Care Home: Althea Park House

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What the care home does well The home obtains comprehensive information regarding prospective users of the service before they are admitted to the home and in turn provides them with good information about the service. As part of the therapeutic care provided, people using the service take part in employment and education outside of the home and form relationships in order that they may benefit from positive and normal social experiences. The home has an excellent approach to consulting people about their individual care and in supporting them to make decisions and to take risks. There is also an excellent approach to meeting both the physical and emotional health needs of people using the service. In addition information about making complaints is circulated and regular meetings are held where issues in the home can be discussed.In line with the nature of the service the approach to ensuring that all people`s needs relating to meals and mealtimes are met is excellent with any risks associated with this fully assessed. Staff are provided with a training programme appropriate to the needs of people using the service so that they are supported by skilled and experienced staff. People who use the service have the benefit of living in a clean and comfortable environment. What has improved since the last inspection? A new assessment questionnaire document has been introduced as part of standardisation of the assessment process. The review process in relation to the programme of therapeutic care has been improved allowing for weekly meetings between the person and their key worker and fortnightly meetings with the management team. Medication storage temperatures have been monitored and recorded on a regular basis with appropriate temperatures maintained. In addition a series of checks have been introduced, three times daily to ensure that certain tasks in relation to medication administration and storage are carried out. Information has now been obtained and is held in the home relating to the local authority adult protection procedures. There are now more staff who have achieved an NVQ at both levels 2 and 3 with others working towards this. There are regular checks on window restrictors and a security risk assessment has been completed for the premises. What the care home could do better: Checks on hand written directions on medication administration records should be more formalised. Although good training is provided appropriate to people`s needs some work still needs to be done to show that induction training meets with national specifications and standards. Some further improvements should be made to recruitment processes although these are generally robust. The views of people who use the service in relation to how the service performs should be gathered and used as part of the quality assurance process as identified in the homes quality audit. CARE HOME ADULTS 18-65 Althea Park House 51 Stratford Road Stroud Glos GL5 4AJ Lead Inspector Mr Adam Parker Key Unannounced Inspection 18th March 2008 09:35 Althea Park House DS0000063826.V353168.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 Althea Park House DS0000063826.V353168.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. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Althea Park House Address 51 Stratford Road Stroud Glos GL5 4AJ 01453 767096 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) lucy.chappell@careuk.com Althea Park Specialist Services Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home accommodates people only between the ages of 15 and 21. No service user under the age of 18 years shares a bedroom with any service user over the age of 18. Any bedrooms that are shared must be through the choice of the individuals involved and consent to do so be written into service user placement plans. The Manager of the home must provide a monthly update of admissions and discharges to the home including name and date of birth. 29th August 2006 Date of last inspection Brief Description of the Service: Althea Park House is a care home with nursing which provides a specialist service for up to 8 females with eating disorders. The home provides for people who have usually had experience of treatment in other settings. The home uses a multi-disciplinary team to offer a therapeutic approach entitled ‘Therapy in the Living’ which is used alongside other more widely recognised interventions for eating disorders. The home provides a variety of communal space and outbuildings are available for therapeutic work. At the rear of the home is the Althea Park Education Unit, which is registered and inspected by Ofsted. The home is situated just outside of the centre of Stroud. The home is also registered with the Office for Standards in Education (Ofsted) as a Children’s Home. This report relates to the home’s registration as a Care Home for adults and is the second inspection following registration in 2005. Current fees range from £3475.00 to £4501.00 per week paid by placing authorities with extra charges for private health provision and additional staffing were required. The home makes information about the service, including CSCI reports available through a service user guide and statement of purpose available in the home. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. The inspection visit was carried out by one inspector on one day in March 2008 with an additional visit on another day to the offices of the provider to inspect recruitment records. The manager of the home was present for the inspection visit to the home as well as a senior nurse practitioner. A tour of the premises was conducted and examination of care documentation took place. In addition staff training was looked at as well as documents relating to the management and safe running of the home. Samples of records were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. During the inspection visit two people using the service were briefly spoken to. Although no surveys were received from people using the service at this inspection, one survey form was received in June 2007. A survey form was also received from a representative of a funding authority. An Annual Quality Assurance Assessment (AQAA) form was completed by the home and forwarded to the Commission prior to the inspection. This contained clear and relevant information about the service including where and how improvements to the service may be made. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home obtains comprehensive information regarding prospective users of the service before they are admitted to the home and in turn provides them with good information about the service. As part of the therapeutic care provided, people using the service take part in employment and education outside of the home and form relationships in order that they may benefit from positive and normal social experiences. The home has an excellent approach to consulting people about their individual care and in supporting them to make decisions and to take risks. There is also an excellent approach to meeting both the physical and emotional health needs of people using the service. In addition information about making complaints is circulated and regular meetings are held where issues in the home can be discussed. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 6 In line with the nature of the service the approach to ensuring that all people’s needs relating to meals and mealtimes are met is excellent with any risks associated with this fully assessed. Staff are provided with a training programme appropriate to the needs of people using the service so that they are supported by skilled and experienced staff. People who use the service have the benefit of living in a clean and comfortable environment. What has improved since the last inspection? What they could do better: Checks on hand written directions on medication administration records should be more formalised. Although good training is provided appropriate to people’s needs some work still needs to be done to show that induction training meets with national specifications and standards. Some further improvements should be made to recruitment processes although these are generally robust. The views of people who use the service in relation to how the service performs should be gathered and used as part of the quality assurance process as identified in the homes quality audit. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 7 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. Althea Park House DS0000063826.V353168.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 Althea Park House DS0000063826.V353168.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): 2&3 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective users of the service are involved in a comprehensive assessment prior to admission and are given well-presented information to ensure that the home can meet their needs within the specialist therapeutic care provided. EVIDENCE: Although standard one was not inspected in full it was noted that information about the service is contained within a document titled “Althea Park House A Young Person’s Guide” This was attractively presented with pictures and contained a wealth of accessible information about the service. The care files for two people who use the service were examined. Comprehensive information had been obtained prior to admission from funding authorities and from previous placements. These included care plans, weight charts and psychological reports. As well as a recently introduced assessment questionnaire document, letters were on file confirming the home’s position in relation to offering a placement at the service. In the case of one person who had been admitted to the service the letter from the manager to the funding authority demonstrated that Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 10 consideration had been given to current people using the service in respect of their levels in terms of community, educational and social outlets as well as staffing levels. The assessment document for one person had been completed by staff from the home on a visit to the person in another care facility and on a trial visit to Althea Park House. The letter also outlined key elements identified during the assessment process and how these may be addressed if admission to the service was to take place. In addition a pre-admission risk and safety plans were drawn up addressing any issues relating to self-harming. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An individualised approach to care planning with robust risk assessment, together with documentation on any restrictions on people using the service gives staff clear information on how people’s needs can be met as well promoting safety and delivering a programme of therapeutic care. EVIDENCE: Comprehensive care plans had been drawn up for a variety of identified needs. As well as relating to the therapeutic care provided for eating disorders such as meal support these also addressed social issues such as education and health care issues not directly related to eating disorders. These plans had been drawn up with the involvement of the person using the service and were individualised and specific to needs. One person had signed a number of their care plans. In addition care plans were linked to any relevant risk assessments. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 12 Care plan reviews had been documented on a monthly basis. The process of review enabled the person to discuss any issues that that they may have making use of review books, written notes or diaries. In addition a monthly progress report was completed by key workers, in one case it had been documented that the person had read the report but had declined to comment. Since the previous inspection the review process has been improved allowing for weekly meetings between the person and their key worker and fortnightly meetings with the management team. With two of the people’s files looked at there had been some delay in arranging Care Programme Approach (CPA) meetings. With one person this was partly due to a move to an adult mental health team although this was in hand during the inspection visit. Another example was seen where CPA arrangements were already in place and meetings had been documented. Examination of care planning documentation showed that people using the service were supported to make decisions about their lives particularly in areas such as education, employment and relationships with people outside of the home. One recorded example showed how a person had been supported in making a decision about contact with family members. In the survey form received in June 2007, in relation to decision making the person commented positively “Staff liaison was very influential”. Any limitations on people’s choice were documented and in line with the therapeutic care given in the home. All adults using the service were managing their own finances. The AQAA document supplied prior to the inspection visit described how “Independent advocacy services have been introduced to the YP’s (Young People) and information provided regarding contacting services.” The home had obtained full information about any identified risks to people prior to admission. This lead to a thorough and robust assessment of all risks with a risk and safety plan being drawn up. People using the service were supported to take reasonable risks as part of their therapeutic care in line with risk assessments and care plans. In addition the homes approach to self harming behaviour was one of safe tolerance and was described in a statement “to find healthy and positive ways for the Young Person to deal with their need to self injure” Individual approaches detailed tolerable behaviour in relation to this. Other risk assessments were completed for activities such as shopping with staff or going out with family members and eating at a local restaurant. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in appropriate activities outside of the home, linked with the therapeutic care provided and in line with the nature of the service; nutritional needs are catered for with thorough assessment, planning and involvement. EVIDENCE: People using the service were supported to pursue education and to take up opportunities for work in line with the therapeutic care provided. A number of people were attending college courses and had been working in part-time jobs. Another had been supported with issues around leaving one job and finding another. In addition the facilities and support provided by the Althea Park House Education Unit situated at the rear of the home were used and this has Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 14 resulted in successful results with examinations. The unit is registered and inspected by Ofsted. People using the service were encouraged to make use of facilities in the local community such as the local leisure centre, which is situated close to the home. Public transport is also used with a bus route running by the home and access to rail transport in Stroud. Staff were able to support people on a flexible basis where required including evenings and weekends. Evidence was seen in care plans of good practice in relation to people being supported to maintain family relationships and to meet people and form relationships outside of the home. Doors to people’s rooms were fitted with a lock for privacy although this can be overridden by staff in the event of an emergency. People using the service are responsible for cleaning their own rooms and for doing their own laundry. Since the previous inspection the practice of keeping rabbits and other small animals as pets has been revived and is seen as having therapeutic benefits. The home has facilities such as hutches and runs. In line with the nature of the service, the home places great emphasis on providing people who use the service with a healthy and nutritious diet. All menus seen were individualised with people having involvement in planning these on a weekly basis. Three meals and three snacks were provided in a day with the main meal being a unit meal based on a choice of two meals, with one being a vegetarian or a meat free choice such as fish. Another option was available if the unit meal has a person’s recorded food dislikes in it. Meals were usually taken in the dining room which is large enough to accommodate staff providing support according to the person’s plan. In some circumstances meals may be taken in other rooms in the home. Meals were well presented and were covered prior to serving. Individual preferences regarding the presentation of meals are recorded and provided for. Nutritional needs are assessed on an ongoing basis and any risks associated with low weight were thoroughly assessed and reviewed. Part of the therapeutic care provided is in seeking normalisation with eating and preparing food and at times there are people preparing their own meals with appropriate support and information as required. In addition records gave evidence of people taking meals outside of the home such as at a local restaurant in preparation for the time when they eventually leave. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 15 Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 16 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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have their both physical and emotional health needs addressed with generally good systems in place for the administration of their medication. EVIDENCE: Consistency of support was ensured through designated key workers. Any restrictions on getting up, going to bed, mealtimes and activities were in line with people’s therapeutic programmes and documented in care plans. The provider employs a specialist medical advisor who regularly visits the home and provides liaison with general practitioners where necessary. Evidence was seen in care plans of how people are supported with any health issues including those not associated with an eating disorder. People using the service were registered with a local GP practice and are encouraged to book and attend their own appointments where appropriate. A dentist can be accessed based at a local health centre. There was good recording of whether people had attended healthcare appointments or not and the reasons for this. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 17 The manager spoke of the importance that the service places on ensuring that people’s physical health needs are met. In relation to self-harming behaviours there was a record in the form of a body map chart to document where any injuries had occurred. The home has recently introduced the use of the Health of the Nation Outcomes Scales (HoNOS) tool. This is a tool designed to measure clinical outcomes to treatment and is used by many National Health Service (NHS) trusts. The use of this tool in the service provides an easier method of sharing information about outcomes with funding authorities. With one person using the service a contingency plan was in place for admission to an NHS facility if weight dropped below a certain level. This had taken place in line with the contingency plan. In the survey form received in June 2007 the person stated that they had received “the most successful treatment yet.” and had moved there because treatment at another eating disorders facility was “ineffective”. The arrangements for medication storage, administration and recording were checked. The recording of storage temperatures had been carried out and demonstrated that medication was being stored at the correct temperature. The home has a cooling device and a fan in the medication storage room