Inspection on 06/05/05 for 1 & 2 Markyes Close

This inspection was carried out on 6th May 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 & 2 Markyes Close 05/01/07

1 & 2 Markyes Close 03/11/05

1 & 2 Markyes Close 17/12/04

1 & 2 Markyes Close 02/09/04

1 & 2 Markyes Close 09/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 1 & 2 Markyes Close Edde Cross Street Ross-On-Wye Herefordshire HR9 7BZ Lead Inspector Christina Lavelle Unannounced Inspection 6.May 2005 at13:45 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 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 Stationary 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. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 1 & 2 Markyes Close Address Edde Cross Street Ross-On-Wye Herefordshire HR9 7BZ 01989 769034 01989 769035 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aspire Living and Choices Limited. Mrs Elizabeth Watkins Care Home 8 Category(ies) of Learning Disability (8) registration, with number Learning Disability over 65 (8) of places 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the registration conditions detailed on the previous page the following condition of registration applies to this service:(1). Residents may have a physical disability in addition to a learning disability. Date of last inspection 17th of December 2004 Brief Description of the Service: Markyes Close was first registered as a care home in 1992. The service provider is Aspire Living and Choices Limited, which is a voluntary organisation and a registered charity operating in Herefordshire. Their head office is based at the Fred Bulmer Centre, Wall Street, Hereford, HR4 9HP. The property is owned by the Health Authority and leased to the provider organisation. The home provides personal care for eight adults and can accommodate men and women. Residents must require care due to learning disabilities and can also have associated physical disabilities and sensory impairments that can be profound. Some residents may also display behaviour that could be considered as challenging to the service. The home comprises of two self-contained purpose-built bungalows, which are adjacent, have a secure garden area and both can accommodate four people. All the residents have single bedrooms, and each bungalow has a lounge, assisted shower and bathing facilities, a separate dining room, kitchen and laudry room. Markyes Close is located in a convenient position, within a short, walking distance of Ross-on-Wye town centre and so has easy access to the towns services and facilities. Suitable transport is also provided by the home to enable service users to go out further afield. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out in three hours on a Friday afternoon and intended to obtain an overview of the service provided. An additional inspection visit was made to Aspire’s head office on the 20th April 2005 for two hours to check the organisation’s recruitment processes. The residents and staff of bungalow 1 were about to go out for a drive and so most of the visit was spent in bungalow 2. The three people living in bungalow 2 were at home and as one resident was having a lie down and another had been ill recently no activities or trips had been planned. Some time was spent in the sitting rooms of both bungalows with the four care staff on duty and seven residents, although due to their communication difficulties the residents were not able to express their views of the service provided. A sample of care and various other records were checked and a brief tour made of the premises. The support workers on duty were very open and co-operative and gave every assistance with the inspection. The manager had been seconded to work in another Aspire home for about six months and it was confirmed she had recently returned and resumed responsibility solely for Markyes Close. What the service does well: What has improved since the last inspection? Work to maintain and improve the premises is ongoing and new kitchen units had recently been fitted in bungalow 1 and recarpetting in both bungalows. Aspire has further developed policies and procedures to guide staff and to inform working practices in the home. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 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. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 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 standard(s) 1 & 4 Appropriate information documents about the home are made available to residents and their representatives in a suitable format. These documents can help future residents decide where they would like to live and whether the home could meet their needs. As no new residents had been admitted recently the operation of the home’s assessment and admission procedures could not be assessed during this inspection, although suitable procedures are in place when needed. EVIDENCE: There is a Statement of Purpose, Service Users’ Guide and Terms & Conditions of Residence for the home that has been given to current residents and their relatives and representatives. The Service Users’ Guide includes a photograph of the home and pictures and is also written in simple language so that the format is more likely to be understood by people with learning disabilities. It was confirmed in previous inspections that when a potential resident is referred for a placement at the home suitable procedures would be followed. This process includes staff visiting to assess prospective residents’ needs at their current residence. Also arranging for them to make introductory visits to the home and have trial stays before placements are confirmed. This would all include the involvement of relevant people e.g. families and social workers. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6 & 9.. An appropriate care planning system is in place to enable residents’ needs to be identified and met by staff and to show how risks can be minimised. Plans should reflect residents’ care needs and the action needed from staff to meet them and the Plans and risk assessments should be reviewed and updated as changes occur. This is not always apparent in current practice and care records and could mean that staff are not fully aware of residents’ needs and could also affect consistency of care delivery. Although the Plan format is person centred it was not clearly shown how involved residents had been in drawing up their Plans or that a relative or representative had been involved in the care planning process as is expected. When staff consider bed rails are needed, residents’ welfare and rights would be better protected if relevant people and specialists are consulted and their agreement obtained before a decision is made for the bed rails to be used. EVIDENCE: Residents all have individual care files, including details of their personal care, health and social support, activities, management of risks and daily reports. One resident’s care records in each bungalow were looked at in some depth. One Plan had not been signed by the resident or their relative/representative and there was no other recorded evidence that they had been consulted. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 10 Plans seen had not been dated when first drawn up or been revised at least six monthly following review and when there were changes in an individual’s needs. One person had an annual review last December and although staff report their needs have changed recently and help needed from staff greatly increased, their personal care Plan and moving & handling assessment and Plan had not been revised since March. The Plan therefore does not reflect their current needs and the action staff should take to meet them. One resident has recently become less mobile and needs help from staff to move, although their Plan indicates they are still able to walk with an aid. This person has also just been given a new bed by staff with bed rails being used, although their risk assessment includes they do not need bed rails. It is essential that health care specialists and relevant others are involved if the use of bed rails is considered and that a joint decision is taken to agree they are necessary. This is because bed rails are a form of restraint and to ensure those used are suitable as they can be a serious hazard. Although staff said the resident’s family were aware of the proposal to use bed rails (and apparently agreed the home should decide about this) there must be recorded evidence of the risk assessment carried out and agreements made. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 11,12,14 & 15 Opportunities for residents’ personal development (including jobs, education or training) are somewhat limited anyway due to their disabilities. Whilst this is so care staff and designated activities workers make efforts to arrange suitable activities for residents, based on their needs and wishes. Staff are very familiar with individuals’ interests and what they enjoy doing, both whilst at home and within the wider community and arrange activities based on this. Records of residents’ daily activities should be more detailed to demonstrate their social needs have been fully assessed and how they are being met. Staffing levels and the needs of certain residents can sometimes restrict staff taking other residents on outings and pursuing activities in the community. Staff support residents to maintain appropriate contact with their families. EVIDENCE: A weekly activities programme is available in each bungalow drawn up by activities workers who work at the home on four weekdays. The local authority had recently cut day services without notice, which had meant that one resident could no longer attend the centre they had been to for years every weekday. It was positive staff had arranged for this person to visit the day centre once a week to have lunch and so maintain contact with their 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 12 friends. Also to go out shopping more and to sew and do craft work at home. The home provides a suitable, unmarked vehicle with a tail lift for transport. A recommendation is brought forward that activities and outings for residents should be provided to meet their assessed needs and be shown in their Plans. One resident’s daily reports has many days when no activities are recorded and most completed in the last month simply state “out for a drive” with no destination and whether outings were enjoyed and/or met their social needs. One resident’s daily reports state several times they did no activities that day due to a shortage of staff. Staff report that because the manager was on leave today and one resident is unwell and could not go out, they are not able to take the other residents for a picnic on this sunny day as they wanted to. This should be considered in the review of staffing arrangements at the home. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18 & 19 Contracted staff know and understand each person’s needs well and are able to provide personal support to residents in a way they prefer and require. The home also involves other professionals appropriately, although the health care of residents could be improved if advice given was recorded better and needs and relevant checks more carefully monitored. EVIDENCE: Staff describe residents’ personal and health care needs in detail. Records are also kept of all visits arranged for residents with their GPs and other specialists for routine checks and input for particular health and behavioural issues. Staff said district nurses are visiting one resident regularly to check for skin breakdown and staff are also monitoring possible pressure areas and moving and turning them regularly. However, this was not reflected in the resident’s Plan with instructions to staff to check their skin integrity and such as what to look for and how often to move them. Such records would ensure and