Inspection on 01/06/07 for 1 - 2 Meade Close

This inspection was carried out on 1st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

1 - 2 Meade Close 17/02/06

1 - 2 Meade Close 23/03/05

1 - 2 Meade Close 12/08/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1 - 2 Meade Close Urmston Manchester M41 5BL Lead Inspector Sylvia Brown Unannounced Inspection 1 and 26th June 2007 10:30 st 1 - 2 Meade Close DS0000005623.V320415.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 1 - 2 Meade Close DS0000005623.V320415.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. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 - 2 Meade Close Address Urmston Manchester M41 5BL 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) 0161 746 8313 0161 746 8343 www.scope.org.uk SCOPE Yvonne Latham Care Home 8 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users will fall within the category of learning disability but may have an associated physical disability. 17th February 2006 Date of last inspection Brief Description of the Service: Meade Close is a registered care home providing 24 hour residential support to eight residents who have a learning disability and profound physical disabilites. The home is located in Urmston and is close to public and local amenities. The home consists of two purpose built bungalows, accommodating four residents who have cerebral palsy. All the bedrooms are single occupancy and have been equipped with aids and adaptations. The home has been adapted to meet the physical needs of residents. Each bungalow is fully wheelchair accessible and parking bays are located close to each house. The home has access to it own minibus, to assist in supporting residents to access public resources. A third building is used for administration purposes. On the day of inspection there were eight (8) service users living at Meade Close, a provision staffed and managed by SCOPE. The current cost for services range from £ 1,111.64 to £ 1,221.60 per week. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection visit of Meade Close was undertaken over two days with a total of 9 hours being spent on the premises. A key inspection looks specifically at all the key National Minimum Standards and sees what the home is doing to meet them. Other standards were also looked at. Prior to the inspection the home completed a pre-inspection questionnaire that detailed some of the homes actions to ensure the safety of people who use the service and is one of the ways the CSCI gathers information about the home. One the first day of the inspection visit time was spent observing staff as they went about supporting people who use the service. The building was inspected as was a number of records which related to the health and safety of people and the running of the home. Two people were case tracked, this means the care of two people were looked at in depth. One the second day the inspector spent time with the services manager and registered manager discussing and clarifying management matters and how the home is run. Comment cards were provided to people who use the service, their family and professional visitors. Information received will be included within the report where appropriate and applicable. Comments received after the report is completed will be included within the next inspection process. To ensure the views of people who use the service were independently provided, the home secured the services of an advocate to complete comment cards. The advocacy service contacted the CSCI regarding a number of concerns relating to daytime occupation of people, the lack of stimulating and enjoyable activities and holidays. All these matters were looked at during the inspection and discussed with the service and registered manager, the outcome of which is included within the report. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection S.C.O.P.E has undertaken a major review of its services and staffing structure. As a consequence a new service manager has been appointed to oversee as part of her responsibility the effective running and management of Meade Close. The service manager is experienced and expertise for the role and responsibilities she is employed for. The service manager along with others continues to conduct the service review. S.C.O.P.E. aim to establish if funding arrangements are correct and that the service offers value for money. A review staffing provision and staffing structures is also taking place. It is anticipated that significant changes will be made in the future regarding roles and responsibilities of staff including their deployment to ensure the service remains cost affective. The registered manager who has been at the home for some time has also been included within the staffing structure review and has successfully applied for and been re-appointed as the continued manager of Mead Close. The service manager explained that systems within Mead Close have been reviewed and that a number of policies, procedures and practices have been and will continue to be developed to ensure people who use the service have a consistent good quality service. Again as part of the reviewing procedures it has been identified that some people who use the service have increased restricted life styles and choice due to their initial contracting arrangements with the Local Authority which states they attend day care. Due to the expected absence of people as they attend 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 7 day care one bungalow is not staffed after 11.30 a.m. Should a person not attend day care they are transferred to the adjacent bungalow which is staffed appropriately. S.C.O.P.E recognise this practice reduces peoples choice about where they spend their day mid week. Negotiations are underway with the Local Authority to have the needs of all people who use the service reviewed and assessed it is expected that funding and contractual arrangements will alter to ensure that people who use the service have increased choice about their attendance at day care or spending the day in their own home. Communication passports for people who use the service have been developed. The ones looked at were personal and reflected the individual needs and preferences of people. Digital photographs of the individual demonstrated the non verbal communications of the individual i.e. expressions of happiness, worry, comfort or discomfort etc all of which enables the reader to support the person appropriately. What they could do better: There still remains some opportunities to develop the homes recording