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Inspection report

Date of Inspection: 8 August 2011
Date of Publication: 12 October 2011
Inspection Report published 12 October 2011 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

Although detailed care plans, risk assessments and behaviour plans were in place, these were not being consistently put into practice by the staff. People living in the home did not always experience effective, safe and appropriate personalised care, treatment and support. There was little interaction by staff with the people living in the home and what there was did not always follow written support plans or promote individual choice and decision making. There were limited opportunities for participation in constructive activity for people who lived in the home.

Overall, we found that improvements were needed for this essential standard.

User experience

One person living in the home told us that the home had changed for the better while he was living there. He said he liked the food but wasn’t sure the new serving system would work. He was worried his food might get cold on the way from the kitchen. He told us he found the other people living in the home quite challenging but always reminded himself that “they couldn’t help it”. He said that one person took up all the staff time and other people couldn’t get their attention. He said he was happy living at Dysons Wood House and that it was much better than the last home he was in. He felt his behaviour was getting better because of the support he received from the psychologist and the staff.

Other evidence

We examined four care plans and associated records. Each person had three files containing different elements of the records relating to their care. The “working file” contained risk assessments, assessments of mental capacity, support plans and related guidelines and person centred plans. There were recent minutes of annual reviews and multi-disciplinary meetings as well as clinical reports and details of family contact. A second file contained daily notes, records of personal care, behaviour monitoring reports and night reports. The third file contained detailed health records which indicated regular appointments and information on diet and nutrition. The files contained individual risk assessments and behavioural guidelines relevant to each person. Files contained information on the individual’s methods of communication and guidelines on how to respond to them.

The support plans were very detailed and included details of individual likes and dislikes, achievements and progress. However, the recorded achievements/progress were not reflected in the risk assessments and behaviour support plans. In one case relating to an inappropriate behaviour, this was stated to have ‘mostly stopped’ in the support plan, but the risk assessments/behaviour plans still reflected that this behaviour was a major problem. We saw some instances where behaviour plans were not being followed by the staff. For example, one person began to display a particular inappropriate behaviour and staff did not follow the written guidelines to manage this. The brief attempt to address the behaviour by one staff member was ineffective and was not followed through. The behaviour escalated and staff did not intervene until instructed to do so by the senior manager. Their intervention was not in accordance with the guidelines. Another person’s guidelines specifically identified the importance of staff using a calm, even, but firm tone of voice when speaking to him. Yet we saw staff using raised voices and sounding agitated when responding to him. Some of the behaviour plans were undated. In one file some of the risk assessments were hand written and difficult to read. Clinical support was available with members of the psychology team regularly on site to observe behaviours and devise detailed behaviour plans for staff to follow. However, members of the psychology team reported that the degree to which staff followed the behaviour plans was variable.

We observed that staff spent time with people living in the home. However, we saw very little conversation or engagement initiated by staff. Often the staff were seen just talking amongst themselves. One person was waiting for lunch and was repeatedly told by three different staff “to sit and wait”. It took about half an hour before he was served. During that time none of the staff spoke to him except to say ”come here, sit and wait” if he moved from the settee. Another person sat down to wait for lunch some time before it was ready. There was very little interaction with him by staff, aside from a comment that it would only be another five minutes.

An agency chef had been brought in on the day of our visit to develop improved menus and improve the food ordering system. This was to enable the care staff to spend more time with people living in the home rather than in the kitchen. Senior staff told us that the food served that day was a significant improvement on previous meals. We saw several of the people in the home enjoying their lunch, two of whom went back for second helpings. One person decided to make his own sandwich for lunch and he was supported to do this.

Lunch was being served individually to people, from the kitchen, based on their personal choices rather than from a heated trolley in the dining room. This was said to better enable personal choice and be less institutional. We saw individuals being offered a choice of drinks at lunchtime and also being offered sauce with their meal. However,