Straightforward guide to the CSCI (Thu 20th Nov 2008)

The CSCI’s star rating system has suffered from a great deal of confusion both within and outside the industry. Perhaps the root cause of this is the technique used when rating the quality of care services. The use of ‘stars’, for classification purposes, has automatically brought up comparisons with established star systems, such as those used in hotels. But the services each industry offers simply cannot be compared. So at Shackletons, we thought we’d spell out the key considerations of what the CSCI will mark you on in plain and simple English. This of course, should not be relied upon and we recommend that you read the full CSCI report. The inspection A ‘key inspection’ is the most thorough type of inspection that you will receive. The inspectors check your care services to make sure they are meeting people’s needs and the national minimum standards, set by the government You will receive no prior warning from the CSCI, but they will have done their research before even stepping foot into your door. This includes looking at: • concerns, complaints or safeguarding matters . • incidents. • previous inspections and reports. • your ‘annual quality assurance assessment’ to find out how you think your service is doing. • opinions of your residents, their families and any professional involved within your home. A couple of things to remember here is that the CSCI are not only looking at the current state of your home, but comparing it with past performances. And it’s not just their observations that go into their report; it’s the opinion of your residents, their families, the people around you and your own view. The findings At the end of their visit the CSCI will tell you their preliminary findings. The full inspection report will follow a few weeks later. On receipt of the report you then have 28 days to make any comments before it is published on the CSCI’s website. The whole process will take about 8 to 10 weeks, after the inspection has taken place. So what’s in the report? 1. Basic details, including type of service, name, address and number of places 2. A brief description of the service, including details of fees 3. A summary, aimed at the public, saying: • what your home does well/how you have improved since the last inspection • what you could do better 4. How well your home meets the national minimum standards. This is where the ‘star’ rating comes in. The CSCI have created 38 standards, which are all individual points that your care home needs to meet. The inspector will assess how well you meet these standards and award you with a number of stars. These are also called outcomes. 3 stars *** (excellent) 2 stars ** (good) 1 star * (adequate) 0 stars (poor) Outcomes These are the points that you need to assess you care home against and tick off that you meet them. The outcomes that we have described below are the national minimum standards for care homes and older people (65+). Choice of home (standards 1 to 6) Standard 1 You must produce a service users’ guide, which provides full details on your home so that prospective residents can make a fully informed choice on whether it meets their needs and is suitable for them. Standard 2 Each of your residents has a written contract or a statement of terms and conditions. Standard 3 New residents are admitted only after having a full assessment of their needs by someone fully trained to do so. You then need to create a plan of daily care and longer term outcomes. Standard 4 You are able to deliver all of the specialised services that you offer (e.g. dementia, sensory impairment etc.) Standard 5 Prospect residents and their families are able to visit and assess your home before making a decision to stay. Standard 6 You provide dedicated accommodation and appropriate care for residents staying on a short term basis, before returning to their home. Health and personal care (standards 7 to 11) Standard 7 Each resident has an individual service users plan detailing the level and type of care to be delivered, with their own input. This needs to be reviewed at least once a month. Standard 8 Residents are responsible for their own personal care and medicines, where possible. Otherwise, their needs and healthcare are assisted. Standard 9 Your staff adhere to procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Residents can take responsibility for their own medicine, if they wish, within a risk management framework. Standard 10 You residents privacy and dignity are respected at all times. Standard 11 At the time of death, residents are treated with care, sensitivity and respect. Their wishes should be discussed and carried out. Daily life and social activities (standards 12 to 15) Standard 12 You offer flexibility in the daily living of residents so that they can adopt the lifestyle that they require. This includes social, cultural, religious and recreational interests. Standard 13 You welcome visitors at any reasonable time and maintain links with the local community, if required. Standard 14 Residents are helped by yourselves to exercise choice and control over their lives. This includes their financial affairs, maintaining contact with friends and family and keeping personal possessions. Standard 15 Residents are regularly offered varied and appealing, nutritious meals and snacks. Complaints and protection (standards 16 to 18) Standard 16 Should a complaint arise, residents and their families are confident that it will be dealt with promptly and effectively. You should have a simple, clear and accessible complaints procedure. Standard 17 Residents’ legal rights are protected. Standard 18 Residents are protected from abuse; financial or physical. Environment (standards 19 to 26) Standard 19 Your residents live in a safe, well-maintained environment. Standard 20 You home provides safe and comfortable communal space, both inside and outside. Furnishings should be domestic in character and of a good quality. If you require more information on this, call Shackletons and they will be able to advise you. Standard 21 There are sufficient and suitable lavatories and washing facilities available. Standard 22 All necessary adaptations and specialist equipment is in place in order to maximize residents’ independence. Standard 23 Residents have a set amount of usable space in their room and it is suitable for their needs. Standard 24 Your rooms offer safe and comfortable surroundings. If necessary, furnishings for individual rooms should be provided. Shackletons can offer assistance here. Standard 25 The heating, lighting, water supply and ventilation in your home meet environment health and safety requirements. These can also be controlled by the resident Standard 26 Your home is clean, pleasant and hygienic. Systems should be in place to control the spread of infection. Staffing (standards 27 to 30) Standard 27 Staffing numbers and skill