instructed to read the log book when they come on duty. The home follows the Borough’s adult protection procedure. The home also has a whistle blowing policy. All staff attend compulsory abuse awareness training as part of their induction programme and there is a Vulnerable Adults Phase 2 course organised by Bournemouth Borough Council for staff who wish to develop their knowledge further.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Residents live in a comfortable home which meets their needs and provides them with a pleasant environment in which to live. Systems and procedures are in place to ensure that good levels of hygiene are maintained and that residents benefit from living in a clean environment. EVIDENCE: A guided tour of the home showed that redecoration has taken place of the large lounge and new chairs have been purchased for residents. The manager reported that these were proving easier to clean and that had been well received by residents with one resident who generally chose not to sit on the previous armchairs now sometimes choosing to sit on the new chairs. Plants, ornaments and some new pictures provided a homely feel to the room and there was a new television and DVD / video player in place which had been the chosen purchase of residents out of the home’s amenity monies. During the guided tour, it was noted that residents had access to the home’s dining room if they preferred to sit there. The manager reported that the dining room had been refurbished approximately one year ago. The registered manager stated that the home’s smaller lounge is due for redecoration and new upholstery in the next year.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 19 The home has an infection control policy. Staff are given training in infection control procedures as part of their induction programme. The manager reported that there are plans in place to provide an industrial-type washing machine and tumble drier in the laundry area of the home which will meet the needs of residents more effectively than the existing facilities. Alcohol hand sanitiser was seen to be in place by the sink in the laundry and a supply of paper towels are in place at each sink in the home. There is a ‘yellow bin’ for the disposal of clinical waste. One resident is due to move bedrooms in the near future so that she has more personal space and the room has been redecorated in preparation for this with colours of her choosing. The manager reported that the resident concerned was supported to make a choice as to the type of wooden furniture she wanted in her new room. During the inspection a professional clean was being undertaken of the kitchen area and new kitchen units were being installed. A repair to a crack in the kitchen floor and wall tiles was due to take place at the end of the week. Refrigerator temperatures are recorded twice a day and records were seen to be up-to-date. DS0000032029.V287895.R01.S.doc Version 5.1 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Staff access accredited training which gives them the essential knowledge base to work effectively with service users and meet their needs. The home’s recruitment procedures are sufficiently robust in order to protect service users. Systems are in place to identify the training needs of staff and provide them with opportunities to access training relevant to their role and which will enable them to meet the needs of residents. EVIDENCE: The assistant manager stated that, at present, two staff have completed their NVQ Level 2 qualification and four staff are working towards their NVQ Level 2 qualification. Three members of the staff team are working towards an NVQ Level 3 qualification that is relevant to their role. Two assistant managers are qualified NVQ assessors and therefore are available to support staff with achieving their qualifications. A sample of staff personnel files were inspected and showed that appropriate checks had been undertaken prior to staff employment. These included evidence of enhanced disclosures from the Criminal Records Bureau, two written references and proof of identity on each file.