systems to ensure clarity and demonstrate the support provided to people who use the service. Some care plans did not detail all the care needs of people who use the service or the individualised support required. Daily records or diaries did not fully reflect the care, attention and support provided to some people. Due to contractual arrangements with the Local Authority and staffing ratios some people are not able to remain in their own home when they are not at day care or are unwell. They are transferred to the adjacent bungalow which is appropriately staffed. As a consequence people have restricted opportunity to make choices about where they wish to remain on a week day. People who use the service do not have sufficient opportunities for social stimulation and/or meeting others outside of the home in a social environment. The home could not demonstrate that people who use the service have frequent and routine visits into the community, visit places of interest to them To enable people who use the service to make choices and keep them informed, some records such as menus and staffing rotas should be made service user friendly by inclusion of pictures and appropriate wording. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 8 The homes menu needs developing to ensure that people who use the service are informed of all meal choices at each mealtime including lunchtime and suppers. The homes training programme did not identify that staff had completed all the required training particularly where specialised support was required. It is essential that staff have individualised training and development programmes which are kept under review to ensure they are trained and competent to do the work for which they are employed. 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. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 9 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 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 10 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): 1,2 & 4 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with information, have their needs assessed and are able to visit the home prior to making any decisions about moving in. EVIDENCE: There have been no new admissions since the last inspection, however a place has become available and plans were underway between the Local Authority and the home to prepare for a new admission. The homes admission procedure includes providing the prospective person with information about S.C.O.P.E and the home. The registered manager will visit the perspective service user in their own home or placement and conduct an assessment of their needs. Once it has been determined that the persons needs can be met by the home they are invited to look around the bungalows at Meade Close. They can spend time observing the day to day routines of people who use the service, meet with them and staff members. If the person and/or relative decides they wish to be accommodated, an individualised moving in programmes is developed which enables them to move into the home at their own pace. 1 - 2 Meade Close DS0000005623.V320415.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): 6,7,8, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have care plans in place and have their needs met and recognised. Recording systems require some development to enable the home to demonstrate that actual support is provided at the required times and frequency. EVIDENCE: All people who use the service have a written care plan in place. The information within care plans varied in their content, whilst there was good manufactures information/ guidance in place about procedures to be undertaken for such things as Percutaneous Endoscopic Gastrostomy tube (PEG) feeding equipment and the use of individual slings and equipment. PEG care plans were not specific or identify individualised routines for practice such as feeding and medication, cleaning or the practice required to maintain PEG site. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 12 Another care plan identified that one person was planned to have physiotherapy, though it was unclear who this was to be provided by and at what frequency. Another’s records stated a person required help with their speech. There was some evidence the person received support however there was no care plan to direct staff on how and when this work should be undertaken, nor were there any specific records to demonstrate staff had completed the support at the required frequency. Daily records were adequately completed, however more detailed recordings are needed if the home is to demonstrate the day to day life of each person, the support they receive, day time occupation, and activities undertaken. Night time records detailed support provided, but it was unclear as to the times the support was given, furthermore rising times of people who use the service were not routinely recorded. To ensure the needs of people are known and met appropriately, records should clearly detail the needs of people and how those needs should be and are met. The registered manager confirmed that all people who use the service had received annual healthcare checks, however records did not fully record this. Communication passport contained good personal information about likes and dislikes. Individual photographs demonstrate non verbal communication and expressions of comfort, pleasure, anxiety and discomfort. As stated within the summery due to contracting arrangements with the Local Authority some people who use the service have limited say in how they live their lives. Some people who use the service are expected to attend day care, as a consequence one bungalow is staffed until approximately 11.30am during the week and then again at 2.00pm to 3.30pm. If people are not able to attend day care centres they are taken to the next bungalow to join other people who live there. On the day of the inspection one person who was due to go to day care centre was unwell and was not able to attend, as a consequence another person was sent to day care in their place. Neither person was consulted about where they wanted to spend the day. Whilst it is understood that people who use the service benefit from company, they have the right to remain in their own home when not attending day care or are unwell. Where the home manages people’s finances, records are maintained. Receipts for expenditure are retained and balance sheets record balances held as well as auditing routines. People who use the service also have a family member, advocate or appointed people who over see the management of their personal finances and bank balances. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 13 The registered manager stated that current service users do not have the ability to fully communicate and for those that have some ability communication is very limited and relates to basic immediate need. As a consequence people who use the service are not able to participate in the dayto-day running of the home or actively influence the development of the service. In order to ensure that peoples views are as far as possible sought the home secures independent advocacy services who act on their service users behalf. The registered manager confirmed that people who use the service have profound physical disabilities and are immobile and require assistance from staff. As a consequence people who use the service have support packages which promote their safety but limits their experience in taking risks. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 & 17 Quality in this outcome area is adequate, This judgement has been made using available evidence including a visit to this service. People who use the service are supported well, however there is a lack of opportunity for people to make informed choices about meals and activities. EVIDENCE: As stated in the summary the advocacy services have raised concerns regarding the lack of meaningful activities and leisure opportunities for people who use the service. Records looked at identified insufficient group or individual activities being carried out. Individual care plans did not detail social routines and support provided to promote social involvement, hobbies or interests. Some records did indicate that one person liked cricket and went to watch a match on one occasion over the past seven months. Some people enjoy the theatre but opportunities are not routinely offered to support them to do this. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 15 One person went bowling once within a twelve month period. A significant number of people appear to leave the home only once a month for social outings including walks in the park. Some appear to have months where they have not been supported in an activity outside of the home. The home does not have planned activities programme or ensure people who use the service are provided with opportunities to visit the local community and places of interest. Care staff spoken with stated that there was limited opportunity to take people out during the week as staffing levels are not structured to provide this support. They stated more activities take place at week ends as both bungalows are equally staffed which enables more flexibility in each place. The registered manager stated that due to the complex needs of some people the home has not provided people who use the service with the opportunity to have full annual holidays, however records provided did detail that people who use the service did have a few days break away at the sea-side last year. The registered manager stated that systems are in place to look at suitable safe accommodation which can meet the needs of people who use the service, enabling them to have a full annual holiday away from the home in the future. Family members and friends are able to visit service users as they desire. Staff were observed supporting service users in a caring and sensitive manner. It was evident that people who use the service were relaxed and recognised staff who were speaking to them. Staff were observed spending one to one time speaking and drawing with one person. Most of the people who use the service have specialised requirements at mealtimes, a number require support through PEG feeding routines, others have soft and or semi soft diets. The menu offered appears somewhat basic. It did not detail lunchtime meals or supper choices, no alternative meals choices were recorded. It was also evident that hot food at breakfast is only available on a Sunday. There was no indication of sweet choices or that people who use the service have access to or are offered nutritious snacks, treats or were able to have fresh fruit. The menu was not in a service user friendly format which supports and or encourages people who use the service to make their own choice where possible. Staff take full responsibility for the preparation and serving of meals including specialised diets. Whilst it was evident that basic food hygiene training had been completed by most staff two had not received training and some were due for updated training. It was not evident that staff had completed training in the preparation of nutritious and specialised diets. It was unclear if they had knowledge of calorific values of food and were aware of the methods used 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 16 to promote better health through nutrition. Additional training should be provided to those staff with responsibility it is for the preparation of meals and specialised diets. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 17 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 & 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their health care needs recognised and met. EVIDENCE: People who use the service appeared well dressed and clean. Throughout the inspection staff supported people in a discreet and dignified manner. Peoples care files identified that their general healthcare needs were recorded and monitored. Records of professional health care and support services were in place. All people who use the service require assistance to take their medication. Some of which is administered through the PEG tube. There was no specific care plan relating to the manner in which people required specialised support to take their medication. Such records ensure that individual routines are known and that staff are aware of the procedures to be followed which can then monitored. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 18 Medication administration records were looked at and found to be in the main completed correctly. However there was no indication of the practice undertaken when a person is on social leave at the time of administration. Records should identify if medication was taken with them when they left the building or the time administered if later than that prescribed. In the event of illness, staffing levels are increased and or staff are deployed to look after them. Recent events confirm that staff accompany people to hospital and remain with them at all times to offer support and advice. In the event of a death, the home ensures people who use the service are informed and offered the choice of attending funeral services. 