mix is relevant to the size, layout and purpose of your home. Standard 28 Residents are in safe hands at all times, under appropriate staffing levels. Standard 29 You home practices a thorough recruitment policy with a detailed employment records. Standard 30 Your staff are trained and competent to do their jobs. Management and administration (standards 31 to 38) Standard 31 Your home is managed by a person who is qualified, competent and of good character. Standard 32 Your residents benefit from the ethos, leadership and management approach of the home. Standard 33 The way your home is manager and run is in the best interest of your residents. Standard 34 Your residents are safeguarded by the accounting and financial procedures of the home. Standard 35 Your residents’ financial interests are safeguarded. Standard 36 Your staff are appropriately supervised. Standard 37 All of your records are maintained, up to date and accurate to safeguard your residents’ interests. Standard 38 The health, safety and welfare of service users and staff are promoted and protected. 38.1 The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 38.2 The registered manager ensures safe working practices including: _ moving and handling: use of techniques for moving people and objects that avoid injury to services users or staff; _ fire safety: understanding and implementation of appropriate fire procedures; _ first aid: knowledge of how to deal with accidents and health emergencies; provision of a first aid box and a qualified first aider at all times; and recording of all cases; _ food hygiene: correct storage and preparation of food to avoid food poisoning, including labelling and dating of stored food; _ infection control: understanding and practice of measures to prevent spread of infection and communicable diseases. 38.3 The registered manager ensures the health and safety of service users and staff including: _ safe storage and disposal of hazardous substances; _ regular servicing of boilers and central heating systems under contract by competent persons (eg members of Council of Registered Gas Installers (CORGI)); _ maintenance of electrical systems and electrical equipment; _ regulation of water temperature, and design solutions to control: _ risk of Legionella, OUTCOME The health, safety and welfare of service users and staff are promoted and protected. CARE HOMES FOR OLDER PEOPLE 36 _ risks from hot water/surfaces (ie temperature close to 43°C); _ provision and maintenance of window restrictors, based on assessment of vulnerability of and risk to service users; _ maintenance of a safe environment including kitchen equipment and laundry machinery; outdoor steps and pathways; gardening equipment; _ security of the premises; _ security of service users based on an assessment of their vulnerability. 38.4 The registered manager ensures compliance with relevant legislation including: _ Health and Safety at Work Act 1974; _ Management of Health and Safety at Work Regulations 1999; _ Workplace (Health, Safety and Welfare) Regulations 1992; _ Provision and Use of Work Equipment Regulations 1992; _ Electricity at Work Regulations 1989; _ Health and Safety (First Aid) Regulations 1981; _ Control of Substances Hazardous to Health Regulations (COSHH) 1988; _ Manual Handling Operations Regulations 1992; _ Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)1985. 38.5 The registered manager provides a written statement of the policy, organisation and arrangements for maintaining safe working practices. 38.6 The registered manager ensures that risk assessments are carried out for all safe working practice topics and that significant findings of the risk assessment are recorded. 38.7 All accidents, injuries and incidents of illness or communicable disease are recorded and reported. 38.8 Safety procedures are posted, and explained, in formats that are easily understood and take account of service users’ special communication needs. 38.9 All staff receive induction and foundation training and updates to meet TOPSS specification on all safe working practice topics (see Standard (30) Training). The standards are grouped into outcomes. For a care home for adults this would be: • Choice of home (standards 1-5) – What facilities the home has and who would be suitable living there so you can make a fully informed choice. • Individual needs and choices (standards 6-10) - Care must be specific to the individual’s plan. Residents have privacy and dignity. Dealing with dying and death sympathetically. • Lifestyle (standards 11-17) – Make sure everyone is happy - some people will want an active, well-organised social life; in contrast, others will want a level of privacy and independence from other residents, although looking to the home for resources such as a library, quiet room or a space for religious observance. Food and mealtime requirements are handled sympathetically. • Concerns, complaints and protection (standards 16-18) – complaints procedure. • Environment (standards 19-26) – physical environment and special needs. Home or hotel style feel. • Staffing (standards 27-30) – staffing needs reflect the needs of the residents and they have the right skills. • Management and Administration (standards 33-38) – the qualities and qualifications of the person in control. The home is run appropriately. 5. Judgements for the key standards for each outcome heading: poor, adequate, good or excellent. (We do not inspect every standard, just the ones we think are the most important for your service at the time of inspection.) To help our inspectors make judgements we give them a set of guidelines called the Key lines of regulatory assessment. 6. Details of the quality rating we have awarded the service. 7. Evidence of why we have made the judgements. 8. A list of statutory requirements – things the care service must do by law according to the regulations – and a timescale for action. The report also says if there are any outstanding requirements from the last inspection. 9. Recommendations for improvements based on the national minimum standards. These are not required by law but are things we consider as good practice for the service provider to consider carrying out. How often do we inspect? How often we inspect your service depends on how we judge its quality, but every new service gets a key inspection in its first six months. Key inspections are major assessments of the quality of a service and any risk that it might present. Frequency of inspections Quality rating Frequency 3 star *** (Excellent) One key inspection at least once every three years 2 star ** (Good) One key inspection at least once every two years 1 star * (Adequate) One key inspection at least once a year 0 star (Poor) Two key inspections a year Where we are considering enforcement action we may do more key inspections. In addition to key inspections we may also carry out random or thematic inspection visits.