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Inspection report

Date of Inspection: 9 April 2013
Date of Publication: 25 April 2013
Inspection Report published 25 April 2013 PDF

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

Meeting 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

We looked at the personal care or treatment records of people who use the service, carried out a visit on 9 April 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We sent a questionnaire to people who use the service, talked with people who use the service, talked with carers and / or family members and talked with staff. We reviewed information sent to us by other authorities and talked with other authorities.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

People experienced care, treatment and support that met their needs and protected their rights.

Reasons for our judgement

When we arrived at Cymar House at 7.10am the night staff were still on duty. Ten of the 23 people who used the service were already up and dressed appropriately. People we spoke with who were able to give their views; explained they liked to get up early. One person said “I get up early every day, I would like a lie in but I always wake up early”. Another person said “I like to get up early, always have done”. One person who used the service clearly knew the other people well and was able to tell us who liked to get up early and who liked to sleep in. Staff told us people could choose when they wanted to get up and some people liked to get up early, whereas others chose to stay in bed longer. We saw people rising as late as mid morning. We also saw evidence of this in people’s care records we looked at, which reflected people’s preferred times for getting up and going to bed.

We reviewed four care records, we found people's needs were assessed and care was planned and delivered in line with their individual plan. The care records provided clear guidance to staff about how people's care and support should be delivered. We found care records were person centred, detailed and individualised. For example, one person’s plan recorded the type of face cream they liked to wear and gave specific details about what needed to be in place to help them sleep well, such as two pillows on the bed and the curtains drawn. Care plans also included information about communication; nutrition; personal hygiene; mobility; sociability; sexuality; sleeping; pressure areas care and maintaining a safe environment, information about people’s life history and interests was also recorded. We saw evidence of recent reviews where care plans were discussed with the person using the service and their relatives. Daily records were detailed about the care and support provided and showed staff were providing care in accordance with the care plan.

Risk assessments identified where people were at risk of harm and were used to develop guidelines for staff to follow. In people’s care plans we saw examples of risk assessments for falls, moving and handling and nutrition, using the Malnutrition Universal Screening Tool (MUST). Also the provider used the NHS Kirklees risk assessment tools for infection prevention and control; Methicillin-resistant Staphylococcus aureus (MRSA) and management of Clostridium difficile (C.diff).

People's care was planned and delivered in a way that ensured people's safety and welfare. We found people had a behaviour management plan, which identified 'triggers' that influenced how a person behaved, how these needed to be recognised and managed by staff.

There was a keyworker system in place. The care plans were up to date, reviewed monthly, reflected people’s health needs and other professional involvement such as District Nurse, GP or Dietician input. There was evidence that people's families had been kept informed of people's welfare and any changes.

Throughout the day we observed good interaction between people who used the service and the staff. Staff were kind, supportive and encouraging in their communication with people, promoting independence whilst reminding people of safety issues. We observed safe moving and handling, using the appropriate aides or equipment correctly. Staff were respectful and discreet when asking people if they would like to go to the toilet. People looked well cared for, clean and tidy, wearing clean clothes. It was clear staff gave attention to detail when supporting people.

The manager and staff we spoke with told us an activity organiser worked two days per week and activities were planned around people's wishes and interests.

Staff showed a good understanding of people's individual needs and explained how they supported people to live a fulfilling life and remain independent and have as much control over their lives as was possible. One member of staff told us "With people who have dementia it i