1 - 2 Meade Close DS0000005623.V320415.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): 18,19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written complaints procedures in place ensure people who use the service or their representatives have a means to raise views about the service they receive. Procedures relating to adult protection ensure residents are protected from abuse. EVIDENCE: The organisation has a written complaints procedure in place. From comment cards received it is evident that relatives feel able to raise matters of concern and feel confident complaints will be dealt with appropriately. The PIQ stated that no complaints have been received at the home within the last twelve months. Training records do not confirm that all staff have received training in the complaints procedure. Adult protection procedures are also in place, Comment cards indicated that relatives had confidence in the staff to protect their loved ones. Training records identified that some staff had not received adult protection training whilst others training was out of date. Issues’ regarding the training of staff in adult protection procedures was raised at the last inspection. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 20 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): 24,25,27,28,29 &30.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a homely, comfortable and safe environment. EVIDENCE: On entering the homes you enter into the dining and activities areas. Lounges areas are of an adequate size and fitted with fixtures and fittings which promote a homely environment. Observations were that one bungalow had developed a specific relaxing area for one person. Whilst both bungalows offer adequate communal areas, both would benefit from more communal living space. Consideration should be given in the future to developing additional communal areas which would enable people who use the service to have other places to sit and relax or join in activities. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 21 It was observed that one television in a lounge had a poor quality picture. Staff reported that the reception is not good and one channel cannot really be accessed which limits television viewing. Bedrooms were clean, bright and cheerful places. It was evident that staff and or relatives had taken an active part in supporting people to have a private room which are enjoyable places to sit and relax. Considerable time has been spent ensuring that bedrooms are personalised and decorated to the individualised persons tastes. Records demonstrated that people who use the service had been involved in redecoration and choosing fixtures and fittings. Two people have with consent from families and or representatives, purchased patio doors for their rooms. Arrangements are in place to fit balcony styled patio which will enable those people to access to the outside from their bedroom. Bathrooms were of a suitable size and were equipped with aids and adaptations. During the inspection visit it was observed that all bathrooms had gloves, aprons and continence aids on view. This increases the risk of cross infection and detracts from the homely environment. Laundry facilities were clean and of sufficient size to meet the needs and demands of the home. Washing machines did not have sluicing facilities which ensures that soiled items are appropriately disinfected and clean all of which reduces the risk of cross infection. Staff training records identified that staff do not appear to have completed training in infection control procedures. Both bungalows were clean and free from odours. Since the last inspection a garden area has been developed between the two bungalows. Pathways and lawns enable people who use the service to accesses them safely. The garden areas could be further developed to include raised flower beds with scented and tactile plans, and structures which would be in the eye line of service users. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 22 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): 31,32,33,34,& 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service received support from staff who have been appropriately recruited and selected. Training requires implementing and or updating for staff to ensure that people who use the service are supported by trained and competent staff. EVIDENCE: The home has appropriate recruitment and selection procedures in place which ensures that all staff are appropriately vetted and have statutory checks made on them before they commence employment. Two staff files were looked at and found to contain all the required information. At the time of the inspection the home had staffing vacancies that culminated in excess of sixty hours a week being covered by agency staff. The service and registered manager are both aware of the implications of such a reliance on agency staff. As a consequence S.C.O.P.E has increased its advertising strategies and is currently advertising nationally. The registered manager confirmed that agency staff are trained and experienced in working with people 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 23 who have a disability. Wherever possible the same agency staff are secured to work at the home. Despite the reliance of agency staff to support staffing levels, continuity of direct care provision has been maintained to a good standard. The manner and format in which the home compiles staffing rotas do not comply with correct standards. Full names of staff are not included and agency staff are not identified. First aiders were not identifiable and the hours worked by the registered manager and team leader were not recorded. To support and inform people who use the service staffing rotas should be in a user friendly format which informs people who use the service who is on duty and who will be coming on duty. Some staff have responsibility for providing specialised support to people who use the service in that they administer medication and food through the PEG tube procedures. The registered manager confirmed that staff had been trained, however there was no training record to support this. Specialised training must be completed at level three, records should demonstrate where training was received from and verify staff competency and agreement to carry out such procedures. The PIQ identifies that 40 of staff have achieved NVQ training at level 2 or above. It is thought that the delay in reaching the 50 target is due to changes