Inspection on 19/10/06 for Wellington House

This inspection was carried out on 19th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wellington House 19/04/07

Wellington House 25/01/06

Wellington House 12/07/05

Wellington House 01/03/05

Wellington House 03/11/04

Wellington House 30/01/04

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

CARE HOME ADULTS 18-65 Wellington House 371 Dover Road Walmer Deal Kent CT14 7NZ Lead Inspector Kim Rogers Unannounced Inspection 19 and 20 October 2006 09:15 th th Wellington House DS0000023123.V301531.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 Wellington House DS0000023123.V301531.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. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington House Address 371 Dover Road Walmer Deal Kent CT14 7NZ 01304 379950 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Robinia Care Group Ltd Miss Sharon Anne Head Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 People with learning disabilities over 18 years of age. Date of last inspection 25th January 2006 Brief Description of the Service: Wellington House is a large detached house in the village of Walmer. The home is registered for12 younger adults who have a learning disability. The home is situated on the main Dover to Deal road, with local public transport services, and a variety of shops and a public house nearby. A car parking area is situated at the side of the house and there is a small garden to the rear. All the service users in the home have their own bedrooms, with bathrooms and toilets facilities in close proximity. Robinia care staff provide personal care and support. The fee for this home ranges between £90,000 and 103,000 a year (average £ 1,855.77 per week). For more information about the fee and what the fee includes please contact the Provider. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out by two inspectors over two days. A total of about ten hours was spent on the site visit. Some pre inspection work was carried out including speaking to care managers and relatives and speaking to and surveying service users. A pre inspection questionnaire supplied by the manager was looked at. The inspectors spent time with service users as a group and in private, spoke to and observed staff and interviewed and observed the manager. A selection of records relating to service users was sampled. Service users said ’ I would like to move somewhere smaller and have more control over my life’ ‘I love my bedroom a lot’ ‘If I had my own little kitchen no one would come in and torment me’ Care managers said ‘I have been impressed by the care and support given to my client’ ‘My client seems happy….and active’ ‘The manager is good’ What the service does well: What has improved since the last inspection? A competency assessment to test staff in safe medication practices has been developed but not yet implemented. Some parts of the home have been redecorated since the last inspection. Some new carpets have been fitted. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users and care managers cannot be sure about the purpose of the home and therefore the home may admit people whose needs they cannot meet. Service users cannot be sure of the terms and conditions of their stay. Service users cannot be sure their needs and aspirations will be assessed. EVIDENCE: The home has a statement of purpose, which is in the process of being reviewed. This is needed, as there is a conflict between what care managers, service uses and the manager think the purpose of the home is. Some think the home is an assessment centre, others a stepping stone to greater independence. For some, Wellington House is a long term placement- up to 8 years. Although the service user guide is new there are some mistakes and wrong information included. The guide is not individualised to Wellington House and is produced in small print with small pictures that are difficult to make out. The manager said she has brought this to the attention of the area manager. A recommendation was made to address this. The manager said she visits prospective service users and makes notes. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 9 There were no pre admission assessment documents at the home for the inspectors to view. Therefore some important information about service users was missing from their service user plans. The minimum standards recognise the assessment process as crucial as the assessment forms the basis of the service user plan. This assessment process is important in the process of a person choosing the right home. The minimum standards require that the manager can demonstrate that a full professional assessment has been carried out. The manager should provide evidence that service users have been genuinely involved in this assessment process. The manager should not admit anyone to the home without considering the quantity and quality of staff and resources to meet the person’s assessed needs as determined by this assessment. As there no assessments the home there was no evidence that this standard is met. A requirement was made to address this. The terms and conditions of occupancy state that I can live here…… ’as long as I pay’ ‘ as long as it is safe for me to do so’ ‘as long as I want to live here ‘ There is no mention of moving on, developing skills, or a stepping stone or assessment centre as care managers and the manager described. The purpose of the home should be made clear to prospective service users then the suitable terms and conditions be developed. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users cannot be sure their aspirations and personal goals will be supported in a person centred way. Individual communication interventions should be developed to improve choice and decision making. Attitude to risk assessing needs improvement to enable, rather than restrict, service user opportunity. EVIDENCE: Each service user has a service user plan or care plan. These are quite clinical and based on a person’s deficiencies. After reading a service user plan the inspectors did not get a feel for who the person is, where they came from and where they want to be. After discussion about this the manager agreed. Most service users have a separate personal planning book, which they keep. Personal goals are identified for some people but not shared with the staff team and are therefore not planned for and supported. For some no personal Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 11 goals or aspirations have been identified. Some service user plans contained conflicting information. Four female service users have compiled a person centred plan in individual folders with staff support. No male service user has a person centred plan. These files are an example of good practice being individualised and include photos and pictures. Personal history, significant life events and hopes and dreams for the future are included. Unfortunately there are no plans in place to support these hopes and dreams. The files remain on a shelf in a room at the home and are therefore not implemented and regularly reviewed as working documents. For service users this means personal goals are not supported so they do not move on. Some service users spoken to confirmed this was the case. Risk assessments have a focus on deficiencies and restrictive strategies rather than enabling strategies. Some risk assessments were not clear noting ‘look for warning signs’ but there was no detail about what these warning signs are. Restrictions and limitations on facilities have been made when a potential risk is identified, however the lack of effective review means that these restrictions continue even though it may no longer be necessary. One service user has been permanently excluded from the kitchen with no review carried out. Therefore there is no plan in place to support the person back into the kitchen. Some service users have communication needs and use alternative forms of communication. There were no communication assessments or interventions in place to aid consistency and communication. This is especially important to service users who may use behaviour as a form of communication. For one service user a behaviour management intervention was to ensure that you know the signs for the person’s key words although there was no mention of what these are. Some behaviour management guidelines were unclear and inconsistent with no evidence of service user involvement. Restrictive physical interventions are used but no service user has consented to this. There are no individual clear guidelines relating to the use of restrictive physical interventions, as the standards and the law require. There is a lack of effective review of incidents involving restrictive interventions. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have access to a range of activities and feel part of the community. Support with personal relationships and relationships between peers could be improved. Service user rights and responsibilities in daily life are not recognised and developed. Service users enjoy a healthy diet but could be more involved in the preparation of food. EVIDENCE: Each service user has an individual activity planner for weekdays. Weekends and evening are not included. The manager said this is service users’ own time. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 13 Service users access a range of external activities including work experience, college courses and day services. Community facilities are accessed including pubs, clubs, shops and cafes. Daily records show access to a range of community activities and facilities. Service users confirmed this as did care managers. In house activities are offered including cooking, cleaning and arts and crafts. The home has a cook who works from 8am to 1pm preparing breakfast and lunch. Staff cook the evening meal. Access to the kitchen and laundry is restricted for some service users. Some service uses wish to develop their independent skills and move onto more independent living. These restrictions must be reviewed of service users are to develop their skills. It was evident that there are missed opportunities for service users to be more independent and therefore increase their control over their lives. Some staff spoken to had an unrealistic expectation of independence. Staff have free access to all areas of the home. All staff have a door key. No service user has a door key and access is restricted with no individual assessment in place to support this. Service users cannot answer incoming calls on the payphone, as the door to the lobby is kept locked. The front door is kept locked. Low levels of participation were noted for some service users and this could be increased. Relationships are quite well supported but without plans to support service user’s personal goals some relationships do not move on. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Personal care needs are adequately met but there are missed opportunities to increase independence. Service users would benefit from detailed health assessments and health action plans. Service users could have more control over their medication. EVIDENCE: Personal care needs are recorded in limited detail. One service user plan recorded for personal care needs ‘buys own toiletries’. There are no personal care support plans to increase independence so true progress goes unsupported and not recognised. Health appointments are recorded but the outcomes are not always clear or recorded leading to inconsistent information which can be dangerous. No health assessments were evident even though health impacts on all areas of a person’s life including their behaviour. There were no health action plans in files sampled although one had been started in a file kept in a locked room. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 15 Medication procedures were discussed with staff. No service user controls their own medication although no assessments have been carried out to support this. Therefore there are no assessments or plans to increase service users control and ownership over their medication. The manager agreed that this is an area that some service users could have more control and independence in. Staff attend training before they can administer medication although there is no observation or questioning carried out to check competency on an ongoing intermittent basis. The manager said that a competency assessment has been developed which she plans to introduce. Storage of medication is currently an issue and is not in line with the minimum standard. This was discussed with the manager. Some good practice was noted regarding the audit of ‘when needed’ medication. Individual guidelines are in place for this ‘when needed’ medication. There are good systems for recording and returning medication but no consistent system to show when medication is spoiled and replaced. The manager should give thought to this. A stock of paracetamol is held but audit sheets were not accurate. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users have support to complain and these complaints are dealt with swiftly and effectively. Service users are at risk of harm from restrictive physical interventions. Service users could be supported to more in control of their finances. EVIDENCE: The home has a complaints procedure and keeps a record of all complaints. Service users said they would talk to staff and the manager if they were not happy about something. It was evident that complaints raised by service users are acted on and handled well. Staff support service users with their finances. After talking to service users and staff it was evident that some service users could be more in control of their finances. Some service users have challenging behaviours. Guidelines in place to manage these behaviours are unclear with no functional analysis to establish the reasons for the behaviours. There are no behavioural support plans developed with service users. Consent has not been obtained from service users regarding the use of restrictive physical interventions. Staff use restrictive physical interventions to manage some challenging behaviours. Some care plans noted ‘use interventions 1-4’. Intervention number 3 in the manual showed the use of a swan neck wrist hold and stated ‘flex aggressor’s wrist and apply sufficient pressure to gain control’ Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 17 From incident reports and speaking to staff it was clear that one service user has been subjected to this pain compliant restraint four times in September 2006 and twice in February 2006. Restrictive physical interventions are used at this home about four times a week. To protect service users from harm and abuse there are clear guidelines by the Department of Health re. Restrictive physical interventions that homes must follow. It was evidenced that the home have not complied with the guidance from the Department of Health and therefore this practice is abusive, harmful and potentially a breach of the Human Rights Act, Health and Safety at work Act and common law. These incidents of physical intervention have gone unmonitored but discussion has taken place if an injury is reported. The manager said she sends figures weekly to area manger at the local area office. She said that no one has ever contacted her from head office concerned about the amount and use of these interventions. There has been no analysis of the incidents to establish common factors that could be prevent further incidents. Staff have been injured during incidents and have suffered broken bones. Despite this the interventions have continued with no review. The language used on incident reports by staff shows a need for staff training. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Access is restricted to some parts of the home for service users and this must be reviewed. The home is clean and well maintained. EVIDENCE: The home was clean during the two day visit and has undergone some redecoration recently. Some new carpets have been fitted which was good to see as a service user had previously commented that the home needs some new carpets. Some service users were happy to show the inspectors their room, which are personalised. A service user said their room had been redecorated recently and she chose the colour. Bedrooms are to service user’s liking and all have keys to their rooms. One bedroom is fitted with an alarm although there is no assessment for this detailing good reason for this. This could effect service users dignity, privacy and control. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 19 There is a comfortable large lounge, which is a smoking lounge. However only a small percentage of service users smoke. The alternative to this lounge is the lounge/diner, which is not so private and cosy. The home has a no-smoking policy. After talking to service users and the manager about this a recommendation was made that he manager consult with service users about continuing to use this lounge as a smoking room. There is a quiet room on the first floor but this is kept locked and only staff have a key. Other areas are restricted with doors kept locked including the laundry, kitchen, and access to rear garden, access to the communal pay phone (currently means no service user can answer their own phone) and access to the front garden. No assessments were evident to show that these restrictions to facilities are the least restrictive option and are made in the best interests of service users. If the aim of the home is a ‘stepping stone’ to more independent living then these restrictions must be kept under review. The manager agreed to do this. There is opportunity to increase the amount of communal space for service users and this was discussed. The standards require that by April 2007 homes accommodate a maximum of 10 people with their own facilities and staff team. The manager should give thought to achieving this. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Training in learning disabilities and challenging behaviour for staff is limited. Staff are not appropriately supervised and their practice unmonitored. Recruitment checks are robust which protects service users. EVIDENCE: The home has a high staff to service user ratio. The manager said that this enables staffing to be flexible. However shift patterns have not been reviewed in response to potential risks. From training records and discussion it was evident that staff training has an emphasis on heath and safety rather than values, learning disability and positive approaches to support challenging behaviours. It was evident from incident reports by staff that staff need this training. A tick list induction was seen in staff files sampled although the inspectors understand that new staff complete an induction in line with the standard. (Certificate in Working with People with a Learning Disability). Statutory training is accessed through a training manager. Staff have had very limited person centred planning training and no person centred active support training. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 21 Limited training in supporting challenging behaviour means that aversive and possibly abusive strategies are used placing service users at risk. Staff files were sampled and had the references, documentation and checks expected. It was evident that staff supervision is not in line with the standard. One staff has not had a supervision meeting since 7/6/05. The manager said this was due to senior staff sickness and vacancies. There should be a contingency plan in place to ensure that staff are appropriately supervised. This should include observation of the staff member at work. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is adequately managed although the manager has no qualification relating to the service users needs. The lack of quality assurance systems and monitoring places service users and staff at risk. The health and safety of staff and service users could be better protected. EVIDENCE: The manager has worked for Robinia since 1989 and has been a home manager for several years. Although this experience is important the manager has no recent qualification and none relating specifically to service users needs (learning disability and challenging behaviour). Care managers said that the manager is a ‘good manager’. The inspectors observed the manager to be approachable and positive in interactions with staff and service users. The manager is also the registered manager of another home nearby. A lack of supervision for the manager was evident. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 23 The lack of effective monitoring and audit systems means that the home is not improving and developing and has placed service users at risk of harm. Incidents of challenging behaviour and restrictive physical interventions have gone unmonitored leading to no review of strategies and support plans. There have been several incidents when pain complaint restrictive physical intervention was used. Weekly figures of these incidents are sent to the local area office. Some staff have been injured including broken bones. There was no evidence that these figures and incident reports are analysed, audited and acted on. Most of the incident reports sampled had no action taken to prevent further occurrence recorded. Most had not been reported to statutory authorities as required and there are issues with the way staff record incidents. Some monthly visits required by Regulation 26 have been carried out although appear ineffective as no real issues have been identified. No quality assurance system based on service users views has been established. The lack of effective monitoring and audit of practice places service users at risk. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 1 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 1 X X 2 1 Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 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. 1. Standard YA2 Regulation 14 Requirement Assessments must be carried out and include a person’s needs (including communication and health) and aspirations. These assessments must be kept at the home and regularly reviewed. The manager must ensure that any identified personal goals and aspirations are recorded and fully supported using person centred approaches. The manager must review the use of restrictive physical interventions and the ways challenging behaviours are supported. Any physical intervention but be used in accordance with the Department of Health Guidance. The manager must ensure that individual guidelines to support challenging behaviours are in place, up to date, consistent and reviewed regularly. Service users consent must be sought for any interventions. An effective quality assurance and monitoring system must be DS0000023123.V301531.R01.S.doc Timescale for action 31/12/06 2. YA6 12 31/12/06 3. YA23 12,13 31/12/06 4. YA23 12,13 31/12/06 5. YA39 24 31/12/06 Wellington House Version 5.2 Page 26 developed and implemented. 6. YA35 18 The manager and staff must have the training and skills required to support service users specific needs. This includes learning disabilities, challenging behaviour and communication. Imposed restrictions on facilities, choices, and freedom must be reviewed. Risk assessments must be regularly reviewed with a focus on enabling people rather than restricting them. The manager must ensure that incidents etc are properly recorded and reported. 30/04/07 7. 8. YA23 YA9 12,13 12,13 31/12/06 31/12/06 9. YA42 37 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA1 YA19 YA36 YA5 YA20 Good Practice Recommendations The Statement of Purpose and service user guide should be reviewed and updated to ensure the information is correct. Service users should have individual health action plans. Staff and the manager should have supervision, including an element of observation in line with the standard. Reliable contracts should be developed with service users so people know the conditions of their stay. Storage of medication should be in line with the standard. Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Wellington House DS0000023123.V301531.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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