DS0000032029.V287895.R01.S.doc Version 5.1 Page 21 One assistant manager has designated responsibility for the training and development programme at the home. The manager reported that this responsibility will be taken on by the newly-appointed deputy manager once he has completed his induction period. All staff undertake a structured induction programme which meets Skills for Care specifications and then progress to a programme of training that is accredited by the Learning Disability Awards Framework (LDAF). Evidence of this was seen on staff files. One staff member who did not have previous experience of working with people with learning disabilities stated that since she has been working at Wallfield she has been offered many training opportunities. She reported that this has enabled her to develop confidence in her role and meet the needs of residents. Personal Achievement Development Reviews are arranged for all staff once a year and provide an opportunity for their training needs to be identified. The manager reported that training needs identified at review then form part of the training plan at the home. The manager demonstrated awareness of the need to ensure that staff have the necessary training to meet the changing needs of residents and reported that she is looking to identify suitable training in dementia and ageing in people with learning disabilities for staff. An assistant manager stated that she is a link worker for total communication training at the home and having completed the training herself is now responsible for cascading the information to all staff. DS0000032029.V287895.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The views of residents and their relatives and friends are sought on a regular basis and contribute towards the review and development of the home. Policies and procedures are in place to ensure that the health and safety of residents is protected. However, gaps in training updates for staff on safe working practices, including fire safety, means that not all staff have received the necessary training to fully protect the welfare of residents. EVIDENCE: A quality assurance process is in place at the home. Questionnaires are sent out once a year to residents, parents and carers to assess their satisfaction with the service provided. The responses from questionnaires are collated and are incorporated into an action plan for the next year. It was evident from records that questionnaires for residents are converted into simple text and symbols to promote their understanding. It was also evident that one former resident had indicated in her responses that she would prefer to live in a smaller home and she had recently been supported to achieve this. DS0000032029.V287895.R01.S.doc Version 5.1 Page 23 Fire records were inspected. These showed that regular servicing of the fire warning system and emergency lighting had taken place and been recorded. Annual inspection of fire fighting equipment was seen to be up to date. Records of fire drills indicated that two are held every year and are recorded in appropriate detail. Records of inspections by the Dorset Fire and Rescue Service are maintained within the home. Fire training records showed that although fire training sessions are held at the home, not all staff had attended an appropriate number of sessions. Case tracking of three staff indicated that none of the three had undertaken fire training during 2005. The assistant manager reported that staff who miss formal fire training sessions are talked through the procedures at a later date but there was no evidence on record to show that this had been done. Although policies and procedures relating to health and safety are in place, gaps in moving and handling, food hygiene, infection control and first aid training were identified. All staff are reported to receive training in these areas during their induction period. The manager stated that training updates should be available to staff in first aid and moving and handling every two years. A spreadsheet that had been produced to detail training updates that had taken place for individual staff indicated that some staff had not received updates at appropriate intervals. For example, five staff out of fifteen were identified as being in need of moving and handling training. The manager stated that an Occupational Therapist visits the home to offer guidance to staff on the specific moving and handling needs of individual residents, including the use of a hoist. However, there was no record to show that this training had taken place with evidence of the content of the training and who had attended. The record showed that training in infection control had taken place for staff but the last recorded date for a number of staff was more than three years ago and it was unclear as to whether updates were being arranged. DS0000032029.V287895.R01.S.doc Version 5.1 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 X 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 3 23 3 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 X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X X 3 X X 2 X DS0000032029.V287895.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement The registered person must ensure that all staff, including night staff, participate in the appropriate number of formal fire training sessions and fire drills each year. The registered person must make proper provision for the health and welfare of service users by ensuring that all staff attend regular updates on moving and handling, food hygiene, infection control and first aid. Timescale for action 1. YA42 23 30/04/06 2. YA42 13 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA2 Good Practice Recommendations The prospective service user and/or his advocate or representative should be involved in the assessment process. Their involvement should be reflected in the assessment documentation. Individual Plans should be reviewed and updated to reflect changing needs. Contributors should ‘sign up’ to the Plan. The Plan should be made available in a language and
DS0000032029.V287895.R01.S.doc Version 5.1 Page 26 1. 2. YA6 format the service user can understand. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. The medication of one resident should be reviewed to ensure that what is given in practice corresponds with what has been prescribed to him by his general medical practitioner. When details of medication are added to the medication administration record by a member of staff, a second competent person should sign to confirm that all the details of prescribed medicines are correct. 3. YA20 Accredited training should be made available to all staff who administer medication. Service users’ allergies should be added to the medication administration records. The date on which packs or bottles of medication are opened should be recorded to provide an audit trail. A photograph of each service user on their medication administration record is recommended to support staff with the correct identification of residents when they are administering medication. Staffing levels should be regularly reviewed to reflect the changing needs of individual service users. 4. YA33 DS0000032029.V287895.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000032029.V287895.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