in staffing. It is envisioned that newly appointed staff will have NVQ training or are willing to undertake such training. The service manager explained that under the reviewing process of the organisation, training has been prioritised and plans are underway to ensure that all staff receive the required training in a timely manner. Staff training records identified that gaps in training. In addition to training identified within previous sections of the report not all staff had received epilepsy training, first aid, health and safety, communication or specialised training relating to supporting people with a profound disability. Some staffs training was out of date and required updating. The PIQ stated that training in equality and diversity, first aid, communication, eating and drinking and adult protection is planned for in the future. The home takes an active role to ensure that standards of care practices are maintained and service users health, wellbeing and safety are protected. Since the last inspection the home has implemented disciplinary procedures where it was felt that a staff member had not acted in accordance with organisational policy, or followed directives from the manager, which led to inappropriate practice. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 24 Staff receive supervision at the required frequency and attend staff meetings. Both the registered and deputy manager have received training in appraisals and supervision procedures. 1 - 2 Meade Close DS0000005623.V320415.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a fairly well managed home. To ensure their safety staff training should detail practical fire drill training is undertaken at the required frequency for all staff including night staff. EVIDENCE: There have been no changes to the immediate management structure of the home since the last inspection. The manager is trained to NVQ level 4 and is an NVQ assessor. The team leader is NVQ trained to level 3. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 26 One comment card received from a service user and their relative stated “ I am satisfied with the home and the way it is run” They felt that staff treated them well and always listen to what they had to say. Quality assurance procedures have not been completed in line with NMS standards and regulations. Health and safety records looked at identified that safety checks and services were in place. However weekly and monthly fire safety checks were not appropriately dated, and fire safety records did not confirm that practical fire drill training had been undertaken by all staff at the required frequency. The organisation ensures that Regulation 26 visits are completed each month, which means they consult with people who use the service and staff about service provision and standards, look at records and discuss the running of the home with manager. Copies of the outcome report are made available to the CSCI. Insurance certificates alongside registration certificates were publicly displayed. The lines of accountability within the home and with external management is clearly understood by staff. 1 - 2 Meade Close DS0000005623.V320415.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 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 3 28 3 29 4 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 x LIFESTYLES Standard No Score 11 x 12 N/A 13 2 14 2 15 3 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 x 2 x x 2 3 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 28 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 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 Refer to Standard YA6 Good Practice Recommendations Care plans should clearly detail all the needs and support requirements of people who use the service and how those needs are to be met. Records maintained should enable the home to demonstrate the day to day routines of individual people who use the service, including rising and retiring routines, care support provision, their achievements and successes and any activities undertaken. People who use the service should be given choice on their attendance to day care, where they spend their day and opportunities to remain in their own home when not attending day care or are sick. People who use the service should have in accordance with their assessed needs, routine opportunities to socialise and mix with others who do not have a disability, visit the local community and places of interest. The homes menu should detail all the mealtime options and alternative choices. Medication records and or related documents should DS0000005623.V320415.R01.S.doc Version 5.2 Page 29 YA7 YA8 3 YA7 YA8 4 YA13 YA14 5 6 YA17 YA20 1 - 2 Meade Close 7 YA17 YA35 YA20 8 9 10 11 12 13 YA22 YA23 YA28 YA30 YA33 YA35 14 15 YA35 YA39 16 YA42 clearly detail medication entering and leaving the building when people who use the service are on social leave and or the accurate times of administration if medication is administered earlier or later than prescribed. People with the responsibility for administering medication and or food through the PEG feeding procedure should be appropriately trained in specialised administration procedures in accordance with The Medicines Act 1968, the Care homes regulations 2001 and the National minimum standards. All staff should be trained in the homes complaints procedures. All staff should be trained in adult protection procedures including Local Authority procedures. Consideration should be given to the provision of additional communal space. All staff should be trained in infection control procedures, particularly where specialised support is being provided. The staffing rota should detail all the required information. relating to the staff team. The home should conduct a full audit of staffs training. Ensuring that gaps in training are prioritised. A copy of the outcome of the training audit should be supplied to the CSCI. All staff should have individual training and development plans which are kept under review and ensure that training is provided in a timely manner. Mead Close should commence a quality assurance audit which is based on seeking the views of people who use the service family, staff and stakeholders within the community. The outcome of which is published. All staff including night staff should receive practical fire drill training at the required frequency. 1 - 2 Meade Close DS0000005623.V320415.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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. 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