show staff are taking appropriate action to prevent pressure sores from developing. Reports made by a Psychologist, Psychiatrist and Speech Therapist following referral by the home and visits to assess residents were seen in their care files. One letter from a Specialist advised a resident be weighed regularly to monitor any weight gain or loss. However there were no records of their weight and staff confirmed they had not been weighing them. A recommendation was made previously about the home accessing suitably adapted weighing scales 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 14 and residents’ weights being monitored regularly. This has not been fully implemented and is strongly recommended again. Other advice had been given about a resident’s diet which is also not included in their Plan, such as having smaller amounts of food, a softer diet and to encourage regular fluids. Their daily reports just noted at times if they had drunk a lot or not eaten much, without giving details as would be expected as they clearly have dietary problems which could affect their health. There should be further development of the recording in residents’ Plans in respect of their health care needs and how they are met. This is covered in the requirement already discussed in this report and a recommendation is also made that advice given by health care professionals should be taken up. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22 & 23 It is very difficult to assess if residents’ views and concerns are listened to because of the nature of their disabilities and limited communication. However there are appropriate procedures in place for the management of complaints and matters relating to the protection of vulnerable adults and these help to safeguard the residents. Better protection could be achieved by maintaining more robust recruitment procedures and up to date care Plans and risk assessments. EVIDENCE: It was confirmed in previous inspections that the home has a clear written complaints procedure. There have not been any complaints or concerns reported to the Commission about the home since the last inspection. Staff receive training to guide them to deal with complaints and protection issues. Appropriate policies, including whistle blowing are also provided. As detailed in the section of this report on Staffing, recruitment practices need to be made more robust to increase the protection offered to residents, Plans must reflect service users’ current needs and relevant risk assessments to ensure their assessed needs are known to all staff and are being met consistently and so that any risks to their safety and welfare are minimised. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24 - 30 Markyes Close is conveniently located and was purpose built to offer suitable accommodation for people who may require a secure environment due to their learning disability, and/or challenging behaviour and could also have profound physical disabilities. The evidence indicates the home provides a safe, homely and comfortable environment for residents that is well furnished and maintained in most aspects. The arrangements to maintain cleanliness and hygiene and deal with repairs appear to be working effectively. EVIDENCE: There are ramps, grabrails and other aids and equipment (e.g. assisted baths and showers) available to meet the general and individual needs of residents. Both bungalows are found to be very clean, tidy, fresh, airy and bright. Residents bedrooms are well personalised, both to meet particular needs such as with sensory equipment and in line with their preferred décor, colour etc Overall the premises appear to be maintained to a good standard of repair, furnishings and décor. However, although the carpetting in the corridor and lounge of bungalow 1 had been replaced and looked very nice, in bungalow 2 only the corridor carpet had been renewed. The lounge carpet looked rather tired and stained, despite the efforts of staff to wash it and the decor in the corridors and dining room is chipped and patchy. Staff report that plans are in hand to address these shortfalls and hence a recommendation is not made. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33, & 34 Many staff have worked at Markyes Close for a long time and appear well motivated and committed to ensuring residents receive good quality care. The evidence indicates that staff receive appropriate management support, supervision and training. However, whilst adequate staffing levels are maintained overall there are pressures being placed on staff currently due to their deployment which could have an adverse affect on residents. Attention should be paid to ensure reports written by staff about residents are always objective and staff action is not and/or could not be viewed as punitive as this could be taken to show a lack of a respectful approach and attitude. Recruitment practices fall below the standards required to protect residents. EVIDENCE: The inspector spoke with three permanent care staff who clearly know the residents, their needs and preferences well and try to ensure they lead as full and interesting lives to the extent possible. The atmosphere in the home is friendly and a supportive relationship is apparent between staff and residents. Aspire employ a training officer and the organisation require staff to undertake mandatory health and safety training topics, and some care related training. Staff report they receive regular supervision and two confirm they have completed all the required health and safety training. Both had also achieved an NVQ qualification in care; attended a safe medicines handling course, and 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 18 sessions on epilepsy and positive interventions for the management of challenging behaviour One support worker on duty today was working a twelve-hour shift and staff report full time staff have recently been working overtime routinely to cover