should these be needed to control temperatures during any hot weather. A refrigerator is situated in the clinical room for medication storage although this was not being used to store medication at the time of the inspection visit and had apparently not been in use for some time. The refrigerator is equipped with a digital thermometer to monitor storage temperatures. The recording of medication administration and of medication entering and leaving the home was in good order. Medication refusals by people had been recorded consistently. Consent to taking medication had been recorded in care plans. Care plans were in place to provide guidance to staff in the administration of any medication prescribed on an ‘as required’ basis. In addition medication risk assessments had also been completed. It was noted that containers of medication had been dated on opening which is good practice and acts as an indication of any expiry date of the medication. Some handwritten entries in medication administration sheets had not been signed by the staff member making the entry although the senior nurse practitioner explained how checks on handwritten entries were made and had signed these herself. Although it is accepted that there is a system for checking handwritten entries in place this should be more formalised so that as well as signing and dating any handwritten entries on the medication administration charts, there should be a second signature by the person checking that the entry is correct. Since the previous inspection new front sheets had been introduced with basic information and a photograph of the person using the service as an aid to identification during administration. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 18 Staff administering medication had completed training in conjunction with the supplying pharmacist who also visits the home to examine medication procedures and produces a report. In addition staff competency assessments were carried out in line with the provider’s medication policy. Designated staff perform a number of checks in relation to medication storage and other aspects of the use of the clinical room with records kept. Medication practice forms part of the annual quality improvement plan. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place that safeguard people using the service from possible harm and from abuse including bullying and allow for complaints and concerns to be raised by them and on their behalf. EVIDENCE: People who use the service have access to the complaints procedure through the Young Person’s Guide that is given to each of them on admission into the home. Complaints were described in two ways, “Day to Day Complaints” and “More Serious Complaints” with clear guidance as to how these would be dealt with. A form was included in the guide to record a complaint. Contact details of a number of outside agencies were also included in the complaints section of the Young Person’s Guide. The home holds daily community business meetings and a weekly business meeting where any issues can be discussed before they develop into problems and complaints. Where a complaint is received this is documented in a complaints log. A number of complaints had been recorded since the previous inspection and came from a variety of sources as well as from one person using the service. All complaints had been responded to with written responses kept on file. In the survey form received in June 2007, the person indicated that they knew how to make a complaint. Due to the dual registration of the home as a Children’s Home and a Care home, staff have received training in both child and adult protection issues. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 20 Attendance at these training events is monitored. Information on local adult protection procedures and contacts was now available in the home. There was also a policy about bullying and information about this is included in the Young Person’s Guide. The home had policies for responding to suspicion or evidence of abuse and a ‘whistleblowing’ policy in line with the Public Interest Disclosure Act 1998. The service has demonstrated how it responds to suspicion of evidence of abuse through liaison and information sharing with other agencies. In one recent case a staff member acted on information received about a person using the service that led to contact with relevant persons and agencies. Any risks to people using the service through self harm were identified prior to admission and subject to assessment, following this a risk and safety plan was drawn up to guide staff in managing any self harming behaviour. Restraint is rarely used with only two instances being reported in the homes AQAA during the preceding 12 months. These were reported to the Commission. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have the benefit of living in a clean, safe, comfortable environment that is domestic in character and within reach of local facilities. EVIDENCE: A tour of the premises showed that the home was clean and had been well maintained. People using the service had been consulted regarding the decoration of their individual rooms and have also had input into choosing the decoration of communal areas which consisted of a dining room, a lounge on the middle floor and two rooms on the top floor. One person spoken to was happy with their individual room. The manager described plans for the future changes to the use of the two rooms on the top floor that would create one room as a quiet space and the other as a games room. In addition there were two outbuildings that may be used for therapy sessions or for communal purposes. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 22 A school operated by the provider was situated at the rear of the home. The style of the home was in keeping with other neighbouring properties and is situated just outside of Stroud, close to the leisure centre, college and a large park. A regular bus service into Stroud runs by the home. The home employs a cleaner for communal areas and people generally take responsibility for cleaning their own rooms. A laundry is provided for people’s use, where they can also iron their clothes. In the survey form received in June 2007, the person indicated that the home was always fresh and clean. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 23 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures are generally robust ensuring that people using the service are safeguarded. Staff have access to training with regular updates that will equip them to meet the specific needs of people using the service. EVIDENCE: Staff had kept themselves informed about developments in the treatment of eating disorders in a number of ways including attending a national professional forum relating to eating disorders where they had made presentations and have also attended international conferences on the subject. At the time of the inspection visit a ‘staff exchange’ was being organised with another eating disorders treatment facility. There is an ongoing training programme that enables staff to develop the skills and attitudes needed for working with people who use the service. Training had been undertaken in report writing, crisis intervention and there is specific training in eating disorders and self-harming. In addition to this a regular Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 24 clinical meeting is held where staff can discuss clinical issues and aid the development of the skills required for working with people who use the service. At the time of the inspection the home had achieved over 50 of care staff with a qualification at NVQ level 2 or 3 further staff currently undertaking the training. On the survey form received from the representative of a funding authority the indication was that the service’s managers and staff always had the right skills and experience to support individuals’ social and health care needs. Staff starting work in the home have structured induction training lasting six weeks which is mainly based at the service provider’s offices in Stroud but also includes ‘shadow shifts’ at the home where the staff member is supernumerary to the staff team. Staff are issued with an induction pack, this is comprehensive and appropriate to the needs of people using the service. While covering many of the areas in the Common Induction Standards for Social Care for adults it is not specifically clear how the induction covers the Common Induction Standards and it was recommended at the previous inspection that this should be made clearer in the document. This recommendation had not been adopted and this was discussed with the training manager during the visit to the provider’s offices in Stroud. Staff recruitment was looked at during a visit to the offices of the registered provider in Stroud. The files of four staff were looked at; recruitment generally followed robust lines although with one member of staff dates of previous employment had only been given in years. These dates were not sufficient to determine if there had been any gaps in employment and written notes of the interview did not indicate if this had been explored. Employment histories for other staff had been provided with dates in months and years of employment. Two staff files looked at related to the employment of registered nurses. The provider had included a printout from the website of the Nursing and Midwifery Council on the file that indicated the nurse registration of the staff members. However it is recommended that the nurses’ registration should be checked using the NMC’s on line employer verification service through their website. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has been well managed in the interests of people who use the service although seeking their views would enhance the quality assurance process. EVIDENCE: The current manager for the home has applied for registration with the Commission. The manager is a qualified occupational therapist and has achieved an NVQ level 4 in management. She was previously a senior practitioner and deputy manager at the home. In addition she has experience of working in other eating disorders services in the past. The manager is supported by a deputy manager and senior practitioners. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 26 The home has a quality improvement plan. This was conducted in response to a clinical governance audit conducted at the home in 2007 and is an annual occurrence. This did not include the views of people using the service although the need for this was identified in the audit. In the past a survey had been undertaken on behalf of the provider by an independent marketing group, this had been directed at authorities funding people’s placements in the various care homes operated. Visits are carried out and reports made on the home by a representative of the registered provider under regulation 26 of the Care Homes Regulations 2001. Staff in the home have received training in relevant safe working practices such as first aid, food hygiene, infection control, health and safety and fire safety. Heating and electrical systems and appliances had been serviced and maintained with relevant certificates displayed in the office. Work had also been done in the home by a specialist consultant regarding reducing any risks associated with Legionella and a comprehensive file relating to this work had been recently received by the home. A risk assessment had been completed relating to the security of the premises with evidence of several reviews. Window restrictors are fitted to the windows in the middle and top floor of the home, these were now featuring in regular maintenance checks. An inspection by the fire safety officer had resulted in a number of issues that needed attention with regard to the homes fire risk assessment. It was reported that these had been attended to during and further evidence of this was provided following the inspection visit. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 27 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 4 3 4 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 N/A 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 N/A 2 X 2 X X 3 X Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action No requirements. 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 YA20 YA34 YA34 YA35 YA39 Good Practice Recommendations Handwritten entries in medication administration records should be signed and dated by the staff member making the entry and by the staff member checking this. Applicants should be asked to provide for more accurate information regarding dates of previous employment. The registration of nurses should be checked using the employer verification service provided by the Nursing and Midwifery Council. The staff induction pack should show where the induction process meets the Common Induction Standards for Social Care. Make use of the views of people who use the service as part of the quality assurance process. Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Althea Park House DS0000063826.V353168.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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