staff leave as well as agency staff deployed. An agency care worker was working their first shift and had not received any induction to the home and although was experienced working with people with learning disabilities had to be totally directed by the other staff member in the bungalow. This person had not seen residents’ care records or received instruction about basic fire and health and safety procedures. Other agency staff have reportedly refused to carry out particular tasks and their input is sometimes not felt to be helpful. A requirement is made that staffing arrangements must be reviewed. In particular the ongoing deployment of contracted staff on overtime and agency staff as this can adversely affect consistency of care; create difficulties for residents and also lead to low staff morale and reduce effectiveness. The lack of staff time to take residents out of the home has already been discussed. It would also be beneficial if the role of team leader is clarified as there was not a manager or senior on duty today and staff seemed unsure about who was actually taking responsibility for the home. It is also recommended that an induction checklist for agency staff should be drawn up and operated. An inspection visit to assess recruitment processes within the provider organisation was carried out at their head office on 20th April 2005. The sample of records seen showed the Care Home Regulations had been breached in regard to two written references being obtained. A separate report is available on request from the Commission detailing requirements made. One resident’s daily reports include references to them as being” vulgar”, their behaviour as “over the top” and that they were “made to eat by themself”. Whilst it is acknowledged this person’s behaviour can be challenging a recommendation is made that that the subjectivity and inferences of such language should be discussed in supervision sessions and/or team meetings. In addition the punitive inference in the last comment should be checked out. . 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were fully assessed. The evidence seen supports the view that the environment and working practices promotes the safety and welfare of service users and staff. EVIDENCE: Accident records are maintained although any action taken to deal with risks highlighted by accidents should be detailed. For instance a service user had fallen out and of bed and staff said this influenced a decision to use bedside rails, although this was not recorded or guidance given in their care records. The fire log in bungalow 2 showed required tests and checks on the fire safety system and equipment was recorded as carried out at the specified intervals. A previous requirement in relation to the implementation of an effective quality assurance system is known to be outstanding and so is brought forward. 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 x 2 3 x x Standard No 31 32 33 34 35 36 Score x 3 2 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1 & 2 Markyes Close Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 21 YES 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. 1. Standard YA6 Regulation 15 Timescale for action Service users current care needs 30/06/04 and how they will be met must be reflected in their individual Plan. Plans must be reviewed at least every six months and updated to reflect their changing needs. Plans must be drawn up, reviewed and any revisions agreed with service users to the extent they are capable and with their representatives input The use of bed rails for service 31/05/06 users must be risk assessed and agreed in consulation with relevant other specialists. This must all be recorded in their individual Plan. A review of curent staffing 30/06/05 arrangements must be undertaken, in consultation with the staff team. In particular to assess the affect on the service of ongoing deployment of staff on overtime and of agency staff. The registered must ensure that staffing levels are not adversely affecting the quality of residents lives and continuity of care. If there is any indication they are then action must be taken to recruit additional contracted staff Version 1.30 Page 22 Requirement 2. YA9 13 3. YA18 33 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc 4. YA39 24 An effective Quality Assurance system must be developed and actioned. Results of reviews must be reported and circulated to participants, other stakeholders and the Commission (Previous timescale was the 31/01/05 which is brought forward as not fully actioned) 31/07/05 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. Refer to Standard YA6 & 14 YA19 YA19 YA32 Good Practice Recommendations It should be ensured suitable activities, outings and social interventions are provided for residents which meet their assessed needs and that this is clearly stated in their Plans Suitably adapted weighing scales should be available to the home and residents weights should be monitored regularly, with records kept. When input is obtained from health care professionals procedures should be in place and followed to ensure that any advice given is taken up and recorded in their Plans Consideration should be given to ensuring that records made in respect of residents are always objective. Also that the actual reporting and any references that could reflect on the attitudes and approach of staff be discussed in individual supervsion with them and staff team meetings An induction checklist should be introduced for agency staff to ensure they receive basic introductions to the home, residents and staff and instructions on emergency procedures on their first shift at the home. 5. YA35 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 178 Widemarsh Street Hereford Herefordshire HR4 9HN 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 1 & 2 Markyes Close E52 E02 S24681 Markyes Close V225914 060505 Stage 4.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!